Express Healthcare (Vol.11, No.9) September, 2017 by Indian Express

Committed to a Healthier and Happier World

65,000+ Installations

30,000+ 104 Countries

700+ Customer facing specialists

1 test every 2 seconds on a Transasia product

Toll Free Number : 1800 102 5740

Labs equipped with Transasia products

CONTENTS

FAST-TRACKING PPPs

Vol 11. No 9, September, 2017

Chairman of the Board Viveck Goenka

MARKET

SECOND EDITION OF HEALTHCARE SENATE TO BE HELD IN HYDERABAD

HEALTHCARE PHARMA & MEDICAL DEVICES SUMMIT & EXCELLENCE AWARDS 2017 HELD IN MUMBAI

FIRST NATIONAL HEALTH CONCLAVE ON NCD HELD IN NEW DELHI

Sr Vice President-BPD Neil Viegas Editor Viveka Roychowdhury* Chief of Product Harit Mohanty BUREAUS Mumbai Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das, Mansha Gagneja Swati Rana

KNOWLEDGE

Delhi Prathiba Raju

Design National Design Editor Bivash Barua

POLICY WATCH

Asst. Art Director Pravin Temble Senior Designer Rekha Bisht Graphics Designer Gauri Deorukhkar Artists Vivek Chitrakar, Rakesh Sharma Photo Editor Sandeep Patil MARKETING Regional Heads Prabhas Jha - North Harit Mohanty - West Kailash Purohit – South Debnarayan Dutta - East

Pragmatic PPP projects can strengthen healthcare ecosystem in the country | P-17

SPECIAL FOCUS -FUTURE READY HEALTHCARE

PRODUCTION General Manager BR Tipnis

Scheduling & Coordination Ashish Anchan CIRCULATION Circulation Team Mohan Varadkar

THE INDIAN ADVANTAGE

Marketing Team Ajanta Sengupta, Ambuj Kumar, Douglas Menezes, E.Mujahid, Mathen Mathew, Nirav Mistry, Rajesh Bhatkal

Manager Bhadresh Valia

BUILDING BLOCKS

MANAGING THE HOSPITALS OF FUTURE

BUILDING PATIENT-CENTRIC HOSPITAL OF FUTURE

NURSES TODAY HAVE A VARIED AND MULTI-FACETED ROLE

COULD THE GORAKHPUR TRAGEDY BEEN AVERTED?

RADIOLOGY

CARESTREAM WINS AWARD FOR REDUCING ENERGY CONSUMPTION AT ITS MANUFACTURING FACILITY

ZEBRA MEDICAL VISION IN PARTNERSHIP WITH TELERADTECH

INTERVIEWS P10: AMARINDER SINGH CEO, Clove Dental

Express Healthcare® Regd. With RNI No.MAHENG/2007/22045. Postal Regd.No.MCS/162/2016-18. Printed and Published by Vaidehi Thakar on behalf of The Indian Express (P) Limited and Printed at The Indian Express Press, Plot No.EL-208, TTC Industrial Area, Mahape, Navi Mumbai-400710 and Published at 2nd floor, Express Towers, Nariman Point, Mumbai 400021. Editor: Viveka Roychowdhury.* (Editorial & Administrative Offices: Express Towers, 1st floor, Nariman Point, Mumbai 400021) * Responsible for selection of news under the PRB Act. Copyright © 2017. 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.

EXPRESS HEALTHCARE

September 2017

EDITOR’S NOTE

Towards a healthcare utopia

n the month when we commemorate 70 years of independence, it was indeed heartbreaking to see more than 70 children succumb to Japanese Encephalitis (JE) in Baba Raghav Das (BRD) Medical College Gorakhpur, Uttar Pradesh. The tragedy is a harsh wake up call that pockets of India are still caught in a time warp as far as healthcare services are concerned. In a sad irony, the September issue of Express Healthcare is a curtain raiser to our upcoming conference, the second edition of Healthcare Senate, (September 7-9, 2017), which is focussed on the theme, ‘Building a Future Ready Healthcare Sector for India’. Gorakhpur forces us to accept that we are a long way from this goal. While politicians are busy playing the blame game, healthcare professionals can only learn from this tragedy, in the hope that such an incident is prevented. The findings of an inquiry committee put together by the Indian Medical Association (IMA) point to an overburdened medical/paramedical staff (at the scene of the tragedy, the BRD Medical College, Gorakhpur as well as PHCs/CHCs of neighbouring districts) lack of equipment and supplies (like oxygen due to non-payment of dues to the suppliers), poor cleanliness standards, etc. Perhaps the biggest new learning is the lack of hospital management skills. According to the IMA, although there is no evidence of medical clinical negligence against Dr Rajiv Mishra (the Principal of BRD Medical College, Gorakhpur at the time of the incident ) and Dr Kafeel Khan (Asst Prof and Nodal Officer, Encephalitis Ward, Dept of Paediatrics, Medical College, Gorakhpur, who was credited with borrowing oxygen cylinders from private hospitals on the night of August 11 but was removed from duty). Prima facie it appears that ‘a case of administrative negligence against them cannot be ruled out’. The IMA report further points out that doctors are clinicians as well as administrators and it is important to make a distinction between clinical medical negligence and administrative negligence. IMA's suggestions to avoid similar situations in future include a novel one: the airlifting of critically ill patients to nearby best facilities. Helicopter ambulance services for critical patients are now becoming more common as are 'green corridors' for emergency transport of organs for transplant, but the cost is a major hindrance. Who will pay for such services, when the resource crunch is

EXPRESS HEALTHCARE

September 2017

Gorakhpur forces us to accept that we are a long wayfrom this goal though Maharashtra’s move against cut practice is a step in the right direction

all pervading? The suggestion that patients denied treatment at government hospitals should be reimbursed for the cost of treatment in the private sector at pre-defined rates could be abused, as one of the allegations is that doctors at the hospital were diverting supplies and patients to their private practices. It is alleged that the Principal’s wife was taking bribes from the company supplying oxygen. More constructively, the IMA suggests that the insurance regulator's Insurance Regulatory and Development Authority (IRDA) mandate for all private hospitals to get NABH accreditation should be extended to all government set ups. This would be a very good move but would obviously also need a lot of investment. There are signs that individual states are cracking down on corruption. One such move is the Maharashtra government's determination to stop or regulate the infamous 'cut practice’ system, which adds to the total cost of healthcare. The state's Directorate of Medical Education and Research (DMER) has received the draft of the proposed legislation, tentatively called The Prevention of Cut Practices in Healthcare Services Act, 2017 which is now open for comments from the public. A good feature of the proposed Act is that it protects the identity of the complainant/whistle blower, but also provides for a fine for frivolous complaints. The Act proposes five years in jail for offending doctors or a fine upto ` 50000 or both. It also proposes to penalise repeat offenders though these terms have been left blank in the draft. Another aspect is that it can hold the heads of hospitals responsible if a direct nexus is found between the violator and the people in charge of the facility, like the deans, director, partner proprietor etc. This is easier said than done but at least the Act attempts to be as comprehensive as possible. It also mentions a suspension of minimum three months for the facility. Of course, these are early days. And intent is one thing, implementation another story. The Medical Council of India has similar strictures, but by and large has been unable to translate it from paper to practice. If indeed other state governments follow Maharashtra's lead, we would be one step closer to a more affordable healthcare utopia. VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

LETTERS QUOTE

AUGUST 2017

Today, public private partnerships are no longer an option or a privilege but in fact a necessity

Dr Jitendra Singh Check out the online version of our magazine at

www.expresshealthcare.in

HEAD OFFICE Express Healthcare® MUMBAI Douglas Menezes The Indian Express (P) Ltd. Business Publication Division 2nd Floor, Express Tower, Nariman Point Mumbai- 400 021 Board line: 022- 67440000 Ext. 502 Mobile: +91 9821580403 Email Id: douglas.menezes@expressindia.com Branch Offices NEW DELHI Gaurav Sobti The Indian Express (P) Ltd. Business Publication Division Express Building, B-1/B Sector 10 Noida 201 301 Dist.Gautam Budh nagar (U.P.) India. Board line: 0120-6651500.

EXPRESS HEALTHCARE

September 2017

Union Minister of State (Independent Charge) for Development of North Eastern Region (DoNER), MoS PMO, Personnel, Public Grievances, Pensions, Atomic Energy and Space said during CII’s Public Health Conference

Mobile: 91-9810843239 Fax: 0120-4367933 Email id: gaurav.sobti@expressindia.com CHENNAI Mathen Mathew 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 Mobile: +91 9840826366 Email id: mathen.mathew@expressindia.com BENGALURU Mathen Mathew The Indian Express (P) Ltd. Business Publication Division 502, 5th Floor, Devatha Plaza,

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

The disease burden on account of NCDs is increasing resulting in substantial economic loss for families and the nation as a whole

CK Mishra Health Secretary said during national review of the National Health Mission

The Indian Express (P) Ltd. Business Publication Division JL No. 29&30, NH-6,Mouza- Prasastha & Ankurhati,Vill & PO- Ankurhati, P.S.- Domjur (Nr. Ankurhati Check Bus Stop) Dist. Howrah- 711 409 Mobile: +91 9831182580 Email id: ajanta.sengupta@expressindia.com

AHMEDABAD Nirav Mistry The Indian Express (P) Ltd. 3rd Floor, Sambhav House, Near Judges Bunglows, Bodakdev, Ahmedabad - 380 015 Mobile: +91 9586424033 Email Id: nirav.mistry@expressindia.com

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

MARKET I N T E R V I E W

‘By the end of this year, we will have around 280 clinics’ Amarinder Singh, CEO, Clove Dental, talks about the growth prospects of dental clinics in India and chalks out plans for the company’s progress, in an interaction with Prathiba Raju Tell us more about the partnership with Denty's? What are your expansion plans? We have partnered with Denty’s as we were looking out to expand nationally. Clove Dental being a bigger network, all the clinics located in South India will be known as Clove clinics and it will be a consistent brand. Our next focus is to expand in three major cities of South India — Hyderabad, Bengaluru and Chennai. There are plans to open 30 to 40 clinics in next nine to 12 months. By end of this year, we will have around 280 clinics – 145 in the north and 140 in south. The concept of neighbourhood dental clinics is not new. Dentistry as a profession is a neighbourhood business globally and not a destination business like hospitals. The needs of the patient are not that different and the difference is in the level of the oral hygiene. A corporate chain like us give significant importance to the quality of treatment and today we have 451 dentists in our network. There is not a single dental complexity case that we are not able to solve. Twice a month, each clinic of ours is audited for quality by a set of dentists. The pricing is standardised across a city. You have large clinics besides smaller ones. How has it helped to improve your business? In cluster approach, we have four to five zones in each lo-

EXPRESS HEALTHCARE

September 2017

cation, which has a network of 20 to 30 clinics. For example in NCR, Gurgaon alone, we have 20 clinics with 40 or 50 doctors. We have rotating multi-specialist team of doctors at any segment of dentistry be it endodontist, orthodontist, periodontist and prosthodontist. It becomes convenient for patients as each clinic is fully capable of performing all treatments as specialists come in and the clinics are open from 9 am to 9 pm, even on weekends. Cluster approach increases efficiency and lowers the price. How do patients stand to gain when compared to My Dentist, Axis Dental, Apollo White Dental? Clove Dental is the only dental clinic in this segment which has a dedicated department that focuses on quality audits and case reviews. We spend our time, money and energy on making sure that treatment quality is consistent and high. Our prices are comparable to all of them. In some treatment we are lower and higher than other dental chains by ` 50 to ` 100. We are the biggest buyer of dental chairs, be it gloves or files used for root canals. We bring in high quality equipment and consumables. For example, the manufacturer recommends to discard a file used for root canal after using for five times (sterlising after every use), as the bristles fade away. In Clove clinics it is used four to five times, at times

offers free service for lower income groups and two mobile clinics for CSR camps.

Clove Dental is the only dental clinic in this segment which has a dedicated department that focuses on quality audits and case reviews and not beyond that. Many dentists or private clinics don't follow such stringent quality. Apart from it, consumers get the benefit of comparable prices, best equipment and quality. We don't want to compete with

anyone here, we are looking for collaborations and not competition. With the same standards not compromising with the quality, we have two clinics one in Okhla and other in Red Cross Hospital in Dilshad Garden, which

How much is invested in equipment? What is your take on GST? Dentistry is a segment which is technologically advanced. The equipment used ranges from 9,000 to 10,000 rpm (rotary instruments in operative dentistry) and they are usually small micro high precision equipment moving at high speed. Hence, we can't compromise on the safety and quality of these equipment. This year, we will invest at least ` 40 crore on equipment for our new clinics. So far, we have invested about ` 60 to 70 crore on equipment alone. As for the GST, we hope that it will increase our efficiency, as we can buy national and international goods from vendors and distribute them across without worrying about the inter-state tax. We are hopeful that it will increase our efficiency. Do you have any case studies on oral health by Clove Dental? Clove Dental has done oral hygiene check-up of over 100,000 school children in Delhi and the NCR from over 200 schools, which includes both private and the government. We have a proper data but nothing has been published yet. We will publish it soon. prathiba.raju@expressindia.com

MARKET

WORLD FORUM FOR MEDICINE

PRE EVENT

Second edition of Healthcare Senate to be held in Hyderabad The theme for the second edition is ‘Building a future-ready healthcare sector for India’ AFTER THE success of the inaugural edition of Healthcare Senate last year, Express Healthcare is gearing to host the second edition of the event. This time, the theme is ‘Building a futureready healthcare sector for India.’ The summit will be held at Novotel Airport, Hyderabad, from September 79, 2017. Thought leaders from the healthcare industry will congregate to exchange insights, share innovative ideas and build healthy connections. The event will address pivotal topics through panel discussions: They would include: ◗ Overcoming obstacles in business expansion: In this session, the panel will discuss strategies, infrastructure required and resource development needed for expansion of businesses. ◗ Healthcare policies: Are they making or breaking the sector?: Association heads of AIMED, NATHEALTH, NABH, AHPI, NPPA and government officials will discuss the impact of pricing policies, quality codes etc., on the sector. The panel will also deliberate on the need for an Affordability Act in India. ◗ Fighting the antibiotic apocalypse: Infection control experts, hospital administrators, pharma companies,

The summit will be held at Novotel Airport, Hyderabad, from September 7-9, 2017

NABH representatives will discuss ways to control the increasing burden of antibiotic resistance ◗ Ensuring cost efficiencies within capital intensive department: Radiology department heads of hospitals, imaging diagnostic promoters, Cath lab heads, OT heads and hospital CFOs will discuss how to reduce operating costs of these capital intensive departments to make the business profitable. ◗ People first: Hospital CEOs, promoters, nursing heads, HR heads, management consultants will discuss on building talent and capabilities for the future. Revenue cycle transformation- A must for healthcare organisations: Hospital CAs, financial experts, healthcare CFOs, COOs or CEOs and PE investors will discuss on ways and means to increase their net revenue, accelerate cash flow, and reduce costs by addressing people, process, and technology components within their hospitals. The other topics which would be addressed at the event will be: ◗ Building an effective supply chain inventory management system ◗ Developing a physician leadership programme within hospitals ◗ Effective brand building for business success ◗ Understanding medical laws: a must for healthcare providers ◗ Medical tourism: An ocean of opportunities for India ◗ Evolving role of hospital pharmacies in India To register, click: http://healthcaresenate.financialexpress.com/registeration/ Or Contact Details: Vinita HassijaMob: 9820590053Email: vinitahassija@gmail.com

EXPRESS HEALTHCARE

September 2017

13 – 16 NOVEMBER 2017 DÜSSELDORF GERMANY www.medica-tradefair.com

The world of medicine at a glance: • Electromedical equipment/ Medical technology • Laboratory technology/Diagnostics • Physiotherapy/ orthopaedic technology • Commodities and consumer goods • Information and communications technology If you want to see it all, understand it all and experience it all, then come to Düsseldorf for the world’s largest forum for medicine!

BE PART OF THE NO.1!

Messe Duesseldorf India Pvt.Ltd. Centre Point 7th. Floor Junction of S.V. Road & Juhu Tara Road, Santacruz West Mumbai 400 054 Tel. (0091 22) 6678 99 33 _ Fax (0091 22) 6678 99 11 messeduesseldorf@md-india.com

MARKET

POST EVENT

Healthcare - Pharma & Medical Devices Summit & Excellence Awards 2017 held in Mumbai The event deliberates on key pertinent issues, challenges and opportunities in pharma and medical devices industry LEGAL LEAGUE Consulting recently organised the Healthcare - Pharma & Medical Devices Summit & Excellence awards 2017 in Mumbai. The event celebrated the growth and revolution of Indian healthcare industry, discussing and deliberating on some of the key pertinent issues, challenges and opportunities through focussed sessions with leading experts from the industry encapsulating their perspective, views and deep insight on the latest developments and trends in the field of pharmaceuticals and medical devices industry. The summit brought together a congregation of more than 130 participants consisting of top echelons from pharma, medical devices companies and industry forums such as Abbott India, Johnson & Johnson, Lupin, Novartis India, Metropolis Healthcare, Siemens Healthineers, Indian Pharmaceutical Association (IPA), Indian Drugs Manufacturers' Association (IDMA) and Organisation of Pharmaceutical Producers of India (OPPI) etc. Bithika Anand, Founder and CEO, Legal League Consulting in her welcome speech said, “The sheer size of the healthcare industry and its effect on allied sectors like pharma, medical equipment and devices, clinical research, medical e-commerce, medical tourism, medical insurance, healthcare IT and software, made it as our next choice for the theme of the summit. With the summit, we move one step further towards our vision to blend the legal sector with other sectors of the economy. In every economy, a sound and

EXPRESS HEALTHCARE

September 2017

Winners in pharma and medical devices category

The summit brought together a congregation of more than 130 participants consisting of top echelons from pharma, medical devices companies and industry forums developed legal sector ensures that development in business is in consonance with legal compliances and any repercussions associated with non-compliance are avoided.” Ameera Shah, MD (Metropolis Healthcare) inaugurated the summit as the chief guest and Pravin Anand, Managing Partner (Anand and Anand) and Dr Annurag Batra, renowned media personality delivered key note addresses. The industry veterans recounted their experience of growth and success with the audience, echoing the immense opportunities for entre-

preneurs and professionals in the pharma and medical devices sector. The sessions commenced on a high note with Anand Desai, Managing Partner (DSK Legal), Suhail Nathani, Managing Partner (Economic Laws Practices), Kaizad Hazari, Head Legal & Corporate Affairs (GlaxoSmithKline Pharmaceuticals) and Dr Raja B Smarta, MD (Interlink Marketing Consultancy) taking the stage as the panelist of the inaugural session, Pharma Vision 2010: Bridging the Gap. They shared their holistic views on the recent policies

and government initiatives aimed at establishing India into top five pharma innovation hubs by 2020, key trends and current and future opportunities in the healthcare industry and how India can make the most out of it. Session 2 on Innovation, Drug Access & Pricing, consisted of panelists — Aarthi Sivanandh, Partner, J Sagar Associates, Daara B Patel, Secretary General, IDMA, Ghanshyam Hegde, Director Legal, Abbott India, Dr Vivek Mittal, Head Legal, Lupin, Tapan Pati, Director & Senior Legal Counsel, Johnson & Johnson and Neha Mishra, Senior Associate, Gaggar and Partners. The session constituted discussions on the issues of rising cost of patented and breakthrough medicines and the effectiveness of recently introduced regulatory mechanism such as Drug Price Control Order and the National Pharmaceutical Pricing Authority to deal with the issue of afford-

ability and availability of medicines. Session 3 on Medical Devices Industry: A Fostering Hub for Domestic Innovations & Challenges, had Dr Anil Pareek, President, Medical Affairs & Clinical Research, (Ipca Laboratories), Dr Milind Antani, Partner & Head - Pharma, Life Science & Healthcare Practice; Head - Social Sector Practice, Nishith Desai Associates, Vivek Padgaonkar, Director - Project & Policy, OPPI, Dr Subhash C Mandal, Chairman Regulatory Affairs Division and VP, The Indian Pharmaceutical Association and Kriti Sharma, Senior Commercial Counsel (India), Smith & Nephew on the panel. They discussed on burgeoning industry of medical devices in India and the nuances, possible impact and opportunities expected by the upcoming Medical Devices Rules 2017. Session 4 of the summit, 'Digitisation of Healthcare', embarked with a special address by Sandeep Saxena, CEO (Dr Batra’s Healthcare). The panelist, Vivek Tiwari, CEO & Director, Medikabazaar, Debolina Partap, General Counsel and VP (Legal), Wockhardt, Dhiroj Barad, Head Legal & Company Secretary, Siemens Healthineers, Javin Bhinde, Founder and Director, SynCore Consulting Group and Kunal Thakore, Partner, Talwar Thakore & Associates, deliberated on the topic of health technologies and how they can bridge the gaps in the medical challenges like unequal access, poor quality and rising costs faced by the industry. Partap highlighted the importance of consumer data privacy.

MARKET

The fifth session, 'Investment Curve and the road ahead,' focussed on the Indian Healthcare Investment landscape. Jayanta Banerjee, Managing Partner, ASK Pravi Capital Advisors, Alekh Dalal, Ex Director, Carlyle Group, Founder, One Thirty Capital, Amar Merani, MD and CEO, Xander Finance, Amit Chander, Partner, Baring Private Equity Partners, Nishant Singh, Partner, Indus Law Firm and Ritika Ganju, Partner, Phoenix Legal, shared their views on how India is gradually becoming a green spot for healthcare investments across the globe and the opportunities it offers to all the stakeholders. The sessions concluded with closing remarks from Ashish Prasad, Partner Economic Laws Practice. Ranjit Shahani, VC and MD, Novartis India inaugurated the Excellence Award ceremony with a special address. He emphasised on the importance of convergence of technology and healthcare industry together and how technological breakthroughs in R&D, treatments, data collection are revolutionising structure and organisation of the entire medical field. The awards were presented by Ranjit Shahani, Dr Lalit Bhasin, President, SILF & Bar Association of India and Manjula Chawla, Founder & Partner (Phoenix Legal). The felicitation ceremony celebrated the spirit of achievement and honoured distinguished business leaders, policy makers and other key stakeholders in Indian Medical Devices & Pharma Industry for their unmatchable contributions. The winners in pharma industry category were: Abbott India – Leading Pharmaceutical Company; Eisai Pharmaceuticals – Leading Green Pharmaceutical Company; Pulse Pharmaceuticals – Excellence in Product differentiation & Innovation; GlaxoSmithKline Pharmaceuticals – Excellence in CSR initiative; Medikabazaar – Excellence in E – healthcare initiative; Koye Pharmaceuticals – Emerging leader in pharmaceutical in-

EXPRESS HEALTHCARE

September 2017

dustry; Schott Kaisha – Exceptional Contribution to the pharma industry; Wockhardt – Excellence in Research & Development. The winners in Medical Devices Category were: Smith & Nephew Pvt. Ltd – Outstanding contribution to the Medical

Devices Industry; GE Healthcare – Leading Medical Devices Company; S.S. Medical Systems Pvt. Ltd - Excellence in Innovation in the Medical Devices Industry; Siemens Healthineers India - Excellence in Global Expansion; Martin & Harris - Excellence in Business

Innovation; 3M Capital India Excellence in Research & Development in the Medical Devices Industry; DiponED BioIntelligence LLP - Emerging Leader in the Medical Devices Industry. Vivek Tiwari, CEO and Director, Medikabazaar, said,

“The summit was organised well with a panel of distinguished and experienced speakers. The inaugural and key note addresses were informative and relevant to the industry challenges and opportunities.” EH News Bureau

MARKET

POST EVENT

First National Health Conclave on NCD held in NewDelhi Key stakeholders in healthcare deliberated on knowledge innovation, quality improvement, policy regulations and human resource development with regard to chronic care diseases

Dignitaries at the launch of Health Quest, a first-of-its-kind compendium of best practices on Emergency Medicine and Critical Care

AS INDIA is experiencing a rapid health transition with a rising burden of Non Communicable Disease (NCDs), Association of Health Providers India (AHPI), Public Health Foundation of India (PHFI), Indian Council of Medical Research (ICMR), Indian Space Research Organisation (ISRO), National Board of Examinations along with other key partners from government, research institutions, academia and international agencies organised a National Health Conclave 2017 focusing on NCDs with the theme Chronic Care – Innovation, Opportunities and Challenges. The two-day conclave saw a conglomeration of top leaders from both the government and private healthcare fraternity, who urged the need for incentivising higher private investments in the healthcare sector and also synergise the efforts of the government and private healthcare sector to achieve the goal of Universal Health Coverage (UHC), as NCDs not only have a serious impact on human health, but

EXPRESS HEALTHCARE

September 2017

also on economic growth. In his inaugural video address JP Nadda, Union Minister for Health and Family Welfare, Government of India, said, “Combating NCDs is one of the most significant challenge for the public health community globally and our government is geared up to tackle the chronic disease epidemic efficiently and effectively. I am glad that the National Health Conclave 2017 is developing a road map to address the issues related to chronic care conditions that is a need of the hour. I am sure that the conclave will be a constructive step towards a multisectoral collaborative approach to strengthen healthcare systems in India by bringing all stake holders on one platform to find constructive and lasting solution.” Highlighting that the new National Health Policy (NHP) concentrates on NCDs, Rajendra Pratap Gupta, Advisor, MoH&FW said,“NHP paves the road-map for accountable, affordable and acceptable healthcare. The NHP indi-

The two-day conclave saw top leaders from both the government and private healthcare fraternity

cates on increasing access, improving the quality and lowering the costs. The central government is increasing the utilisation of public health facilities. We are taking steps to progressively achieve the UHC, by assuring free comprehensive primary, geriatric, palliative and rehabilitative healthcare services. We have enhanced outreach programme of healthcare via MMU, health screening of NCDs and addressing micro-

nutrient deficiencies.” Dr Soumya Swaminathan, Director General, ICMR in her address lauded the organisers AHPI and PHFI for getting a huge number healthcare organisations and relevant stakeholders together to discuss and create a strategy to tackle the prevalence of NCDs in the country under the umbrella of National Health Conclave Alliance. “NCDs requires action at different levels and at various times we have been flagged about the high prevalence of NCDs, especially after multiple data has raised concerns over India’s alarming malnutrition rates and disease burden. There is a huge potential for control and prevention of NCDs through early screening and we need to emphasise on understanding the social-economic and cultural contexts in countering the rising NCDs, further laying stress on social behavior change. I am glad that this conclave has a multisectoral and convergent approach for prevention and control of NCDs, and can advise

the government on advocacy, awareness, access, alliance and accountability towards NCD control in India,” Dr Swaminathan said. Speaking on the burden of NCDs from the context of rural India, Dr Devi Prasad Shetty, Chairman and Founder, Narayana Health, said, “The health policy makers should ensure that 5500 Community Health Centres (CHC), 600 district hospitals of the country are staffed and equipped to perform Bell Weather procedures. The procedures ensure that the hospitals can handle three emergencies like C-section laparotomy and surgery for compound fractures. If these three procedures are done in every CHC level, we will have a best healthcare delivery in the country. We have created regulatory structure that a doctor cannot do a procedure without a PG. So essentially, we have disassociated the medical education from the needs of a common man. The country needs a policy on medical education, which emphasises on

MARKET

training doctors for CHC and taluka hospitals, this will transform rural health in two years. Today, doctor with just MBBS degree cannot anaesthetise a patient, or do a appendix procedure even a ultrasound, interpret X-rays, this is the regulation of the country. Government hospitals employs 65,697 MBBS across the country, but they are not allowed to do any of the Bell Weather procedures, we have created a first world regulatory structure with the third world infrastructure, we need to change our attitude towards medical education.” Dr Alex Thomas, Organising Chairman of the Conclave and President, AHPI, in his address said, “Advancement in science has led to a fair level of success in our fight against communicable diseases. However, we are now being faced with an alarming increase in the number of NCDs. Most of the NCD’s are chronic and are associated with a huge loss of potentially productive years (35-64 years) and also account for 42 per cent of all deaths. NCD’s are a great ‘equaliser’ affecting both sexes, rich and poor, urban and rural in almost equal proportions. In order to strengthen the fight against NCD’s, we at AHPI along with PHFI and other key partners have joined hands to organise the National Health Conclave 2017 with the theme Chronic Care – Innovation, opportunities and Challenges.” Representing PHFI at the National Health Conclave 2017, Prof D Prabhakaran, VP Research and Policy, PHFI, said, “As a key partner to this Conclave, PHFI reaffirms its commitment to embark upon a renewed roadmap to address the current constraints in the health system to effectively manage NCDs and its associated complications in India. Through our globally acclaimed courses, quality educational and research initiatives coupled with technology wherewithal, we are confident that the healthcare community will be able to clinically diagnosis and manage NCDs through a more systematic and structured approach, aug-

EXPRESS HEALTHCARE

September 2017

menting the government’s agenda towards successfully rolling the National Health Policy 2017 and meeting the Sustainable Development Goal on health.” At the National Health Conclave, ISRO launched its first healthcare intervention,

Health Quest, a compendium of best practices on Emergency Medicine and Critical Care jointly developed by ISRO along with representatives of specialists from Society of Emergency Medicine India [SEMI], Indian Society for Critical Care medicine [IS-

CCM], National Accreditation Board for Hospitals and Healthcare Providers [NABH] Consortium of Healthcare Organizations [CAHO], AHPI, Public Health Foundation of India and NBE. A white paper will be released that will have policy ad-

vocacies and resource requirements to enable the government to arrive at a more meaningful, outcome-oriented resource allocation in health. Express Healthcare was one of the media partners for the conclave. EH News Bureau

MARKET I N T E R V I E W

â&#x20AC;&#x2DC;Awareness on various cardiac issues is dismal in our countryâ&#x20AC;&#x2122; Renowned cardiologist and recipient of Padma Bhushan award, Dr TS Kler, recently took charge as the Chairman of the PSRI Heart Institute and heads its Electrophysiology Programme. In a candid chat with Prathiba Raju, he divulges his plans to transform PSRI Institute into a centre of excellence for cardiac care PSRI super speciality hospital is already known for its medical and surgical management of liver, renal and digestive diseases. What are your plans to turn it into a notable heart institute? There are many heart institutes and hospitals in Delhi, but we lack a centre of excellence in cardiology and my mission is to make PSRI Heart Institute a state-of-the-art institute. I also want to carry out some specific cardiology research, which is relevant for Indian patients, particularly on refractory heart failure. In refractory heart failure, a patient undergoes all the cardiac surgeries like angioplasty, bypass surgery etc and yet he/she has cardiac decompensation and the heart fails to respond satisfactorily to routine therapeutic measures. Globally, there are 25 million with such a condition, about four million in India are suffering with refractory heart failure. So, I want to develop a dedicated heart failure programme for such cases. Also, there is an increased risk of coronary disease in India. In Western countries, people aged 55 and above suffer from cardiac diseases, whereas in India, people aged 40 and above have cardiac issues. Also, there is an increase in incidence of cardiovascular disease (CVD) among women, which can be related to highlevel of stress. These factors need study and we need to act upon it. The first step is to conduct a research on such observations and I plan to conduct multi-centre trials.

EXPRESS HEALTHCARE

September 2017

What will be PSRI's take on the cost front? Awareness among people on the various cardiac issues is very less in our country. Main issue is the dearth of cardiologists. We have thousands of cardiologists available but patients with CVDs are in millions and are increasing year-on-year. 70 per cent of the population cannot afford the cost of procedures involved in CVDs. We at PSRI are trying to create a category for those who are less privileged and those who don't fall under BPL category and charge them a little low than private hospitals. For example; on an average, private hospitals in Delhi charges `2 to 2.5 lakh for an angioplasty. We want to reduce it to at least Rs 75,000. Rapid rise of CVDs have increased the need for more electrophysiologists. Can you share the benefits offered by an electrophysiologist. Do we have enough number of electrophysiologists in the country? Many are not aware of what is electrophysiology. It is a branch of cardiology which deals specifically with rhythm problems of the heart. If one has palpitation and syncopy (transitory loss of consciousness) they should go and meet preferably cardiac electrophysiologist for checkup. As the public is not aware of which specialist to meet, many end up not receiving the right therapy at the right time. Right now the members en-

What role should genomics play in CVDs? As far as genomics in CVD is concerned, there are no therapeutic models. The research is still going on and it can be a revolution in future. I want to inform that at present, stem cell therapy in heart diseases doesn't work.

Patients with CVDs are increasing year-on-year. 70 per cent of the population cannot afford the cost of procedures involved in CVDs rolled in Indian Heart Rhythm Society (IHRS) are approximately 150, and among them those who are well trained in electrophysiology are around 40. The number is definitely very less compared to what is actually required in our country. Building awareness of different kind of heart disorder &

referring them to the right specialist is the need of the hour. There should be a structured awareness programme for CVDs by the government. There should be lessons on CVDs at the school level. I hope these small changes will have larger impact.

What are the five rules to avoid CVDs? Keep your weight and tummy girth in order. Tummy circumference should be below 95 cm in men and 85 cm in women measured at the level of umbilicus in quite respiration. Check your BP and blood sugars every six months, blood level of bad (LDL) cholesterol once a year, any form of exercise test once in two years. Exercise test should be conducted every year in high risk individuals like diabetics, strong history of heart disease, smokers etc. If you have blood pressure, it should be properly controlled, which means keeping the BP below 140/90 in adults. If you have diabetes, good control of diabetes is must and good control means keeping HbA1c between 6-7. Keep your LDL (bad cholesterol) below 100 if you do not have CAD, but below 70 if you have already established coronary artery disease. Regular exercise of 45 minutes should be undertaken at least five days a week and one should learn and handle stress. prathiba.raju@expressindia.com

cover )

(

FOCUS:PPP

FAST-TRACKING PPPs Pragmatic PPP projects are the need of the hour to strengthen the healthcare ecosystem in the country BY PRATHIBA RAJU

ublic-Private Partnership (PPP) is a two-way street, and in healthcare both the government and the private sector need to fast-forward the PPP process as they have the potential to drastically change the healthcare landscape in India. A pragmatic, balanced framework with realistic, risk-sharing and robust dispute mechanisms and reasonable exit norms can help synergise the government and the private segment with a balanced PPP model. This is the need of the hour, according to experts. The National Health Policy (NHP) 2017 envisages building a strong partnership between the government and the private organisations to strengthen overall functioning and efficiency of the health system. The policy also talks about strategic pur-

chasing by the government to fill critical gaps in public health facilities and outlines the process of creating a demand for private healthcare sector in alignment with public health goals. Assuring that the PPP model can provide the much-required fillip to public health infrastructure in India, Dr Ajay Rajan Gupta, MD and Group CEO, Indo-UK Institute of Health (IUIH) said, “As per available industry estimates, to address the issues plaguing Indian healthcare, an investment of `150,000 crore is required, of which 80 per cent is likely to come from the private sector, primarily under the PPP model. The government has promised to increase state contribution from one per cent to 2.5 per cent over a period, and we feel this will mainly be in primary healthcare. However, linking of this system with secondary, tertiary hospitals

which are primarily in larger towns will need to be done by private sector both for private and government hospitals. Good policy initiatives from the government will attract private investment in health infrastructure by making it a viable business.” IUIH has proposed 11 new UK-Indo Institutes for Health in India which, would amount to an investment of `17600 crores into India’s healthcare system. “We, at IUIH, which is the largest PPP project, firmly believe that it is the way forward to improve healthcare in India.The PPP models will encourage much higher use of resources, bringing standardisation in delivery, increasing the reach of health systems to rural areas by use of digital technology, including medical record as well as telemedicine,” Gupta added.

EXPRESS HEALTHCARE

September 2017

cover ) To address the issues plaguing the Indian healthcare, an investment of ` 150,000 crore is required, of which 80 per cent is likely to come from the private sector, primarily under the PPP model

PPP is the only way going forward, as 70 per cent of healthcare is currently managed by the private sector and they have strength and the flexibility to come up with innovative models

Dr Ajay Rajan Gupta

Dr Devi Prasad Shetty

MD and Group CEO, Indo UK Institute of Health (IUIH)

According to a recent McKinsey report, India will have a total bed density of 1.84 per 1,000 people against the global average of 2.9 and the WHO guideline of 3.5 by 2022. As a country, we account for 20 per cent of the global disease burden and only 12-15 per cent of our population is under health insurance cover. Private sector caters to over 90 per cent of hospitals, 80 per cent of doctors, 80 per cent of outdoor patients and close to 60 per cent of indoor patient care services in India. This overtly high dependence on the private sector has debilitating effects on the poor leading to liquidation of their assets, indebtedness and poverty. Two-fifth of those hospitalised in India end up becoming BPL category every year owing to out-of-pocket expenses which is often as high as 80 per cent of their income. As per a KPMG report, PPP in the context of the health sector is an instrument for improving the health of the population. PPP is to be seen in the context of viewing the whole medical sector as a national asset with health promotion as goal of all health providers, private or public. The private and non-profit sectors are also very much accountable to overall health systems and services of the country. Therefore, synergies where all the stakeholders feel they are part of the system and do everything possible to strengthen national policies and programmes needs to be emphasised with a proactive role from the government. Going forward, PPP in healthcare has emerged as one of the options to influence the growth of private sector with public goals in mind. One such instance would be a major multi-million collaboration in healthcare recently happened between India and the UK,

Partnering for development The IUIH programme included the proposal for 11

EXPRESS HEALTHCARE

September 2017

Dr N Prathap Kumar

A real PPP can be based on a level-playing field. Terms have to be fair and the risks have to be equally divided, only then it will be a levelplayed game

MD & Chairman, Meditrina Group of Hospitals

Chairman and Founder, Narayana Hrudayalaya

Need for PPPs

Having tried out many business models in the healthcare industry, I can affirm that PPP is one of the best models in the country today

By 2020, Piramal Swasthya endeavours to reduce MMR by 30 per cent, IMR by 20 per cent and risk of premature mortality by 25 per cent in intervention areas Vishal Phanse CEO, Piramal Swasthya

K Sujatha Rao Former Union Health Secretary

new UK Indo Institutes for Health in India, accompanied by strategic clinical and training partnerships with the UK’s finest NHS organisations, universities and private sector companies. “Healthcare enjoys a central position in the bilateral relationship between India and the UK, and has been identified as one of the priority areas for the two countries to work more closely together. The benefits of this collaboration are broad ranging. They will include the provision of international standards of healthcare in India for the exchange of ideas in advanced medical research and development, training and education of doctors and nurses in both countries, state-of-the-art training facilities and extensive technology and innovation links. The IUIH will have 11 medicities and each medicity is planned to include a 1,000-bed hospital in close partnership with one of

KEY THRUST AREAS WHERE THE PRIVATE SECTOR CAN CONTRIBUTE + Healthcare infrastructure development; + Review, rationalisation and design of patient centred care pathways

+ Establishing integrated care pathways to improve health outcome

+ Management and operations of healthcare facilities for efficiency, economy, quality

+ Capacity building and training; + Financing mechanisms; + IT backbone and data repositories for access to clinical information;

+ Materials management including supply chains for ready availability of equipment, appliances, medical supplies etc. Source - IUIH

the UK’s leading NHS hospitals. The first two medicities at Nagpur, Maharashtra and Amravati, the new capital of Andhra Pradesh for which the foundation stones were unveiled recently. Each medicity are being built with an investment outlay of ` 1,600 crores in association with King’s College Hospital, London,” Gupta said. Also, the IUIH Programme, which is designated for the provision of integrated healthcare facilities to all Indians, assures to build a capacity of 11,000 beds, 5,000 doctors, 25,000 nurses and generate direct and indirect employment for over 300,000 Indians. 20 per cent of patients are said to be given free treatment at IUIH facilities. Apart from the conventional medicine and treatment of patients, IUIH assures efficient sharing of ideas and resources and creates invaluable economies of scale and size in several ancillary and complementary areas such as education and training, clinical support, manufacturing and technology, research and development, mental health, alternative medicine and commercial health. “The IUIH will provide an integrated approach to healthcare across India by partnering with the UK’s best organisations in research, education, manufacturing and healthcare delivery. The goal is to bring healthcare to India which is available, affordable - no patient is turned away, reduce costs across the value chain, operate a tiered system of charges, cross-subsidise patients, accountable - transparency of charges, treatments and outcome and appropriate - bring in all major specialities and treatments, provide outreach programmes to rural and semi- urban areas, develop digital health initiatives by providing remote consultations, advice and monitoring to all,” Gupta said.

Getting PPPs right Similarly, various state governments have also

cover ) experimented with PPP models in healthcare delivery and got it right as well. Projects like Yeshasvini Health scheme in Karnataka, Arogya Raksha Scheme in Andhra Pradesh, telemedicine initiative by Narayana Hrudayalaya in Karnataka, The Uttaranchal Mobile Hospital and Research Center (UMHRC), Primary Health Centres (PHC) in Gumballi and Sugganahalli, Karnataka, emergency ambulance services scheme in Tamil Nadu are a few innovative and successful models. Informing that PPP mode will deliver high impact solutions more efficiently, and help tackle systemic challenges, Dr Devi Prasad Shetty, Chairman and Founder of Narayana Hrudayalaya who runs several PPP models pan-India said, “PPP is the only way going forward, as 70 per cent of the healthcare is currently managed by the private sector they have strength and the flexibility to come up with innovative models. One such model is the Yeshasvini Health Insurance Scheme in Karnataka, which was conceived by us. We have multiple successful PPP models in Assam, Jammu and Kashmir, Karnataka, Andhra Pradesh where the government gave us the land to build up hospitals.” Developing one such successful PPP model, Speciality In Hospital (SIH), Dr N Prathap Kumar, MD and Chairman, Meditrina Group of Hospitals, said, “Having tried out many business models in healthcare industry, I can affirm that PPP is one of the best models in the country today. The perception in public regarding the civil hospitals being service oriented and meant for welfare of general public has given them a wider acceptance. There are quite a good number of civil hospitals that operate in the most remote villages of our country. The only drawback with these is the lack of advanced speciality care facilities. The government has limitations to invest to convert these civil hospitals into speciality care facilities as well as hire skilled professionals for these hospitals, but a private player capable of investing can provide expertise and required capital infusion in these hospitals.” Explaining the SIH model, Prathap Kumar said that every hospital needs a department like cardiology, cardiac surgery, neurosurgery and requires huge investment in modern equipment, machinery as well highly-skilled professionals. It is a tough game for a government hospital to afford the entire expenses of the building, power supply, staff along with high-end machinery and equipment. The SIH model is where Meditrina will invest only in the cardiology department whereas other facilities like housekeeping, security, CSSD, HR department and accounts are run by the parent hospital. The partnership delivers free quality treatment to state government health card holders and BPL citizen. The centres will not only cater to the medical requirement of people from Haryana but even from neighbouring states. “The response to SIH has been great as it mobilises a department with less investment, assuring quality service and sufficient revenue out of it. The model brings in a favourable change, particularly in tier-II and tier-III cities, as it offers expert specialty care at very affordable rates. The Haryana state health department in an attempt to empower the health scenario of the state called a global tender to start, operate and run cardiology service and cardiac surgeries in four civil hospitals across the state. The government was looking forward for a private player for these serv-

EXPRESS HEALTHCARE

September 2017

OVER YEARS, VARIOUS STATE GOVERNMENTS’AND THE HEALTHCARE INDUSTRY HAVE BEEN PARTNERING TO MAKE SEVERAL SERVICES AVAILABLE TO THE MASSES

Punjab Construction and operation of new super specialty hospitals in Mohali and Bhatinda, Punjab – Max Hospital

Uttaranchal Mobile health clinics in collaboration with Uttaranchal Institute of Scientific research, Bhimtal (NGO)

Rajasthan Diagnostic PPP with Sawai Mansingh Hospital and Soni Hospital. Public Health Engineering Department, Rajasthan is also involved in the development of a multi specialty hospital in Jaipur district under PPP

Bihar State of Bihar Initiated an unique telemedicine project for delivering service in alternative medicine – Ayurveda , Yoga, Unani, Sidha & Homeopathy (AYUSH)

Kerala Telemedicine Network Onconet - Cancer Care For Rural Masses (in six hospitals), Telemedicine Kerala for Taluk hospitals (in eight hospitals). Telehealth and Medical Education Kerala (in 18 hospitals), Rural Telemedicine Project for primary care in Tirur taluk (in 11 hospitals)

Andhra Pradesh B Braun PPP for dialysis. PPP Model: Eleven dialysis centres were established in district hospitals – in Chittoor, Guntur, Hyderabad, Kakinada, Kurnool, Srikakulam, Vijayawada, Visakhapatnam and Warangal. Tamil Nadu Nexus PPP with government for one centre with 15 dialysis machines. Apollo PPP with one centre and nine dialysis machines

ices since the state had no facilities of interventional cardiology or cardiac surgery in civil hospitals. We quoted just less than ` 50,000 for angioplasty with a drug eluting stent for any patient in the state. This proposal offered the government a very different plan because here BPL card holders as well Haryana government health card holders will get the entire treatment free of cost (where the cost is borne by the government); the highlight being that the patients other than the ones eligible for free treatment also could avail the treatments at just `49,000,” Kumar informed. Not just corporates, but also NGOs like Piramal Swasthya, act as catalysts between governments and corporate bodies. They have developed an integrated community outreach programme that reaches out to people in six states with the help of 388 MMUs. “Piramal Swasthya has served more than 8.6 crore beneficiaries. Nearly 4.5 crore beneficiaries have been provided validated health advice through remote health advisory and intervention services, which has a direct impact on health related awareness of the beneficiaries. By 2020, Piramal Swasthya endeavours to reduce maternal mortality rate (MMR) by 30 per cent, infant mortality rate (IMR) by 20 per cent and risk of premature mortality by 25 per cent in intervention areas. Today, we deliver mobile medical services in 13,523 villages in Andhra Pradesh through equipped MMUs, with real time data transferred to the AP chief ministers dashboard, a real time executive integrated dashboard established AP to monitor category-wise key performance indicators,” Phanse added.

Thus, there are certain exemplary PPP models in healthcare. Simultaneously, there have been numerous projects driven by the state governments, which suffered setbacks due to lack of evaluation.

Design with care However, in the coming times, PPPs would take on even more significance in the healthcare sector given their manifold benefits like improved access to healthcare and reduction of out-of-pocket expenses. They also improve equity and higher efficiency through use of digital technology. PPPs can also ensure higher accountability, opportunity for regulation and better quality of services. Hence, it is time to get our act together and design PPPs right. It is essential to ascertain that the PPP model is realistic and the capacities of the government and the private sector are well utilised. The financial and project structuring, detailing scope of services, technical advisory, tendering process and eventually shortlisting of private partners should be done with care. Any PPP model needs to be well scrutinised before implementation, advised a health expert. As Former Union Health Secretary, K Sujatha Rao informed, “PPPs in health segment can work when the risk is shared. It can’t be a one-sided game with all benefits taken by one partner and all risks borne by the other. In many cases, the private sector is the dominant provider. A real PPP can be based on a level-playing field. Terms have to be fair and the risks have to be equally divided, only then it will be a levelplayed game.” prathiba.raju@expressindia.com

SPECIAL FOCUS -Future ready healthcare

The Indian advantage Here is how India’s healthcare organisation can stay ahead of its time By Raelene Kambli Moreover, he went further to turn their principles into practical applications, from calculators to helicopters, hydrodynamics to solar power. Just when we were discussing Leonardo da Vinci’s exemplary vision, our boss asked if any one of us could explain his secret mantra? Well, all of us had different answers. Some called him gifted. Some said because Leonardo was a mathemati-

cian, he learnt patterns that existed in nature and used it in his work and imagination. Different interpretations and hypothesis existed in that room, but the answer lied in a simple thought- the way Leonardo saw the world around him. While pondering over this piece of knowledge that I received that day, I realised its true essence. Most geniuses around the world simply look at things and patterns in na-

ture differently and that’s why they come up with innovations, strategies and techniques that are ahead of its time. Off course, this demands us to stretch our minds. Indeed, this is worthwhile and can teach us some interesting business lessons. World over, many prosperous industries and entrepreneurs have adopted this theory to build successful businesses. This philosophy

teaches us to look beyond the present scenarios and learn velocity ratios that exist within various industries. What is the rate of change within a particular industry? What is the momentum at which business models change within an industry? How quickly new products enter a market? So on and so forth. What’s more compelling is that this urges us to understand how industries, busi-

Map for representational purpose

nce, during a team meeting, one of my bosses explained to us how Leonardo da Vinci’s creative vision and ability to see the future enabled him to predict many scientific discoveries. Leonardo was indeed an inventive genius and was ahead of his time in many ways. He anticipated about many scientific discoveries, including those by Copernicus, Galileo, Newton and Darwin.

EXPRESS HEALTHCARE

September 2017

SPECIAL FOCUS -Future ready healthcare nesses and economies react to a certain situation and also helps us in joining the dots to predict future course of actions. Well, presently there are fewer organisations who have adapted to this culture but in the near future, this can become the way of life that most industries and nations will adopt. In fact, in a recent automobile industry gathering, CP Gurnani, MD and CEO, Tech Mahindra, spoke about the future of the automobile industry and stated, “The future will not see the big beating the small, the future will see the fast beating the slow.” He said this in context of the changing business environment in the future for the automobile industry across the world. Further, during his address, he also urged organisations to become ready in order to embrace the changes and challenges that the future brings along. If we carefully analyse, his anticipation is not just applicable to his industry, but industries across verticals, big and small. So where does the healthcare sector stand when it comes to being future ready?

Future scenario worldwide Across the globe, healthcare organisations and government systems are trying to be prepared for future disruptions, challenges and opportunities. Digital technologies have been increasingly utilised to fast track healthcare delivery, improve systems and achieve business growth. According to a PwC report, the global market for connected healthcare will expand by a third every year to reach £37billion by 2020. As per a Deloitte report, global healthcare spend is projected to reach $8.7 trillion by 2020. This shows that there will be more demand for healthcare services as the population of most of the developed countries begin to age and more and more lifestyle related diseases crop up. However, as global markets climb the

EXPRESS HEALTHCARE

September 2017

growth ladder there are some areas of concern as some of the well known healthcare systems have begun to dwindle.

“Developed countries across the world will struggle to deal with two simultaneous problems – a large population of aged and non-productive citizens and a declining fertility rate. Their entire social security apparatus was built on the pyramidal assumptions of a sufficiently large working population whose taxes will contribute towards healthcare and pensions for retirees. As fertility rates in developed nations fall below the replacement rate and automation displaces low-wage jobs, the growth of the non-productive population will outpace the growth of the working population. This leads to a massive underfunding of future pension and healthcare liabilities which will impact how much money is available to pay for healthcare,” analyses, Viren Shetty, Senior VP - Strategy & Planning, Narayana Hrudayalaya Hospital. Abhay Soi, CMD, Radiant Life Care, “Immediate competitor markets such as those based in the Middle East have started to witness stagnation. Therefore, a lot of the middleeastern healthcare group are now venturing into India. In comparison to this, India's healthcare providers offer, quality healthcare solutions by the best of experts at an affordable cost that gives us an edge over other markets.” In such circumstances, does the India healthcare sector stand a chance to prove its worth and work ahead of its time? Can it become the biggest healthcare market that serves the entire world? Does this sound absurd to you? Think again….

UK’s failing government sector but growing private sector Let’s look at the governmentdriven healthcare programmes such as UK’s NHS programme. For decades, UK’s healthcare system has been an example for ensured access, affordability and good governance. However, a CNN report revealed that the last decade the health budgets in the UK have been plateauing. Its NHS is labouring under several operational, governance, financial and security challenges. UK’s spring budget for 2017 announced a pledge to invest $2.5 billion towards adult social care over the next three years. $525 million was also announced to be invested in the NHS in the next three years to help them manage increasing demand. Despite these efforts, experts such as Professor Martin McKee, from the London School of Hygiene & Tropical Medicine, believe these effort may not help is reviving the NHS completely. by 2018

America caught between a political crossfire Currently, North America’s growth rate is expected to be at 4.3 per cent and Latin America will grow at 2.4 per cent as reported by Deloitte. However, some experts are of the opinion that the American market is expected to slow down due to its political crisis. While Donald Trump struggles to put together a plan to repeal and replace Obamacare, its healthcare sector will continue to be pressurised.

India’s path to glory The Chinese race against time The Chinese healthcare spending has rapidly increased in the past decade. Its population of individuals aged 60 or older is set to rise 90 per cent to 240 million by 2020, according to the World Health Organisation. This has been a growth driver for hospitals and the medical device sector. The healthcare sector in

China is therefore set to become a $1 trillion a year business by 2020, according to a report by consulting firm McKinsey & Company. It’s medical device sector is growing at 14 per cent per annum as per its stock market report in January this year. The market is dominated by foreign brands such as Siemens, GE Healthcare and Philip Healthcare apart from its budding domes-

tic device market. However, some experts believe that the sector is racing at full speed over the past few decades, yet it can't possibly move fast enough to keep pace with its nation’s changing social and economic dynamics. Its rising older population can become a barrier to its growth. Some Indian experts see this as an opportunity for India.

As per the Ministry of Statistics and Programme Implementation, GoI, India had 34.8 per cent of youth population counted in the year 2011. The ministry also published a report that stated that it has the largest share of youth population in the world and it will continue to hold so for the next 20 years. This has provided a greater opportunity for the country to reap this demo-

SPECIAL FOCUS -Future ready healthcare

Every organisation needs efficient processes like well-defined standard operating procedures, operational flexibility and technology to maintain highest levels of clinical excellence

Innovative business models, particularly those that integrate healthcare activities, can increase efficiency, improve care, and save consumers time Rajeev Boudhankar CEO, Bhatia Hospital

Gautam Khanna CEO, PD Hinduja Hospital

graphic dividend for making rapid economic growth. Again if we look at our progressive healthcare sector, it is dominated by the private sector which is witnessing a constant transformation with new ideas, approaches and techniques being adopted to achieve clinical excellence, better patient outcomes and business success. It has also begun its journey towards creating sustainable solutions for patients in many ways. According to a report by the Healthcare Federation of India (NATHEALTH), the sector is expected to become a $145 billion industry by 2018 and a $280 billion industry by 2025. India is also known to be the 'Pharmacy of the World' and is estimated to be worth `10,000 crore sector, growing at a CAGR of 22.9 per cent. Over 80 per cent of the antiretroviral drugs used globally to combat AIDS (Acquired Immuno Deficiency Syndrome) are supplied by Indian pharmaceutical firms. The sector is said to create 58,000 additional job opportunities and is expected to grow up to 45 per cent by 2025, as per experts from IIHMR University, Jaipur.

As per Brand Equity Foundation, the country is witnessing 22-25 per cent growth in medical tourism and healthcare providers expect the industry to double to $6 billion by 2018 from $3 billion now. Medical tourist arrivals in India increased by more than 50 per cent to 200,000 in 2016 from 1,30,000 in 2015. The Healthcare Information Technology (IT) market is valued at $1 billion in April 2016 and is expected to grow 1.5 times by 2020. Rural India, which accounts for over 70 per cent of the population, is set to emerge as a potential demand source. A total of 3,598 hospitals and 25,723 dispensaries across the country offer AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy) treatment, thus ensuring availability of alternative medicine and treatment to the people. What’s more, Indian doctors and nurses are spread across the world offering their expertise and services to several nations. The future does look bright in many ways and with such great potential can we envision India to be the healthcare provider of the world?

Embracing the changes and challenges that the future brings, and moving ahead while expanding business capabilities through diversification of services is also imperative

A future-ready organisation knows that margins will dip over time, so in order to meet the growth imperative, they add complementary business lines that strengthen the core business

Tony Mira

Senior VP - Strategy & Planning at Narayana Hrudayalaya Hospital Narayana Hrudayalaya Hospital

Dean Research, Indian Institute of Health Management Research (IIHMR) University, Jaipur

Are healthcare organisations prepared to stay ahead of their time? And what are the steps to needed to be taken to move in this direction? Is being future-ready the answer?

Defining future-ready for Indian organisations Gunther Sonnenfeld, HigherOrderVC and ExileLeadership, in his blog on building an infrastructure for the next economy writes, “Being ready means being ready to be valuable, and to produce value in groups. Whereas in the past, we thought of the future as an element that exists ‘over there’, the future is really right now, which requires us to be in the moment and to act within it. So being ‘future ready’ really means having an expressive capacity to create value.” Putting this in perspective for healthcare organisations, Shetty believes, “A futureready organisation is one that doesn’t pretend to know exactly what the future holds and bet the farm on that outcome. Rather, a future-ready organisation bets on a couple of likely scenarios and invests small amounts of money and attention on independent projects to test them out. The core

Viren Shetty

business operates as per usual but generates enough of a surplus that can go towards these micro-experiments. Furthermore, a future-ready organisation knows that margins will dip over time, so in order to meet the growth imperative, they add complementary business lines that strengthen the core business or move towards higher value-added services that leverage their innate strengths. Finally, a future-ready organisation is one that isn’t afraid to move into businesses that cannibalise the sacred cash cow, as long as it ensures that the whole business will survive over the long run.” “A hospital needs a good strategy and financial fitness to achieve its goals within set timelines. A future-ready hospital requires a patient-centric culture which promotes and reinforces innovation and adaption along with a skilled and empowered staff. Every organisation also needs efficient processes like well-defined standard operating procedures, operational flexibility and technology to maintain highest levels of clinical excellence”, opines Gautam Khanna, CEO, PD Hinduja

Success in an healthcare business can be achieved only by a collaborative approach within the organisation, where the team embraces change and is open to innovation at a greater speed Abhay Soi CMD, Radiant Life Care

Hospital. Similarly, Tony Mira, President and CEO, MiraMed Global Services, says that his organisation is already on the path to be future ready and shares, “It takes a commitment to your unique circumstances. There is no 'cookie cutter' approach to success. A company needs an inspiring leadership and top management must be receptive to change and ready to adapt to the changing trends and disruptions in the industry. A future-ready organisation must, of course, ensure its commitment to technology is ongoing and its financial situation is stable in order to maintain a long-term growth plan and execution of ideals. Ongoing training of staff and focus on nurturing staff with unique skill sets and specialists in a diverse range of expertise, based on the changing trends and industry expectations, will be a priority and challenge. A company that is not receptive to change and adapt will have a difficult time competing and surviving. Only then, we can keep our employees happy and motivated in the long term, can we win the hearts of our client. We can also focus on being future ready, irrespective of any un-

EXPRESS HEALTHCARE

September 2017

SPECIAL FOCUS -Future ready healthcare certainties or market changes which may, can or could impact the business in the long term.”

The pre-requisites As stated by these experts, we understand that organisations who are prepared to take advantage of opportunities, are committed to sustainable growth, focussed on constant innovation that meets the needs of the consumers, embrace technology and create an inclusive work culture are the ones who are braced for the future. There are four important characteristics that will lead organisations to be future ready.

Invest in innovation The first step in this direction would be to focus on innovation. Says Dr Rajeev Boudhankar, CEO, Bhatia Hospital, “Innovations in the delivery of healthcare can result in moreconvenient, more effective and less-expensive treatments for today’s time-stressed and increasingly empowered healthcare consumers. For example, a health plan can involve consumers in the service delivery process by offering low-cost, high-deductible insurance, which can give members greater control over their personal healthcare spending. Or a health plan (or service provider) can focus on becoming more user-friendly. Patients, after all, are like other consumers: They want not only a good product—quality care at a good price—but also ease of use.” Further, he suggests, “Innovative business models, particularly those that integrate healthcare activities, can increase efficiency, improve care, and save consumers time. You can roll a number of independent players up into a single organisation—horizontal integration—to generate economies of scale. Or you can bring the treatment of a chronic disease under one roof—vertical integration— and make the treatment more effective and convenient. In the latter case, patients get onestop shopping and are freed from the burden of coordinating their care with myriad

EXPRESS HEALTHCARE

September 2017

providers (for example, the ophthalmologists, podiatrists, cardiologists, neurologists, and nephrologists who care for diabetics). Such 'focussed healthcare Unions,' can cut costs by improving patients’ health. Furthermore, they reduce the likelihood that an individual’s care will fall between the cracks of different medical disciplines.” Adding to this, Mira suggests, “Focus on R&D, where much investment and time should be spent and strategise your goals with a well-planned and an organised deadlinebound timeframe. Unless we prioritise our goals and services based on the changing trends, as well as the surging client expectations, the road ahead may be complicated. We must have an analytical insight and a smart ability to predict various options based with a futuristic vision. Companies need to reconnect with their customers more than ever before and try to understand their future needs. Don’t assume what is working for today will work for tomorrow. Usually the customer is last to

tell you their future needs, you need to ask. By the time they tell you its too late and you potentially are in the process of losing them as a customer.”

People centric policies Increasing workforce fluidity, offering challenging growth opportunities, making room for more ownership by distributing authorities etc., are strategies that work for fastmoving organisations today. A Wall Street Journal article titled, ‘Together We Innovate’, explains the importance of employees working together in an effort to pull new ideas from multiple sources regardless of hierarchy or rank. It states that, “most companies continue to assume that innovation comes from that individual genius, or, at best, small, sequestered teams that vanish from sight and then return with big ideas.” The article expounds on the fact that “most innovations are created through networks -- groups of people working in concert.” To achieve this, leaders will need to be cognizant of their employees’ strengths and build

upon it in a synergetic manner. Soi, is of the opinion that success in an healthcare business can be achieved only by a collaborative approach within the organisation, where the team embraces change and is open to innovation at a greater speed. To nurture a team that is capable of all that, a company first needs to be nimble and flexible themselves. It has to build a team that is forward looking. He says that within his organisation, they have created a system where each and every department works in tandem with each other. They have leaders at every level. This gives every employee a career path and an assured future. Also, every morning leaders and representatives of all departments gather together for a briefing and to share each department’s action plan for the day. The communication of this meeting is circulated among the rest to ensure a seamless flow of function. This, technique he says have benefited them in increasing efficiencies within the organisation which reflects an increased profitability ratio in

the last five years. The company is currently growing at 50 per cent CAGR. Soi attributes this success to his team and their smart working style. Similarly, leaders who can think on their feet, and take informed decisions are those that will manoeuvre their organisations to winning positions. Therefore, healthcare organisations need to look at building strong leaderships at all levels who can lead the the rest of the workforce to optimal performance outcomes.

Solution over function The only way to provide a value preposition that differentiates your organisation from the rest will be by way of providing for a solution rather than a function. Giving an example of how Hinduja Hospital provide value to their patients, Khanna informs, “We continuously upgrade our medical technology thus bringing the latest medical treatment for our patients. We utilise information technology for enhancing patient experience and to further increase our efficiency. To provide more value to our

SPECIAL FOCUS -Future ready healthcare patients, we have started a homecare service through our Care@Home initiative, wheelchair-friendly transportation services etc.” “Embracing the changes and challenges that the future brings, and moving ahead while expanding business capabilities through diversification of services is also imperative,” opines Mira.

Revenue cycle management One cannot compromise on the most crucial aspect- financial stability of an organisation for which revenue cycle management plays a significant role. Healthcare revenue cycle is a dynamic process and as per experts it is in a continuous state of evolution. Therefore, healthcare organisations, especially, hospitals face several challenges that range from billing errors to failure to have certain processes, lack of data and improper policies etc. However, it is vital for providers to look at ways they can improve their organisation’s revenue cycle. “A large number of hospitals are dependent on processing insurance-related services, along with helping out clinicians and doctors in diagnosis and treating various medical complications. The increase in an ageing population, along with a vast variety of health-related complications on the rise, enhanced technology with smart-based models and RCM processes help in ensuring proper treatments. Medical technology has evolved to the next level and slowly in the coming years these disruptions will become dominant along with world class benchmarks like the ICD-10 format in medical coding. The potential opportunities for future-ready organisations are enormous and commitment to this should be a major goal in ensuring your future,” explains Mira.

The big dream Finally, I would like to once again poop this question, can India become the biggest healthcare market that serves

EXPRESS HEALTHCARE

September 2017

the entire world? Perhaps yes! Healthcare leaders mentioned above believe it. Will the entire healthcare fraternity in India be convinced of this concept? I leave it for each one of you to think… In my opinion, if every healthcare service provider, re-

search organisation, manufacturing sector and every leaders move towards being future ready or even more, stay ahead of our time, then India can be the healthcare provider of the world in the coming years. Reiterating on the lessons that can be learnt from

Leonardo da Vinci’s creative vision. Every healthcare organisation in India will need to understand the velocity ratios that exist in this industry as well as, worldwide. It will be really interesting to study how healthcare markets world over are functioning-

what are their challenges, their demands and strengths etc. This will facilitate us to find those white spaces that we can fill in providing the perfect value preposition to the world. raelene.kambli@expressindia.com

SPECIAL FOCUS -Future ready healthcare

Managing the hospitals of future Vivek Shukla, Senior Advisor, Frost and Sullivan - Healthcare and Life Sciences MENASA, gives an insight on how hospitals should evolve to provide better services and improve healthcare outcomes

EXPRESS HEALTHCARE

September 2017

●Medical T ou tion n r e l a m c i v a n n p o is re e c h t ns u ra n ce w i ● th

●Laws that gov er rds ea co n o f i d s ● Te n t i o c a re ● Le a d c th

tronic Medic El e c ● C ro s s p o l al Re lin m r● e osts in he a al C

re ●Focus hca alt ● Tr a i on p he o l o g y ne hn sh ip ● Hea d l er

s we know change is the only constant. As time lapses, industries and businesses evolve. Healthcare is no exception. Hospitals of the future will have to keep pace with changing times. The norms are already being challenged. Disruption is inevitable in any industry. Typewriters were done in with computers, film roll cameras are now replaced by digital ones, large incision surgeries are now being replaced by laparoscopic ones and people can now Google their symptoms and even their doctor’s prescription! As an industry moves from the growth to a maturity phase, the consensus around the paradigms in which the industry was operating are challenged. Since there are still players who want to make a mark and create a market for themselves, they see enough incentive in disrupting the current paradigms. We are likely to witness the same in the way hospitals are managed and provide services. Traditional methods of providing care are being challenged and new dimensions are emerging. The peculiar nature of healthcare where the user is not necessarily the payer, will have far reaching consequences as the payers seek to take control of their profitability. As health insurance penetration increases, the rules of the game will change rapidly. Hospitals will have to work at reducing rejections and creating formidable revenue cycle management protocols. We are witnessing interesting developments in international markets that have higher percentage of insured lives. There are places where the price for procedures is capped by the insurance companies and the hospitals cannot charge on a fee-for-service model. There are even mar-

kets where insurance companies are ‘recovering’ any excess payments that they have paid to the providers in the past months. In some countries, there are capitation models in play and HMOs are common. Much of this is likely to come to India as years go by. The hospitals of future need to watch carefully as the insurance penetration story unfolds. In the same breath as we talk about insurance, we will need to speak about costs. When pricing is under pressure, hospitals with lean cost structures will stand to gain. Markets will be dominated by hospitals with higher margins. They will hire the best doctors, they will invest in brand building and they will have deeper pockets to acquire superior technology, they can even offer volume discounts to the payers. As I write this, there are hospitals in the country who have actively engaged in getting clear on the costs of their top procedures and investigations. They intend to use this information to price their services and negotiate better with the payers.

There is one caveat though whenever I speak of costs in healthcare. We must not attempt at reducing costs by endangering quality and patient outcomes. That attempt, if made, will inevitably backfire. The aim has to be superior or at least the same quality with a lower cost. Counter intuitive as it may sound, because we think quality comes at a cost, but good quality can actually reduce costs and waste. A game changer in future will also be how the hospitals are led. I reckon ‘carrot and stick’ leadership will be juiced out and will not render itself useful in future. Leaders who can move and inspire their teams and employees will be in demand and will succeed more often than not. They will create agile organisations that quickly adapt to the changing times. Their hospitals will move faster and gain lead on various fronts. Leaders who continue to flog their teams for performance and leaders who keep using greed of incentive to extract performance will see dwindling enthusiasm and higher attri-

tions. The new era will be an era where extracting commitment will score big time over extracting compliance. The inner resistance amongst employees and departments is invariably a function of poor leadership. It is amazing to see the quantum of growth and execution that is choked because department heads or various team members continue to harbour differences. Worse still, leaders do not take to conflict resolution upfront. Usually, these issues are put on the back burner with a hope that they will get resolved on their own. Seldom does that happen. Hospitals that will thrive in the future will be the ones where the culture of working as a team is intentionally created. They will have leaders who galvanise teams and lead by example. This way, they will create nimble organisations that will make use of the dynamic markets and resulting opportunities. Close to the subject of inspirational leadership is the issue of retaining and grooming high quality talent. Unless hospital leaders create more leaders, the direction and speed of change will be compromised. Hospitals of future will have higher staff engagement and lower attrition levels. Needless to say, the supply of trained technical manpower including doctors and nurses will not be able to keep pace with the increase in demand in the coming years. Failure to retain talent will add to the woes and pose a threat to further growth. There is also a possibility of reverse brain drain of doctors as more Centres of Excellence develop in India. Hospitals in future will not shy away from crossing borders to bring back doctors and managers that have gone away because of better opportunities

VIVEK SHUKLA, Senior Advisor, Frost and Sullivan - Healthcare and Life Sciences MENASA

abroad. Cross pollination of ideas will be crucial to survival in healthcare. Learning from other players, industries and other countries will enable hospitals to keep pace with the changing times. We already see learnings from other industries being deployed in modern healthcare. Healthcare at home is one such example. Taking a cue from manufacturing, are a couple of hospitals that have embarked upon vertical integration of business and are producing the implants or consumables that they then use for their patients. Others are working closely with their vendors to ensure that the quality of supplied goods is ensured for better outcomes. This not only includes surgical goods, but also includes services like IT systems. Technology will be a critical element that will change the way hospitals operate in future. We have already seen a sea change in medical technology over the past decades. One of the likely game changers in future would be artificial intelligence. Imagine preliminary diagnosis is done without the need of a doctor. Or hands of a robot performing a surgery and not a human being. You may even have nursing robots in future. Hospitals will have to keep pace with technological advances to insulate themselves from being redundant. Needless to say, technology will need investment. This takes us to one of the points made earlier about better cost control. We will see that cost leaders in the industry will be more likely to adopt new technology and disrupt the dynamics of the game, thereby creating a chance for themselves to continue to lead further. Hospitals will rethink the way they manage patients with chronic medical conditions. The

SPECIAL FOCUS -Future ready healthcare number of such patients is rising with each passing day. Remote health monitoring, as a system to manage chronic medical conditions, has already gained ground. People in some parts of the world are already monitoring and trying to manage their blood sugar and blood pressure levels from the comforts of their home. The services are getting extended to ECG and even ultrasounds. I also see an increase in the ‘focus factories’ as compared to ‘all services under one roof’ model. As the supply of healthcare increases, the ubiquitous multi-specialty hospitals will have to give way to single specialty experts. This will go way beyond eye hospitals, birthing centres or IVF Centres. There is already a small chain that only does bariatric surgeries. As time goes by, we will witness more providers who do only one procedure or master only one specialty. Focus factories have better utilisation, steeper learning curves and higher profitability. The future will also see an added focus on prevention. More and innovative ways to prompt people to stay healthy, get check-ups done and prevent ailments will be seen. We can expect some hospitals to have dedicated prevention wings where the otherwise healthier people will visit and get preventive check-ups done. Cross border travel for healthcare, popularly known as medical tourism, will continue to evolve. Every other day we see new studies and predictions on the number of medical travellers that will seek or arrive for treatment in some country or the other. Indian hospitals seem to have found their markets and are competing hard to get more and more international patients. This will be an interesting space to watch out for in the coming years. Hospitals of tomorrow will make drastic progress in the way they use, create and manage their medical records. Predictive medical conditions and preventive interventions can significantly alter the rules of the game. Managing the entire cycle of care instead of episodic management of conditions will

EXPRESS HEALTHCARE

September 2017

get enabled with next generation electronic medical records. This will also ensure retention of patients for longer periods, whereby making patient retention and subsequent crossselling an important aspect of the business. The laws that govern health-

care providers are evolving as the time goes by. This is likely to continue and we will see more clarity when it comes to fixing responsibility and liability. The interests of both the provider and the patient will be safeguarded in a better way. Consumer Protection Act, IPC pro-

visions with regards to healthcare and Civil Laws, will all evolve and impact how care is provided. Hospitals who keep themselves abreast with these developments are less likely to be affected adversely in case of a litigation. The list of how healthcare

delivery will evolve can go on. The bottom-line for hospitals of the future is – they need to closely watch the key dynamics that have a bearing on their functioning and be quick to adapt in case there is a definitive change.

DS20

DIAGNOSTIC STATION DS20 DS20

SIMPLIFY YOUR DAILY WORK î Most vital signs and physical assessment tools in one device î Perfect tool for Atrial Fibrillation Screening: One resting

rhythm channel can be acquired just by connecting only 3 electrodes, without multiple ECG cable connections î Large interactive touch screen and self-explanatory user

interface for maximum user-friendliness î 12-lead ECG interpretation, spirometry and Pulse Wave

Analysis (PWA) î Connectivity to EMR, PACS, HIS for easy data access

DS20 is a Practical and yet Sophisticated Diagnostic Station

For enquiries contact : sales@schillerindia.com | Website : www.schillerindia.com | Toll-Free No. : 1-800-2098998 Swiss H.Q.: Schiller AG, Altgasse 68, P. O. Box 1052, CH - 6341 Baar, Switzerland, Indian Corporate Ofﬁce: Schiller Healthcare India Pvt Ltd., Advance House, Makwana Rd, Off. Andheri Kurla Road, Marol Naka Metro Station, Andheri (East), Mumbai - 400 059. Tel.: + 91- 9323799863, +91-22 61523333/ 29209141 | Fax: +91-22-29209142 E-mail: sales@schillerindia.com, support@schillerindia.com Factory : No. 17, Balaji Nagar, Puducherry 605010 CIN : U33110MH1997PTC111307

All registered trademarks acknowledged

SPECIAL FOCUS -Future ready healthcare

Building patient-centric hospital of future Vidya Priya Rao, Founder, Customer Experience, Marketing, and Service Design Thinking Consultancy, Innovatus Marketers Touchpoint, gives an insight on how a hospital can shift from volume- to value-based care by using design thinking and a holistic service minded approach

ndia has seen an increase in life expectancy and the rise of chronic illnesses. At the same time, current models of healthcare delivery are increasingly becoming unsustainable to manage this shift from volume (diagnose and treat) to value (prevent and manage) based care. With technology playing a lead role, there is a seismic shift in patient expectations

of an ‘always-on’ approach to care, disrupting the dynamics of the patient-provider relationship. Today’s patients have more choice and options when it comes to handling their own recovery, along with increased health insurance burden. In turn, healthcare providers are needed to understand the non-linear, multi-stage patient journey via the different channels and

Patient journey - from admission to discharge and beyond

EXPRESS HEALTHCARE

September 2017

touch points. While, doctors, nurses, support staff, clinics and hospital management teams may perform well as stand-alone experts, but they often do not form interprofessional centres of treatment excellence let alone, service and patient centeredness. To add to this, hospitals have to deal with the discomfort and insecurities of doctors and nursing

staff due to new technology interventions and the need to improve the bottom line and drive down costs, while enhancing performance and patient satisfaction under the value-based care model.

Prescription to design future hospital To adopt a patient-centric lens and a holistic serviceminded approach requires a

VIDYA PRIYA RAO, Founder, Customer Experience, Marketing, and Service Design Thinking Consultancy, Innovatus Marketers Touchpoint

shift in thinking. The hospital management team cannot confuse restructuring this complex digital disruption with traditional methods myopic cost slashing, digitalisation of standard operation procedures and haphazard efficiency gains through inhouse process improvements. On similar lines, for the sake of value creation and eagerness for cost savings, they can’t make ‘less value’ departments or clinics, redundant activities, overhead costs, and slack resources as their popular targets. They can’t compromise with safety,

SPECIAL FOCUS -Future ready healthcare supervision, security, and surveillance requirements since zero risks often come at the cost of zero conveniences. While technology will be a significant component in providing patient care in the digital future, it is even more critical for hospitals to strengthen the human element to support hospitalphysician-patient relationship. A better understanding of the patient population, enables them to be proactive and effective at managing their health. This is where design thinking makes it entry with its human-centric problem-solving approach, allowing hospitals to empathise with patients and their families while driving a measurable return on investment. The first step, of design thinking, is to understand the myths and realities about what patients expect from digital healthcare, their current frustrations. The next step is how should the hospital go about designing the service by removing the lumps and bumps that make them annoying, and shape the service experiences that really work not just for the patients, but also all the relevant stakeholders. And finally, hospitals should continually add magic via new services and make them compelling to keep patient attention and build lasting value. Indian hospitals will not be the first to adopt these principles. It has been tried and tested by Mayo Clinic, Rotterdam Eye Hospital, Stanford Hospital and many more, and all are reaping the benefits of having invested in design thinking. Their teams use a variety of digestible tools and techniques like objective observation, patient journey maps, expectation maps, service safaris, cultural probes, cocreation and so on, they challenge conventional ways of thinking in healthcare.

Innovation to increase OPD efficiency Hereâ&#x20AC;&#x2122;s a scenario that illustrates how innovative design principles applied to redesign the OPD can lead to create

EXPRESS HEALTHCARE

September 2017

more efficient healthcare delivery, higher quality, improved patient experience, and outstanding outcomes. At a leading hospital, the OPD area was always a bustling area, and there was a general perception that the department was overloaded

and overworked, and there was always long wait times for patients. The design team, comprising design leaders, doctors, clinic administrators, medical staff and others, set out to understand how can this be changed. The first outcome was to make sure

that the OPD team offer the safest and highest possible quality care to their patients while ensuring itâ&#x20AC;&#x2122;s profitable and operation is sustainable. The second outcome was to make sure that a positive first impression gets shaped in the minds of the patients and

those who accompany them.

Empathise and find the problem The team observed, interviewed patients and their families, focussed discussions with the OPD team, analysed the insights generated by the

SPECIAL FOCUS -Future ready healthcare

Design thinking framework

software used by them and were able to understand the bottlenecks. The key areas they identified were: ◗ Patient dissatisfaction: A typical patient would be stressed with the medical condition, fearing the results of the diagnosis and would be juggling to balance work and family responsibilities, as well as transportation. In few cases, they could also have financial concerns and language barriers. For a visit to the OPD, the patient had to wait in front of the registration desk, at the doctor's office, at the cashier's counter, at the laboratory for getting a test done or collecting report, pharmacy and in between appointments – leaving them exhausted, unable to take muchrequired rest. They also felt lost, as to how to cope up with the daily chores. ◗ Appointment bookings: Poorly managed patient list and appointment bookings, most of the patients were walk-ins with prior appointment and took one on the spot. As a result, the software showed it as both underutilised and overbooked. There was no mandate to cap-

EXPRESS HEALTHCARE

September 2017

ture the follow-up appointment schedule, to help map the patient to the same attending doctor. ◗ Case note management: Different doctors, could attend the patient while treating the same case. As the physicians were adopting different ways to manage case notes, often it was not entered timely in the hospital database, resulting in patient repeating the same information minus the notes of the previous doctor if they forgot to get the prescription, resulting in dissatisfaction for patients and staff. In the define stage, the team tries to understand ‘what are implications of wait time in the OPD and how does it impact the perception of care?’ The team asked this simple series of questions, often trying to break through the stereotypes and assumptions. A partial list is shared: Should 50 waiting patients be funnelled through multiple front desks to receive care in the fifteen available exam rooms? Must the patients be left idle in the impersonal waiting room while they wait for care? Should there be an easy way to book an appoint-

ment to cut down patient wait time? Can the patient view the medical reports on their laptop, mobile device as well as the physician's computer screen, without having to go to collect it? How can the hospital have access to the previous case history and treatment record from other hospitals? Is there a better and efficient way to utilise OPD space and the patients’ time? The answers were: “No. No. Yes. Yes. Yes. Yes!” In the ideation phase, the multi-disciplined team brainstormed the different alternatives to address inefficiencies, critically reviewed the existing constraints interfering with patient care. The team prioritised what is the best doable idea in a limited time frame and what would be a logical next step beyond it. The exercise also helped the team see how working smarter could lead to better care for patients and a happier and more productive staff. Based on the most promising ideas, small-scale informal experiments was designed to refine the concept aimed to eliminate waste within the system and get the buy-in

from the larger team for formal adoption. If this worked, this was adopted by other departments as well. Some highlights from the work are: ◗ Better bookings: If an OPD patient required to come for a follow-up, the appointment was given well in advance and recorded in the software. They were also educated to call and book an appointment via the different channels available before coming for an unscheduled visit, to minimise wait time. ◗ Improving use of appointment slots: As the patient case history, medical reports was available with the doctor, they could spend more time ensuring the patient has a thorough understanding of their health status. The next step was to integrate data from personal monitoring devices with the hospital systems. ◗ Usage of the patient wait time: Health coaches were around to inspire and educate patients to better manage his/her care and how to track the progress or to how to seek any clarifications at a later date using the hospital app. It helped reduce patient anxiety

and improve service quality. ◗ Centralising case notes: A new process for storing notes centrally and providing access to the concerned staff. There was initial frustration with the extent of deepdive being done, but as the work took shape and many of the experiments succeeded, it became evident that the changes were making a significant impact and the internal scepticism declined. The hospital team realised that a better design had a positive impact not only patients but also their professional life and the momentum picked up.

Design a value-based care model Those players who think “beyond the hospital walls” will be able to deliver value across the full breadth of the patient experience. Looking upstream, hospitals may consider value-driving initiatives such as more efficient diagnosis to identify the root cause of the disease and even disease prevention. Looking downstream, disease management opportunities abound in the areas of patient monitoring and treatment adherence to prevent readmissions.

SPECIAL FOCUS -Future ready healthcare To redesign a future-ready hospital, they should use design thinking to address the following questions, and pass the stress test to assure the stakeholders that they are ‘better,' ‘leaner,' ‘different,' and ‘disruptive.’ ◗ How to reimagine care management and innovate the models for the front-, middle-, and back-office service delivery to define service from the patient’s perspective, considering them as a cornerstone for co-value creation? ◗ Which combinations of services (personalised medicine, genome based diagnostics and so on) can be offered to reduce re-admission rates and support the recovery process for chronic care management? ◗ How to ensure patient accountability and empower them to take an active role in their recovery and well-being? ◗ How to standardise and adopt IT to aid collaboration across multi-user, multi-device environments for endend disease management with an accuracy of patient data capture and reporting? ◗ How to manage the shift from functional professional organisation to integrated healthcare providers resembling a hub with outgoing service spokes? ◗ How to use technology to improve physician consultations, and redesign the traditional exam room? ◗ How to re-purpose spaces, use distributed facilities and enhance collaboration between different care entities to get closer geographically to patients? ◗ What are the emerging roles, skill-mix changes and different approaches to workforce planning? What is the expiry date of the current job functions? ◗ How to add substantial value to the core business or enhance the latter using business development, competency-based diversification or portfolio restructuring? ◗ What are the steps required to overcome hospital legacies, current structure, core rigidities and constraints with service model redesign?

EXPRESS HEALTHCARE

September 2017

◗ How to develop risk-sharing models with insurers, medical device manufacturers, regulators, industry and other providers? While the hospital gets an internal consensus regarding the digital future, do note there will be considerable uncertainty

and challenges to achieve the shared digital vision.

Think beyond today While the digital future may seem uncertain, players willing to invest in time, money and effort into reshaping deep-rooted systems and atti-

tudes, and embrace supporting technology will lead in the marketplace. By applying and learning design thinking, the hospital and related service organisations can gain the ‘creative confidence’ to make this change happen. It requires a change in mindset

from leadership as well so that the doctors, nurses and the support staff are both supported and encouraged to apply their knowledge to provide better care, design more efficient processes, improving the lives of everyone who interacts with the hospital.

Connect with us to meet your treasury requirements AWARDS: Best Foreign Exchange Provider, India, 2016

Best Derivatives House & Best Bond House, India, 2016

Best Structured Products House, India, 2016

Best Domestic Provider of FX Services, India, 2016

from Global Finance Magazine

from The Asset Magazine

from Asiamoney Magazine

To take advantage of our award winning markets solutions, please contact:

Akash Chopra akash.chopra@icicibank.com

THINK TREASURY - THINK ICICI BANK We can help you fulfill your treasury requirements, across FX services, Fixed Income, Liability Management, Structured Products, Hedging Solution and a host of other markets solutions. Do get in touch with us to help you with your treasury requirements. Any information in this advertisement should not be construed as an offer, invitation, solicitation, solution or advice of any kind to buy or sell any financial product or service offered by ICICI Bank, unless specifically stated so. Forex Transactions carry inherent risk and the client is required to take all such measures & continuously monitor the transactions offered under these product and services. ICICI bank is not acting as your financial adviser or in a fiduciary capacity in respect of this proposed transaction with you unless otherwise expressly agreed by us in writing. Please consult your professional advisors accordingly. The product and services mentioned in the advertisement are provided by ICICI Bank and are subject to specific terms and conditions. ICICI Bank reserves the right to change/alter/amend the above mentioned products and services without prior notice. ‘ICICI Bank’ logo is trademark and property of ICICI Bank.

SPECIAL FOCUS -Future ready healthcare I N T E R V I E W

Nurses today have a varied and multi-faceted role Nurses are encountering more opportunities and challenges than ever before in the rapidly changing dynamics of modern medicine and healthcare delivery. Lt Col (Retd) Binu Sharma,VP-Nursing Services, Columbia Asia Hospitals, India, shares invaluable insights on the evolving role of nurses and make them future-ready, in an interview with Lakshmipriya Nair How has the role of nurses become more diverse and complex in the current healthcare scenario? The nursing role is evolving very rapidly as nurses are entrusted with a lot more responsibilities than ever before. The changing demographics, disease profiles and other factors have broadened and deepened the field of nursing. Today, nurses are giving talks, engaged in scientific research and actively addressing healthcare policy among other things. They also have the opportunity to pursue medical specialisations. Technology too has opened up new avenues of growth. Thus, nurses today have a very varied and multifaceted role which can have significant impact on the healthcare system. Moreover, the current scenario has also made it necessary for nurses to don several hats as they deliver care and act as the first point of contact with the families of patients. They have to culturally wise, knowledgeoriented and agents of care innovation. Thus, nursing has become more complex in ways that couldn’t have been imagined earlier. How can nursing leaders be the agents of quality improvement and care innovation today and in times to come? Not all nurses think of becoming a leader as they start their career. Yet, nursing leaders are pivotal to the healthcare system to collaborate with other health professionals and leaders. All nurses must be leaders

EXPRESS HEALTHCARE

September 2017

in the design, implementation, evaluation and advocacy of ongoing reforms to the healthcare system. Research and practice in nursing should be encouraged to ensure evidence-based improvements to care delivery. Nursing leaders are essential to convert new research findings to the practice environment and into nursing education and from nursing education into practice and policy. Nurses need strong leadership skills to contribute to patient safety and quality of care. Nurses should have a say in health policy decision making and serve on advisory committees, commissions, and boards where policy decisions are made to health systems for improved patient care. In the current IT-enabled healthcare delivery sector, how has the scope of nursing practice expanded? Nursing technology includes several devices, systems and software which reduce the time expended on tasks like tracking down equipment, collaborating and co-ordinating with other staff members, updating patient charts etc. Technology can also be crucial component to improve patient care and outcomes as it can help improve response times, increase accuracy and ensure safety. Technology also aids nurses and other clinical staffs improve communication and enable better efficiencies in clinical workflow thereby freeing up time to improve patient care. Columbia Asia has a policy of ensuring that nurses are key

radiology and pathology and even here all records are maintained digitally. There is a business intelligence portal that sits on top of the medical record, this helps the nurses pull out the dashboards including key performance indicators (KPIs) for performance.

Nursing has a lot of potential for career growth and professional development participants in the digital health initiatives. We have a proprietary Health Information System (HIS) called ‘CARE 21’. It was developed by the internal IT team at Columbia Asia. Today, there are hardly any paper forms at Columbia Asia. The few paper formats you might get at the hospital are the consent form, a few checklists. Most patient related forms are in electronic format. Today, all patient related processes are done through HIS-registrations, admissions, out- patient and inpatient assessments and consults, inpatient transfers, progress notes and communications from ICU, operating rooms and wards are done through the system. It also connects all the diagnostic departments like

What needs to be done to make the nurses futureready? Nursing in India is at crossroads. While digital technology has enabled patients to seek the best in care, but nurses in India have to wage a constant battle against rising stress levels, lower pay and growing demands of the modern healthcare system. This has led to high rates of attrition among nursing staff, which is around 40-60 per cent. In this scenario, healthcare leaders striving to improve working environments should undertake digital transformation initiatives and continue to improve standards of care. There is a vital need to empower nurses by upgrading their skills, knowledge and becoming specialists. However, the existing system of nursing education and practice is inadequate to meet the future healthcare needs and challenges. There is an urgent need to understand the scope of nursing practice with clearly defined educational curriculum and licensure. What are the immediate and long-term steps needed to revitalise the nursing profession in India? Nursing has a lot of potential for career growth and profes-

sional development. A nursing career begins as a registered nurse but it doesn't have to end at that. It can branch into several directions, including advanced practice nursing, healthcare administration, government healthcare policy making, nursing education and nursing research. Skilled and specialised nurses are in high demand by the health organisations.There are wide employment opportunities for B.Sc/M.Sc Nursing/GNM/ANM Degree holders in the public as well private sector. They can also be employed in schools, orphanages and old age homes. They can also look at getting employed in industrial houses and factories. Besides, these they can opt for teaching in training institutes as educators. However, there are some issues that need to be addressed urgently, such as ◗ Nurses should receive their due recognition for the service they render humanity ◗ Measures should be taken to ensure and enhance job opportunities in governmentrun hospitals and prevent exploitation of the nursing fraternity at private/corporate hospitals. ◗ Prevent workplace harassment by doctors and the hospital management. ◗ Standardise wages as per the the minimum wages fixed by the government. Revise the wage structure recording to the current cost of living, with mandatory yearly increments. ◗ Start overtime allowances to be started lakshmipriya.nair@expressindia.com

KNOWLEDGE

BUILDING BLOCKS Regenerative medicines could be a potential gamechanger in healthcare, provided the market is streamlined with effective regulations and guidelines, finds Mansha Gagneja

ne era’s fantasy is another era’s reality. The world keeps mentioning regeneration in multifarious ways, be it in comics or movies and what seems remarkably fictional is more likely a fact in reality. Many sci-fi movies portray fictional characters experimenting and acquiring the ability to regenerate organs. And many a times aftermath illustrates the catastrophic effects of ungoverned research. Regeneration as an answer to cure a disease or personalised medicines are far from being a new idea. Ancient Greek legend of Prometheus, the god who was cursed to have an eagle peck out his liver each day, only to grow it back overnight, recognised the power of regeneration and claimed that the liver could heal itself. This made them address liver as ‘hepar’ meaning to heal itself. The modern science is intrigued by the applications of regenerative medicine which include genetical engineering, stem cell biology, cloning, biomaterials and biomedical devices to name a few. Dr Pradeep Mahajan, Regenerative Medicine Researcher and MD, StemRx Bioscience Solutions highlights, “Early works on regenerative medicine were in the form of cell based therapy for blood related conditions (leukaemia, bleeding disorders etc.) Medical science is now analysing the mechanics of utilising the power of these dynamic molecules in treatment of various chronic and previously untreatable conditions.” Yash Sanghavi, CMD, Regenerative Medical Services informs, “India is a major

EXPRESS HEALTHCARE

September 2017

biotech player in the Asia Pacific region, coming next to Japan and South Korea. The stem cell therapy market in India was valued at `1 billion in 2013. This is expected to reach `2 billion by the year 2018. India is projected to witness a rise in the number of stem cell banks and stem cell depositors in the near future and liberalisation of regenerative medicine research, along with government support, are the major factors aiding this growth gradient. Currently, over 40 institutions, hospitals and industry are engaged in research all over the country.” This rapidly growing interdisciplinary field involving the life, physical and engineering sciences also raises several ethical, legal and social issues. Dr Geeta Jotwani, Senior

Scientist, ICMR pointed out that the misleading and luring advertisements by private cord blood banks is increasing. Initially, started in metro urban class people who could afford the cost of banking are now, with intensive advertisement, are spreading across smaller cities and towns. But several international bodies such as American Academy of Pediatrician, American Society for Blood and Marrow Transplant, Royal College of Obstetricians and Gynecologists, American College of Obstetrics and Gynecology, American Medical Association, European Group on Ethics in Science and New Technologies etc., do not recommend routine private banking for future self use. The reasons include the likelihood of the stored blood be-

ing used for Hematopoietic stem cell transplantation (HSCT) is very small, probably as low as 0.005 to 0.04 per cent in the first 20 years of life and stem cell transplant using an individual’s own cord blood cannot be recommended for genetic disorders. Dr Venkatesh Movva, MD Regenexx, deliberated that in the western world these advertisements are strictly prohibited whereas in India, they make way for commercial players to enter which raises the credibility issue. Thus, to maintain standardisation, there arises the demand for companies to work within the regulatory framework of the governing bodies. The private sector and the government institutions are developing systems to establish processes to for-

mulate clinical research protocol, review and monitor the human studies.

Evolution of regulatory framework Inception The Indian Council of Medical Research (ICMR) and the Department of Biotechnology (DBT), in 2007, jointly released guidelines for stem cell research and therapy. These guidelines are directions for scientist, clinicians and industry involved in the field. Due to the growing scope along with new scientific and clinical findings these guidelines have been periodically updated. Revision The guidelines were revised in 2013 and a report on National Guidelines for Stem

KNOWLEDGE

Cell Research 2013 by ICMR informed, “The present guidelines have retained the earlier classification of stem cell research into three categories, namely Permitted, Restricted and Prohibited categories. An additional layer of oversight, besides the Institutional Ethics Committee (IEC), in the form of Institutional Committee for Stem Cell Research (IC-SCR) and National Apex Committee for Stem Cell Research and Therapy (NAC-SCRT) has been introduced. This mechanism of additional review has been accepted by the scientific community in the country and the required NAC-SCRT has become operational. The role and functioning of these committees is being streamlined." Another integral recommendation of

the Committee during the revision included omitting the word ‘therapy’ from the title of guidelines. This has been done to emphasise the fact that stem cells are still not a part of standard of care; hence there can be no guidelines for therapy until efficacy is proven. This year a proposal for revision in the form of guidelines has been drafted. Dr Jotwani, highlighted, “The draft National Guidelines for Stem Cell Research 2017 addresses to rampant unethical use of stem cells for treatment of unproven indications without scientific backing. The stakeholders were of the opinion that there is no regulation for stem cell research and therapy and therefore it was initially proposed to frame separate regulation for

An integral recommendation of the Committee during the revision included omitting the word 'therapy' from the title of guidelines

stem cell research but it would have taken long to formalise the same as ART Bill and Biomedical Ethics Bill which is still pending. Therefore, we have chosen path of harmonising existing acts, rules and regulations. The following existing acts and rules were revisited and an attempt made to harmonise them in the draft guidelines: ◗ Drugs and Cosmetics Act, 1940 and Drugs and Cosmetics Rules, 1945. ◗ Indian Medical Council (Professional Conduct, Etiquettes and Ethics) Regulation 2002 and amendments. ◗ Drugs and Magical Remedies (The Objectionable Advertisements) Act- 1954. ◗ The Code for Self-Regulation of Advertising Content in India by ASCI ◗ ICMR National Ethical

Guidelines for Biomedical and Health Research Involving Human Participants, 2017.”

Industry opines Industry stakeholders throw light on the many challenges that are faced in the market. Satyen Sanghavi, Chief Scientific Officer, Regenerative Medical Services observes, "The field of regenerative medicine has to contend with several challenges associated with the evolution of its science and technology of which the major are regulatory framework, education to the clinicians and funding. From an ethical perspective, concerns ranging from proper guidelines/ instruction for conducting research to investigator-initiated clinical practice without regulatory ap-

EXPRESS HEALTHCARE

September 2017

KNOWLEDGE

provals is something that India is facing currently. In the early part of this century, India was among the few active countries in the field of regenerative medicine and had a head start. However, regrettably, with obscurity in the regulations and funding, proposals for clinical trials have been languishing for years. Consequently, India is lagging in the world order in the domain of regenerative medicine. With the establishment of standards in regulatory approvals, evidence-based research and clinical practice, cell therapies will find a major niche in medical advancement in the future." He further added India has sharp conflicts developed between local funders of stem cell product applications and the national government over the conditions under which they may be used and marketed. Countires like Thailand, Japan, South Korea and Taiwan, regularly find stem cell products on offer as cosmetic cell therapy or as holistic medicine. Disagreement about the interpretation of key terms can undermine effective regulation.

The way forward Dr Jotwani strongly refutes it and informs,"R & D industry initially faced challenges like delay in getting regulatory approvals. But later from 2011 the process is streamlined by establishing separate committee under CDSCO to review clinical trial applications i.e. CBBTDEC. For approval of clinical trials, Drug Con-

troller General India DCG(I) has established a committee namely ‘Cellular Biology Based Therapeutic Drug Evaluation Committee (CBBTDEC)’ for the ‘Therapeutic products derived from Stem Cells, human Gene manipulation and Xenotransplantation technology’. This committee is chaired by Secretary DHR and DG, ICMR

and till date, approved around 30 clinical trials. Few stem cell and cell therapy products have been given conditional approval by the committee to address the unmet need in the field of medicine after evaluating safety and efficacy.So far 30 trials have been approved. One stem cell based product has been given conditional approval (StempuCell).

Another cell-based products approved are Ossron and Chondron. Industry stakeholders share solutions in regards to providing education at medical school level along with introduction of fellowship/post-graduate programmes." Dr Jotwani adds, "Contrary to the popular belief that there is no regulatory framework to curb the unethical practices, above acts and rules do exist that can very well regulate the misuse of innovative technologies in medical field including stem cells. Proposed guidelines are therefore critical to incorporate these advances and to harmonise them with the internationally revised guidelines." To continue to grow at a fast pace , both the government as well as the private players need to come to a common consesus to carry on the evolution and transformation of regenerative medicines in a smooth way in India. A conceited effort is the need of the hour mansha.gagneja@expressindia.com

CONTRIBUTOR’S CHECKLIST ●

●

Express Healthcare accepts editorial material for the regular columns and from preapproved contributors/ columnists. Express Healthcare has a strict non-tolerance policy towards plagiarism and will blacklist all authors found to have used/referred to previously published material in any form, without giving due credit in the industry-accepted format. As per our organisation’s guidelines, we need to keep on record a signed and dated declaration from the author that the article is authored by him/her/them, that it is his/her/their original work, and that all references have been quoted in full where necessary or due acknowledgement has been given. The declaration also needs to state that the article has not been published before and there exist no impediment to our publication. Without this declaration we cannot proceed. If the article/column is not an original piece of work, the author/s will bear the onus of taking permission for re-publishing in Express Healthcare. The final decision to carry such republished articles rests with the Editor. Express Healthcare’s prime audience is senior management and professionals in the hospital industry. Editorial material addressing this audi-

EXPRESS HEALTHCARE

September 2017

● ●

●

● ●

●

ence would be given preference. The articles should cover technology and policy trends and business related discussions. Articles by columnists should talk about concepts or trends without being too company or product specific. Article length for regular columns: Between 1300 - 1500 words. These should be accompanied by diagrams, illustrations, tables and photographs, wherever relevant. We welcome information on new products and services introduced by your organisation for our Products sections. Related photographs and brochures must accompany the information. Besides the regular columns, each issue will have a special focus on a specific topic of relevance to the Indian market. You may write to the Editor for more details of the schedule. In e-mail communications, avoid large document attachments (above 1MB) as far as possible. Articles may be edited for brevity, style, relevance. Do specify name, designation, company name, department and e-mail address for feedback, in the article. We encourage authors to send a short profile of professional achievements and a recent

photograph, preferably in colour, high resolution with a good contrast. Email your contribution to: viveka.r@expressindia.com Editor, Express Healthcare

POLICY WATCH

Could the Gorakhpur tragedybeen averted? CAG report had revealed irregularities in Baba Raghav Das (BRD) Medical College, Uttar Pradesh By Prathiba Raju

recent tragedy saw 63 children, including 17 infants, lose their life at the Baba Raghav Das (BRD) Medical College Hospital in Gorakhpur. It once again showcased the deplorable state of public healthcare in India. Initially, the death of children was cited due to lack of oxygen supply as the hospital hadn’t paid its dues to the supplier, but the Uttar Pradesh government denied it and attributed the cause of the deaths to Acute Encephalitis Syndrome (AES). In the days that ensued the tragedy, as families mourned the untimely deaths of their children, the irregularities of the four government-run medical colleges in Uttar Pradesh and the callous approach of the state government in mitigating them also came to light. Especially, in the backdrop wherein it was revealed that the Comptroller and Auditor General (CAG) of India's General Social Sector for the government of Uttar Pradesh report had already red-flagged the flaws in the running of these hospitals.

Decoding the CAG report The CAG audited four colleges of the 19 government medical colleges (GMC) in UP - King George Medical University, Lucknow (KGMU, Lucknow); Lala Lajpat Rai Memorial Medical College, Meerut (LLRM, Meerut); Baba Raghav Das Medical College, Gorakhpur (BRD, Gorakhpur) and Maharani Laxmi Bai, Medical College, Jhansi (MLB, Jhansi). The CAG social sector report states, “Uttar Pradesh is the most populous state in the country and has public health indicators far below the national average. Inadequacy of infrastructure available in medical colleges and their associated teaching hospitals are areas of serious concern in the state which need to be

addressed on priority. The Medical Education Department is responsible for establishment and maintenance of well-equipped medical colleges, including teaching institutions, which are the premier referral centres for peripheral hospitals.” It further informs, “The GMCs violated the provisions of General Financial Rules while procuring equipment. By extending undue favour to suppliers and purchasing equipment at a higher rate, financial management of the GMCs was not adequate as there were instances of retention funds for long periods in personal ledger account, diversion of funds, etc. This not only violated the provisions of financial rules but also deprived the patients of adequate healthcare as essential equipment were not procured in time.” The CAG informed that the four hospitals, including BRD, parked their funds in Lucknow’s Kasturba Gandhi Medical Unit (KGMU) in violation of rules, resulting in delay in realisation of funds. The BRD hospital had parked ` 27.38 crores. “The parking of funds not only violated the financial rules but also deprived the patients of adequate healthcare as essential equipment could not be procured in time. Government should enforce effective control

systems to discourage parking of funds and to ensure that funds are utilised for the purposes for which it was sanctioned,” the government auditor stated.

A diseased state The report also stated that gaping shortage of clinical equipment in BRD hospital was 27.21 per cent and non-clinical equipment was 56.33 per cent, which was against the minimum requirement prescribed by the Medical Council of India (MCI). The supply of oxygen comes under the non-clinical equipment segment. The audit also cautioned the state, “Large shortages of clinical equipment not only had an adverse impact on the quality of education imparted to students but also affected health care service delivery to general public in these areas.” Giving a grim picture of the GMC in Uttar Pradesh, the CAG report observed that the state did not procure clinical and teaching equipment though adequate funds were provided by the Government, resulting in shortages of equipment. “The GMCs failed to provide adequate treatment to cancer/heart patients as equipment such as Cobalt Teletherapy, Brachytherapy unit, Left Ventricular Assist Device, etc. were not being op-

erated in hospitals due to lack of doctors/technical personnel/infrastructure. The GMCs did not execute Annual Maintenance Contract for equipment. As a result, the machines were not functional and tests for cervix cancer, foetal monitoring, prenatal diagnosis, bio-chemical and hormonal tests etc. could not be conducted. GMCs violated the provisions of General Financial Rules while procuring equipment by extending undue favour to suppliers and purchasing equipment at a higher rate. Financial management of the GMCs was not adequate as there were instances of retention funds for long periods in PLA, diversion of funds, etc. This not only violated the provisions of financial rules but also deprived the patients of adequate healthcare as essential equipment were not procured in time,” reveals the CAG report. The audit report also mentioned that in March 2012, the UP government instructed that interest accrued out of its funds must be deposited in the government account. The audit observes that records of KGMU from 2011-16 reveal an amount of ` 210 crores was provided by the government for procurement of equipment. But an unspent amount of ` 58.53 crores pertaining to the period 2011-16 was parked in savings bank account as of March 2016. The minimum interest accrued on the amount kept in the bank was ` 2.83 crores. Against the aforementioned accrued interest of ` 2.83 crores, KGMU deposited only ` 0.95 crore in the Government account as of March 2016 and ` 1.88 crores was yet to be deposited by KGMU in the Government account.

cause of death was due to AES, including Japanese Encephalitis (JE). After the death of 63 children, the Ministry of Health and Family Welfare (MoHFW) has announced a research facility for JE, which has been pending since 2014. Year-on-year, the cases of AES and JE are long-time scourge in Uttar Pradesh. The major outbreak of JE was reported from eastern UP during 2005 which recorded more than 6000 cases and 1500 deaths. This led to a major decision to introduce vaccines in high endemic areas. As per National Vector Borne Disease Control Programme (NVBDCP), 26,686 cases of encephalitis were reported between 2010 and August 2017. Of this, 24,668 cases were of AES and 2,018 of JE. Out of those 4,093 died due to AES and 308 JE deaths were registered in the state. Talking to Express Healthcare, a senior MoHFW official pleading anonymity said, “So many cannot die of encephalitis in two days, the cause of death can be different.” Meanwhile, a public interest litigation (PIL) has been filed in the Allahabad High Court seeking a judicial inquiry into the BRD Hospital deaths. PIL has blamed the carelessness of the doctors at the hospital, questions the lack of effective measures to contain the outbreak of the vector-borne disease despite encephalitis claiming many young lives every year.

Reference:

The encephalitis angle

CAG report http://www.cag.gov.in/sites/default/files/audit_report_files/Re port_No_2_of_2017_General_an d_Social_Sector_Government_o f_Uttar_Pradesh_0.pdf

Meanwhile the state government has informed that the

prathiba.raju@expressindia.com

EXPRESS HEALTHCARE

September 2017

RADIOLOGY NEWS

Carestream wins award for reducing energy consumption at its Colorado manufacturing facility Windsor plant trimmed energy use by 5.4 per cent in two years

arestream’s manufacturing plant in Windsor, Colo, earned a Colorado Industrial Energy Efficiency award from the Colorado Energy Office. In the past two years, Carestream Colorado has reduced energy consumption by 5.4 per cent at its Windsor manufacturing facility. The company’s goal is to achieve an additional 5 per cent reduction in energy use from 2015 to 2020. Carestream joined the Colorado Industrial Energy Challenge (CIEC) in 2011 and has reduced energy consumption by 21 per cent during the last five years. “We continuously examine our manufacturing processes and product components to identify areas where we can help preserve the environment,” said Cavan Kelsey, Carestream’s Corporate Environmental Health and Safety & Sustainability Director. “Our aim is to reduce energy use by

increasing the efficiency of our operations even when we are adding additional equipment to achieve production goals.” The Colorado plant achieved energy savings of 5119 megawatt hours over two years with several major renovation efforts: ◗ Plant engineers rebuilt a 40-year-old steam turbine chiller that significantly reduces electricity consumption; and ◗ Variable frequency drives were installed on four cooling tower fan motors, eight cooling tower supply pumps and three chilled water pumps to allow each system to use only the precise amount of energy required to obtain the desired flow of water for manufacturing operations. Carestream Colorado maintains an ongoing list of projects designed to enhance production and reduce energy use. The facility has invested in training a certified energy

manager (CEM) to more effectively analyse and prioritise opportunities for energy savings. In addition, Carestream recycles a variety of materials and works to control haz-

ardous waste from product manufacturing and maintenance activities. Carestream is updating its Environmental Management System to meet the new ISO 14001:2015 standard. The lat-

est standard includes goals for sustainable resource use and climate change mitigation, as well as the incorporation of lifecycle thinking into product design. EH News Bureau

International Isotopes obtains additional radiological field service contracts The contracts are both with the US Department of Energy and the International Atomic Energy Agency for work within the US and in South America INTERNATIONAL ISOTOPES has obtained several significant contracts for radiological field services that are to be completed during the remainder of 2017. The company reports these contracts are both with the US Department of Energy (DOE) and the International Atomic Energy

EXPRESS HEALTHCARE

September 2017

Agency (IAEA) for work within the US and in South America. All contract work will involve performing source removals from inactive radiation therapy devices and shipping these devices to secure locations for storage and disposal. Steve T Laflin, President and CEO, International Iso-

topes, said, “The company has been continuing to build upon our radiological field service experience and equipment capability for performing these types of activities for several years. The company has continued to build a reputation for safe, cost-effective, on-time completion of these services,

and these recent contract awards are a further recognition of that capability. We have an outstanding group of technicians and engineers that have a real talent for performing these types of activities and the company’s development of a mobile hot cell offers us a real competitive advantage. We an-

ticipate the new contract work is likely to be completed in 2017, which should result in approximately a 120 per cent increase in the radiological services segment revenue for the year end 2017 compared to the same period in 2016.” EH News Bureau

RADIOLOGY

Cytecare introduces 3-D imaging technology for breast cancer screening 3D mammography is a special kind of mammogram that uses several low dose X-rays obtained at different angles to create multiple images or sequential slices CYTECARE HOSPITAL has introduced Digital Breast Tomosynthesis, popularly known as 3D-Mammography, for women. 3D mammography is a special kind of mammogram that uses several low dose x-rays obtained at different angles to create multiple images or ‘sequential slices’ that step through the breast tissue and allows radiologists to see more clearly. The breast is positioned and compressed in the same way as for a 2D mammogram

but the X-ray tube moves in a circular arc around the breast. It takes less than 10 seconds for the scan. The X-ray information is sent to a computer, which produces a focussed 3-D digital image of the breast. Talking about Digital Breast Tomosynthesis, Dr Mukta Mahajan, Consultant Radiologist, Breast Imaging and Intervention said, “The most important aspect as a breast radiologist at Cytecare Hospital is to spread awareness about personal risk-

based screening and extent evaluation of breast cancer prior to planning treatment.” 3D mammography has shown to reduce percentage of missed cancers by 15 per cent. More recent studies show about 30 per cent increased 3D mammography sensitivity and specificity compared to 2D Mammography with a recalls reduction in screening by approximately 40 per cent EH News Bureau

Global dental diagnostics and surgical equipment market to growby$10 bn by2022 Cases of dental diseases and increasing demand for minimal persistent painless surgeries are the main reason the growth of the dental equipment market GLOBAL DENTAL diagnostics and surgical equipment market are estimated to be more than $10 billion by 2022. Dental diagnostic and surgical equipment consist of equipment which is used for diagnosis and treatment of dental infection and other oral diseases. The cases of dental diseases and increasing demand for minimal persistent painless surgeries are the main reason the growth of the dental equipment market. Fast aging population and increasing demand for cosmetic dentistry are the other factors anticipated to fuel the rise of this market. People over the age of 65 years undergo dental treatment such as implants and periodontal surgeries more often than those who are younger age, as a result of which speedy aging population directly

widening the dental patient pool are the main drivers of this market. For the year 2017, dental radiology equipment is the leader in global dental diagnostics and surgical equipment market share. This market research report also covers the market of CAD/CAM system, dental lasers, dental chairs, dental curing lights, dental handpieces, dental scaling units and instruments delivery system. CAD/CAM system consists of stand- alone scanners, full in-lab system and chair side systems. Dental laser discards the need to use surgical instruments, such as hand pieces, dental drills, as well as dental anesthetics. The laser ensures less bleeding at the site of surgery, less trauma, and overall comfort to the patient. Dental

Fast aging population and increasing demand for cosmetic dentistry are the other factors anticipated to fuel the rise of this market radiology equipment helps dentists in treatments with clearly scanned dental images. The technique is used to iden-

tify hidden structures, wisdom teeth, bone loss, cavities, and malignant or benign masses which are not easily detectable. North America dominates the market share of dental diagnostics and surgical equipment followed by the European nation. The reason behind North America is dominating the market because of aging population which can afford the costlier dental treatment and by the presence of market leaders who allow easy penetration into the market. Europe dental diagnostics and equipment market follows the North America market trends because of various promotions and accounts of oral health care facilities by the Government of Europe. Asia-Pacific nations are estimated to witness the fastest growth rate in

the future because of rising population and increasing awareness about the dental and oral health hygiene. However, growth of this market might be restrained because of the lack of proper reimbursement policies in the developed nations. The key players in this industry are Dentsply Sirona, Danaher Corporation, Straumann, Henry Schein and Patterson was the main share holders of the dental equipment market. The company's main focus is on the development of new products, partnerships and acquisitions to maintain their positions in the market. The other players in this industry are Planmeca OY, Zimmer Holdings, Ivoclar Vivadent and Biolase. EH News Bureau

EXPRESS HEALTHCARE

September 2017

RADIOLOGY

Zebra Medical Vision in partnership with TeleradTech Zebra’s cloud-based deep learning analytics engine will be used in over 20 countries and 150 hospitals and healthcare organisations ZEBRA MEDICAL Vision and Telerad Tech, the technology arm of India’s first and largest teleradiology company – Teleradiology Solutions (TRS) corporation, have signed a partnership to bring Zebra’s cloud-based deep learning analytics engine to over 20 countries and 150 hospitals and healthcare organisations. Zebra Medical Vision has been a pioneer in the development and commercialisation of deep learning imaging analytics solutions, and since 2015 has released clinical applications that automatically identify liver,

EXPRESS HEALTHCARE

September 2017

Zebra Medical Vision has been a pioneer in the development and commercialisation of deep learning imaging analytics solutions, and since 2015 has released clinical applications that automatically identify liver, lung, bone and cardiovascular disease, as well as breast cancer and intra-cranial bleeding lung, bone and cardiovascular disease, as well as breast cancer and intra-cranial bleeding. The company’s solutions have been implemented in hospitals across Europe and the US, and

the collaboration with Telerad Tech will allow expansion of the company’s footprint to India, broader Asia and Africa. “Our company is proud to serve healthcare systems that

treat millions of patients in over 20 countries globally,” noted Dr Arjun Kalyanpur, Founder and CEO, Teleradiology Solutions and Telerad Tech. “Our em-

phasis and focus has always been on high quality radiology reporting and accessibility. Zebra’s ability to produce and deploy AI for radiology is the exact type of added value we hope to bring to help fulfil our vision of impacting patient diagnosis and medical care in India, Asia, and Africa.” “Zebra’s mission has always been to make radiology more accessible and affordable globally,” added Elad Benjamin, Cofounder and CEO, Zebra Medical Vision. EH News Bureau

BUSINESS AVENUES

EXPRESS HEALTHCARE

September 2017

BUSINESS AVENUES

September 2017

EXPRESS HEALTHCARE

BUSINESS AVENUES

EXPRESS HEALTHCARE

INDIAâ&#x20AC;&#x2122;S LARGEST MANUFACTURER OF INFUSION PUMPS

Nation wide Service Network

For Service:

AKAS Call 098840-79116 support@akasmedical.com

CARDIOTHORACIC Drug Delivery

Weightless, carrying 4 pumps, mobility is comfortable.

DELIVERY LINE DISCONNECTED Safety alarms are generated when drug delivery line is accidentally disconnected from patient.

240/1, Periya Colony, Athipet, Ambattur, Chennai 600 058. Tamilnadu, India. Ph:+91 44 3253 3333 sales@akasmedical.com

SMALL & COMPACT Small & Compact, occupies less space near the patient even when 5pumps are stacked. Allows easy access for medical & paramedical staff.

HIGH FLOW RATES

PCA FUNCTION

High flow rate of 1500ml/hr can quickly deliver in an emergency.

PORTING MULTIPLE PUMPS

DOSAGE RAMP UP & TAPPER DOWN

Easily port 4 pumps on a carrying stand. Enhances patient mobility.

5 Sequential programs for Dosage Ramp up & Taper down funtion

PCA Handset (Optional Accessory)

DRUG LIBRARY Drug library function with mg/kg/hr, mg/kg/min, mcg/kg/min

Mob: +91 98403 79116

Infusion, Syringe Pumps Patient Monitors, Oxygen Concentrator, 1/2/3 Para Monitors

Available Across 29 States and 7 UT's

LCD Vision Chart, A-Scan, B-Scan

Ophthalmology Division Clinical Division

RX/AI/20/2017/XPH

1.5KG WEIGHT

Quick Vital Sign, Infusion Controller

EXPRESS HEALTHCARE

September 2017

BUSINESS AVENUES

September 2017

EXPRESS HEALTHCARE

BUSINESS AVENUES

EXPRESS HEALTHCARE

Health care is not a privilege... It's a Human right. Now, get all healthcare products at a highly affordable price

Air Mattress

Nebulizer

Pulse Oximeter

Digital Thermometer

Skin Stapler

Skin Graft Blade

Infusion/ Syringe Pump

Oxygen Concentrator

JMS Infusion Set

JMS Scalp vein Set

JMS burette set

JMS Meditape

Our Brands

FEATHER

Available at all leading online marketplace

Hemant Surgical Industries Ltd. +91 - 96194 84952 +91 - 96194 84153 EXPRESS HEALTHCARE

f in

September 2017

BUSINESS AVENUES

September 2017

EXPRESS HEALTHCARE

BUSINESS AVENUES

EXPRESS HEALTHCARE

The Greatest Wealth is... Health

Healthcare Services at your Home...! It feels good to hear someone say Respiratory care at Home

“Take care” But it feels

Dialysis care at Home

so much better to hear someone say

“I will take care of you” Medical Consultation at Home

- Hemant Surgical team

I.C.U Facility at Home

Healthcare Equipment on Sale & Rent

Hemant Surgical Industries Ltd. +91 - 96194 84952 +91 - 96194 84153 EXPRESS HEALTHCARE

f in

September 2017

BUSINESS AVENUES

September 2017

EXPRESS HEALTHCARE

BUSINESS AVENUES

EXPRESS HEALTHCARE



Quantitative results within 3 -15 minutes



Single chip calibration, no need to plot curve



Compact and portable



Very convenient sampling



Universal sampling options (Whole blood/serum/plasma)



Low maintenance

DiaSys Diagnostics India Pvt. Ltd. Plot No. A -821, TTC, MIDC, Mahape, Navi-Mumbai - 400 710. Maharashtra, INDIA. Toll Free number : 1800 120 1447 | Email ID : info@diasys.in | www.diasys.in

EXPRESS HEALTHCARE

September 2017

BUSINESS AVENUES

OXYTEC-PRO

EXPRESS HEALTHCARE

OXYGEN CONCENTRATOR Feature: Compact Light weight 16kg Low power- average 330 watts Quiet Operation Stainless Steel outlet Extensive Ventilation Can be used without air conditioning. 0-5 lpm upto 95% pure oxygen Valve and Motor American make Sieve from France Useful: To Strengthen your heart, reducing the risk of heart attacks

To Detoxify your Blood, Raise Energy Levels To Improve Strength & Build Endurance To Revitalize the skin To Prevent disease, relieve hangovers To Help fight off depression

An ISO 9001: 2008 Certified Company

Nulife Global Medical Devices Pvt. Ltd. Corporate Off.: B6, Byculla Service Ind., D. K. Marg, Byculla (E), Mumbai-27. INDIA Tel.: 91-22-66578989 E mail : info@nutecmedical.com website: www.nutecmedical.com 50

September 2017

REGISTERED FIRM

EXPRESS HEALTHCARE

BUSINESS AVENUES

AVITEX® TURBO Serum Proteins

EXPRESS HEALTHCARE

When it’s time to diagnose beyond.....

AVITEX® TURBO RF

AVITEX® TURBO ASO

End Point Assay with 2 minute incubation

Two Point Assay with 2 minute incubation

Sensitivity 6 IU/ml & Linearity upto 160 IU/ml

Sensitivity 20 IU/m/l & Linearity upto 800 IU/ml

No prozone effect upto 800 IU/ml

No prozone effect upto 3000 IU/ml

Calibrator included

AVITEX® TURBO CRP

Calibrator included

AVITEX® TURBO MICROALBUMIN

Two Point Assay with 2 minute incubation

Sensitivity 2mg/l & Linearity upto 150 mg/l

Sensitivity 2 mg/l & Linearity upto 150 mg/l

No prozone effect upto 800 mg/l

No prozone effect upto 1000 mg/l

Calibrator included

AVITEX® TURBO CYSTATIN- C

EXPRESS HEALTHCARE

Two Step Assay

Sensitivity 0.1mg/l & Linearity upto 10 mg/l

No prozone effect upto 60 mg/l

5x2 ml calibrator set separately available

September 2017

BUSINESS AVENUES

EXPRESS HEALTHCARE

Enzymatic Cleaner

l l l

Enzyme Detergent (Multi Enzyme Concentrated and Super Concentrated) Glass & Stainless Steel Cleaner Concentrated Rust & Stain Remover Concentrated No Rinse Floor Cleaner Concentrated Oil & Grease Cleaner Concentrated

Instrument Marking Tape

Identification of Insrument for Various Department l

Intended to Help Identify Surgical Instruments Through Processing and Use

Tape is Flexible

Adheres Strongly to Instruments

Non-sterile

Not Made with Natural Rubber Latex

June Enterprises Pvt. Ltd. l +91 9323021231 l +91 9930359528 www.june4gmp.com l info@june4gmp.com

Advertise in

Business Avenues Please Contact: ■ Mumbai: Douglas Menezes 91-9821580403 ■ Ahmedabad: Nirav Mistry 91-9586424033 ■ Delhi: Ambuj Kumar / Gaurav Sobti 91-9999070900 / 91-9810843239 ■ Chennai/Bangalore: Mathen Mathew 91-9840826366 ■ Hyderabad: E.Mujahid 91-9849039936 ■ Kolkata: Ajanta 91-9831182580 52

September 2017

EXPRESS HEALTHCARE

BUSINESS AVENUES

EXPRESS HEALTHCARE

® ...future of medical supplies

50 K+ Products Catalogue & Continuing...

50 K + Quotation Generated & continuing..

Extensive Reach in Tier II & Tier III Cities

for Medical & Dental Supplies this Festive Season Limited Period Oﬀer Get 10% oﬀ * on purchases Use Coupon Code

MEDFEST10

►Disposables

300+ Brands from Across the World

Q Participation in 100+ Medical & Doctors’ Symposiums +

Associated with world class Logistics Companies

TOLL FREE : 1800 123 0201 E-mail : info@medikabazaar.com Web : www.medikabazaar.com

►Consumables

500+ Manufacturer/ Suppliers Domestic & International

►Devices

STOCK

560 K ++ Units Delivered and counting....

Engaged with Hyperlocal Delivery companies India Post

Covering more than 16000 Pin Codes all over INDIA

►Equipment

BONANZA OFFER

B2B Medical Procurement Platform for Hospitals Clinics, Medical Professionals & Individuals

*T&C

OUR OFFICES

MUMBAI I AHMEDABAD I DELHI I KOLKATA I HYDERABAD I CHENNAI* I BENGALURU* *Upcoming Ofﬁces

EXPRESS HEALTHCARE

September 2017

BUSINESS AVENUES

EXPRESS HEALTHCARE

Blood Bank Equipments

Blood / IV Fluid Warmer

Plasmatherm Blood Donor Chair

Blood Collection Monitor

Blood Bank Centrifuge

Biological Refrigerator

Platelet Incubator with Agitator

Benchtop Sealer

Centrifuge Bucket Equalizer

Blood Bank Refrigerator

Biological Deep Freezer

REMI SALES & ENGINEERING LTD.

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

Advertise in

September 2017

EXPRESS HEALTHCARE

BUSINESS AVENUES

EXPRESS HEALTHCARE

September 2017

BUSINESS AVENUES

September 2017

EXPRESS HEALTHCARE

BUSINESS AVENUES

EXPRESS HEALTHCARE

September 2017

TRADE AND TRENDS

Refurbished medical devices market Vivek Tiwari, Founder and CEO, Medikabazaar gives an insight on the growth prospects of medical devices market in the coming years REFURBISHMENT SUGGESTS restoring of the equipment or device to a reusable condition without changing the basic specifications of the device. The process of refurbishing medical devices ensures the safety and efficacy of the device so that the performance of the device is not altered. Refurbishment therefore replaces the endto-end manufacturing process. According to the many researches conducted, the refurbished medical devices market is expected to show tremendous growth in the upcoming years. Due to budget constraints, medical institutions in the developing and under developed nations are trying to reduce their capital investments and spending on medical devices and related equipment. Along with the rapid growth and advancements in medical technology, new inven-

tions are being introduced into the market constantly. The concept for affordable buying is therefore developing strong roots accelerating growth of the refurbished medical devices market. Growing industrialisation in the healthcare sector, poor medical facilities for various medical treatments, huge population to be served, growing number of hospitals and clinics with budget constraints especially in the developing countries altogether have created enormous growth opportunities for this market. The increasing need to adopt more eco-friendly practices is one added advantage to the spurring growth of this market in the coming days. The increase in adoption of refurbished medical devices contributes to the industry, by reducing the burden of disposing wastage, thereby

VIVEK TIWARI, Founder and CEO, Medikabazaar

decreasing pollution. It is both an economical as well as environment-friendly option. Many manufacturers and vendors are implementing this concept by introducing the process of re-manufacturing and commercialising used medical devices. Apart from this, selling out surplus devices to medical institutions or exporting them to other developing or under developed coun-

tries also generates extra revenue for manufacturers. Considering the existence of many large, medium, and small companies in the healthcare market, the global refurbished medical devices market is largely divided into fragments. The refurbished market is dominated by diagnostic imaging equipment segment accounting for over 75 per cent of the total market share. Furthermore, demand for improved and easily accessible treatment for cancer and cardiovascular diseases is increasing for patient safety, thus increasing the growth opportunities. Geographically, the North American market account to approximately 50 per cent of the total market and, is the largest regional market for refurbished medical supplies. Whereas, The Asia Pacific, is expected to be the

highest growth market due to the developing healthcare infrastructure of the countries. Leading healthcare market players are coming forward and taking initiatives to create refurbishment facilities in developed as well as developing markets, further adding to the growth prospects of refurbished medical devices market. Developing markets including India offer a high growth potential for organisations engaged in manufacture and distribution of refurbished medical devices. Initiatives undertaken by leading market players, constant increase in patient population, and rising participation among original manufacturers and third-party refurbishers are the key reasons boosting the growth of refurbished medical equipment market in emerging markets.

PoCT market: On the right track Harshad Bhanushali, Product Manager- Instruments, DiaSys Diagnostic India, gives an insight on the PoCT market in India which is going to witness a phenomenal growth THE POINT-OF-CARE testing (PoCT) market has steadily increased over the last 40 years since its widespread introduction. This growth is likely to continue by the virtue of changes in healthcare delivery which are aimed at delivering less costly care closer to the patientâ&#x20AC;&#x2122;s home. PoCT testing is generally performed by technology, first devised more than two decades ago. These have undoubtedly been refined and improved to deliver easy-to-use devices with incremental improvements in analytical performance. PoCT devices can be divided into two categories. The first is small handheld devices, providing qualitative or quantitative determination of an increasing range of analytes. These use biosensor strips and

EXPRESS HEALTHCARE

September 2017

lateral flow strips with immobilised antibodies that bind to the analyte detected by reflectance or fluorescence spectrophotometry. The second category of devices are larger bench-top devices, essentially the laboratory instruments, reduced in both size and complexity. These include critical care analysers and more recently, small haematology and immunology analysers. New emerging PoCT devices include those that utilise molecular techniques such as PCR to provide infectious disease testing in a sufficiently small device. This area is likely to grow with many devices being developed and reaching the commercial market in the next few years. Data on the growth of molec-

HARSHAD BHANUSHALI, Product Manager- Instruments, DiaSys Diagnostic India

ular testing market in PoCT is interesting in the context of increase in infectious disease testing. The total molecular diagnostics market is believed to be worth $4 billion in 2011 and will grow to $7 billion by 2016 with a compound annual growth rate

by more than 18 per cent. With the emergence of new devices to perform molecular testing at the point of care and the well-documented needs for more infectious disease testing in the developing world, it will be interesting to see the growth that takes place in PoCT. Yet, there are areas where new technologies are needed in order to deliver the required analytical performance. PoCT devices that use PCR to detect a number of different pathogens are just starting to appear and in the next few years, we are likely to see a number of these reach commercialisation and be used in healthcare markets. Given that, the analytical performance of these devices is well proven. The remaining challenge will be to see if they can be

produced at a price which will enable them to have an impact on dealing with infectious disease in developing countries. QDx Instacheck, marketed by DiaSys Diagnostics India is a table top PoCT device based on sandwich immune-detection method used for analysis of various analytes such as hormones, Sepsis (PCT), C-RP, Micro albumin, Cancer markers and Cardiac markers. Quantitative results in 3-15 minutes, convenient to use, minimum training, very low maintenance and using universal sampling (WB/Plasma/ Serum) are some of the attributes that make QDX Instacheck a powerful and superior PoCT analyser. Contact details: Website: www.diasys.in

TRADE AND TRENDS

Breast cancer: Early diagnosis is everything Ing Juergen Heckel, VP, Medical Business Sales and Marketing, EIZO Corporation, elaborates on how breast cancer can be cured with quality medical grade monitors BREAST CANCER is the leading cancer in women worldwide. In 2012, 1.7 million people were newly diagnosed with breast cancer. The earlier a breast cancer can be detected and treated, the higher the chance of the patient surviving and receiving benefit from medical treatments. The World Health Organization states that in countries with advanced medical care, the five-year survival rate of early stage breast cancers is 80 – 90 per cent, however, for cancer diagnosed at advanced stages, the survival rate drops to 24 per cent. Because of this, ontime breast screening is the most common and effective way to diagnose breast cancer in many countries. A lot of education and information is required for women to reduce the fear of breast screening for their own benefit. Breast screening is a series of procedures that run a mammography scan of the patient. The screening procedure takes a few seconds and is meant to detect the existence of breast cancer. If a cancer is found, more thorough testing is required to determine the characteristics of such cancer. However, detecting some breast cancers early enough is a challenge that we have to overcome. Sometimes a screening cannot show all the needed information so other modalities need to be used to go into the depth of the breast tissue. Breast tissue can be divided into four types: mostly fatty, scattered density, consistent density and extremely dense. Mammograms discern between these four types of breast tissue through varying shades of grey; fattier material being dark and dense material being bright. Cancers are able to show up as varying shades of grey; small bright and dark dots or small abnormal breast shapes that only trained eyes can recognise

ING JUERGEN HECKEL VP, Medical Business Sales and Marketing, EIZO Corporation

as risky. However, sometimes such cancerous spots can blend in with the surrounding breast tissue. This makes it very difficult for doctors to distinguish cancers from breast tissue. In fact approximately one in five existing breast cancers are not discovered in screening. Such a case is called a false-negative diagnosis. Nonetheless there are ways to minimise the likelihood of a false-negative diagnosis. One of these is to invest in a high-quality medical-grade monitor with specifications designed for mammography. Printed scans and commercial monitors cannot be compared to the reliability and accuracy of medical grade monitors. Only medical grade monitors are able to display DICOM defined greyscale changes. Using DICOM GSDF (DICOM Part 14) means that doctors are able to see breast cancers that may be invisible on printed scans or commercial monitors which only display in greyscales that are not appropriate for diagnosis. The human eye (HVS) distinguishes grey levels in various steps (called JND = Just Noticeable Difference) and the importance in linear grey levels is herewith underlined. Medical grade monitors certified with FDA 510(k) clearance for mammography are a minimum requirement to follow. Without a medical-grade monitor, cancers

may not be diagnosed early enough, leading to delayed treatments and lowering the survival rates for patients. The most important feature that a medical grade monitor to be used for mammograms requires is a perceptually linear greyscale according to DICOM GSDF (DICOM Part 14) that can be calibrated to remain stable over the usage time. Further, it allows doctors to consult patient cases independent from their location as both will see the same information displayed. A perceptually linear greyscale allows one to see even minimal changes in the shades of breast tissue, allowing doctors to see tiny details more accurately. In breast screening, the process goes fast and doctors have limited time analysing scans, so any difference in greyscale needs to be recognised as fast as possible. Medical grade monitors following DICOM GSDF (DICOM Part 14) standards are proven to have a linear greyscale already precalibrated at the factory. But as mentioned above, according to the ambient light conditions in the reading room, the medical grade monitor may require an adjustment and re-calibration

before the first usage. This is called Acceptance Testing. After such an Acceptance Test the medical grade monitor requires a periodical test method that includes luminance, greyscale and uniformity control to maintain optimal conditions. This is so called Constancy Testing. In addition to an appropriate greyscale, a maximum brightness above 350cd/m2and a contrast ratio above 1000:1 are also required. The human eye (HVS) is better at distinguishing changes in contrast with increased luminance, therefore by increasing the overall brightness of the monitor such differences in shading can be more easily noticed – even in dark areas. The American College of Radiology (ACR) recommends diagnostic monitors to have luminance levels of 350cd/m2 for general diagnostic purpose and 420cd/m² for digital mammography. Another best way to ensure you’re viewing images as best as possible is through controlling the reading room environment. Human eyes (HVS) are sensitive to contrast changes, so it’s important to have an

ideal environment where the doctor can see details on the screen without being affected by their surroundings. Furthermore, fatigue and eye strain increase with brighter ambient lighting, making interpretations less accurate and dark areas may be too bright. The ACR suggests that ambient light has to be low and consistent, and equal to the average luminance of a clinical image being displayed (generally from 20 to 45lx). Global regulations like EN (European Standard) and ISO (International Standard) recommend an ambient environment have no more than 50lx for mammography and general diagnostic usage with 100lx as the maximum allowed. Furthermore glare and reflections have to be minimised using medical grade monitors. This can be achieved by special antiglare coatings mounted on the medical grade monitor. Another point to consider when purchasing a monitor for breast cancer diagnosis is whether to buy a colour or monochrome monitor. 2D mammograms and 3D rendered breast images are the

EXPRESS HEALTHCARE

September 2017

TRADE AND TRENDS most common breast cancerdetecting methods, and are inherently monochrome. However, other breast cancer-detecting tests, like ultrasound, MRI and pathology use colour to highlight artefacts. Doctors frequently use these tests in conjunction with each other in order to understand as much as possible about each patient’s case. These images can either be displayed separately on both a monochrome and colour monitor, however, many doctors find this expensive and not efficient as they lose information with such fragmented viewing. The most preferred option is to use colour medical grade

2D mammograms and 3D rendered breast images are the most common breast cancerdetecting methods, and are inherently monochrome. However, other breast cancerdetecting tests, like ultrasound, MRI and pathology use colour to highlight artefacts monitors, which allow both image types to be shown at the same time. Currently some

medical grade monitor technologies are available to switch between DICOM

Greyscale images and coloured Gamma 2.2 values to show both accurately. This supports an efficient and best workflow for the radiologist. Breast cancer is one of the most prevalent and difficult to treat cancers in the world, and early diagnosis is essential for patient survival. To ensure early detection, several factors need to be considered: a combination of well-educated doctors, the correctly adjusted ambient environment, recent technology and a medical grade monitor with the recommended technical parameters. It is mandatory to have a Quality Control (QC) solution in place to be sure that the de-

vices will maintain quality constantly and accurately. This is the best way to ensure breast cancer patients are receiving the best possible chance of survival. Only by following all these important aspects are doctors able to find cancers early. References 1. World Cancer Research Fund International (WCRF) 2. American Cancer Society; www.carcer.org 3.American College of Radiation 4. World Health Organization 5. DICOM Part 14 GSDF http://dicom.nema.org/dicom/2004/04_14pu.pdf

vTitan Corporation aims to develop next generation, safer healthcare products Peri Kasthuri, Co-founder and CEO, vTitan Corporation, improves operational efficiencies with multiple strategies vTitan Corporation has been founded by professionals with international experience in medical and advanced technologies. The company having its offices in California, Tamil Nadu and Karnataka, is engaged in the development, manufacture, distribution and sales of a broad range of medical devices and consumables used in global healthcare markets. The company's focus is to develop next generation, safer healthcare products. They do end-toend R&D, design, development, manufacture and marketing of medical devices/equipment for global market. vTitan has an innovation centric team of technologists and engineers. Currently, they are manufacturing Accuflow SP-550 and IBP-550 Syringe Infusion Pumps. Peri Kasthuri, Co-founder and CEO, vTitan Corporation,

EXPRESS HEALTHCARE

September 2017

who holds a Master's degree in Mechanical Engineering and an MBA from the US, has 20 + years of experience in general management, global operations, product marketing and design and development of systems. He has also successfully improved operational efficiencies with multiple strategies including Asia-centric sourcing and development. He has marketed advanced wafer equipment in existing markets and penetrated new markets and designed and developed hydraulic systems for fighter aircraft and commercial airlines. He is a member of AAMI. Kasthuri said, “Medicall is a remarkable forum for all the manufacturers to present their product and technology to end users. People who visit Medicall are very knowledgeable, they understand and appreciate the

PERI KASTHURI, Co-founder and CEO, vTitan Corporation

advancements in technology. This year vTitan's Syringe Infusion Pumps Accuflow SP-550 and IBP-550 won the Gold Medicall Innovation Award in ‘Medical Devices other than POC & Wearables’ category.” Kasthuri further said, “We have been in Medicall for the past two years and it has been a great experience for us. We feel honoured to receive the Innovation award and delighted that the advancements in technology are recognised and appreciated.” Contact details DLF IT Park, Block IC, 1/124 Shivaji Gardens, Mount-Poonamallee Road, Nandambakkam PO, Ramapuram, Chennai-600089 Ph: +91 44 4211 6411 / +91 44 4211 6422

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

Hospital Information System

Electronic Medical Records

Solution for Diagnostic Centers

Pharmacy Information System

The

Complete IT Solution for Healthcare Industry Miracle healthcare solutions provides you the most advanced and powerful solution that makes the working of your Healthcare institutions seamless. This gives you the power of automation which enhances the operational eﬃciency, Patient satisfaction and serves you the benefits in diverse ways.

Akhil Systems Pvt. Ltd. your healthcare IT Partner

205-206, Vardhman Times Plaza, Plot No. 13, Road No. 44, Pitampura, Commercial Complex, New Delhi-110034. Website: www.akhilsystems.com

Mail: contact@akhilsystems.com

Contact: +9111-42644111, +91 9968464439