Express Healthcare (Vol.11, No.12) December, 2017 by Indian Express

CONTENTS Vol 11. No 12, December 2017

ARE YOU AFRAID OFTHE DARKWEB?

Chairman of the Board Viveck Goenka 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 Delhi Prathiba Raju Design National Design Editor Bivash Barua Asst. Art Director Pravin Temble Chief Designer Prasad Tate Senior Designer Rekha Bisht

Digital technologies such as cloud-computing,block-chain and big data are changing the way government and industry use medical information in India.This calls for an urgent need to invest intensively in cyber security.Without data security and privacy laws,medical records in India are highly vulnerable | P-26

START UP CORNER STRATEGY

MARKET

Graphics Designer Gauri Deorukhkar Artists Rakesh Sharma

OPINION

IS IT TOO EARLY TO TALK OF GLOBAL HEALTH?

IT’S A TWO-WAY STREET

Photo Editor Sandeep Patil MARKETING Regional Heads Prabhas Jha - North Harit Mohanty - West Kailash Purohit – South Debnarayan Dutta - East Marketing Team Ajanta Sengupta, Ambuj Kumar, Douglas Menezes, E.Mujahid, Nirav Mistry, Rajesh Bhatkal, Sunil Kumar PRODUCTION General Manager BR Tipnis

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‘WE HAVE A MULTIFOLD FOCUS AND CATER TO DIFFERENT CATEGORIES THROUGH OUR CHANNEL PARTNERS’ NURTURING EFFECTIVE PPPS CLAIRVOYANCE 2017 HELD IN MUMBAI

‘MAKING MISTAKES EQUIPS THE ORGANISATION WITH A MINDSET AND AN EXPERIENCE TOOLBOX THAT CAN BE REUSED ANYTIME’

SPECIAL FEATURE

INNOVATIONS THAT WILL MATTER IN 2018

THE INDIAN DIAGNOSTICS SECTOR IS COMING OF AGE

TOYOTA WAY OF RISK ASSESSMENT FOR SAFE HOSPITALS

Manager Bhadresh Valia Scheduling & Coordination Santosh Lokare

‘WE STRIVE TO CHANGE THE WAY MEDICAL TREATMENT IS PRACTISED ACROSS THE WORLD’

KNOWLEDGE

A RAY OF HOPE FOR SILENT HEART ATTACKS

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,

CIRCULATION Circulation Team Mohan Varadkar

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.

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LETTERS Apart from promoting organ donation it is also important to improve the infrastructure and capacity of government hospitals to undertake transplantation so that the poor and needy could benefit Anupriya Patel Minister of State for Health, during the inauguration of National Biomaterial Centre (National Tissue Bank) at the National Organ and Tissue Transplant Organization

There is a need for public education programme on nutrition and training of frontline healthcare workers regarding the management of hypertension

NOVEMBER 2017

Dr Soumya Swaminathan Secretary, DHR and DG, ICMR, at the launch of India Hypertension Management Initiative in New Delhi

India is deeply committed nationally and globally to achieve all public health goals and also focussing on developing India as a hub for affordable medical devices JP Nadda Union Minister of Health and Family Welfare at the inauguration of ‘1st World Conference on Access to Medical Products and International Laws for Trade and Health in the Context of the 2030 Agenda for Sustainable Development’in New Delhi

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 Sunil Kumar The Indian Express (P) Ltd. Business Publication Division Express Building, B-1/B Sector 10 Noida 201 301 Dist.Gautam Budh nagar (U.P.) India. Board line: 0120-6651500. Mobile: 91-9810718050

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Fax: 0120-4367933 Email id: sunilkumar@expressindia.com CHENNAI Kailash Purohit 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 9552537922 Email id: kailash.purohit@expressindia.com BENGALURU Kailash Purohit 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 9552537922 Email id: kailash.purohit@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 Indian Express (P) Ltd.

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EDITOR’S NOTE

Introspect, self regulate or face the music ... again

s Ahmedabad’s Shalby Hospitals prepares for its IPO on December 5, the trend of healthcare entrepreneurs tapping capital markets continues. The rationale seems obvious. The cost of services in the private healthcare segment is pretty high, particularly since most of it is out-of-pocket. But there are no quick gains on healthcare stocks. For instance, an Equirus Capital report of October shows that the BSE Healthcare Index recorded a one-year return of 13 per cent, way below the S&P BSE Sensex (19 per cent) and the Nifty (marginally higher at 20 per cent). The stock prices of major hospital groups registered sizable negative percentage returns over the past year: Fortis group (19 per cent), Narayana Health (11 per cent) and Apollo Hospitals (22 per cent). In the diagnostics sector, Dr Lal Path Labs registered a negative stock return of 34 per cent over the same period. But with an eye on the future, investments continue. For example, the Apollo Hospitals group plans to add 765 beds at a total estimated project cost of ` 11,900 million over FY18-22. Thus across the sector, growth will be slow and balance sheets stressed. But given the lack of choice and the demand-supply gap, healthcare enterprises will be a steady long-term bet, provided they work on the trust deficit with their primary customers: their patients. The tragic death of seven-year-old Aadya Singh in Gurugram’s Fortis Memorial Research Institute (FMRI) has revived public outrage against private healthcare institutions. The case, where the father was presented with a bill of almost ` 16 lakhs for the treatment of his daughter over a fortnight, seemed to cement the perception that private hospitals are profiteering from patients. Social media exploded with unverified calculations of the FMRI bill to show that doctors’ fees were a fraction, while the government got the lion’s share, thanks to GST and other taxes. Faced with mounting criticism on social media, the public health administration swung into action. Under instruction from the Union Health Ministry, the Haryana government ordered a probe into the matter. FMRI

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Aadya’s death and family’s decision to go public,even though it meant reliving their tragedytwo months after her death,will not be in vain if the introspection leads to true change in protocols and practice

responded by going public with a detailed statement defending all its decisions through Aadya’s treatment. Preeti Sudan, who was appointed Union Health Secretary just a month before, urged chief health secretaries of all states and union territories to get the Clinical Establishment Act 2010 adopted/ implemented. But the Act is no magic bullet. For example, the Karnataka government recently attempted to pass an amendment to the Karnataka Private Medical Establishments (Amendment) Bill, 2017 to rein in the cost of medical treatments and procedures. Doctors went on strike in protest, while private hospitals shut their OPDs for a day, to protest against certain clauses in the proposed amendment. The state legislature finally passed a watered down version, which had patient groups crying foul. Aadya’s death and family’s decision to go public, even though it meant reliving their tragedy two months after her death, will not be in vain if the introspection leads to true change in protocols and practice The good news is that there is some movement in this direction. For instance, in late November, IMA listed 20 suggestions ranging from asking the government to implement the ‘one price-one drug one company’ policy (so that cost of 80 per cent of medicine can be reduced) to elimination of standing orders for laboratory studies, electrocardiograms, and chest X-ray films. The release states that physicians must learn to order specific tests and not simply a battery of tests which includes the actual test desired. It is a sincere hope that health ministry officials ensure that such suggestions become part of standard protocol. The bad news is that public memory is short. Without self regulation, there will be more Aadya Singhs to further erode the trust. Patients in India may not have a choice but as the crackdown on medical device prices has proved, doesn’t it make better business sense to self regulate rather than face a backlash from policy makers under public pressure? VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

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MARKET I N T E R V I E W

‘We have a multi-fold focus and cater to different categories through our channel partners’ Chander Shekhar Sibal, Executive VP, Medical Division, Fujifilm, in an interaction with Prathiba Raju, shares his views on how Fujifilm is catering to the changes in the Indian medical devices market A leader in digital imaging solutions for healthcare, how Fujifilm caters to the changes in the Indian market for medical devices? What is the growth potential in the Indian market? In 2007-08, Fujifilm started its direct subsidiary business and dealership network and it has grown since then. We have acquired large base of customers be it hospitals, diagnostic centres, even in tier II and tier III cities. We have a broad bandwidth of customers. Our installation base was 3000 in 2007 and we have more 25,000 installations as of now. Fujifilm is a leader in sales of Computed Radiography (CR) and we are the largest consumers of CR worldwide and has overtaken the US, China and Japan. One fourth of the global production of CR is taken care by India and 50 per cent of market share for CR is within the country. With more than 75 years of imaging and clinical expertise in film and thousands of systems installed, Fujifilm is a leading provider of digital X-ray systems. We have a multi-fold focus and cater to different categories through our channel partners in tier II and tier III cities. How are PPPs working in digital imaging space? We have a separate team working on PPPs, as it is a specialised business and we have lot of documentation works and tendering process. We have supplied 92 CR machines to the Government of Andhra Pradesh. They were installed even in smaller areas. However, we are yet to receive the payments. The cost has also over run for this project.

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gap with technology like quality picture archiving and communication system (PACS) and Radio Information System (RIS)? Yes, definitely there is a shortage of radiologists. There are only 10,000 radiologists for one billion people. Fujifilm helps to bridge the gap via its advanced technology solutions by improving the efficiency of the system and the quality of reporting is enhanced. Fujifilm is HIPAA (Health Insurance Portability and Accountability Act) compliant of 1996. We take reports of tele-radiology network and digital signatures of doctors.

The major problem in PPPs is that the project timeline is not fixed, payments from the state governments don’t come on time. At times, it takes two to four years and the profitability is very less in such tenders. We have worked with the Government of Rajasthan and they are fine with the payments. As of now, we are working with the Governments of Kerala, Karnataka and Madhya Pradesh. Even

Government of Delhi has placed LOIs but they have not released the payments. Many state governments are digitising X-rays. Big private players like Max, Fortis, Apollo are upgrading from CR to DR gradually as there is a cost constraint in it. How important is it to bridge the shortage of radiologists in the country? How is Fujifilm trying to bridge this

What are the latest technological advancements made in this segment? In CR segment, the latest model is Prima version. It can do mammography and also do X-rays, at 50 micron resolution. It is compact table-top reader unit and has outstandingly high-speed processing. In terms of PACS, we have Synapse 5.0 where the speed is very high and the bandwidth requirement is 50 per cent less than the earlier version. The Synpase PACS solution is embedded with Oracle database and stability of the product is high. It has less service problem. Synapse 5.0 version will be available in the market by next year. Gives us the details on tie-up with KRSNAA Diagnostics for PPP model and Skanray, to develop local PAP solutions. How does these initiatives help? Our machines are present in most of the tier II and tier III cities, even the smaller villages

have our CR machines. We have tie ups with KRSNAA Diagnostics. They have acquired CR machines from us for their complete Assam project. They have digitised X-rays where it was connected through the tele-radiology system. A central teleradiology station is present where all the doctors sit and reports are sent back immediately. Similarly, we have tied up with Skanray for there analog machines and jointly made the mobile DR system. Fujifilm wants to tie up with such organisations to make indigenous and low cost products. We give solutions to the customer which is cost effective and it also increases our revenue and sales. What is the advantage of Fujifilm’s newest mammography solution Amulet Innovality. How will it help patients? Fujifilm’s Amulet Innovality uses advanced tomosynthesis technology which enables the conversion of digital breast images into a 3-D reconstruction of the breast, in contrast to the flat images produced by traditional 2-D digital mammography. The advanced tomosynthesis technology reveals the internal structure of the breast thus simplifying the detection of lesions that gets overlooked in a routine mammography. The latest 50 micron 3D mammography enables technician to obtain a clearer view of the breast tissue, facilitating identification of early stage breast cancer and reducing the need for additional tests and biopsies.

As for patients, the Fit Sweet (FS) compression paddle bends along the breasts, hence there is less pull on the chest wall. It results in no discomfort for the patient. Also, with three slits on the front side and right and left lateral sides of the paddle, the pressure is dispersed. With this new technology, we take care of doctorsâ&#x20AC;&#x2122; concerns in terms of resolution, operators â&#x20AC;&#x201C; in ease of use and for patients, it is the comfortability offered. We have done 20 installations in India and it is one of the best mammography solution. It facilitates early detection of cancer and the patient undergoes less radiation exposure even than a standard chest X-ray.

How do you see the move of the Union Health Ministry which has spent over ` 100 crore for maintenance of 4,560 medical devices? The

ministry informed that out of 756,000 equipment in 29,115 government medical institutions, 4,560 medical devices were not working.

Your comments. It is a right step by the central government. Even the state governments are focussed on the functions of the machines

they acquire. It is better to review the machines on a timely manner and use it rather keeping them aside. prathiba.raju@expressindia.com

How different and innovative is Fujifilm compared to other medical devices players in the market? Our focus is mainly on the service. We give best experience to our costumers and supply the consumables and machines on time. We have warehouses pan India and we deliver faster. Our team of service engineers, vast dealer network and service franchise network helps our service engineers to reach anywhere in India within four hours. We are increasing our manpower in India and train diploma holders and employ them in smaller places, so that faster service or application support can be given to the doctors and that is the need of the hour. How has Make in India initiative helped the medical devices segment? Definitely, it is is a very good initiative by the government. As for Fujifilm, we are tying up with Indian companies and share our technology like the softwares, detectors and combining with their X-ray system. We are not into direct manufacturing but we will tie up with the existing Indian companies. As many state governments like Andhra Pradesh are coming out with Andhra Pradesh Medtech Zone Limited (AMTZ), they are giving a lot of incentives. I think it is quite exciting but will take time to be implemented.

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MARKET

Nurturing effective PPPs Chhitiz Kumar,Head - Government Affairs,PPP,and Healthcare Transformation Services,Philips India, believes that healthcare challenges in India can be solved if right PPP interventions can be achieved Prathiba Raju New Delhi PHILIPS INDIA which goes with the tagline ‘Innovating meaningful healthcare’, is focussing on increasing PPP centres in Jharkhand and Haryana from 10 to 36 by early 2019. The diversified technology company is enabling, a high volumelow margin PPP model across these two states and they are enabling access to high-end technology at half the rates charged by private diagnostic players. Giving insights about PPPs success in healthcare, Chhitiz Kumar, CEO – Phillips Capital & Head – Govt Business & PPP, Phillips India said, “PPPs are all about bringing private efficiency into the public domain. Philips India has been doing a lot of work in healthcare domain for the past six to seven years. In the last two to three years, we have worked very closely with Manipal Hospital Group. We wanted to bring in a PPP model where a wide scale impact can be achieved in the remotest of the places and showcase how affordable, accessible and quality healthcare can be provided. Our partnership with the Manipal Group has showcased that long-term financially and technically strong partners can bring in a workable healthcare PPP model, which is a high volumelow margin business model where patients are benefited the most.” According to the company, at present there are two PPP projects in diagnostic imaging in Haryana and Jharkhand which were run by Healthcare Diagnostic, an SPV (special purpose vehicle) between Philips India and Manipal Health Enterprises. The first PPP inked in mid of 2015 with

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At present, there are two PPP projects in diagnostic imaging in Haryana and Jharkhand, which were run by Healthcare Diagnostic, an SPV (special purpose vehicle) between Philips India and Manipal Health Enterprises the Government of Haryana was providing radiology services (CT and MR) for eight centres — four district hospitals and four medical college hospitals. Currently, they are operational across 10 locations. Some of these locations are — Rohtak, Gurgaon, Panchkula, Mewat, Sonepat (village –Khanpur), Bhiwadi, Agroha. Over 12,000 scans have been done out of the Gurgaon centre,

out of which 1000 scans were completed free of cost, for select patient categories. Cost difference: for a government empanelled patient, the cost of a scan is reduced to one third (1/3rd) of the market price. The technology provided in the centres range from 16 slice to 128 slice CT and 1.5 T MR. The PPP centres in Haryana offer high-end services only i.e. high MRI’s and CT scans–

1.5teslaMRI, high-end CT scans The company added that the second PPP was signed with the Government of Jharkhand for all 24 districts. The technology spans from basic radiology like ECG, X-ray, ultrasound to high-end CT-scans and MRI. “We are focussing on highend radiology like MRI and CT scans in Haryana, as district

hospitals already have facilities like X-ray, ultrasound. In Jharkhand, we need to give some of the basic healthcare facilities like X-ray, ultrasound, ECG facilities. We follow CGHS pricing,” Kumar informed. Philips’ role does not end with facilitating with the technology, but they work with the radiology department to optimise the workflow and trained technicians to significantly increase the throughput. Informing that healthcare challenges in India can be solved if we get the right interventions at the PPP, Kumar, said, “The state government and private players should work hand-in-hand. Philips Healthcare, wants to make a meaningful impact where the PPP model we provide offers affordability, accessibility and quality. PPP is always about making balance between the government and private players and keeping the patients in the centre. Any PPP model should follow these five steps first is the right bidder selection, second is a viable business model where the private players can make a fair return, third a list of quality parameters to be followed should be mentioned. Fourth is about a balanced contract, clauses in the contract should be simpler, fifth one is about choosing the relevant, right technology as per the needs of the locality.” Touching upon the National Health Policy (NHP) 2017, Kumar said, “The new NHP talks a lot about PPP which according to me, is a good starting point as the healthcare challenges in India are enormous and the best way to deliver the right outcome for the masses is when the public healthcare system and private players can work together.” prathiba.raju@expressindia.com

MARKET POST EVENT

Clairvoyance 2017 held in Mumbai Participants from colleges in Gujarat,Maharashtra,New Delhi,Hyderabad and Karnataka took part in the event CLAIRVOYANCE 2017, the 20th edition of the annual National Conference of the School of Health Systems Studies of the Tata Institute of Social Sciences (TISS), was recently held on the TISS campus in Mumbai. Focussing on the theme – ‘Innovate, Integrate and Inspire’ — signifying the evolution of the health sector and its functioning in an integrated manner towards achieving health and well being for all and inspiring future health professionals — the event saw participants from colleges in Gujarat, Maharashtra, New Delhi, Hyderabad and Karnataka among other states. T Sundararaman, Dean of Health System Studies, TISS, Mumbai, said, “The aim of our annual event is to bring leaders from the field of public health sector on one platform. We discussed a few key areas in which India should emerge a leader – data and management, social entrepreneurship in healthcare, and healthcare financing. Our platform helps the students to understand how to choose their job, and over the past few years, we have seen that this has led to 100 per cent placement.” The event saw Sarvmitra Sharma, Director, Jagran Pehal; Smita Mahale, research scientist; Shankar Prinja from Postgraduate Institute of Medical Education and Research, Chandigarh; Ravi Ramaswamy from Philips India; and Venkat Changavalli, an advisor to the Government of Haryana, among others in attendance. Sharma, who was the Chief of Honour for the event, said, “It’s a privilege for us to attend this event. A majority of our work force comes from TISS. They are the ones who influence people’s attitude regarding use of toilets, and overall hygiene and health. We hope that

(L-R) Pradeep Jaisingh, Founder, Healthstart, Dr Akash Rajpal, COO, Jaslok Hospital and Research Centre, Leadership Mentor Venkat Changavalli, Vivek Tiwari, CEO, Medikabazaar (Boston Ivy Healthcare) and Dr Jagdish Chaturvedi, Director, Innaccel Technologies, during a panel discussion on the session ‘Entrepreneurship in Healthcare’

Chief Guest SM Sharma with faculty coordinator Dr T Sundararaman (Dean, SHSS, TISS), Dr Bal Rakshase along with Team Clairvoyance

they join Jagran more in number. Also, because we have a presence in several villages, it will give talented youngsters

the opportunity to test their potential.” Changavalli, a senior advisor to Tata Trust and first to

launch the 108 ambulance service in Hyderabad, said, “It was heartening to see the huge number of participants and en-

thusiasm, and a great feeling to share my skills with them and help the students.” EH News Bureau

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FOCUS:MEDICAL TOURISM

A NEW HUB FOR MEDICAL TOURISM? With leading healthcare players foraying into the state and the government's growing focus on the sector, Rajasthan may be the next go-to destination for medical tourists in the country BY MANSHA GAGNEJA

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‘A

tithi Devo Bhava’ or •ÁÃÁÕŒÒ√ÊÙ ÷√Ê is a Sanskrit verse which means that ‘The guest is equivalent to God.’ It is taken from an ancient Hindu scripture which became a part of the code of conduct for the Indian society. Atithi Devo Bhava prescribes the dynamics of the host-guest relationship and building on this, the Government of India launched the campaign ‘Incredible India’ with the same mantra to attract more tourists to the heritage land. India has always enjoyed attention from travellers around the globe for culture and its healing powers. The World Travel & Tourism Council calculated that tourism industry in India generated `6.4 trillion or 6.6 per cent of the nation’s GDP in 2012. The sector is predicted to grow at an average annual rate of 7.9 per cent from 2013 to 2023. A major chunk of this share would come from medical tourism, estimated to be worth $3.9 billion in 2016 and is projected to be $8 billion by 2020, according to a report on ‘A Multi-trillion Dollar Opportunity for Global Symbiotic Growth’. World over, people have been travelling offshores in the name of health, seeking higher quality healthcare services and standards, more affordable medical treatment as well as shorter waiting times. To fulfill these expectations, patients are willing to travel across the globe to receive treatments that can give them value for money. Recognising the demand, India is taking steps to attract these tourists and already ranks amongst the most popular medical tourism destinations. Being cost competitive, compared to its peers in Asia and Western countries, the cost of surgery is about one-tenth of that in the US or Western Europe. It is also among the few nations that offer the first world healthcare facilities at third world prices. Nowadays, patients are travelling to India for more planned surgeries that do not involve

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We will tap medical tourists aggressively in the coming financial year” Nitin Saraswat DGM, Manas Arogya Sadan Heartcare & Multi-Specialty Hospital

Rajasthan is expected to attract more medical tourists as the human resources and infrastructure in both government and private hospitals have developed rapidly in the last few years here Swadeep Srivastava Managing Partner, India Virtual Hospital

There is a significant flow of international tourists to the state of Rajasthan which is a sizeable target audience for the hospitals. Hospitals are reaching out to international assistance and travel companies to launch insurance covers Sunil Kapur Head, Sales, Fortis Healthcare

tourism could bring into the state, the Government of Rajasthan is putting in concerted efforts along with the private sector majorly in Jaipur, which is a part of the golden triangle, a tourist circuit which connects the national capital Delhi, Agra and Jaipur. Be it by offering concession for acquiring land or easing the policy procedures for hospitals, the state government is encouraging multispeciality hospitals to set up their base. In addition, the government is also promoting public private partnership (PPP) models to provide more efficient and cost-effective solutions. One such example is Manas Arogya Sadan Heartcare & MultiSpecialty Hospital in Jaipur, which runs on a PPP model with Metro Institute of Medical Sciences. Nitin Saraswat, DGM, Manas Arogya Sadan Heartcare & Multi-Specialty Hospital, shared that they have plans to tap medical tourists aggressively in the coming financial year.”

Recent developments

We have got a new building sanctioned by the government of Rajasthan and one wing in the building is solely allocated to medical tourism. We are investing a sum of `20 crores which will cover the equipment, building and furniture cost for the wing Dr SC Pareek Medical Director, BMCHRC

any emergency action and thus have a long waiting time in the home country. India, on the other hand, provides quick healthcare service which brings more patients to the country. These are among the factors that attribute to the growth of the industry. While the medical tourism industry in India is established in quite a lot of places including Delhi, Kerala, Tamil Nadu, Maharashtra and Telangana, there are still many unexplored regions that can be potential hubs in the near future.

Rajasthan: The next medical tourism hub Being sixth in terms of attracting foreign tourists and a favourable tourist destination, the colourful state of Rajasthan compels tourists to flock here with the spirit of Padharo Mhare Des which literally means ‘Welcome to my land.’ Now, it offers much more than just culture and heritage by gradually making provisions to upgrade itself into a much sought after medical tourist destination. The major reason for the state to flourish in this

segment is the fact that it has always been tourist friendly. The presence of existing multi speciality hospitals is aiding in building the state as a medical hub as well. The state is also widely known for treatment through traditional forms of medication including AYUSH, a major pull factor for medical tourists. While enquiring about the go-to place for medical tourism in the state, we found out that the ‘pink city’ Jaipur tops the chart. Understanding the economic boost that medical

Although the government is aiming to transform the state into the new medical tourism capital, aggressive efforts from both the private and public sector are still needed. The state, especially Jaipur, is a centre for many multi-speciality chain of hospitals, which cater to all specialities including cardiology, oncology, orthopaedics, dental, organ transplants and cosmetology. In addition, there are new chains like Bombay Hospital which are burgeoning. Swadeep Srivastava, Managing Partner, India Virtual Hospital informs, “Rajasthan is expected to attract more medical tourists as the human resources and infrastructure in both the government and private hospitals have developed rapidly in the last few years here. Experts and government officials believe that there is scope for 25 to 30 per cent growth in the medical tourism sector in the state in view of low costs involved in the healthcare facilities and attraction to the

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historical monuments and tourist spots.” Sunil Kapur, Head, Sales, Fortis Healthcare also highlights, “There is a significant flow of international tourists to the state of Rajasthan which is a sizeable target audience for the hospitals. Hospitals are reaching out to international assistance and travel companies to launch insurance covers, which can be used for preventive health check-ups and any medical emergencies if required. For tertiary care, efforts are being made to reach out to markets like Afghanistan and Pakistan for planned movement of patients to the hospitals in Rajasthan.” While many of these hospitals pointed out that medical tourism is still in the nascent stage in the state, they all emphasised on the potential that the industry holds. Although this potential is vast, actions taken to exploit it are still primitive. Some, among these hospitals are actively putting in efforts to get the first mover advantage by strategically planning the next step. Bhagwan Mahaveer Cancer Hospital and Research Centre (BMCHRC) is one such hospital. Dr SC Pareek, Medical Director, BMCHRC announced, “We have got a new building sanctioned by the Government of Rajasthan and one wing in the building is solely allocated to medical tourism. The infrastructure for the wing will be infused with luxurious facilities to make international patients feel more comfortable. We are already in talks with Jaipur Development Authority and the approvals are expected any time soon. In addition, the hospital is NABH accredited and has received all the required licences from the state authorities. We are investing a sum of `20 crores which will cover the equipment, building and furniture cost for the wing. Another `30 crores will be invested for radiology and oncology equipment that are already in the procurement stage. The wing is supposed to be functional in the next two years.” Multispeciality chains like

Apollo and Fortis are already generating around 10 per cent

of their revenue through medical tourism and this share is

bound to increase in the next couple of years.

Challenges Despite the advancements

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FOCUS:MEDICAL TOURISM

made for the development of medical tourism in Rajasthan, there are some fundamental issues hindering, which include difficulty in commuting due to lack of transportation services. Dr Pareek added that many medical tourists who visit India do not travel beyond the NCR region as it offers more affordable commute facilities and travelling to Rajasthan involves higher air fares. As the capital of India enjoys this competitive edge, it is certainly a laggard for the state of Rajasthan. Another hurdle for medical tourism to thrive is that the roadmap for it is still in the designing stage. Kapur indicated, “Support from the state administration for promoting Rajasthan as medical tourism hub is required. There is already a strong wave which has highlighted Rajasthan as a tourist destination. Medical expertise offered by the state needs to be added to this propaganda so that more and more tourists can look at the state for medical treatment as well. We have been working with the Ministry of Tourism and bodies like FICCI and CII to push medical tourism. Positive outcomes on the same are expected.” Thus concerted efforts from both private and public sector will catalyse the growth of medical tourism in the state.

hospitals need to aggressively start exploring the latest dynamics and trends, and thus strategically act upon them. Uniform price band in major

specialities needs to be made public, which would facilitate foreign patients seeking treatments in India. These moves will have a positive impact in the

revenue growth of medical tourism sector. The growth of this industry will clearly enhance GDP growth and result in generation of more medical

and tourism-related jobs. To sum up, Rajasthan’s medical tourism industry is a gold mine waiting around to be explored. mansha.gagneja@expressindia.com

Road ahead Medical tourism sector is much diversified and is full of opportunities. In order to shape the industry better, the government should take more initiatives to harmonise policies and rules to provide ease in entry for new hospitals. With regards to attracting more patients, the government can aid the industry in streamline the immigration process for medical visitors by setting up a single window approval system for granting visas along with improving air capacity. Initialising government programmes and arranging separate care facilities for foreign patients even in public hospitals can help generate much more revenue, which can eventually improve the quality of care for domestic patients in the state. As far as the private sector is concerned, the chain of

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EXPRESS HEALTHCARE

December 2017

SPECIAL FEATURE

Innovations that will matter in 2018 Innovations in healthcare has and will always play a key role in shaping the future of this sector. In the past few years, the Indian healthcare sector has witnessed some amazing innovations in terms of technology, medical applications, breakthrough procedures and business models that have been a great contributor to the sector's progress. Express Healthcare spoke to some experts who share their observations on key innovations and related aspects that will influence India's healthcare progress in the coming year.These leaders elaborate on how these innovation will impact the live of people in India and how it groom the industry further. Excerpts....

Revolutionising heart care Dr Ramakanta Panda, Vice Chairman and MD, Asian Heart Institute, Mumbai

reatment of heart disease has evolved a great deal. Options that will become popular in the coming year will involve least trauma, greatest safety and best results. Transcatheter Aortic Replacement (TAVR): Until

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recently, the only way to replace a heart valve (in case of severe aortic stenosis, or narrowing of the aortic valve opening) was through a major surgery. This involved putting the patient on a bypass pump, stopping the heart, and cutting the heart open to put in a

new valve. Now it can be done non-surgically through a puncture in the groin. In an angioplasty-like procedure, a compressed tissue heart valve is placed on the balloon catheter and is positioned directly inside the damaged valve. Once in position, the

balloon is inflated to secure the valve in place. Itâ&#x20AC;&#x2122;s much safer and recovery is quick too. The whole procedure takes just one to two hour. At present, it is recommended only to those patients who have a high risk for surgical AVR as the complication rates

are still high. This is a relatively new procedure and affordability remains an issue for a majority of patients. Doctors in India are still getting trained in this procedure. As time passes, more and more such cases will be done once doctors get trained and the cost of valve comes down. Augmented Reality (AR) in medicine: AR has the potential to revolutionise the way surgeons are getting trained and planning surgical treatments for patients. Doctors and even patients are aware of the fact that when it comes to surgery, precision is of prime importance. AR can help sur-

prohibitive. We are hoping that it doesn't have the statin side effects which include liver dysfunction, muscle pain etc.

3-D bioprinting: With applications in congenital heart disease, coronary artery disease, and surgical and catheter-based structural dis-

ease, 3D printing is a new tool that is challenging how we image, plan, and carry out cardiovascular interventions. It can help with planning inter-

ventional procedure, placing percutaneous valves, print implantable devices such as cardiac valves that could then be customsised to the patient.

AR has the potential to revolutionise the way surgeons are getting trained and planning surgical treatments for patients geons become more efficient at surgeries as they can use AR platform to plan complex procedures. This will definitely reduce the complications. AR can thus help save lives and treat patients seamlessly. PCSK9 inhibitors: The PCSK9 inhibitors (PSK9i) are a new class of injectable drugs that have been shown to dramatically lower LDL cholesterol levels. If you need medicine to lower your cholesterol, chances are your doctor will prescribe a statin which is currently the main medicine for reducing cholesterol levels. Some people canâ&#x20AC;&#x2122;t take them because of their side effects. For such patients, no other medication is available. PCSK9 is said to be more effective than statins, however, we still do not know the longterm effects and the cost is

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SPECIAL FEATURE

Role of prebiotics and probiotics in managing diabetes Dr Ramen Goel, Senior Metabolic & Bariatric Surgeon, Director - Center of Bariatric & Metabolic Surgery, Wockhardt Hospital

ecent understanding of role of gut bacteria in management of obesity and diabetes is probably the most important finding of the century. The last decades have experienced an exponential increase in the number of people suffering from obesity and its associated disorders such as type II diabetes. Recent research has been highlighting an increasingly more important role of gut microbiota in metabolic disorders. It’s well known that gut microbiota plays a major role in the de-

velopment of food absorption and low grade inflammation, two key processes in obesity and diabetes. A recent study published in the International Journal of Obesity, shows that people who have a stable weight over nine years or lose weight, have a large number of different types of microbes in their guts, eat more fibre and have a higher abundance of certain types of gut microbes. Studies in mice have demonstrated that how the body converts food into energy depends in large part on

the different types of microbes a person has in their gut and also on the kind of microbes they carry.

Why is it an innovation? Research suggests that changes in life style that involves increased food consumption and reduced exercise in addition to gut microbiota contribute more to metabolic diseases. As a result, better understanding and utilisation of various prebiotic and probiotic bacteria may prove to be beneficial in the treatment of

metabolic diseases in the future. This find will transform the management of chronic diseases through bacterial relocation. If effectiveness of this treatment is established then vast population can be cured of these illnesses. Food industry will evolve to play therapeutic role in management of chronic diseases. This is likely to result in healthier individuals living longer. Pharma and food industry may work together for positive health.

Augmenting information ecosystem Abhijeet Ghosh, Director, Vertical Market (Health), Insurance, India LexisNexis Risk Solutions

tory on five innovations (technology, medical applications, breakthrough procedures or business models) that will impact the industry

Role of Big Data The next big innovation in India in healthcare will not be a miracle drug. It will not be built just with fibre optic cable or new hospitals. It is going to be built with big data, that gets generated by insurers, healthcare providers, medical practitioners, research centres and other organisations in the healthcare ecosystem. Enormous data is already being generated across the ecosystem– though mostly in silos and is non digitised – from insured applications and claims information, electronic medical records, treatment costs and outcomes, and clinical trial results. However, the biggest innovation is not the amount of data, but what is done with it. There is a need to build a health information ecosystem that looks at capturing the data electroni-

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Impact

cally and allows data to flow through and interact with various permitted stake-holders. Bringing all of this data together with different stakeholders will help every stakeholder draw significant insights on how to better manage various aspects of healthcare using their respective business models.

Preventive aspects The vision of the government is to give India’s citizens a wider access to healthcare and guarantee the best quality treatment at an affordable cost. This necessarily calls for a system that looks at both the preventive and curative aspects. While the physical infrastructure of primary, secondary and tertiary healthcare facilities will deliver the last mile care, the digital and data infrastructure would help in preventive side as well as bring greater efficiencies in the curative side. The efficiencies would come from standardising treatments, cutting unwarranted costs due to frauds or abuses and create a

platform of preventive care that addresses not just wellness and social priorities but also helps prevent or control epidemics or other communicable diseases. This would also be a great social leveller. The innovation also lies in the fact that organisations aligned to healthcare are capable of using the data to create wider benefits like research on drug efficacies to better penetration of health insurance to a wider angle of population health management.

It is apparent that India’s healthcare is on the verge of a digital transformation, able to deliver personalised care, underpinned by a data-rich and data-driven ecosystem. With the increasing amount of data being generated in healthcare as a result of advancements in biomedical technologies and data standardisation at the point of care between health insurers and the providers, it is important for stakeholders such as health insurers and healthcare companies to capture, as well as engage with, the new data sources and appropriate technologies. Analysis of this big data will help the sector deliver better patient care, develop innovative methods for improving healthcare, as well as make payments faster to the providers and decrease the fraud, waste and abuse in the health ecosystem, thus easing out the cost burden.

Common ground for data governance While the move towards creat-

ing an information technology infrastructure for healthcare was first started by the government in 2002, it has not been a sustained endeavour. The imperative for health analytics today is that all the stakeholders must establish common ground for data governance and usability, and invest in capabilities to share and work with data. It all adds up to acquiring capabilities for data analysis, data management, and data systems management. In order to harness this innovation, all healthcare stakeholders must invest in technology, which today is a major hurdle in standardising and consolidating data. We need to see an accelerated move towards creating electronic records of all data generated, making the stored data usable, searchable, and actionable by all the stakeholders. Data on a common, open platform will enable stakeholders to analyse the data for obtaining relevant insights.

SPECIAL FEATURE

Boon for IVF treatment Dr Rajalaxmi Walavalkar, Consultant Reproductive Medicine and Surgery, Cocoon Fertility, India

gg freezing technology is a technique by which eggs can be preserved to create an embryo at a later date. It allows a woman to take control of her reproductive life, she can plan life and pregnancy and need not be bogged down by the ‘biological clock’. Egg freezing empowers a woman by allowing her to postpone child bearing till stable in her career and or in her relationship. Only in 2012 did the American Society for Reproductive Medicine lift the label of experimental technique from the art of egg freezing, though the first healthy birth from a frozen egg was documented in 1986. The information about this in general public is lacking and dissipation of availability of egg freezing will allow women the option of planning their life. This will allow the career woman to have well planned breaks thus allowing increase in self potential and also beneficial for the team she works with. For employers, this may translate into effective work force planning and thus posi-

tively affect productivity. Companies like Apple and Google have already a funded for their women employees to freeze egg, much like a life insurance policy this is a fertility insurance for the staff.

chains of IVF are aiming to keep the costs low, IVF may not be within reach of everybody.

surance to offer its women customers insurance to provide cover for fertility treatments.

Two things can help towards making IVF more affordable

EMI facility

INVOcell --- innovation

Fertility insurance

INVOcell is a patented medical device where the eggs collected in IVF are mixed with sperm in a receptacle that can then be placed inside the woman’s body so that embryos form. The job of the incubator of a IVF lab is instead done by this device inside the woman’s body. All steps are same as for IVF except the incubation. This reduces the cost of incubation from the IVF procedure and is aimed at offering a cheaper option for the patient. Studies have shown that for the correctly selected patient this is as effective as IVF and keeps cost low. This has worked very well in the African setting offering affordable IVF there. INVOcell was introduced in India but has not gained popularity due to its cost structure.

This has been practically nonexistent in India due to a host of reasons. Infertility rates in India are high while the treatment is expensive and hard to find in every hospital. Infertility affects one in six couples, hence, from an insurance company point of view, high chances of claims and pay outs. Fertility is generally not considered necessary for healthy survival. Also, unfortunately despite the first baby born in 1974, most treatments are not considered as time tested by the insurance providers. Hence, funding for infertility insurance is a highrisk proposition. Only recently has the WHO declared infertility as a disease. However, times are changing for the better. Bharatiya Mahila Bank (BMB) has tied up with New India As-

It is as costly as a standard IVF cycle in the urban setting or even more so considering the costing in second tire cities. Training to identify the right patient who can benefit from this innovation and reduction in the cost of it will be a boon for the industry and may allow for cheaper IVF to be available.

Affordable IVF — business model IVF cost can be divided into cost of medication, cost of lab procedures and surgeries and cost of freezing. Though certain

There are IVF chains that are making the EMI finance options available for their patients enabling a patient to convert their medical bills into no cost EMI finance loan by tying up with a leading finance companies e.g Bajaj Finserve etc. Some features of such finances include easy repayment options, minimal documentation, instant approval and on-spot approval, zero/No foreclosure charges, where and as applicable. This will greatly change the ease of access to treatment and many couples who may have otherwise postponed treatments till financial security will be able to have treatments earlier with better clinical outcomes. The more a couples age, the poorer the outcome of treatments. Finance options have come as boon for couples struggling due to financial constraints.

Capturing real time data Girish Koppar, Secretary, Hospital Information Technology Association and Sr Manager - IT, Lilavati Hospital & Research Center

OT/ Business Analytics and AI will completely take over the healthcare industry in the coming years and change the dynamics of this industry in terms of the process of treatment provided to the Patient. IOT (Internet of Things) will help to capture real time data from all possible medical equipment including wearable devices like watches and blood pressure equipment. Business analytics will help this captured data to convert it into meaningful outputs for treating existing patients and predicting their health for any future eventualities. Artificial Intelligence (AI) will use the above captured data

and analytics to prepare robots to diagnose and operate patients.

doctors had to use his/her own judgement/knowledge to prescribe medicines.

Impact

Industry utilisation

The positive impact is that the healthcare industry will be technology driven and diagnosis will be done more on facts and data that has been captured rather than relying on the doctor’s judgement. The innovation will have a great impact as doctor's can monitor critical/chronic patients remotely with real time data and do an online consultation, which will eliminate the need and pain to travel. Software applications will be built able to assist doctors in

Government/ municipal authorities can use this data to create a health information exchange which can be used to analyse and predict any major epidemic or outburst of disease in a particular locality. Insurance industry can utilise this data to determine their insurance policies based on age, gender, locality, disease, etc. This will help to design new insurance policies or alter existing policies to optimise their business. Doctors can use this data to

diagnosis. Simple example is a drug master which has the intelligence to analyse drug to drug or drug to allergy reaction. This was not possible earlier and

better diagnosis as they will have data available from various medical equipment and wearable devices which was not previously available. With this innovation, it will be possible for doctors to remotely monitor patients with real time data which is transmitted by wearable devices. Telemedicine will be widely used to connect to rural areas wherever Internet is available and there is a lack of specialised doctors. With this innovation, robots will be used to do basic diagnosis and to conduct various procedures and surgeries. IBM Watson is an example where a machine is able to do a basic diagnosis of a patient.

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SPECIAL FEATURE

Technological innovations Anuj Arenja, MD and CEO, QI Spine Clinic, the Back and Neck Specialists

ealthcare delivery is increasingly shaped and enabled by technology. We see technology innovations in three primary areas transforming the manner in which delivery and outcomes will be optimised in 2018 and beyond: Devices/technologies for better diagnosis, treatment and pain management: The Digital Spine Analysis is used to provide an objective understanding of muscle strength and flexibility, allowing for a more customised and targeted treatment plan. Use of Fre-

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quency Specific Micro currents offers pain relief without the side effect of painkillers. Innovations like these lead to significantly better patient outcomes compared to traditional manual approaches. Precision medicine based on a personalised diagnosis and leveraging algorithms based on extensive case history: This is the future of medicine. Patient management and a knowledge management system has been developed to classify patients into one of over 100 different case types and

Digital Spine Analysis is used to provide an objective understanding of muscle strength and flexibility

leverage our learningâ&#x20AC;&#x2122;s over 50,000 patients to provide treatment plans best suited to the specific condition of the patient. Telemedicine: Increasing use of video-based platforms to provide remote delivery of diagnosis and treatment allows for healthcare providers to connect with and provide advanced healthcare solutions even to patients in remote areas. Healthcare leaders of the future are the ones who are innovating and developing technologies across these three areas.

IT@HEALTHCARE

Are you afraid of the dark web? Digital technologies such as cloud-computing, block-chain and big data are changing the way government and industry use medical information in India. This calls for an urgent need to invest intensively in cyber security. Without data security and privacy laws, medical records in India are highly vulnerable BY RAELENE KAMBLI

ay back in 2004, when Apple Inc’s enigmatic leader, Steve Jobs’ discovered about his unusually pancreatic cancer, the company choose to shroud this information in secrecy, thinking this might have an adverse effect on its stocks and brand image. Untill the year 2008, speculations about his ill health kept floating, howbeit; Jobs constant innovations subdued all hearsay. Then, Fortune magazine published a story on his illness in 2008 and how Jobs underwent a liver transplant in an effort to

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retain as much of his organ function as possible after his cancer had spread beyond the pancreas. Soon after the news broke out of his illness, Apple’s stock fell by two per cent, mentioned a report published by the Silicon Valley Business Journal. Apple continued to keep mum about Jobs illness which according to some stock analysts was a safe bet for the company. Offcourse, after Jobs death Apples’ stocks did plunge to a certain extent. Nevertheless, Jobs by then had already trained Tim Cook to take his place and so the

company managed to hold on its strengths. But, imagine what if Jobs’ health information were leaked way back in 2004 when he was first time diagnosed with cancer? How would the world react to this news? How would the company’s stock perform then? Would people still have faith in the innovations Jobs introduced after his illness? Could the company afford to take that risk? Well, experts believe that securing this information for some years was a good business decision. Moreover, knowing the in-

fluence that Jobs had over several people’s lives, it was imperative to maintain his privacy. So, is there a lesson for us to learn from this? Potentially, there is an important lesson to learn about security of information from this example. Secrecy and security of information enabled Apple to retain its position as a market leader in innovation. Although the company did witness a slight plunge in its stock when the news was broken out in 2008, Apple and Jobs still continued to influence the

world in many ways. They also prevented the world from a sudden setback and held back investors’ trust. Similarly, security of health information is paramount not only for large business organisations or influential people but for every individual, industry and to a nation at large. Putting it in perspective to the healthcare sector, security of health information is an extremely important subject to every healthcare provider. It is not just an IT responsibility but a business priority.

Why cyber security is important to healthcare organisations? Breach of health informations can be extremely perilous. We all know that cyberattacks can damage reputations, destroy customer trust and affect revenues, but in the healthcare scenario it is certainly beyond these basics. Says Rajesh Maurya, Regional VP, India & SAARC, Fortinet, “While stolen credit card information can be quickly remedied via cancellation, healthcare records have boundless shelf life. If put in the wrong hands, the information from healthcare records can be fraudulently used to obtain and pay for treatments, prescriptions, or even costly surgeries.” Additionally, Harshil Doshi, Strategic Security Solutions Consulting – India, Forcepoint provides an insight from a recently released 2018 Forcepoint security Labs predictions report. “Data aggregators will be the new gold mine for hackers and the recent Equifax breach in the US was one such example. Likewise, the healthcare sector holds tremendous amount of critical data like personal information, financial details and medical records of patients which offer potential longterm value to cyber criminals. Stealing healthcare records will emerge as a lucrative target for hackers. Also, healthcare industry is one of the critical sectors where preventing access to IT systems can trigger life-anddeath consequences for patients under care and making it urgent for healthcare provider to seek immediate resolution,” he discloses. Well, Doshi’s observation is indeed accurate about healthcare increasing becoming the hackers delight. A case in point was when the International Association of Athletics Foundation (IAAF) in Monaco publicly disclosed that they were victims of a massive cyber attack. An interesting observation in this case was that what was stolen was not the credit card numbers of athletes but their therapeutic use exemption (TUE) data. Ishaq Quadri, Group CIO KIMS Hospital, reminds us of December 2014, Anthem – the

“Cyber criminals understand that many hospitals, doctors, and insurers are simply not prepared to counter today’s sheer volume and sophistication of attacks, such as MEDJACK, social engineering, and ransomware. As more healthcare institutions move their data online to provide more efficient and effective patient care, cyber criminals will likely continue to eye the industry as their number one target” Rajesh Maurya, Regional VP, India & SAARC, Fortinet

“Data aggregators will be the new gold mine for hackers. The healthcare sector holds tremendous amount of critical data like personal information, financial details and medical records of patients which offer potential long-term value to cyber criminals” Harshil Doshi, Strategic Security Solutions Consulting – India, Forcepoint

“Healthcare managements are not sensitive on this front as it is reflected in the poor budget allocation for information security, licensed software purchases, and in majority of the cases there is no investment in a full time information security expert Ishaq Quadri, Group CIO - KIMS Hospital

US’s second largest healthcare insurer cyber attack. This was said to be one of the largest hack to hit the healthcare industry in the US suffered at that time. About 80 million patient records were stolen in one single cyber attack. In a report published by Reuters, the FBI had observed malicious actors targeting healthcare systems, perhaps for the purpose of obtaining Protected Healthcare Information (PHI) and/or Personally Identifiable Information (PII). These actors were seen targeting multiple companies in the healthcare and medical devices industry typically targeting valuable intellectual property, such as medical devices and equipment development data. Similarly, the WannaCry ransomware attack this year crippled several healthcare institutions, hospitals and healthcare systems around the world including UK’s NHS. The NHS was said to be the worst hit. Hospitals and doctors in parts

of England were forced to turn away patients and cancel appointments after they were infected with the ransomware, which scrambled data on computers and demanded payments of $300 to $600 to restore access. People in affected areas were being advised to seek medical care only in emergencies. According to Identity Theft Resource Center, 35.4 per cent of the data breaches reported in 2015 were in the healthcare industry. In addition, Maurya updates on the statistics on global healthcare cyberattacks. “In 2015, more than 113 million medical records were breached. To put this in perspective, if each case were a single individual then almost all the citizens in India’s major cities would have fallen victims. In 2016, we saw a single cyber criminal advertise more than 600,000 healthcare patient records for sale on the dark web. The records included the victims’ full names, social security numbers, birth dates, and

more, which could be used for fraudulent activities,” he mentioned. This indicates that investing in cyber-security is crucial to healthcare organisations. More so because healthcare seems to be the new golden goose for the dark web as mentioned by experts.

The India problem “Information security in general in India is a neglected area. Many organisations are either unaware or under the false pretext that their infrastructure is safe, robust and tenable. More often than not, the IT Heads start and end with anti virus software and firewall deployment. Information security is misconstrued to be a technology problem that can easily be solved with updated anti virus and firewalls. Another misconception is that the threat originates from external sources. Managements also are not sensitive on this front as it is reflected

in the poor budget allocation for information security, licensed software purchases, and in majority of the cases there is no investment in a full time information security expert,” opines Quadri. The issue of cyber security in Indian healthcare is compounded by the fact that our country has the maximum number of smartphone users. For 2017, the number of smartphone users in India is estimated to reach 299.24 million, with the number of smartphone users worldwide forecast to exceed 2.3 billion users by 2022, according to Satista- a statistic provider portal. Secondly, patients, healthcare providers and disease management platforms these days are all connected to the web wherein a continuous exchange of information leave enough room for privacy breach. Moreover, medical devices such as patient monitors and medication-infusing pumps—many of which are

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IT@HEALTHCARE life-sustaining or life-supporting—are also connected to the Internet to enable quicker access of medical records. However, such medical devices and other mobile health solutions can become a double-edged sword if security of data is not maintained. “Cyber criminals understand that many hospitals, doctors, and insurers are simply not prepared to counter today’s sheer volume and sophistication of attacks, such as MEDJACK (Medical Device Hijack by hackers), social engineering, and ransomware. As more healthcare institutions move their data online to provide more efficient and effective patient care, cyber criminals will likely continue to eye the industry as their number one target. For many healthcare organisations, it’s not if they’ll be hacked, but rather when,” Maurya cautions. Besides, he opines that stolen credit cards on the dark web may go for a dollar, two, or three. Social security numbers in the US on their own may go for somewhere around $15. However, complete healthcare records are gold mines, reportedly going for as much as $60 each. When asked about the digital and electronic technologies that are more prone to hacking and data theft, Quadri informed, “As the number of devices and gadgets multiply so is the case with the types and varieties of cyber-attacks. When it comes to handheld devices Android is found to be more vulnerable than iOS from Apple. From an operating system perspective, Microsoft Windows is more prone to an attack than its Linux counterparts.” So, how much should healthcare organisation invest in cyber security?

Investment in cyber security Says Doshi, “The healthcare industry in India has been lagging behind in cyber security investment as compared to most major industries. However, given the spate of cyber security incidents globally in the healthcare sector, there is a growing realisation amongst healthcare services providers in India to secure their critical data, especially

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ransomed or attacked by a distributed denial of service, it will cost your business substantially. Interoperability: Once you understand your enemy and have built appropriate solutions, tighten up the time to defense. Use proactive solutions and look at ways to create interoperability. Most organisations have many different solutions from different providers. Strive to reduce that complexity by further integrating and consolidating existing security devices with a security framework that utilises advanced threat intelligence sharing and an open architecture. Establish a dedicated team: A dedicated team should be put in place to uncover the latest threat intelligence so that realtime threat and mitigation updates can be made expeditiously, before cyber criminals take advantage of any weaknesses in connected IoT devices or the critical services they provide.

Need for privacy and data security regulations against growing number of ransomware attacks. Also, medical devices are also difficult-to-update and they continue to run outdated and vulnerable operating systems.” Maurya spells out that the sector is expected to spend about $ 7.5 million on security solutions in 2018 up from $ 6.4 million in 2017 according to Frost & Sullivan and security spends will continue to grow at a CAGR of 12.5 per cent till 2021. “Fortinet works with leading healthcare service providers in India and I would say that they’re on the right track in terms of staffing and intent. When looking at the specific problems, is healthcare on the right track when it comes to protecting medical records? I would say they are,” he adds. Yet there is more to do. “There is a problem with Internet of Things (IoT) and for most medical devices manufacturers, network security is not a priority. We’re going to see many more automated attacks being launched in 2018 that can penetrate healthcare organisations by moving from corporate net-

works into critical care networks. Healthcare needs to start building trusted intelligence into its automated defense solutions because it’s a primed attack surface,” he further enumerates. Apart from investment in good quality cyber security solutions, healthcare organisations need to incorporate a robust and integrated security strategy. Maurya expounds on the five pre-requisites that healthcare organisations, especially hospitals need to do while adopting cyber security solutions. Maintain good network hygiene: Ensure security posture is up-to-date with prevention and detection measures as well as develop and maintain good network hygiene, which includes systematic patching and updating of vulnerable systems, and replacing outdated technologies that are no longer supported. Implement Internal Segmentation Firewall (ISFW): CSIOs in healthcare organisations need to implement internal segmentation firewalls

(ISFWs) as the landscape of networks is wide, open and flat. ISFWs operate inside the network instead of at the edge, allowing healthcare organisations to intelligently segment networks between patients, administrators, healthcare professionals and guests. ISFW can also identify types of devices – for example, between a patient information system and a life-saving heart monitor or infusion pump. It can then prioritise interconnected medical devices that need the highest degrees of protection and monitoring, and inspect and monitor all traffic moving between segments, all without impacting performance. Focus on visibility : People are always trying to build a fortress against an invisible enemy. Instead of building a wall, one should use threat intelligence solutions to understand attacker profiles and what tactics and procedures they employ, and then start intelligently defending based on that information. Prioritise security around critical assets of an organisation. Otherwise if an asset is

Going forward, with the government considering to link Aadhaar cards for multiple-use cases including medical records, the need for India to critically analyse the data security aspects doubles. Inadequacy in regulations for data security in the healthcare sector is a significant concern. According to experts, India for now should take note of the best practices of countries which have a mature medical records governance systems. Taking into account the extremely sensitive nature of medical information and the adverse impact a breach can have, the government needs to fast-track the Healthcare Data Privacy and Security Act. Simultaneously, solution providers will need to constantly upgrade their solutions with the changing times to provide solutions that have a human-centric approach to solving a security challenge. There is also a need to research on the application and use of behavioural sciences to develop better healthcare security solutions for India. raelene.kambli@expressindia.com

IT@HEALTHCARE

The imminent digital health revolution Arvind Ananthan, Medical Devices Industry Manager, MathWorks, gives an overview of digital health, which will help move healthcare regimes toward personalised medicine TRENDS LIKE artificial intelligence (AI), neural networks, cloud computing, machine learning, deep learning, wearables, and Internet of Things (IoT) are defining a new technological era. While one cannot be blamed for thinking this might be more hype than substance, the changes emerging from these trends are quite real. The traditional healthcare system has enormous amounts of patient data (medical records, images, videos, and ICU signals) that is being used for predictive analytics systems that learn and detect trends that improve patient care. Besides collecting medical data at the point-of-care (at hospitals and clinics), engineers and scientists can now acquire, store, and work with large amounts of data from wearable medical devices in ways that weren’t conceivable even 10 years ago. With all this data, though, comes the very real challenge of transforming it into actionable insights. Often, this involves applying some of the latest analytics to your data to develop an innovative product or service that positively affects patient outcomes and delivers commercial growth. Beyond that, getting your product or service approved and out to the market quickly is another significant challenge. A key enabler of success in overcoming these challenges are engineering software tools, like MATLAB, that let medical device engineers and researchers prototype and implement advanced algorithms, analyse large amounts of varied types of data quickly and effectively, and develop/deploy new machine learning models without coding them from scratch. How the landscape looks? To better understand this big data challenge, you can view this emerging landscape

using two different perspectives: the IoT system framework along with the infrastructure enabling it to be possible, and the data analytics (machine learning) framework, which focusses on smart algorithms that helps physicians and patients make more informed, data-driven decisions.

The IoT system view The first framework that helps us characterise digital health is the IoT system framework. An IoT framework typically has three main elements: ◗ Edge node(s) ◗ A gateway or a cloud aggregator ◗ A back-end data analytics engine operating on the aggregated data for trend analysis, anomaly detection, etc. Edge nodes typically collect raw physiological health data through various sensors. Wearable fitness devices as well as some proprietary FDA-regulated devices, such as blood glucose sensors and ECG monitors, are examples of edge nodes in an IoT system. Data collected from the edge nodes needs to be processed to extract meaningful information from it. With the right signal or image processing algorithms running on the sensor data streamed from the edge nodes, signal features can be extracted and transmitted to a cloud in a way that reduces bandwidth requirements and improves power efficiencies of these wearables that leads to reduced device size and longer times between

recharges. The feature extraction algorithms may be run locally on the low-power embedded processor, which allows processed or compressed information to be sent to the cloud periodically, and then aggregated for a single patient or across a population of patients on the cloud. Predictive analytics can be run on the larger data collected across patients and time to provide patients and physicians with real-time reports. Identifying the right combination of the algorithms for preprocessing and feature extraction is a critical step in this workflow and can determine the effectiveness of the final predictive analytics solution. It can also be difficult and time-consuming to figure out the right partitioning of algorithms without the right engineering and algorithm prototyping tools as seen through Respiri’s process for creating a digital asthma

measurement device. By developing the respiratory monitoring algorithms using advanced signal and image processing techniques, Respiri was able to produce a device that measures the severity of asthma by analysing chest sound from breathing. The device then sends the processed data to the patient (or the parent of the paediatric patient) and the physician, so actions can be taken depending on the severity. Other similar examples would be Philips Healthcare developing smart digital RF Power Subsystem for their MRI Systems and how using data analytics Medrad ensures safety of MRI vascular injection pump.

Data analytics view The second framework that helps us understand this landscape is the machine learning algorithms that adds intelligence into this entire system and helps transform data into actionable insights. Smart algorithms built using machine learning techniques enable the extraction of meaningful information from large amounts of text data, signals, images, and videos to automate and accelerate diagnostic capabilities. A machine learning algorithm has three primary components: ◗ Preprocessing of data ◗ Feature extraction ◗ Developing a predictive model that is trained to learn the features from a training set The training of the model

Today, where data-driven analytics is pushing the boundaries of what’s possible, digital health will help move healthcare regimes toward personalised medicine

is typically done on large amounts of historical data recorded over long periods of time using well established computational approaches. The trained model can then be applied on new, untested data to provide predictions on various parameters acting as an advanced diagnostic aid to the physician and/or patients. In Respiri’s case, a handheld device is used to collect and pre process audio signals that are sent via Bluetooth to the patient’s phone. A smart algorithm built in MATLAB and implemented on a smartphone app using C-code generation analyses the spectral image using computer vision techniques and calculates a wheeze rate which quantifies the severity of wheezing. This information is then sent to the cloud from the smartphone for further aggregation and for sharing the patient’s wheezing trends with physicians. Being able to prototype signal processing algorithms, while quickly exploring machine learning models and rapidly implement them on a target platform through C-code generation technologies is helping companies accelerate the development of such complex medical device products. In today’s world, where data-driven analytics is pushing the boundaries of what’s possible, digital health will help move healthcare regimes toward personalised medicine. It’s quite likely that in the foreseeable future, both preventative and therapeutic care will be driven by predictive analytics collected from wearables and shared on smartphones and personal devices. This technology will allow for a better understanding of a patient’s health and a more effective diagnosis of a wide range of human physiological conditions leading to a healthier society.

EXPRESS HEALTHCARE

December 2017

START UP CORNER I N T E R V I E W

‘Making mistakes equips the organisation with a mindset and an experience toolbox that can be reused anytime’ Establishing an ambulance service in India and making a good business out of it, isn't easy, especially when there are already established players in this segment. But StanPlus as a company has learnt the art of running its business in an efficient and sustainable way. Antoine Poirson, Co-founder and COO, StanPlus shares his recipe for success and plans for the future in an interaction with Raelene Kambli

This year the focus for us is to improve operational flow and to expand in different cities in the Hyderabad – Vijayawada – Vizag region

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December 2017

How do you plan to scale your business and sustain it in the long run? In a very competitive market, StanPlus has developed a category leader position, setting the tone on how the industry will evolve. Our ability to transform the traditional business model and align the incentives of the various stakeholder, coupled with our operational excellence, powered by technology is essential in sustaining in such a market. Also, StanPlus is a very patient centric and focussed system. Our key premise has been to provide an ambulance within 15 minutes during emergency situations. The ability to service 50 per cent of Hyderabad’s population within 15 minutes and 85 per cent of population under 30 minutes is what sets us apart from other established players. The secret for sustaining in long run is technology as we believe that operational and business efficiency are brought together by technology. At StanPlus, we see technology as an enabler rather than an end. We deploy it to cater the exact needs of the business. As an example, we made sure that our callcentre would be equipped with a smart dispatching tool, leveraging real time data from

the ambulances to respond better to patients. We are also obsessed about quality of our ambulances. We ensure that the vans are sanitised daily and fumigated every week, and are stocked with all life-saving devices. All drivers and paramedics are also periodically trained. This year, the focus for us is to improve operational flow and to expand in different cities in the Hyderabad – Vijayawada – Vizag region. We also plan to bring our average response time from 15 to 20 minutes to the eventual target of 12 minutes. What kind of funding have you received thus far and by whom? Very recently, we have secured an investment of $ 1.1 million as seed funding for a minority stake, which is being led by Kstart (Kalaari Capital’s Seed Fund) and coinvested by CM Diamant, a chain of medical centres and hospitals in Canada and Africa, and INSEAD Angels (Asia). And the initial funding was $15,000 which we secured by winning the INSEAD Venture Competition. You mentioned about Kstart and CM Diamant as your latest investment. What kind of impetus will this provide you? Any learning

that these investors bring to you? With the recent funding, we plan to increase our advance life support fleet and expand across regional geographies, innovate with cutting-edge technologies and to cover all medical transportation categories. We also want to consolidate our operations in Andhra Pradesh and Telangana and want to go deeper in the towns and villages. Our start-up at present has a fleet of 300 ambulances each with three trained drivers to take turns during a 24-hour period, alongside trained paramedics on-board at all times and six advanced life support (ALS) ambulances. On an average, we receive over 60 calls per city every day, with each one answered in less than 15 seconds. In addition to being an aggregator, we will also be setting up our own fleet of vehicles to cater to specific segments of the market. Our investors are highly supportive to our efforts, in fact, this is one of the reason we decided to proceed with them. If CM Diamant is a longterm strategic investor, the Kstart and INSEAD Angels (Asia) bring immediate support to the company. Kstart being a venture capitalist entity, they support

the StanPlus with their extensive experience of growing companies at the seed level. Some of the challenges that we face have already been faced by other start-ups that Kstart has invested in, and we benefit instantly from that experience. Kstart also brings an amazing team of professionals and advisors who work with us on tackling our biggest strategic challenges. Similarly, the angels from INSEAD Angels (Asia) have extensive early stage entrepreneurial experience across the globe which we heavily leverage for expertise. Do you plan to venture outside Telangana and its neighbouring states? If yes, which states? StanPlus is currently spread across eight cities including Hyderabad, towns of Andhra Pradesh, Telangana. In a year from now, we will be catering to entire Andhra Pradesh and Telangana region as well as the Bengaluru area. Bengaluru will be a first step towards a nationwide presence and I see the company serving patients and our partners in all major and regional cities of India in less than five years from now. What has been you your learning in this journey and how would you mend mistakes that you have made

Making mistakes, understanding them and learning from it, accelerate the iteration process toward maturity. It equips the organisation with a mindset and an experience toolbox that can be reused anytime.With this model, we are able to give customers a single number access to every hospital ambulance in our chain in your business venture in the past? With experience, we believe that any early stage organisation on a mission to transform an industry will need to be highly adaptive. Mistakes are part of the journey. Mistakes are necessary in the iteration process to reach to a product market fit. To put in other words: to define a product or service that someone is willing to pay for. As an example, we started with an emergency only focus, but rapidly realised that it would be difficult to gain traction from scratch on the emergency front. The customer requests are scattered and random for a service that is operationally heavy. After a few days of attempt, we adjusted our strategy and targeted the nonemergency market for the first months in order to gain traction and finally be ready to

handle emergencies. As we did so, we discover a fantastic untapped market. In the medical transportation space, 70 per cent of the market is not emergency but scheduled transfer. The pain points are almost similar, but as an early stage organisation we could identify many low hanging fruit to harvest. This iteration process is needed at every level of the organisation, for high-level business model adjustments (see above example) as well as for very specific problem solving. Another mistake that we made was to focus on straight-up deployment of mobile applications in the ambulances. Our drivers were not trained on smartphones, charging facilities were not available, monthly data plans were getting consumed overnight. It was creating more challenges than solutions. As

a tactic move, we decided to delay the deployment of the applications and implement passive GPS tracking systems. Then we focussed on developing the relationship with the ambulance partner, on skilling the drivers and harvesting the bulk efficiency gains. Six months later, now that 80 per cent of the efficiency gains have been achieved and drivers are ready for app, we are coming back and deploying the applications. This brings efficiency gains from 80to 99 per cent, serving our initial goals. Making mistakes, understanding them and learning from it, accelerate the iteration process toward maturity. It equips the organisation with a mindset and an experience toolbox that can be reused anytime. But, as we deal with patients at risks, mistakes

cannot be made everywhere in our industry. Hence, whenever it comes to patients, we always perform extensive testing and pilots before deploying a new process / service. You have taken departure from the app model and now rely on a 24-7 Regional Emergency Response Centres. Can you explain why and how this will improve your business model? Yes, we are a phone-only service and operate on a callcentre model. When it comes to ambulance, people want reassurance that their service is arriving than waiting for the app to load. StanPlus receives an average of 60+ calls per day. With this model, we are able to give customers a single number access to every hospital ambulance in our chain. It is easier for us to search and dispatch the nearest available ambulance and the right medical equipment than expect a person at the emergency situation to handle. We currently have 300+ ambulances, 60+ ambulance operators on board, 15 hospitals accounting for 2000+ beds that exclusively use StanPlusâ&#x20AC;&#x2122; highly dependable ambulance network. raelene.kambli@expressindia.com

EXPRESS HEALTHCARE

December 2017

STRATEGY I N T E R V I E W

‘We strive to change the way medical treatment is practised across the world’ Dr Sanjeev Saxena, Founder and CEO, POC Medical Systems, in an interaction with Viveka Roychowdhury, gives information about low cost tests to screen various cancers, which will be launched in the Indian market shortly Point-of-care testing (POCT) is very common in management of blood glucose levels as part of diabetes care. What are the other disease conditions that are now being or could be managed with such diagnostic platforms? We are currently focussing on launching ‘MammoAlert’ for breast cancer screening. However, going ahead, we expect to develop such early screening and low-cost tests for other cancers like prostate, ovarian, cervical, lung, liver etc. Further, we also expect to develop tests for cardiac screening and infectious diseases like TB, typhoid, dengue, STDs, ebola etc. What is the science behind POC Medical Systems’ MammoAlert and the Pandora CDx microfluidicsbased platform? The Pandora CDx developed by POC Medical Systems is a microfluidic platform for rapid, point-of-care serum testing. It is based on a unique, low cost disposable microfluidic disk. The platform is very simple and easy-to-use system. MammoAlert is the first product based on this technology. This portable breast cancer screening test, which runs on Pandora CDx technology, uses a few drops of blood from a finger prick to generate results in 20 minutes. It uses multiple cancer markers for high accuracy. An instrument which is the size of a CD player: 1. A microfluidics disk, where the reaction takes place between the blood and the reagents 2. The chemistry which consists of various reagents already prepared and loaded on

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December 2017

the disk, so no human interaction is required in the field except for loading of blood 3. The software which records and analyses the data that can be accessible from any location to a doctor and a report automatically post the test. So, the instrument which is called the Pandora CDx (runs on rechargeable batteries) that can be taken to any village or in any neighbourhood or can be run in any lab or doctor’s office with minimal training. The way it works is as follows: ◗ The technician or operator enters patient’s information on a tablet ◗ Pricks the patients finger with a lancet ◗ Applies the blood to the inlet in the disc where the blood has to be inserted ◗ Selects the test and presses ‘Enter’ ◗ The test is then performed on its own and the results are displayed and displayed/ printed within 20 minutes. The disk is then removed from the Pandora CDx and disposed ◗ All the results are maintained on cloud for further research and reference So, you have microfluidic channels where you have the antibodies already conjugated on beads and pre-loaded into these micro channels. When we put in a drop of blood, it attaches to that and incubates very quickly because we are dealing with very small samples. It then migrates to another chamber which has a separation median so that the HPLC equivalent is done right there. Because the disk is spinning at a high rpm, the separation takes place right there and blood cells get

separated out. At the end of the chamber, you have detection of the fluorescence. Everything that you are doing outside, you are doing in this little disk itself. That is why you are able to automate the whole process, and you do not need any trained personnel to do it. How can POCT as a diagnostic domain, be applied in a viable and sustainable manner, to improve public health, especially in resource poor countries like India where access to medical care is poor? What is the business model to make it viable for companies like POC Medical Systems, which also have to meet investors’ expectations? I agree, that for a huge country like India, the health accessibility (physical, economical, technological) is the biggest roadblock. It has been proved that existing technologies for breast cancer screening/ detection (mammography) in India has limitations, e.g. geographic inaccessibility, inconvenient, long test-to-result-time, high cost, requirement of trained personnel, and high false positive rate, personal discomforts, etc.

As per WHO statistics, every seven minute one woman succumbs to breast cancer in India, and if we want to fight this dreadful disease, we need to adopt a disruptive technology like POCT. We, at POC have internalised the vision to change the way cancer is perceived across the world, we would like to ‘kill the fear of cancer’ by early screening/ detection. Second biggest challenge is low awareness level. We are planning various public education activities to reach out to the masses. Various awareness initiatives like group activities, seminars, workshops are being planned out which will not only be targeted at the women audience but also their family members, so that everyone is made aware of the grave situation and the possible solution. The idea is to provide low-cost solutions to those, who need it the most. We strive to change the way medical treatment is practised across the world, moving it away from symptom-based treatment to diagnostic/data-based treatments. We are confident of achieving our end goals i.e. ‘erasing fear of cancer’, as early detection means better cure rates. We will also take help of NGOs and government bodies to reach the masses. Business model As mentioned in the last paragraph, we cannot achieve this herculean task without the help of government bodies, NGOs and corporates. We will concentrate on one state at a time and have approached state governments for their support and participation.

Which disease conditions has POCT been applied to in a public health setting? As mentioned above, we are about to launch our test for breast cancer screening in a couple of months. However, going ahead, we expect to develop low cost tests for other cancers like prostate, ovarian, cervical, lung, liver etc. Further, we also expect to develop tests for cardiac screening and infectious diseases like TB, typhoid, dengue, STDs, Ebola etc. In time, we also expect to develop tests for water-borne pathogens and food tests. These will be low cost tests, which will be affordable to all strata of society. What has been the response to MammoAlert since it’s unveiling in India in March 2018? Is it available outside the MoH&FW’s scheme? After unveiling, POC team concentrated its efforts on procurement of quality certifications and clinical validation studies. With respect to availability of the product, we are still in discussions with various state authorities and will be able to give details of the same at the time of launch. What is the cost per test per woman? What are the funding strategies? Each CD is equipped to test 10 samples and POC is planning to offer these tests in the Indian market at a very affordable cost. The final costings are yet to be reached, but we believe that we will be about 1/5th the cost of mammography.

What is the status regarding the validation studies in India? In addition to earlier conducted clinical studies in the US, with support of world renowned breast cancer expert, Dr Raghuram Pillarisetti, we are conducting clinical validation studies at following study centres across India: 1. KIMS Hospitals - Andhra Pradesh 2. Amrita Institute of Medical Sciences and Research Centre - Kochi, Kerala 3. Basvatarakam Indo

American Cancer Hospital and Research Institute -Hyderabad 4. HCG MULTI Specialty Hospital HCG Cancer Center Ahmedabad 5. Manipal Hospital Bengaluru 6. Maulana Azad Medical College University of Delhi &amp; Associated Lok Nayak Hospital - New Delhi 7. Tata Medical Center – Kolkata What are the regulatory certifications necessary for such diagnostic platforms?

Where does MammoAlert currently figure in terms of certifications etc? In India, the regulatory path for IVD devices is guided under non-invasive devices and the Pandora CDx falls under this category. However, we have already acquired a CE certification from Europe. CE marking on a product indicates to all authorities that the product is in compliance with essential health and safety requirements of all directives that apply to the product and also the

requirement needed for commercialisation in India. What kind of tie ups are you looking for to improve the impact of MammoAlert in India? Which are the other resource strained countries and communities that your company is targeting to launch the test? We are about to launch Pandora CDx technology in a couple of months. In India, we are also looking at different market sectors namely government through NGOs,

door-to-door screenings, private sectors for CSR initiatives, certified diagnostic labs etc. Over the period, this product will also be made available to other countries in Africa, China, Europe and the US. The product has already generated huge interest from all over the world. As a matter of fact, every day we receive emails from countries like Africa and Europe asking when the system will be available in their countries. viveka.r@expressindia.com

INSIGHT

The Indian diagnostics sector is coming of age Diagnostic majors are wary of growing organically in India and would prefer to enter the country through a partnership.An insight by Manoj Patkar, Executive Director & Partner, 7i Capital Advisors INDIA HAS been one of the fastest growing diagnostic markets over the past few years, with an increasing share in the global in-vitro diagnostics (IVD) industry. The past decade has seen emergence of organised pan-India laboratory networks like Dr Lal Path Labs, SRL Diagnostics, Metropolis Healthcare and Thyrocare as well as regional players, like Suburban Diagnostics, Medall Healthcare, Vijaya Diagnostic Centre and Suraksha. However, it's still a long way to go for the Indian market to get consolidated and dominated by these organised players. Mid-sized and small individual labs with a presence in metros, towns and rural hinterlands, dominate the industry, as they hold estimated 85 per cent of the market share of the Indian IVD market. On the other hand, in most markets across the globe, the industry is dominated by large organised laboratory chains. This stands as a striking difference between the Indian and global markets. Also, in the developed markets, the diagnostics business is of a B2B kind. The touch point for patients is primarily the hospitals, which in turn outsource their test processing requirements to the laboratories. In India, the diagnostics business is of

a B2C kind, as patients here directly approach the pathology labs to get themselves tested. At times, tests are also conducted without a doctor’s prescription. Further, there is a lack of necessary regulations and structure due to absence of an authoritative central body that would overlook the activities in the healthcare diagnostic sector. For example, it is estimated that less than 1 per cent of the labs in India are accredited by National Accreditation Board for Testing and Calibration Laboratories (NABL). This hampers the quality and standards that should be maintained by the labs. The expectations of the patients too have sky rocketed, and customer service has witnessed a paradigm shift. Earlier, patients would wait for days to receive their test results. But in today’s time and age, patients want immediate and reliable results. Home visits to collect blood samples are becoming routine as the ‘friendly’ neighbourhood pathology labs, attempt to survive in the by-lanes of this country; and if their market share is anything to go by, they are certainly doing exceptionally well. All the above nuances make Indian market quite differentiated from its global peers. Hence most global majors are wary of

growing organically in India and would prefer to enter the Indian market through a partnership or an acquisition. Nevertheless, many aspects in the diagnostics space in our country remain untouched and provide huge growth opportunity. One example would be esoteric tests like prenatal testing and genomic diagnostics. These tests have a huge scope, but are still at their nascent stage in India. If the government introduces child care related regulations like compulsory prenatal and neonatal screening for a few critical diseases in line with some of the developed markets, then it can be a great shot in the

arm to such esoteric testing markets. There are some IVD players like Lilac Insights which have positioned themselves in the esoteric testing space and betting high on the exponential growth opportunities in these areas. Another area which shows a huge potential for growth in the near future is Point of Care Testing (POCT). Due to unique structure of the Indian market, the POCT products have applicability in diagnostic labs in the hinterlands, local doctor clinics and pharmacy stores as initial screening devices, unlike globally where they are positioned as home use products. Further, supplies to the Indian diagnostic labs have traditionally been dominated by global majors like Roche, Siemens and Abbott. However, in the recent years, host of Indian players have emerged as quality suppliers of IVD products which are customised for the Indian laboratory requirements. Indian IVD product companies are focussed on mid-sized and small labs, unlike their global counterparts, that places focus on big labs and reference labs. Most of the Indian IVD product companies have grown significantly higher than the

market average in the last two years, while maintaining high profitability. This is because the mid-sized and small labs market is still under-penetrated with only a handful quality players supplying to these markets. India is the only developing country in Asia (other than China) which has the expertise and resources of manufacturing IVD products. While many Indian companies have already developed strong capabilities of manufacturing high quality IVD reagents and kits, some of them have also developed expertise in instrument assembly and manufacturing operations. If the right incentives are provided by the government, India will have an immense scope of transcending to a manufacturing hub (under the ‘Make in India’ campaign) for the production and export of IVD products to markets like Middle East, South East Asia and Africa. Many foreign strategic as well as PE funds are actively looking to tap on this opportunity by identifying and investing in right IVD targets in India. Recent acquisitions of Tulip Diagnostics by PerkinElmer of US and Lilac Medicare by Tosoh Corporation point towards a trend, which is likely to continue further in the next few years.

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December 2017

STRATEGY

Toyota way of risk assessment for safe hospitals Deepak Venkatesh Agarkhed, GM, Engineering, Facilities & Quality, Sakra World Hospital, Bengaluru, explains how Anzen philosophy can be applied to maintain safety within hospitals

THE HOUSEKEEPING person nearly suffered injury as he was about to accidentally touch the exposed live motor of scrubber unit due to dislodged cap of motor. The post knee replacement surgery vulnerable patient had fall resulting into hip injury while going to rest room as there was uneven gap between rest room and patient room. The above examples illustrate one among few examples of accidents or near miss in hospital. The healthcare delivery system consists of various clinical and non-clinical processes involving various members from clinicians, nurses to ward boys. Unlike manufacturing or aviation industry, the process varies frequently based on patient disease and treatment related to

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December 2017

same. Inspite of various checks and balances in system, there are incidents of breaches in standard operating processes resulting into various levels of harm. The current approach in any quality accredited hospital is to act on reported incidents which have resulted in harm to patient or hospital staff through mechanism of incident report analysis. Unfortunately, most of the incidents are not reported by functional team out of fear of them being penalised on account of reporting. Although corrective actions for that particular incident are taken, mostly the preventive aspects are completely overlooked. The hazard identification and risk assessment (HIRA) using technique like FMEA (failure mode effect analysis) are not

yet popular in high-risk clinical area like operating theatres, intensive care units. The risks to patients and even hospital staff can be minimised using proactive techniques like KYT (Kiken Yochi

Training) and Anzen first (safety first) risk assessment methodology. There is a tendency to get confused in understanding English syntax of harm, hazard, risk and accident. The hazard is a potential source of harm like exposed insulation sleeve of live electrical power chord from electrosurgical unit inside the operating room during surgery. Harm is physical injury or damage to the health of a person, or damage to property or environment, like a surgeon getting an electrical shock after touching the live electrical power chord. The risk is the combination of the probability of occurrence of harm and the severity of that harm. In case of improper maintenance of hospital medical equipment, the risk will be high in this case as

oxygen rich environment operating room and patient under saline irrigation i.e. wet environment. The safety is freedom from unacceptable risk i.e. from medical equipment inside the operating room in this example. The accidents will happen when unsafe conditions like exposed insulation sleeve of live electrical power cord and unsafe acts like surgeon touching power chord take place. The term Anzen means safety in Japanese language. Safety first is the philosophy of Toyota automobiles plants across the world. The risk identification, assessment and arriving at counter measures to mitigate can happen in any hospital wherein top management is supportive on this initiative and good work relation exists between the ground

STRATEGY staff and mid-level management like managers. The Anzen, Toyota way suggests the following four steps to be adopted to improve safety at hospital workplace. 1. First step is to keep the workplace clean and lean using 2 S methodology. First S i.e. Sort means that not needed items of current workplace are removed .This directly results into efficient utilisation of space. Second S i.e. Set in order means results in arranging all needy items with proper labelling and good visualisation in order to retrieve right item at right time from the right place. 2. The second step uses simple and yet effective proactive risk identification through KY (kiken yochi training). It has been noted that number of work related errors can be reduced by pointing and calling while doing certain activity like checking medicine in medication cart. Pointing and calling KY adopts technique wherein one person will point out target objects (eyes) by stretching arm (arm and finger) and stating out loud (mouth) and

In a high stress hospital environment, anzen technique is perfect answer for patient and staff safety.The hospital functional heads should look at work environment risk aspects besides employees, operations and equipment.The continuous education on risk mitigation and using tools like KYT, FMEA will reinforce safe culture at hospital listen own sound (eye) like example “Medicine stock is OO… OK”. Other person acknowledges it by saying 'OK' after verification. The risk identification using KY leads to next anzen step of risk measurement and adoption of countermeasures. 3. The risk assessment includes identification of hazards at workplace, estimation of the degree of hazard, possibility and severity of accident, evaluation of risk level, risk reduction measures for higher priorities and finally implementation of risk reduction measures. The degree of risk evaluated based on hazard is

calculated by referring to following risk evaluation table (A), (B) & (C). The risk evaluation point is summation of frequency of work, degree of accident, occurrence possibility. After calculation of risk evaluation point, the possible control measures to reduce risk need to be worked out. In continuation of earlier example of operating room, electrosurgical equipment is potential source of harm i.e. hazard. The medium risk is obtained through calculation of risk evaluation point (5 + 6 + 4) i.e. 15. Based on risk rank given in table shown, the following are

the possible hierarchy of control. ◗ Risk elimination ◗ Risk substitution by changing the working method ◗ Isolation of hazards like physical barrier, lockout ◗ Using engineering like guards ◗ Administration like signages,work instructions ◗ Usage of personal protection equipment According to each case, it is possible to arrive at appropriate measures using risk control methodology. The quick implementation of counter measures for high rank risk should be priority

for any hospital to achieve safe environment. In the example of electrosurgical unit inside OR it is possible to reduce the risk to (5 + 6 + 1) i.e. 11 through regular preventive maintenance of unit including accessories, establishing checklist for each equipment.The KY technique before start of surgery can be answer to quickly check the safety of operating room. 4. Once the appropriate measures are implemented on ground, the work instruction (standards operating procedures) need to be changed so that all the concerned members can get trained not only in that particular area but across all other places within hospital wherever conditions are applicable. In a high stress hospital environment, anzen technique is perfect answer for patient and staff safety. The hospital functional heads should look at work environment risk aspects besides employees, operations and equipment. The continuous education on risk mitigation and using tools like KYT, FMEA will reinforce safe culture at hospital.

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EXPRESS HEALTHCARE

December 2017

OPINION

Is it too early to talk of global health? Global ill-health can render even health-secure nations vulnerable in a seamless world. An insight by Bharathi Ghanashyam, Founder & Editor, Journalists against TB

wo major international health conferences were held in the past few months where some of the best brains from across the world converged to share the latest research and significant achievements in the healthcare sector. In these conferences, global health also came up for discussion. It was exciting to be part of the discussions as it held out hope that ‘health for all’ across the world, might soon become a reality. Ironically, at the same time, in Jharkhand, in India, there were reports of people dying of hunger because their Aadhaar Cards were not linked to their ration cards. This meant they did not get their monthly quota of subsidised food-grains from the public distribution system (PDS). To state the obvious, food is a vital and indeed the most basic requisite for health. Juxtaposed against the discussions on global health, the hunger deaths were stark reminders of how far we are from achieving global health, and how many obstacles were yet to be overcome. That there are still people in the world who are denied access to a very basic resource such as food highlighted the inequities that can render any discussions on global health empty rhetoric. But let’s begin at the beginning.

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December 2017

Equity and otherwise The most commonly accepted definition of global health is the “…health of populations in the global context; it has been defined as "the area of study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide…” – Koplan JP, Bond TC, Merson MH, et al. (June 2009). Definitions notwithstanding, in place of equity in health, we have two realities – one for the developed and another for the developing world. It begins with birth, continues into life and living, and ends with death. In place of health for all, what we have is actually a patchy, uneven and even unjust palette. We begin with equity which we cannot take credit for; it is the order of the Universe - every living being - plant, animal or human, goes through the cycle of birth, life and death. The inequities begin after that. Developed countries, having achieved health for all are finding ways to conquer diseases like cancer, or finding ways to enable better quality of lives for ageing populations because they are living longer. Developing nations are still struggling to gain victory over vector borne and water borne diseases, and other basic issues such as safe drinking wa-

ductive life are a dream for large sections of developing countries. Little wonder than that end of life too is fraught with inequity.

Pessimism or hard talk?

ter and food for all.

Through the life cycle It begins with birth – there are countries in the world where it is possible for every woman, regardless of whether she is living with diabetes, hypertension, HIV or cancer, can dream of safe motherhood because the medical system guarantees them access to the best healthcare. In others, even otherwise healthy women often don’t survive childbirth simply because they did not have access to quality care. The world is a safe place for babies born in the developed world, and an obstacle-ridden place for babies in developing countries, where they have to defy great odds to live beyond their fifth year. Life for those in developing countries is a struggle all the way. Shelter, assured livelihoods, adequate nutrition and primary healthcare, which constitute the requisites for a healthy and pro-

This piece might be painting a grim picture, but it is important to recognise that while global health is a good goal to aspire to, it is difficult to achieve. It takes a lot more than coming together to discuss it. Why does this situation exist? Why do some countries make such good progress while other leave large sections of their people behind? Is it size? Is it huge populations belonging to hugely varying economic strata? If yes, then it confounds because theories abound about the ease of working to scale. Why is that not applicable to health? In a somewhat conceptual, even philosophical article such as this, it might be out of place to talk figures and data. But the answers might just lie in allocation of resources, percentage of GDP and political will. Inequities exist here too – while there are countries which invest as much as 11 per cent of GDP or more on health, there are countries which spend as little as 2 per cent, and grudgingly at that. Little wonder then that global health is proving hard to achieve. What mechanisms do we

have in place to change the situation? It is yet another anomaly that for an issue as vital as health, we have soft options to bring the world together. With an issue that concerns the wellbeing of millions of people we only have declarations, pledges, commitments etc. etc. There are absolutely no actions that can put errant nations on the carpet. By the same yardstick, we show collective paranoia while policing nations that supposedly (or in reality), build or stock nuclear weapons. We impose sanctions and isolate these nations to keep them in check, when in reality it is not nuclear war but disease that will kill more people. In conclusion, global ‘illhealth’ is a bigger worry than the lack of global health. Because global ill-health can render even health-secure nations vulnerable in a seamless world. TB is a classic example. The refugee situations across the world, people travelling across borders on business and holidays provide an ideal situation for the disease to spread. No country is really safe in this context and it is only ‘global health’ in the real sense than can help. The cost of not getting tough on health is too high. So the discussions that have begun are relevant and timely. They need to be amplified and converted to action.

It’s a two-way street Rajiv Nath, Forum Coordinator, Association of Indian Medical Device Industry (AiMeD), gives an insight on the need to follow Indian norms by US medical devices manufacturers, like it is being done abroad by domestic companies EARLIER THIS year the National Pharmaceutical Pricing Authority (NPPA) capped prices of stents to end exploitative pricing and vulgar profiteering. Data collected by NPPA showed that cardiovascular stents were being sold by hospitals at extremely high markups (for example, 436 per cent for bare metal stents and 654 per cent in the case of drug eluting stents, on average). It is ironic thaton one side the whole world is applauding Government of India’s huge step of price cap towards making essential medical products available across the country at affordable prices, on the other side three US MNCs namely Abbott, Boston and Medtronic are trying to arm-twist Indian government to reverse its decision on price cap of medical devices in India and creating fault lines between India and the US relations. The first bogey raised by these importer MNC’s was their products demanded differential higher pricing when it was being decided that stents are an essential medicine and price capping was inevitable .However, they were unable to demonstrate superiority and clinical benefits to patients between

their own brands and other equivalent Indian brands to the NLEM committee appointed by MoH&FW. Post price caps, the importers protested against the unreasonably low price caps and claimed that this action would be harmful to patients as this move would deny access to innovative medical devices, hurt manufacturing in India and discourage FDI in medical devices sector. This was a blatant misinformation as NPPA and IMA had clearly spelled out that differential pricing for new range of stents could be considered in future subject to claims of superior technology to be backed by clinical data. The bogey went bust when Abbott Vascular, one of the US manufacturers was asked by the US FDA (US Food and Drug Administration), EU Regulators, TGA-Government of Australia and also by Drugs Controller General (India) to withdraw their Absorb Bioabsorbable Stent on charges of public safety concerns, since the ABSORB proved to carry higher side effects for the patients in terms of stent thrombosis globally. The price cap has resulted in simultaneously boosting domestic medical devices manufactur-

ing, increasing the market size due to higher affordable access. It is shocking to see how US MNCs are lobbying with the USTR for using threat of access to the US Market by Indian exporters to suspend or withdraw Indian exporters' import duty benefits under Generalized System of Preference (GSP) to arm twist the Indian government in creating differential pricing for US FDA approved stents. The facts are that it’s the Indian medical devices manufacturers who face discrimination in India and in the US. Every country encourages indigenous products as they would contribute to low dependence on the imported products but Indian stent manufacturers were challenged in our

own country. There were many government tenders where Indian companies couldn’t participate as the same had unfair specifications demanding an USFDA approved product. ◗ The US has TBT - Technical Barriers to Trade under US FDA, while these are near nonexistent in India for US device companies. ◗ Indian manufacturers are barred from selling to the US government-funded health programmes and defence as India is not listed in their TAA (Trade Agreement Act). ◗ Indian medical device manufacturers are discriminated as the US has a 'Buy American' policy. No such government support exists in India for domestic medical device manufacturers. ◗ The US FDA has increased registration charges by 33 per cent to 126 per cent w.e.f. 2018. This makes it very expensive for Indian manufacturers / exporters to register for the US as applicable fees for 510K registration is $10566 for each product compared to $4690 each in 2017 and pre-market approval for high risk devices is at $310,764 up from $234495. So a manufacturer would need to export and sell at least 50 to 100 times the value to justify absorb-

ing such high costs. The big question is should India bow to such threats to access the US market by group of three US MNC lobby when the US is itself suffering from highest healthcare costs in world and three times that of the UK? ◗ We call on the Government of India to uphold the constitutional obligation on right to health and reject any pressure to review reasonable price controls on medical devices. ◗ We ask that reasonable price controls are urgently expanded to cover 19 additional categories of medical devices classified as drugs ◗ We request the US government to investigate the unethical Trade Practices of US Medical Device companies indulge in India, which gives a bad name to the US. Such misinformation has potential to harm excellent relationships between world’s largest two democracies. ◗ We request the Indian government and CCI to expedite its investigation on reported anticompetitive practices in healthcare. If they have to sell in India they have to respect Indian laws and regulations same as we do when we sell to the EU/the US and other countries.

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December 2017

KNOWLEDGE

Aray of hope for silent heart attacks Winning many accolades, for the invention of a non-invasive technique of detecting silent heart attacks, 15-year-old Akash Manoj, promises to bring affordable and accessible healthcare in India. By Prathiba Raju

o you think that non-invasive methods of monitoring can be effective in early detection and prevention of silent heart attacks, which will save or even avert hospitalisation cost? Well, 15-year-old Akash Manoj a student in Tamil Nadu believes that non-invasive method has the potential to do so. Manoj has discovered a method of analysing a specific protein- FABP3 in the blood that can determine if a patient is at risk. He has invented a sensor, which could predict silent heart attacks. The portable and wearable sensor could effectively detect a heart attack several hours prior to an unlikely event. It is said that the sensor is close to 100 per cent accurate and it can detect the silent heart attack, in the earliest stages. The sensor consists of a sensor made up of silicone membrane that represents the skin capillaries, it looks like a skin patch which should be attached to the wrist or the back of the ear. It releases a small ‘positive’ electrical impulse, which will attract the negatively charged protein released by the heart to signal a heart attack. If the quantity of this protein – FABP3 -- is high, the person must seek immediate medical attention. Recipient of the President's award for innovation in 2017 by the then President of India, Pranab Mukherjee, Manoj was recently awarded gold medal (National Child Award for Exceptional Achievement), by President Ram Nath Kovind. His project on silent heart attack was chosen in Initiative for Research and Innovation in Science (IRIS) National Fair 2017 by Intel India, Department of Science and Technology (DST), Government of India and IndoUS Science & Technology Forum. The forum grant the most innovative independent research projects with awards and scholarships worth over

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December 2017

HOW DOES THE SENSOR WORK? ◗ ◗ ◗ ◗ ◗ ◗

It is a method were a unique spectroscopic technique is integrated with mathematical modelling; noninvasive method detects the protein levels immediately without taking a blood test The sensor detects FABP3 proteins levels, as a sensor band and it can be worn around wrist or back of one's ear and works 24/7 The patch uses a positively charged electrical impulse to draw negatively charged protein to the surface, if the amount of FABP3 is high, then the person would need immediate medical attention Anyone at risk of cardiac issues can use the device twice a day morning and at night The product will cost around ` 900, which will be cheaper than a glucometer It is a low-cost, rapid, simple, sensitive, selective, portable and wearable sensor

innumerable trial, I detected FABP3 protein.” He further explained, “On the onset of cardiac ischemia (a sudden, severe blockage of a coronary artery which can lead to a heart attack), the levels of protein keeps increasing absymally. So, I started to detect FABP3, a protein which is found at level close at 50ng/ml in a normal human being and its differentiation.” However, the research was not a cake walk for the young lad, as he had no laboratory access. The 11-year-old (then) mailed hundreds of professors, seeking mentorship but no one entertained a 8th class student. Finally, Manoj request was heard and he started to proceed with his research. “Although I had detected how to go about my research, to make the small-patch type-sensor-band it took me two long years to complete the non-invasive self detection of asymptomatic acute myocardial infarction using BioElectrics: A translational investigation of transcutaneous blood analysis.”

On the anvil $ 4 million. He will participate at the Intel International Science and Engineering Fair at Pittusburgh, US (May 13-18, 2018). Talking about his interest in science, Manoj informed that he had keen interest in reading medical journals but the idea to predict heart attacks came three years back, when his grandfather died due to a silent heart attack (asymptomatic). “The incident was an impetus for me to find a solution to this problem. My interest in reading medical journals now had a focus. I started to read and get an in-depth understanding of cardiology and current technology. I did research on what is silent heart attack in the Internet. I was surprised to know that over 85 per cent of all heart attacks go unnoticed just because

they cannot be diagnosed due to lack of absolute symptoms. Less than 2 per cent is the chance of survival. So, immediately the question that popped up is how can I make progress in diagnosing them.”

The eureka moment Learning that, there should be a way out, Manoj informed that he started to work on his innovation. He said, “I set up a scientific criteria that I should come up with a sensor, which would effectively detect a heart attack several hours prior to an unlikely event. My main objective was to come up with an inexpensive, rapid, simple, sensitive, selective, non-invasive and most importantly portable and wearable sensor.” Explaining about how he

derived to invent the sensor, Manoj said, “The framework to my invention was on the significant changes the organ (heart) undergoes before a total heart failure which eventually results in massive cardiac arrest. The heart keeps sending out SOS impulses before failing. I was wondering what those signals could be and how to detect it. The signal with which heart is reaching out is called a cardiac biomaker or a protein. While doing further research, I got to know that there are 8000 different proteins that are found before heart attacks. So I started to go through each of these proteins one by one, to see which one could serve as an optimal biomaker for a non-invasive detection of these asymptomatic heart attacks. After

Manoj informed that the sensor would cost around ` 900, which is cheaper than a glucometer. He intends to launch this product by next year. “I have already filed a patent. The device is likely to surface out for use to the public by the end of 2018. I would want the Government of India to take the project instead of selling it to a private company because it is for the public good and I want my device to reach people even from the remote locations of India,” he said. Further, Manoj aims to pursue clinical research medicine and study preventive cardiology at the country’s premier All India Institute of Medical Sciences (AIIMS) in Delhi. Manoj informs that his intent is to bring affordable healthcare to India. prathiba.raju@expressindia.com

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TRADE AND TRENDS I N T E R V I E W

‘Our mission is to empower eye care organisations with innovative technology’ Pellucid Networks aims to enable early detection and acceleration in avoiding preventable blindness. Rajesh Sukumaran, CEO, Pellucid Networks, in an interaction with Express Healthcare, talks about how the company has been able to help eradicate blindness with innovative technological support

Founded in 2008, it’s close to a decade for Pellucid Network to be working in eye care technology space. How has been the journey so far? With 7.3 billion population worldwide, there are 36 million people with blindness, 217 million with moderate to severe eye impairment. However, there are less than quarter of a million ophthalmologists. We need to address this gap. Our mission is to empower eye care organisations with innovative technology to upscale their functioning, maximise their efficiency. As an end-to-end solution provider in the healthcare sector, how do you see advances in technology impacting the eye care industry? Big and positive changes are brought in at primary care level, where a lot depends on early detection of eye impairment symptoms, right referrals and follow up till the corrective measure is taken. All of this is now possible in a systematic way.

We believe in not only delivering the perfect software solution, but an ongoing implementation support to our clients

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December 2017

Which healthcare providers in India are well equipped with tackling today's eye care issues? Eye health delivery is undergoing a huge transformation due to rise in diabetes, glaucoma and ageing population. Once abreast with an efficient medical system that

embraces technology, we can certainly tackle today’s health scenario. They should involve technological partnership right from the business planning stage, even before the foundation stone is laid down. It’s should not be an afterthought but at the core. What is the scope of operations for Pellucid currently? How big is the Pellucid team? We believe in not only delivering the perfect software solution, but an ongoing implementation support to our clients. We have undertaken successful implementation for many giants like Singapore National Screening Program, Drishti Eye Center (Nepal’s biggest private eye health network), Sightsavers and OEU. We're a team of 50+ and growing constantly with our base in Singapore and Chennai. Who are your competitors? From budding startups to large companies such as IBM are working in this space. A lot of technology providers that do not specialise in eye care are in the market or are venturing into the market. But in the end clients understand that these vendors are not always appropriate, as eye care providers have special needs. What makes Pellucid unique in eye caring space? Eye care like a lot of

specialities has an ecosystem starting with most primary eye care level which deals with basic eye screening of patients for refraction and cataract. They can dispense spectacles and for small surgeries or procedures refer patients to secondary level. Much severe cases are directed to tertiary care eye hospitals. We specialise in delivering comprehensive and integrated services capable of connecting the entire eco system. We have a wide range of solutions starting from mobility devices to advance HMIS to imagebased EMR system to client specific tele-ophthalmology solutions. What are the possibilities of artificial intelligence (AI) in eye healthcare? We have our own AI solution that's integrated to our screening software for diabetic retinopathy and we are now developing an AI platform for glaucoma screening. So, there is an endless scope for artificial intelligence in eye care. What are your future plans? We are very fortunate with getting business in eye care; our team is growing with plans to venture into newer markets. Don’t think we'll be slowing down anytime soon. EH News Bureau

Carestream exhibits new mobile X-ray system with carbon nanotube technology at RSNA DRX-Revolution nano nobile X-ray system offers reduced size and weight; helps enhance bedside imaging in critical care and inpatient areas CARESTREAM HEALTH exhibited its new CARESTREAM DRX-Revolution Nano Mobile X-ray System at the upcoming Radiological Society of North America tradeshow (Booth #6713). This system uses carbon nanotube technology to deliver significantly reduced size and weight when compared to existing mobile X-ray systems. It is scheduled for availability in 2018 and currently is not available for sale. “We are showcasing our commitment to continued technological advances by demonstrating a new generation of mobile X-ray systems with carbon nanotube technology that offers important productivity and ergonomic advantages,” said Jianqing Bennett, President of Digital Medical Solutions, Carestream. The DRX-Revolution Nano system is a lighter weight, non-motorised system that is easier to move and position even in cramped critical care areas. The new system includes: ◗ Fully integrated digital workflow ◗ Carbon nanotube technology and an advanced lithium iron phosphate battery that contributes to longer life ◗ Sleek design with enhanced visibility both over and around the system ◗ A compact footprint and total weight of about 200 pounds that make it easy to manoeuver and position in tight spaces; and ◗ Support for all Carestream DRX detectors. Carestream offers a comprehensive portfolio of mobile and room-based imaging systems to address the varying needs and budgets of healthcare providers. The company established its reputation for innovation with wireless DRX detectors that have dramatically improved radiology workflows. Carestream’s detector portfolio includes DRX Plus and DRX Core detectors available in a variety of sizes that are designed to meet the workflow requirements and budgets for healthcare facilities of all sizes. Contact details www.carestream.com/rsna

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December 2017

TRADE AND TRENDS

Importance of QC and medical standards for image diagnostic devices Ing Juergen Heckel, VP, Medical Business, Sales & Marketing, Global, Certified Medical Device Advisor, EIZO Corporation, gives an insight about contents of quality control process ACCURACY AND stability are the most important targets we have to achieve in healthcare industry for the best patient treatments. The visibility of cancer is very difficult and depends very much on the visible image contents and used equipment at the hospital. The doctors are only able to diagnose what is visible in special on the medical grade monitor so called image diagnostic device. Why Quality Control (QC) is important and what exactly will be controlled? For image diagnostic devices quality control means to check the ‘stability or also called constancy’ of the image device. Medical diagnostic monitors are already pre-calibrated at the factory side to DICOM Part 14 GSDF Standard in an optimum reading room environment (mainly dark rooms of 0lx). Most of the medical monitor manufactures offer their own optional special QC Software and sensors to periodically control and adjust the device onsite. Such QC is mandatory and highly recommended and unfortunately often forgotten. Having only the medical certification like CE mark label for medical or FDA510K certification does not replace the need of QC. It just shows the device is declared as medical device but does not show the accuracy. Let us understand step by step the contents of the QC process. At first the ‘Acceptance’ test will be performed. This is the test when the medical monitor will be installed at the first time and also depends on the working environment. Here the room ambient light will be measured and set between 0 and 100lx (Lux) for diagnostic. (for mammography it should be even darker between 0-50lx). By knowing the exact ambient room-light the brightness of the monitor will be set

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December 2017

as next via calibration. This means it is not enough just to unpack the new medical monitor and expect that the device works perfect in all environments all the time. The client environment is maybe different to the one the device manufacturer used at the factory side. For calibration there are various sensors available (inbuilt or external). After such calibration process is done the acceptance test can be performed. The test includes a visual check (here various DICOM test patterns will be shown to check the geometry but also contrast visibility), a greyscale test (the DICOM GSDF greyscale levels will be measured), a luminance test (the calibrated luminance will be controlled if reached or not) and finally the uniformity test (it controls the corner to centre uniformity of luminance and greyscale). Such an acceptance test is required one time at the first installation and will be repeated again only in case the working environment will be changed or in service cases. For dual monitor solutions the uniformity test also compares the performance on one and to both medical monitors to each other. The second QC control function is called ‘Constancy’ test. With the constancy test

the stability of the medical monitor could be understood. Here the actual performance of the medical monitor will be checked and compared with the one done during the acceptance test and aligned with the selected medical standard (e.g. AAPM, IEC or DIN). Constancy tests include more or less the same four steps as the acceptance test but require this periodically (at least every six months). In case the medical monitor does not pass the constancy test, the medical monitor requires some adjustment also so called ‘Calibration.’ With the calibration procedure, the medical monitor will be re-adjusted and corrected. Normally after such adjustment method the medical monitor pass then the needed re-

quirement following the selected medical standard. Medical monitors have several components embedded which deteriorates over the life time and because of such parts a ‘maintenance’ and calibration is mandatory to keep the accuracy for diagnostic purpose. Some components are, say for example, the LCD panel module and backlight. If such calibration and QC testing process are missed, the brightness may drop or the uniformity decrease which will end in a dramatic impact on the medical DICOM image and small details may not be seen anymore. It can cause a misreading from the doctor. In such cases, the doctor has no chance to proceed an accurate patient treatment. QC is also extremely important because doctors exchange images within their hospital network but also with tele-radiologists. Even the patient image data will be periodically compared on the image diagnostic devices and have to appear in same contents even after years. The QC is taking care of geometry issues like flicker, artefacts, pixel failure check etc. For such tests, various test patterns are available and embedded in medical standards. The QC Software of the medical

monitor manufacturer supports all medical standards. There are various medical global standards available for example from IEC (worldwide), the USA QC Guideline of AAPM /ACR or the German industry standard DIN and others. In their contents, they are all very similar and matched. The test patterns for the visual check are DICOM based and most of the cases from AAPM TG18 or SMPTE. In terms of brightness, they are almost the same by recommendation of 350cd/m2 for general diagnostic and 450cd/m2 for mammography. There are currently initiatives worldwide to harmonise several existing standards into one global reference standard. Thanks to the existing and future medical standards, the image diagnostic devices can be better understood in their benefits and limitations for better patient healthcare. Medical standards needs to be updated periodically because the equipment is improving so fast. Such standards will be created by several stake holders like medical physicists, industrial experts, doctors and legal experts. Standards will help to improve the accuracy in diagnostic. Some links: AAPM (AAPM TG18/ACR) http://www.aapm.org DIN (6868-157) https://www.din.de/en/ IEC (62563-1) http://www.iec.ch Contact details EIZO Corporation A-5101 Bergheim, Dorfstrasse 15/2 Mobile: +43 664 8440782, Mobile (UAE): +971523381264 E-Mail: juergen.heckel@eizo.com Web: www.eizoglobal.com

TRADE AND TRENDS

PPPs in healthcare: Need of the hour Vivek Tiwari, Founder and CEO, Medikabazar, elaborates on how collaboration between the public and private sectors of the healthcare industry would foster PPPs and encourage investment in India's healthcare sector HEALTH OF the nation is the lifeline for its well being. It is the aggregation of the health conditions of its citizens. The Indian healthcare sector is one of India’s largest sectors, in terms of revenue and employment, and the sector is expanding rapidly. It has emerged as one of the most challenging sectors in India and is expected to reach $280 billion by 2020 with an annual growth of 17 per cent. The Indian healthcare delivery environment is facing distinctive challenges. Inadequate infrastructure and inefficient healthcare delivery process further intensifies the complexity. It is estimated that almost 15 per cent of India’s population, has absolutely no access to healthcare services, either due to unavailability or economic reasons. Around 75 per cent of doctors practice in urban areas and 23 per cent in towns, while only 2

per cent practice in rural areas leading to very low availability of healthcare in rural areas. The Indian healthcare system consists of players from public sector, private sector and other informal networks. The very size, scale, and spread of India are a huge challenge. The industry is largely fragmented with independent and privately run hospitals and health centres. It operates in a largely unregulated environment, with minimal controls on the type of services to be provided. This is further complicated by the usual Indian tendency to lack of standardisation and minimal compliance though there are norms and guidelines. These challenges can be addressed efficiently through combined efforts of both public and private sectors by forming suitable public policies especially for healthcare delivery and incen-

tivising financing and provision of healthcare, and thereby increase healthcare access to the people. The collaboration between the public and private sectors of the healthcare industry, would foster Public Private Partnerships (PPPs) and encourage investment in healthcare sector to shape the future of Indian healthcare Industry. There are five major indicative areas where PPP could be introduced as a synergistic model to achieve the objectives

of Indian healthcare sector and the business objective of running a beneficial healthcare facility. The five areas where PPP contribution can prove very valuable are: ◗ Infrastructural development Development and improvement of healthcare infrastructure to ensure that services are evenly distributed geographically and at all levels of healthcare (primary, secondary and tertiary healthcare) ◗ IT Infrastructure of the industry – Establishing IT as the backbone of healthcare in the industry for easy data management and easy and uninterrupted access to healthcare. ◗ Systematic operations and management – Involvement of PPP in operations will ensure efficient services and quality operations and management of healthcare facilities. ◗ Education and training – Edu-

cation for formal education and continuing education of professional, paraprofessional and ancillary staff engaged in the delivery of healthcare ◗ Financing mechanism - Creation of voluntary as well as mandated third-party financing mechanisms. The private sector investments in healthcare have been driven by free market economy, and the pricing of healthcare services has been largely influenced by investment cost. Consequently, these services have remained out-of-reach of a large majority of our population due to cost consideration. In order to make PPP as a sustainable common ground for both public and private sectors and to evolve successful PPP models, it is essential to have clarity of the public and private sector positions and develop unambiguous criteria for assessing PPP models.

respons 5H: Innovation revolutionising 5 part differential cell counter technology Harshad Bhanushali, Product Manager, DiaSys Diagnostics India, gives an insight on espons 5 H, an innovative five part differential haematology analyser DIASYS DIAGNOSTICS India, a subsidiary of DiaSys Germany, is in the Indian diagnostic market since 2014. It has introduced a variety of new and innovative tests and analysers. With the introduction of respons 5H, an innovative five part differential haematology analyser, DiaSys announced its foray in the field of haematology complementing its vast portfolio in biochemistry, urine analysis and point of care. With a footprint of A4 size paper and weighing only 9.4 kilograms, this is the new gen-next instrument in the field of five part cell counters currently present in Indian IVD market.

respons 5H: Cutting-edge technology respons 5H is equipped with many exiting features. Some of them are listed below: ◗ Shear rotary valve: respons 5H is one of the very few analysers that uses a shear rotary valve (SRV) for sample aspiration. The sample volume aspirated is < 25 µL and processed volume is just 2 µL. ◗ Just one drop of blood required!! ◗ Microfluidics: respons 5H utilises microfluidics in a miniaturised module resulting in very low sample volume and thus very low reagent consumption. 70 per cent less reagent con-

sumption than other analysers. ◗ Economic operations. Low running costs. ◗ Teflon tubing: Unlike majority of the analysers, respons 5H utilises 100 per cent Teflon tubing resulting in very less wear and tear and thus low maintenance. ◗ Elegant design with userfriendly software: Very simple and self-intuitive software which helps user navigate easily through the software. ◗ Just like a smart phone!! Remote access: Remote access tool gives the engineers an opportunity to connect with the analysers greatly reducing its down time!!

Respons 5 H is a state-of-theart instrument with an elegant design, smallest footprint, measuring principle of laser based flow cytometry and volumetric impedance method along with microfluidics, reporting 26 parameters with 2 histograms and 1 scattergram, utilising only three reagents in the smallest of quantities, large LCD-based touch screen with a very easy user interface. With respons 5H, we also aim at going green with use of low volume cyanide free reagents, thus generating very low waste, less power consumption and avoiding paper printing by using Ethernet, Wi-Fi, mails and other

options to share the results directly from the instrument to the end user. Contact details DiaSys Diagnostics India Plot No. A-821, TTC Ind. Area, Mahape, Navi Mumbai - 400710 Mobile: +91 9029023012 Fax: +91 (022) 3371 4333 E-mail: harshad.bhanushali@ diasys.in Web: www.diasys.in

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TRADE AND TRENDS

Keep headache at bay Dr Shamsher Dwivedee, Chairman, Institute of Neurosciences, gives an insight on various types of headaches and what preventive measures should be taken to control them HEADACHE IS one the common symptoms which every human being experience at sometime in their life. Headache generates a lot of anxiety because of associated fear of diseases like brain tumour. One must know the red flags for a sinister headache, which are as follows:◗ Severe headache at onset, which progresses rapidly ◗ Accompanied fever, irrelevant talk, drowsiness, double vision, recurrent projectile vomiting, slurring of speech, weakness in any limb or difficulty in walking ◗ Any new character of headache which was always existing for years,onset of headache after age of 45 Most of the chronic

headaches are not caused by life endangering diseases, but they affect the quality of life. It can lead to depression and have a negative impact on the personal and professional life. Migraine and tension-type headache constitute the bulk of headache patients in a neurology clinic. Tension-type headache is associated with a gripping sensation or heaviness anywhere in head, nape of neck and shoulders. It is commonly associated with depression and anxiety. Tension type headache tends to persist for longer periods of time. Migraine on the other hand appears like a bolt from the blue with or without any warning symptoms like blurring of vision, tingling, giddiness etc.

and is associated with the throbbing headache anywhere in head, nausea, vomiting, dislike for light and sound. They

tend to happen as episodes. It is when such migrainous episodes happen more than once a week, do we introduce migraine preventive medication or else we treat the episodes with suitable pain killer One has to rule out toothache, jaw joint diseases, ear infections, cervical spine diseases, bleed inside brain, brain infection, excessive use of substances and medications particularly pain killers and alcohol etc. These are known as secondary headaches. Certain lifestyle modifications are helpful to prevent and reducing headaches: Exercise, relaxation, meditation and quiet environment helps in tension-type headache

as well as migraine. Professionals who work for long hours on desk jobs should take intermittent breaks for 10-15 minutes and gently move their neck and shoulders to reduce spasm. Patients suffering from migraine should avoid exposure to bright sunlight,erratic sleep timing, prolonged fasting or delayed meals, cheese, chocolate Chinese food too much of tea, coffee and cola drinks, preserved food and alcohol. Strong odours as well as direct exposure of head and face to cold or hot can also trigger or increase headache frequency. Understand your headache, seek a neurophysicians help and improve your quality of life.

Sudden cardiac death, the killer Dr TS Kler, Chairman, PSRI Heart Institute, elaborates on sudden cardiac death and ways to prevent it SUDDEN DEATH is defined as any death occurring within one hour of start of symptoms. More than 95 per cent of sudden deaths are cardiac in nature. Non-cardiac sudden deaths can occur due to major bleeding into brain, massive bleeding in the tummy cavity or chest like rupture of aorta (major blood vessel carrying blood from heart to various organs of body). It can also occur due to severe allergic reaction called anaphylactic reaction. So, majority of sudden deaths are heart related. Sudden death occurs due to severe slowing of heart beat (Bradycardia) or very fast heart beat (Tachycardia). In both the situations of bradycardia and severe tachycardia, heart is not able to pump enough blood into aorta and there is severe drop of

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blood pressure and all the organs especially brain and heart don't get enough blood for their functioning, causing death. Sudden cardiac death usually occurs when there is already significant decrease in the pumping capacity of heart, technically called left ventricular ejection fraction. The chances of sudden cardiac death are many fold when Left Ventricular Ejection Fraction (LVEF) drops below 35 per cent. This drop of LVEF may be due to old heart attack or disease of heart muscle called cardiomyopathy. Sudden death in these patients occurs due to rhythm problems arising from the lower chambers of heart called ventricular tachycardia or ventricular fibrillation. In ventricular tachycardia, usu-

ally there is some blood pressure, but in ventricular fibrillation blood pressure is practically zero and is akin to cardiac arrest. In both ventricular tachycardia and ventricular fibrillation, the most effective and reliable method to save a patient is to give electric shock on the chest and cardiopulmonary resuscitation. Minority of sudden cardiac deaths occur due to major heart attack causing again ventricular tachycardia or ventricular fibrillation though the patient may be totally healthy prior to this attack. Very few sudden cardiac deaths occur in apparently healthy people who are prone to get ventricular tachycardia or ventricular fibrillation due to underlying electrical problems of heart like hyper-

trophic cardiomyopathy, arrythmogenic right ventricular dysplasia and brugada syndrome. Many of these three diseases run in families. So, a history of sudden death in the family should lead to screening of other family members for presence of these rare disorders. Can we prevent sudden cardiac death? Yes, to a major extent. Following preventive actions can be of great value. Prevent damage occurring to heart muscle by avoiding coronary artery blockages by proper diet, regular exercise, controlling cholesterol, blood pressure, diabetes, doing yoga and meditation. Immediate treatment of heart attack by angioplasty or clot dissolving drugs can prevent heart damage and sudden.

TRADE AND TRENDS

Atechnology enterprise that aims to empower and improve a billion lives Archana Samudra, VP, Marketing & PR, Clinivantage, gives an insight on how Clinivantage has developed path breaking, patient-centric healthcare information technology (HIT) innovation that facilitates in maintaining optimal health of providers and consumers

CLINIVANTAGE Healthcare Technologies, a London-based technology company, is marking its presence in India by reaching out to private as well as public healthcare sectors. Clinivantage Healthcare Technologies is a bespoke technology product and solutions provider organisation delivering information management and analytics value propositions to the healthcare industry on proprietary framework. Clinivantage has developed path breaking, patient-centric healthcare information technology (HIT) innovation that facilitates in maintaining optimal health of providers and consumers always, through a connected healthcare ecosystem, that touches and enriches every element of healthcare industry, independently yet with seamless connectivity. Top-notch expertise, jointly, from the fields of healthcare, IT and manufacturing have made every solution of Clinivantage most realistic and usable for every element of healthcare space, as every solution address the exact pain areas rather than create complications generally caused by introduction of technology for digital empowerment. Clinivantage applications and technology help provide life value for health services accessed through healthcare system for a customer. They improve the clinical outcomes through seamless IT framework. The workflows are designed to help healthcare professionals measurably improve clinical outcomes and develop sustainable

health IT-enabled quality measurement. This aids largely in success of the health improvement programmes. Clinivantage applications are meant for extreme easy adoption by the end users making this crucial technology transformation a cake walk for all. The company has stepped into the Indian healthcare scenario with the mission of bringing more efficiency, transparency and cost-optimisation in healthcare delivery, by being the torch bearer of digital healthcare delivery in India, as well as the global markets. It wishes to get acknowledged for its passionate people, high professional standards and best practices. Clinivantage wants to leverage the power of cloud technology in its mission for combating illness and promoting wellness. Clinivantage is giving a new momentum to the entire healthcare ecosystem, making it work in tandem to provide better outcomes for patients and improved productivity resulting in profitable care for providers. Clinivantage is poised to be the game changer in global healthcare landscape. Standing at the crossroads of multiple technologies viz. cloud, mobile, medical and social, Clinivantage spearheads the practice of digital medicine. Clinivantage puts patients in greater control of their health. It is an integrated digital platform that connects doctors, hospitals, caregivers and service providers with the patient in real time. Placing the patient at the focal point in the healthcare loop, Clinivantage

brings speed, simplicity, transparency and efficacy to patient care. Digital empowerment of healthcare consumers can be had with the help of IoT and BoT inclusion in its HIT platform. Clinivantage provides a predictive tool to manage health, foster preventive measures and enable chronic disease management much easily for caregivers as well as the patients. Clinivantage solutions are highly scalable and capable tools successfully encompass healthcare services from a single provider to up to the largest healthcare facilities. Similarly, while managing population health records, these applications glide equally as smooth. Secured and legal health information transfer and interoperability are those keys which enable Clinivantage tools transform healthcare management to wellness management. What is it that makes Clinivantage a venture so unique and different? ◗ ‘Team Clinivantage’ is a fac-

tor that has influenced superiority in their unique platform and every tool operating through this platform ◗ Clinivantage has been founded by an international team of senior doctors with proven track record and a compelling vision to change care delivery ◗ A core team with experience building and deploying healthcare technology for the last two decades with all the best practices and lessons learnt ◗ Members of the founding team have international consulting experience in people, process, and technologydriven transformation delivered globally and at scale ◗ The analytics expertise of the team includes data scientists, big data, and predictive analytics for healthcare domain ◗ Clinivantage mentors have a strong track record of incubating more than 20 early stage startups all the way from seed through series A and second round of funding The team has a remarkable flair for healthcare space, which is what has led them to take up this venture and through it make healthcare a ‘wellness management’ space for healthcare providers as well healthcare consumers. They have taken every care while developing the tools to make them a person’s strength rather than an added burden of clatter and unnecessary information. Highly advance technology used by Clinivantage to build the connected healthcare ecosystem, assures complete privacy and security of every health data. This can be done with the help of IoT (DoT) and

resources that support the coordination of patient care and treatment, across an increasingly diverse landscape of providers and clinical settings and across multiple settings. Clinivantage solutions effectively manage risk of increasing costs associated with non-compliance across a broad spectrum of legislation and regulation. The management of costs is an integral component of the healthcare value equation, so risk management is a developing competency that we deliver to provider and payer organisations. Clinivantage tools use and analyse data captured in the healthcare setting and across the healthcare ecosystem and applies directly to inform decision-making, to positively impact patient care delivery, health outcomes and business operations. Clinivantage tools encourage healthcare providers towards safe, secure mobile and wireless management of their consumers while engaging the patients with their doctors, while successfully doing selfhealth management and planning prevention strategies. The fact that Clinivantage is extending its services to both the public and private healthcare sectors has enriched their platform and tools as per the critical and regular requirements of each of these. This has lead to essential maturation of the products, so much so that they have already made their mark successfully. Clinivantage Healthcare Technologies is proving to be a new star on the healthcare IT horizon.

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TRADE AND TRENDS

Saving lives beyond hospitals Dr Karthik Anantharaman, Chief Marketing Officer (VP-Marketing, Global Markets), BPL Medical Technologies, gives an insight on DF 2628, a revolutionary product that is designed and built to save lives SUDDEN CARDIAC Arrest (SCA) may occur to anyone, anywhere, anytime. A leading cause of death among adults over the age of 40 is heart attack or cardiac arrest. Electrical defibrillation is a proven and effective therapy for cardiac attack. DF 2628 from BPL Medical Technologies, an automated external defibrillator, is a revolutionary product that is designed and built to save lives. A compact and lightweight defibrillator, DF 2628 automatically analyses and records the patient’s ECG and prepares an electric shock. The patient’s ECG is acquired through disposable electrodes applied on to the patient’s chest and if a shock rhythm is recognised, the device guides the user to deliver shock to the patient through the electrodes. A user-friendly device, DF 2628 can easily be operated by lay responders or bystanders successfully with little or no training at all. The device is equipped with easy to understand audio and visual prompts. It uses current controlled biphasic defibrillation waveform for shock delivery, thereby ensuring that the current is optimal and thus damage of the heart tissue is mini-

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mal. The device has self explanatory illustrations and illuminated symbols for ease of use. It is ideal for use in public places such as shopping complex, airport, railway station, bus stand, stadia, technology parks, fitness centres, offices,

medical centres etc. by minimally trained personnel. DF 2628 can store a maximum data of four events or typically three hours of ECG data. The device has automatic self-tests for ensuring operational readiness and de-

livers metronome signal tone for synchronising chest compressions. A signal tone is set for patient movement detection. The bluetooth interface of the device enables its communication with PCs. Public access defibrillation

poses unique challenges and BPL Medical Technologies has been successful in delivering AEDs such as DF 2628 that can be operated easily, even if the operator is a first-time user with minimal training.

TRADE AND TRENDS

The robot is finally here! Robotic technology takes surgery beyond the limits of human hand, introducing precise, versatile instrument movement FOR OVER five decades, surgeons at Ruby Hall Clinic have been at the forefront of surgical care while refining its techniques. We’re now changing the experience of surgery for the surgeon, the hospital and most importantly for the patient. Robotic technology takes surgery beyond the limits of human hand, introducing precise, versatile instrument movement. Revolutionary surgical technology has arrived at our hospital and it is in the form of a robot named the da Vinci Si Surgical System. The robotic system is named after Leonardo da Vinci, inventor of the first robot who was known for his unparalleled anatomical accuracy and 3-D details that brought his masterpieces to life. With the addition of the da Vinci, our surgeons now have

helping hands in the operating room, providing enhanced dexterity, fine motor skills, precision and control during minimally invasive procedures and even multi-quadrant surgeries doing wonders to our surgical prowess. Our multi-disciplinary team now uses the robot in a number of specialist fields: ◗ Gynaecology Utilising robotic technology, surgeons are able to treat many women who have complex gynaecological problems, that traditionally would require large abdominal incisions resulting in significant postoperative pain, blood loss and scarring. ◗ Urology Our robotic surgical system can be used to treat all urological procedures ranging from prostatectomy, cystectomy,

With the addition of da Vinci, surgeons now have helping hands in the operating room, providing enhanced dexterity, fine motor skills, precision and control during minimally invasive procedures

partial nephrectomy, pyeloplasty, uteric re-implantation and bladder augmentation. Doctors now have the opportunity to perform more intricate procedures for prostate, kidneys and bladder with minimally invasive incisions.

ment have made it possible to reach these tumours through the mouth by using robotic technology.

◗ Oncology Our experienced surgeons are leaders in performing minimally-invasive procedures for prostate, kidney, breast, ovarian, colorectal, gastrointestinal, pancreas and thyroid cancers, amongst others.

◗ General Our surgeons are national leaders in using conducting weight-loss surgery, including gastric bypass, adjustable band and revisional bariatric procedures. Using the robot’s micro-instruments, our surgeons can meticulously navigate inside the abdomen, while protecting the surrounding tissues and intestines.

◗ Head and Neck ENT Tumours in the throat, base of the tongue, and tonsils can be a technical challenge to reach and have traditionally been removed through surgeries requiring a large neck incision and cutting of the bottom jaw. Advances in surgical equip-

Contact details Ruby Hall Clinic 40, Sassoon Road, Pune 411001, India Mobile: +91 9890033047/ 9890300507 Tel: +91 20 26163391 Email:info@rubyhall.com Website: www.rubyhall.com

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TRADE AND TRENDS

RelyEon devices: Provides high-quality guide to complete safety ADD Technologies [India] Limited [ATIL], has launched an innovative solution RelyEon, which offers security solutions in the form of most efficient and trustworthy gadgets, to ensure utmost safety and security RELYEON- GPS Based ID card Relyeon GPS-based ID Card helps you ensure round-the-clock safety of your employees with the help of GPS-based monitoring. Some of the key features of Relyeon GPS ID card are listed below: ◗ The real time tracking feature helps you instantly locate your employee/sales executive anytime, anywhere -- even when you are away from your office/home. ◗ The voice monitoring feature enables you to always be aware of your employee’s valuables as well as surroundings, by capturing and transmitting the sounds and voices near the device to you in real time. ◗ The geo-fencing feature automatically sends out alerts to different numbers when the device exits a geographic area predefined as safe. This way, one can ensure that employee or sales executives do not venture into the areas they are not supposed to and stay safe. ◗ Two way communication allows employee to communicate with you (registered mobile number) directly through the ID card or watch or pendent. ◗ SOS panic button sends alerts through SMS, email or call on the registered mobile number.

Relyeon GPS Vehicle Tracker Relyeon GPS vehicle tracker helps individuals, organisations, and fleet operators to monitor the movement of their on-road vehicles. Some of the key features of the vehicle tracker are given below: ◗ Real time tracking helps you instantly locate your moving vehicle anytime and from anywhere. ◗ Sleep mode raises an alarm in case of unauthorised movement or theft of your vehicle is detected. ◗ ACC/Ignition On/Off alert gets activated in case your car's ignition is turned on without your consent. ◗ Geo-fencing sends out alerts to different numbers when your vehicle exits an area that is beyond the predefined safe route. ◗ Relyeon vehicle tracker device records the vehicle tracking history which can later be played back to know the exact route the vehicle has travelled. This information can also be downloaded for record or future reference. ◗ The device has a separate, fleet management feature immensely useful to fleet operators who want to keep a tab on their vehicles round-the-clock. ◗ The Voice Monitoring feature allows you to hear the voices and sounds inside your vehicle. ◗ The immobilise option allows you to remotely halt the vehicle once its speed drops to 20 kmph or below. ◗ The people inside the vehicle can use SOS panic button to send alerts through SMS, email or call on the registered mobile number. Contact details ADD Technologies(India) Ltd No. 16, Apple Villa, 3rd Floor Left Wing, Lalbagh Road, Bangalore - 560027 +91 80 22110461 / 62 / 63 Mob: +91 9448999830 / 31. Fax: +91 80 41514170 email: info@addtech.in

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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