Express Healthcare July-2012 by Indian Express

INDIA’S FOREMOST HEALTHCARE PUBLICATION VOL. 6 NO.7 PAGES 128

July 2012 ` 50

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INSIGHT INTO THE BUSINESS OF HEALTHCARE

INDIA’S FOREMOST HEALTHCARE PUBLICATION VOL. 6 NO.7 PAGES 128

July 2012 ` 50

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August Issue www.expresshealthcare.in

INSIGHT INTO THE BUSINESS OF HEALTHCARE

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Knowledge Regulating ART Page 73

IT@Healthcare

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Express Healthcare reviews the major players in Eastern India who are involved in the making of India's healthcare success saga Page

‘Indian healthcare sector is gradually moving from preventive to curative healthcare’

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VOL 6. NO 7, JULY, 2012

Chairman of the Board Viveck Goenka

Market

Strategy

Editor Viveka Roychowdhury* Assistant Editor Neelam M Kachhap Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das MARKETING Deputy General Manager Harit Mohanty Senior Manager Tushar Kanchan

Mending marketing mistakes in healthcare ............................79

Assistant Manager Kunal Gaurav PRODUCTION General Manager

Hospital Infra

B R Tipnis Production Manager Bhadresh Valia Asst. Manager - Scheduling & Coordination Arvind Mane Photo Editor Sandeep Patil DESIGN

Page 17

Asst Art Director Surajit Patro Chief Designer Pravin Temble Senior Graphic Designer

An achievement, not just for AHI but also for the country

Rushikesh Konka

and the Indian healthcare sector as a whole ........................22

Layout

We plan to open 25 short-stay centres in

Rajesh Jadhav

next five-seven years ..........................................................22

CIRCULATION

Lovely Professional University (LPU) scientists develop

Circulation Team

‘anti-cancer medicine’..........................................................24

Mohan Varadkar

Medica Synergie : Ushering new trends in hospital infra with Sankara Nethralaya ..............84

Radiology

Trivitron Healthcare shifts focus to critical life support Express Healthcare

solution segment ................................................................24

Reg. No. MH/MR/SOUTH-252/2010-12 RNI Regn. No.MAHENG/2007/2045 Printed for the proprietors, The Indian Express Limited by Ms. Vaidehi Thakar at The Indian Express Press, Plot No. EL-208, TTC Industrial Area, Mahape, Navi Mumbai - 400710 and Published from Express Towers, 2nd Floor, Nariman Point, Mumbai - 400021. (Editorial & Administrative Offices: Express Towers, 1st Floor, Nariman Point, Mumbai - 400021)

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BGI, GE Healthcare team up on pioneering stem cell science projects ....................................................26 Jyot-Se-Jyot campaign reaches Mumbai ................................27 Centre for Sight expands network in Chandigarh, Punjab and Haryana ............................................................28 Philips' new greenfield healthcare manufacturing facility in India ..............................................................................28 SRL introduces ‘Universal Genetic Test’ in India....................30 Medtech industry survey highlights globalisation challenges ..31

Interventional radiology: Coming of age... ....................89

Regulars

prohibited.

Letters .........................................................................................................................................................16 JULY 2012

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Editorial

Indian healthcare: the east evolution ccording to an April 2012 Espicom report, West Bengal's 294 government hospitals

and community health centres, mainly in urban areas, account for a total of 54,759 beds, equivalent to 0.6 per thousand population, similar to the national average of 0.5.

The fact remains that West Bengal, as well as the other states in East India, (Bihar, Jharkhand and Odisha) remain under-served in terms of healthcare facilities

The Espicom report titled, Understanding Indiaâ&#x20AC;&#x2122;s Regional Health Markets, also throws

up an interesting fact: pharmacists seem to outnumber other healthcare staff like doctors, dental surgeons, nurses and midwives. West Bengal had 58,872 registered doctors in 2010 at a rate of 0.6 per thousand population, slightly less than the national average of 0.7. Likewise the state has only around 0.02 dental surgeons per thousand population and 0.5 registered nurses and midwives per thousand population; significantly less than the national average rates. There is however around one pharmacist per thousand population, which is approximately twice the national average. These facts are not at all surprising and follow the national trend. In this issue's Best of East special, we focus on the private healthcare sector, which has both national hospital chains as well as regional players vying for a share of the market, as well as making a mark by bringing to the city, and to the Eastern region, top class speciality care. But the fact remains that West Bengal, as well as the other states in East India, (Bihar, Jharkhand and Odisha) remain under-served in terms of healthcare facilities. A reader writes in to tell us about the southern part of Odisha where a "medical facility is a dream for many people" with patients having to go to Vishakapatnam for medical care. We intend to cover the evolving healthcare scenario in the East once again this December and by that time we hope we can expand this review to include more healthcare success stories. The Government of India meanwhile seems to have decided to follow a â&#x20AC;&#x2DC;pro-poorâ&#x20AC;&#x2122; path, at least as far as medications are concerned. According to a Reuters report, the government will provide doctors in public health facilities free generic medicines and has allocated $5.4 billion towards this plan. Pharma industry observers note that generic medication from reputed generic manufacturers are fine, but the government should not implement this scheme unless it puts a strong quality control and supply chain mechanism in place. Concerns are being raised that smaller fly-by-night operators, who may not adhere to good manufacturing practices and quality control mechanisms, could infiltrate the supply chain and release medicines of questionable quality. There have reports of seizures of medicines with varying amounts of the active ingredients and worse, spurious ingredients as well. While the intent is good, one hopes that the content also follows through. Viveka Roychowdhury viveka.r@expressindia.com

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Letters QUOTE UNQUOTE

Healthcare for all â&#x20AC;&#x201C; still a distant dream? would like to draw your attention to the southern parts of Orissa where medical facility is a dream for many people. Here, we have to depend on Vishakapatnam for our medical needs. So I, on behalf of the common people of this area, request the industry to establish a hospital with all facilities at Jeypore Odisha.

This move was pending for quite some time. With a budget deficit hovering around six per cent and the economy poised to achieve a growth of only six per cent this year, it will be interesting to see how the Government manages to accrue funds for making this policy a success. Even with the policy in place in Rajasthan and Tamil Nadu the stark reality is that medicines are out of stock in almost all clinics. The real challenge for the government will be to check leakages in the system. This policy might not be successful like the MNREGA scheme if proper checks are not kept. Second challenge will be the procurement process. If the medicines are not procured directly but via third parties then there is a huge possibility of supply of inferior drugs. Another challenge is that medicines hardly constitute 25-30 per cent of all healthcare expenditures. The real cost is the delivery of the services; the government has not been successful in building the necessary infrastructure and human resources in the last three decades. Dr Ajay Kumar Sharma

Nishan Pattanaik, Orissa

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JULY 2012

UPFRONT Maharashtra CM calls for a â&#x20AC;&#x2DC;tobacco-freeâ&#x20AC;&#x2122; state

he Tata Memorial Centre released the Global Adult Tobacco Survey (GATS) fact sheet for the Maharashtra region. It provides estimates on tobacco use, exposure to secondhand smoke, and quit attempts among adults in the region. It also indirectly measures the impact of tobacco control and prevention initiatives of the state. The GATS indicates that knowledge levels regarding the hazards of tobacco use among adults have been observed to be relatively high (85.9 per cent of those surveyed believed that smokeless tobacco causes serious illness and 86.4 per cent believed that smoking causes serious illness), however current prevalence of tobacco use is still high with 31.4 per cent adults using tobacco in any form (among whom 42.5 per cent are males and 18.9 per cent females). Maharashtra is one of the largest consumers of tobacco in the country. Tobacco use is the leading preventable cause of premature disease and death in the world and kills up to half of those who use it. In the 20th century, the tobacco epidemic killed 100 million people worldwide. During the 21st century, it is estimated that it could kill one billion and hence containing this epidemic is a top public health priority. The report comes at a time when the Maharashtra Government is considering a ban on gutkha products to implement the Food Safety and Standards Act (2011). Data in the GATS report clearly illustrates the need for a gutkha ban in the State as soon as possible. 27.6 per cent adults surveyed in the GATS reported using smokeless products (Males- 35.3 per cent and Females-18.9 per cent). Maharashtra CM, Prithviraj Chavan said that the Maharashtra Government is committed to take strict action against violators of the Cigarettes and Other Tobacco Products Act. He said that the Government is looking forward to a 'tobacco-free' Maharashtra with the proposed ban on gutkha in the state.

Market An achievement not just for AHI but also for the country and the Indian healthcare sector as a whole

We plan to open 25 short-stay centres in next five-seven years

Page 22

EH News Bureau JULY 2012

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M|A|R|K|E|T amous American economist, Ted Levitt, once said, “Just as energy is the basis of life itself, and ideas the source of innovation, so is innovation the vital spark of all human change, improvement and progress”. This is the maxim that the Indian medical technology industry needs to adopt to spark off the change which will help improve the current healthcare system within the country. However, the first query that comes to mind is how can the Indian medical technology industry foster this change? Let’s start off by understanding the current healthcare sector in India that runs in a paradoxical environment. On one hand we have healthcare centres that boast of high-tech facilities, medical tourism and specialised care and on the other hand, the country battles with the affordability and accessibility factor. In such circumstances, adding infrastructure, and generating employment for medical professionals alone will not serve the purpose. The system needs to be backed by medical technology that will be instrumental in ushering a new age of medicine and caregiving.

Role of medical technology Medical technology plays a vital role in the healthcare scenario. The industry consists of the medical equipment, device and medical consumables' market and accounts for around 8-10 per cent of the overall healthcare sector. The amalgamation of these three sectors is mainly responsible for facilitating clinical and administrative capabilities for global interface, better diagnosis,

The cost of medical technology in India is very high and affordability is the one of the biggest hitches Jayant Singh ASSOCIATE DIRECTOR, HEALTHCARE PRACTICE, FROST & SULLIVAN, SOUTH ASIA & MIDDLE EAST FROST & SULLIVAN

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and care-giving. In the true sense, this sector serves as the backbone of the healthcare delivery sector. Currently, India’s medical technology market is ranked as the fourth largest market in Asia, after Japan, China and South Korea. Speaking about the opportunities in India for this sector, S Kalyanaraman, GMGroup Marketing and Corp Communication of Trivitron Healthcare, states that India is one of the world's most lucrative healthcare markets, and is expanding rapidly, according to latest findings by a report published in February 2012, by market research firm RNCOS. Referring to a report titled ‘Indian Healthcare - New Avenues for Growth' published by the RNCOS, Kalyanaraman mentions that India is the most competitive destination with advantages of lower cost and sophisticated treatments. He fills in saying that the medical and surgical appliances industry registered FDI worth $514.08 million. Further, he feels that medical devices has been one area that is thriving in India. “Medical device sector is around nine per cent of Indian healthcare industry. (Source: Hospital Market – India by Research on India, Aranca Research, IBEF)”, he informs. However, on the global front, this sector ranks low in comparison to the rest of the world. Reasons being, lack of an ecosystem specific to medical technology industry, unaffordability, inconsistent access patterns, lack of clear regulatory policies, lack of government support for indigenisation of medical technology manufacturing and innovation, etc. “The challenges in the Indian market are manifold.

It would be useful to think of effective strategies along two dimensions: product / services and business model S Kalyanaraman GM-GROUP MARKETING COMMUNICATION TRIVITRON HEALTHCARE

AND

CORP

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Unfriendly regulatory environments make it difficult to manufacture devices domestically, due to tariffs on the importation of raw materials, and the complicated, lengthy approval process for any finished product. Domestic production is an important element of the strategy to bring down the costs of devices in a significant manner,” reveals Ratan Jalan, Founder and Principal Consultant, Medium Healthcare Consulting. Jayant Singh, Associate Director, Healthcare Practice, Frost & Sullivan, South Asia & Middle East, specifies that compared to income levels, the cost of medical technology in India is very high and affordability is the one of the biggest hitches. “India is the diabetic capital of the world. Nearly 55-60 million people in India live with diabetes, so logically these people should use blood glucose monitors on regular basis to keep a check on their sugar level. However, few people can really afford it and even fewer can afford to use it regularly”, he alludes. Furthering on the same, Jalan informs that 75 per cent of medical devices are imported to India; of which 30 per cent are imported from the US alone. ”Even if a foreign manufacturer sets up shop in India to lower costs, they are still not able to reduce prices enough to bring their products within reach of the vast majority. Devices from Indian manufacturers cost 5-15 per cent of US prices for almost comparable devices; a perfect example could be the intraocular lens (IOLs) manufactured by Auro Labs. In other markets, insurance eases this issue but penetration in India is still very low. We have witnessed that some of the government insurance schemes have helped broaden the market for some of the devices. However, lack of awareness is another factor, which results in under-diagnosis and under-treatment particularly for chronic care,” he reckons. Manoj Gopalakrishna, MD, BD India adds, “As India looks forward to invest in its health systems to extend health services access to more people, we believe that programme- based collaborative approaches will enable the health system strengthen its position in India and create a sustainable business impact. The government, industry, academia, healthcare providers should collectively take necessary steps to

bring about a change. Moreover, the medical devices sector requires a regulatory framework that will accelerate innovation and indigenous manufacturing, thereby helping bring down the cost of healthcare delivery to the patient.” With all this in mind, it won’t be a spurious claim if it is said that here innovation will be the vanguard.

A fair shake for India Innovation drives change. It enhances productivity and improves the quality of life. Moreover, in the healthcare scenario, innovation plays a vital role in doctoring medical practice. “Bringing innovation across the entire care pathway will be the key to growth in the Indian medical devices industry. Innovation that addresses issues as vital as product usage environment, patient awareness, physician adoption and affordability can catapult its penetration in the country,” claims Jalan. Speaking about the opportunities in India, Kaustav Banerjee – Country Manager, India, St Jude Medical Devices predicts, “Innovation will drive the future of medical devices industry in India and emerging markets of the world. India will be one of the top five hubs of innovation, clinical research in the world.” Banerjee further pointed out that medical device innovation helps foster growth for the entire medical sector. With innovative new technologies there is better disease management, increased safety and reduced procedural risks for patients, as well as a diminished burden on healthcare costs.

Impact of innovation in medical technology Globally, the medical technology industry has been thriving on innovations. Be it medications, diagnostics methods and equipment or therapy and procedures; innovation has continued to be a critical component of medical science. Various surveys have revealed that innovation has been one of the top priorities of CEOs and innovative companies. Where innovation in healthcare is concerned, Singh is of the opinion that innovation has caused a paradigm shift for disease management. Citing an example on how innovation improve disease management, Banerjee explains, “As more people are diagnosed with cardiovascular disease and healthcare costs escalate, JULY 2012

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it becomes increasingly important to find treatment options that can improve patient care in a cost effective manner. As an example, over the past few decades, the cardiology space has witnessed significant positive changes when it comes to introducing new technology. The space is consistently advancing and at St Jude Medical, we are doing our part to bring the latest technological advances to India. In the past year alone, we have introduced important tools to help cardiologists improve care, including the launch of the latest generation of optical coherence tomography (OCT) technology, which aids physicians in visualising inside blood vessels.”

Alcon. The pricing combined with the outreach strategy and process standardisation has made the treatment affordable, even for people at the bottom of the pyramid. Similar innovation can be found in the pre-screening ophthalmic device developed by Forus Healthcare, an IDG Ventures promoted company in India. With a single, portable, non-invasive and low cost device for detecting

ailments such as diabetic retinopathy, cataract, glaucoma and few others, they have drastically reduced the effort of identifying patients who need the therapy.” Additionally, he says, “Perfint Healthcare, a Chennai-headquartered small medical devices firm, has already set ambitions to become a global leader in the interventional oncology segment. It has already made

waves as an excellent tool for performing image-guided biopsies, with an extraordinary precision of 100 microns and .1 degree, unfound elsewhere. As market for guided procedures for early stage cancer diagnosis, drug delivery etc, are estimated to grow to about 50-60 per cent, it presents a huge opportunity for such devices. Diagnosing anaemia has long been a national issue,

since it is related with thousands of pregnant deaths. This was primarily because of the unavailability of a rapid point of care diagnosis tool, which can even be used in the rural settings without the aid of electricity or any professional skill set. Biosense, a venture founded by IIM and IIT graduates, addressed this problem with a simple-to-use, portable device that can detect

Innovation and India Though the positive impact of innovation in medical technology is admirable, can this balance costs, enhance healthcare quality and address the challenges of the industry? Is there enough innovation to be found in our Indian medical technology sector? On this, industry experts assert that innovation in India is still in its infancy. While medical technology companies are burdened by all the constraints surrounding the industry, what Indian medical companies do is a kind of 'jugaad' in order to provide quality healthcare and when it comes to medical technology innovations from India we have few examples to draw inferences from. “Innovation indeed flows from the West to us. However, there are companies such as GE, Philips, Perfint Healthcare, Bigtec Lab, Xycton Diagnostic and a few more who are doing their bit by incorporating innovation in their products. The innovation is either in terms of significant lowering of costs or altogether new technologies at a very low cost,” Singh informs. Jalan chips in saying, “In the ophthalmic segment, Aravind Eye Care and Auro Lab are perfect examples of how to make cataract implantation affordable via product, pricing, process and outreach innovation, yet remain profitable. Auro Lab manufactures IOLs at one hundredth the cost of its western counterpart JULY 2012

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anemia without even pricking for blood. This again helped in acceptance of the device among rural women who are averse to pricking because of social taboo.”

What India needs? It is an almost unanimous opinion that only the innovation route can take Indian healthcare towards progress. Nevertheless, for any innovation to succeed a right technique is must. “Innovations need to be designed keeping in mind the needs of the people in India; especially the need for unequal access to healthcare and lack of specialists in the country. Innovators needs to strive a balance between cost and quality,” explains Singh. A new concept called frugal innovation is something that most medical technology manufacturers are embracing off late. In the medical technology field this approach is adopted by companies such as GE and Sonosite. They have developed handheld mobile ultrasound and electrocardiogram (ECG) scanners for use in regions where health clinics are few and far

between, but the needs of the people are just as great as those of city dwellers. These again are excellent citations of the kind of innovation that India needs. But how do medical technology companies ensure a consistent way of thinking out-of-the-box to make sure that they achieve the benefits needed for Indian healthcare? Well, innovation needs to be a continous process, and this is where India lags. What it needs is a systematic focus on product and services as well as value that eliminate the cost component. Kalyanaraman suggests that it would be useful to think of effective strategies along two dimensions: product/services and business model. “Companies address the market with varying combinations of products/services and business models: opportunistic, customising, or innovating. Companies may operate at different points on the continuum for different product lines, so the level of innovation required should match the priorities of the chosen market segment and the degree of differentiation

Programme-based collaborative approaches will enable the health system strengthen its position in India and create a sustainable business impact Manoj Gopalakrishna MD, BD INDIA

required. The structure of local operations in India will depend on the company’s internal capabilities, investment and risk appetite, the availability of specialised services, and intellectual property risks.” Innovation will continue to be the driving force for the upliftment of the Indian medical technology sector and

Innovation that addresses issues like product usage environment, patient awareness, physician adoption and affordability can catapult its penetration in India Ratan Jalan FOUNDER AND PRINCIPAL ONSULTANT, MEDIUM HEALTHCARE CONSULTING

the entire healthcare delivery system at large. The good thing is that India does not fall short of clever ideas. All in all, for those who seek to drive this change, should fecilitate it by furthering evidence-based thinking with their new age products and services. raelene.kambli@expressindia.com

INSIGHT

Capital is king Satyanarayana Eluri, Vice President, Healthcare Financial Services, GE Capital India shares insight on financing healthcare growth in India here is no doubt that India needs to expand its healthcare coverage and make it affordable and effective for the common man. Today, the country only has 0.9 beds per 1000 population, in comparison to Brazil’s 2.6, China’s 2.2 and Malaysia’s 1.9 beds. This gap presents a large potential for growth in the healthcare industry. A recent industry report forecasted a 15 per cent compound average growth rate (CAGR) for healthcare investments between 2006 and 2012. According to the same report, investment in healthcare will have risen to $78 billion in 2012 from $34.2 billion in 2006 with the private sector making a significant contribution of 80 per cent. Industry organisations in India estimate the ratio of beds per 1000 population to improve to 1.85 by 2012. On the other hand, India’s population is slated to grow to 1.3 billion by 2017. This signifies that demand for health-

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care will continue to outstrip supply. Moreover, the increasing life span is a reality which has given rise to a growing population of senior citizens. With rising prosperity, there are higher instances of lifestyle-related diseases such as heart ailments, diabetes and cancer. These diseases require expensive, longterm treatment. According to another industry report, lifestyle diseases will contribute 48 per cent to in-patient revenues in 2013, in comparison to a mere 13.8 per cent in 2008. All these factors put together will lead to a potential patient base of 115 million in India by 2017. Can our healthcare industry meet www.expresshealthcare.in

these demands? A closer look at the industry figures reveals that 90 per cent of the patient base requires primary and secondary healthcare services. By primary, we refer to the basic

healthcare facilities for common and minor ailments. Secondary healthcare represents the segment that requires constant medical attention, including short periods of hospitalisation. The remaining 10 per cent of the patient base required tertiary care i.e. treatment from specialised clinics and facilities. Given the above picture, the need for affordable, accessible and quality healthcare is more important today than ever before. Latest medical equipments help in early detection of diseases and also ensure disease management and cure in a more noninvasive and efficient manner. This will result in both time and cost savings: time savings through a quicker cure and JULY 2012

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cost savings through lesser or no hospitalisation stay. As technology advances, the dependence on medical equipment is steadily becoming a necessity for diagnosis, intervention and treatment to prolong and improve the quality of life. Evidently, there is a growing demand for high quality technology-driven healthcare options. However, non-availability of high-end sophisticated medical and healthcare equipment in both private and government hospitals remains a challenge in the country today. Tier II and Tier III cities remain untouched by advancements in medical technology. In such a scenario, healthcare equipment financing sector can help bridge the gap created by the lack of the 3 A’s – affordability, availability and accessibility – to drive technology to the most remote corners of India. The medical equipment industry, which is an important part of the Indian healthcare industry, was valued at an estimated $3 billion in 2010, with the turnover expected to touch $5 billion by 2012. Although the industry is growing at a brisk CAGR of 15 per cent, it forms only a diminutive portion of the flourishing healthcare ecosystem and is yet to be explored fully by the healthcare financing community of the country. Healthcare equipment financing can make a difference to India’s health burden by making it affordable and effective. It is an option available to growing healthcare facilities as they plan to grow their patient care capabilities. Spreading awareness of the healthcare financing segment can lead to greater levels of penetration, making medical technology accessible to smaller hospitals, medical practitioners and pathological laboratories. There are several financial solutions available to growing healthcare service providers. Specific models of public-private partnerships pertaining to medical equipments have also emerged in different parts of the country. The government-run SMS Hospital in Jaipur is one such instance. The hospital administration had limited capabilities to handle and maintain high-end medical equipments. They collaborated JULY 2012

with a private contractor to operate their own machine in the hospital premises with special concessions and even free services for the poor. Apart from the public-private partnership model, the medical fraternity also has the option of loans and other structured finance alternatives. Leasing is another option with training in equipment installations and maintenance provided to the profes-

sionals. Giving equipment on rent or pay-per-use is yet another option which, apart from making it affordable, reduces the chances of any loss from obsolescence. Healthcare equipments are complex and its financing requires understanding of the equipment’s lifecycle and the technologies involved. Healthcare financing requires understanding of the complex machinery, life of the equip-

ment, chances of its obsolescence and accurate calculation of patient usage costs. While medical equipments are an uncompromising need of the current healthcare scenario, their successful implementation and continued usage is based on the three fundamental aspects of purchase, repair and maintenance. Healthcare providers can ensure that they are taking full advantage of advancing

medical technology by effectively partnering with expert financial service providers.

References: Indian Healthcare & Medical Devices Industry: Challenges & Opportunities http://www.pppinharyana. gov.in/ppp/sector/health/ report-healthcare.pdf Medical technology industry in India: Riding the growth curve (Deloitte CII Report)

A U TO M ATI C

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D O O RS

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M|A|R|K|E|T 30 MINUTE INTERVIEW

An achievement, not just for AHI but also for the country and the Indian healthcare sector as a whole Dr Ramakant Panda VICE CHAIRMAN, MD AND CHIEF OF CARDIOLOGY, AHI

roving once again that India's hospitals can set global benchmarks, Mumbai's Asian Heart Institute (AHI) came out with flying colours in a three year International Cardiac Surgery Benchmarking (ICSB) survey carried out by the Joint Commission International (JCI). Dr Ramakant Panda, Vice Chairman, MD and Chief of Cardiology, AHI gives more details of the results of this survey to Viveka Roychowdhury

Dr Panda, congratulations on this most recent achievement. It's not just me, the whole team at AHI is responsible for and proud of this achievement. We have shown the world what an Indian hospital is capable of, and so I feel that it's an achievement not just for my hospital but also for the country and the Indian healthcare sector as a whole. This reminder of our capabilities is especially needed after Aamir Khan's critical comments on doctors and hospitals in his talk show Satyamev Jayate. Yes, there may be some grey areas, but I believe that the majority of us behave in a very responsible manner. Unfortunately its' the 'bad apples' among the community, not more than 10 per cent, who make the news.

Could you give us details on the scope of the survey?

15 JCI-accredited hospitals from eight countries, spanning Asia, Europe and the US, volunteered to participate in a JCI survey, called the International Cardiac Surgery Benchmarking (ICSB) Project, which is a pilot programme addressing international clinical cardiac indicator. It enables hospitals to evaluate the current status of their coronary artery bypass graft (CABG) and valve-related surgery riskadjusted mortality rates and encourages hospitals to implement and measure rates of improvement using the New York State Department of Health (NYSDOH) Cardiac Surgery Reporting System (CSRS) as a model. The objectives of the ICSB project were that firstly, participating hospitals would get information to help them improve quality of care and assess a patient's risk factors before cardiac surgery. The second objective was that multi-site and multi-country use of the ICSB assessment and reporting tool would guide organised quality improvement and benchmarking efforts. The long-term goal is to improve the outcomes of cardiac surgical procedures in participating organisations.

What exactly did the survey involve, on a daily basis? The participating hospi-

tals had to cooperate in terms of daily data capture on the surgeries conducted and reported, based on certain parameters set to measure the quality of care provided and also allow inspections of JCI officials during the duration of the survey. Data analysis was performed on six quarters of data, across more than 6000 cardiac surgeries from October 2009 - March 2011. Here at AHI the project was driven by senior doctors, particularly Dr Vijay DSilva, Medical Director and Dr Darshana Rathod, ConsultantCritical Care Management Representative (Quality) who is in charge of quality and JCI matters. She was in charge of overseeing that each patient undergoing cardiac surgery during the survey would fill out a nearly 80 page survey form, requiring details as per the parameters laid out. Using various scoring systems and risk stratification techniques to allow for varying levels of risks across individual patient parameters, data across hospitals were compared to arrive at a very objective assessment and results.

What were the highlights of the survey results? After a detailed three year study, AHI ranked No.1 in terms of “lowest complication rates” and “highest survival rates.”

1. AHI performed the maximum number of CABGs (bypass surgeries) of all the surgeries performed in the 15 hospitals. 2. At AHI, the percentage of redo bypass surgeries performed is higher than the benchmark set by ICSB indicating that AHI does more redo bypass surgeries as compared to the benchmark. 3. AHI performs more valve surgeries on females as compared to the benchmark . 4. The number of aortic valve replacements at AHI performed were much higher than the benchmark. 5. AHI performed more number of valve surgeries on patients who have had a previous cardiac surgery as compared to benchmark. 6. AHI performed more number of CABG+ valve surgeries on patients greater than 65 years as compared to benchmark. 7. AHI's complications rates were much lesser than the benchmark. 8. The number of patients requiring blood transfusion was much lesser than the benchmark. 9. AHI's mortality rates were much lower than the benchmarks.

You say that your team

had a big role to play in achieving these benchmarks. How have you succeeded in building a team which works to global standards when the industry is faced with a shortage of skilled talent? One, you have to drive from the front to build up such a team. And that requires you to practice what you preach. For instance, I am absolutely focussed on infection control and carry an alcohol hand wash in the pocket of my surgical scrubs in addition to having them placed in my office as well because this is where I also meet patients. So when my team sees me constantly disinfecting my hands, they follow my example as well. And I constantly audit the level to which these infection control systems are being followed by nominating an intern to keep track of these systems. No one knows who this person is, but they know they are being monitored so now its become a habit to follow these systems. The second important message I want to give to the industry is that quality is not synonymous with cost. For example, putting in place infection control systems may seem costly in the beginning but we save so much on antibiotics. Here at AHI, thanks to the high level of infection control, we do not need to use third generation antibiotics. viveka.r@expressindia.com

30 MINUTE INTERVIEW

We plan to open 25 short-stay centres in next five-seven years Gaurav Malhotra (MD & CEO), PATNI HEALTHCARE

he Patni Group is one of an increasing number of new investors who have entered the healthcare market by setting up a chain of short-stay surgery clinics with

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an aim to cater to the gaps in the healthcare delivery market. Raelene Kambli in an Q&A session with Gaurav Malhotra MD & CEO, Patni Healthcare finds out more about this move, intended results and the company's future plans

Patni Group has been a leading player in India's IT sector, what are the attractive prospects that lures you to the Indian healthcare sector? India has witnessed an increase in the consumers' spend on healthcare as well as an increased demand for

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healthcare facilities. All this has resulted in a CAGR of 15 per cent in the sector and the market size has doubled in every five years. It was Rs 60 billion in the year 2010 and is expected to become Rs 120 billion by the year 2015. The journey started initially

from highly fragmented physicians-owned private clinics to large size super-speciality hospitals, which in turn evolved to large size medicities providing tertiary level of healthcare. The current evolution trend is moving from medium sized, multi-speciality hospitals

JULY 2012

M|A|R|K|E|T providing secondary care to asset light models like short stay surgeries centres and single speciality centres. The sector has witnessed a significant deal of activity and interest from private equity investors and big corporate houses. What are the obstacles in the Indian healthcare sector? The demand-supply gap in hospital beds, doctors, nurses and technicians are the major areas of concern in today’s scenario. Data has shown that out of a total bed count of 1.37 million only 50 per cent beds are functional and relevant. We have 1.1 bed per 1000 population, which is much lower than other BRIC nations including China and Brazil. 40 per cent of hospital beds are located in top 20 cities where only 10 per cent of the population reside and 60 per cent private hospital beds cater to 80 per cent of all patients. Limited penetration of health insurance also remains an impediment for the common public at large to access quality healthcare. The economical and regulatory environment is still unfriendly for initiating and developing newer projects. Accessibility of good healthcare is a problem area wherein people have to travel at least 500 km on an average to get quality oncology treatment and 100 km to receive specialised cardio or a neurological treatment.

for the health sector which is beleaguered with scarce resources. Patni Group is planning to establish a nation-wide chain of ‘short-stay centers’. Tell us what kind of facilities you would be offering. Each short-stay centre is primarily a surgery centre, covering the speciality mix such as general surgeries, orthopaedics, gynaecology, ophthalmology, ENT, bariatric surgery, cosmetic

surgery and gastroenterology. These centres also house operating theatres with modern stateof-the-art medical equipment for minimal and non-invasive surgical procedures. Patient flow shall happen through OPDs run by renowned doctors in each of these specialities. Each centre shall have post operative recovery unit and an ICU backed by trained staff and shall be equipped with pharmacy, radiodiagnostics unit, laboratory, optical shop, cafeteria, etc.

How much have you invested in the healthcare sector so far and what ROI do you expect? We have planned to invest a total amount of Rs 500 crore. The break up will be Rs 300 crore equity and Rs 200 crore debt. The investment doesn’t include real estate investment. Our revenue expectation is Rs 800-1000 crore in next fiveseven years with 22-25 per cent earnings before interest, taxes, depreciation, and amortisation (EBITDA) levels.

In which cities do you intend to establish your short stay centres? How many centres are you planning to set up initially? Our plan in next five-seven years is to open 25 short-stay centres. We want to target few key cities in Maharashtra, UP, Punjab, NCR, Gujarat and Karnataka, initially beginning with Mumbai. raelene.kambli@expressindia.com

Which other healthcare areas would you like to foray, and why? In the wide supply gap existing across all segments of India’s healthcare delivery market, it is critical to focus on the right segments to maximise value. We have identified short stay surgery as the segment to target initially.The reason we want to focus on short stay surgery is the fact that it is an attractive opportunity and in the state of evolution. We believe that this segment, with the inherent mis-match between burgeoning demand and largely unorganised supply, is at an inflexion point in the maturity graph. Short-stay surgery has now come to be an accepted modality of treatment for most surgical patients and it has multiple advantages for all the stakeholders as well as the patients, besides being an economically better option JULY 2012

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M|A|R|K|E|T

Expansion

Philips announces 100 shipments of its mobile DR solution

hilips announced the 100th shipment of MobileDiagnost wDR, a mobile digital radiography (DR) solution with a wireless portable detector that facilitates diagnosis of immobile and critical care patients. MobileDiagnost wDR is a flexible solution that improves workflow and the efficiency of patient exams through an user interface and fast access to high quality digital images. Built on Philips’ wireless portable detector, Eleva user interface, and UNIQUE imaging processing software, the MobileDiagnost wDR helps to accelerate clinician workflow by quickly delivering digital X-ray images anywhere in the hospital. The mobility of MobileDiagnost wDR also improves patient care by avoiding stressful transports to a traditional DR room while delivering good image quality. “The MobileDiagnost wDR makes you feel that you’re a part of the future of X-ray technology,” said Susan Doheny, Senior Radiographer, Galway Clinic, Galway, Ireland. “Having the ability to send images wirelessly greatly improves efficiency. The radiologist can have the images reported within minutes and this report is made available all around the hospital.” It has been commercially available globally since mid-2011, and the 100th shipment of MobileDiagnost wDR is an indication that hospitals are embracing of Philips’ mobile DR technology. “Achieving 100 shipments of MobileDiagnost wDR has been rewarding because it is a new product that thoroughly addresses the needs of busy hospitals. It makes it easier for clinicians to provide timely care to critical patients, and helps enhance patient comfort without sacrificing image quality,” said Ronald Tabaksblat, Senior Vice President and General Manager, Philips Diagnostic X-ray, Philips Healthcare. EH News Bureau

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RESEARCH

Lovely Professional University (LPU) scientists develop ‘anti-cancer medicine’ LPU also signed up MoU with Premier Pharmaceutical Company RHYDBURG for further development of product and to introduce it in market he School of Pharmaceutical Sciences of Lovely Professional University (LPU) has developed a new technology, Targeted Release Microsphere of 5-FU (5-fluorouracil), which is useful in overcoming the side effects of the drugs used in treatment of colon cancer. Developed indigenously by the dean, faculty of Applied Medical Sciences, Dr Monica Gulati and her team at LPU, they have also got their patent (PCT) published in 140 countries vide Publication No. WO/ 2012/035561. Highlighting the impor-

tance of the anti-cancer medicine Dr Gulati explained more about the side effects of colon cancer treatment. She informed, “The side-effects depend on the type of treatment and differ from person to person. In general, anticancer drugs affect cells that divide rapidly especially blood cells, cells in hair roots and cells that line the digestive tract. When drugs affect these cells, patients are more likely to get infections, bruise, hair loss, poor appetite, nausea, vomiting, diarrhoea, mouth and lip sores or feel very weak and tired. Almost similar effects can

occur during radiation and biological therapy. However, many of these side effects of colon cancer chemotherapy can be controlled with drugs. For this reason, our department strived to invent the remedy and further collaborated with a top pharmaceutical company.” Congratulating Dr Gulati and her team for their remarkable achievement, Ashok Mittal, Chancellor, LPU said, “The research facilities at the university are being extended to aim at the world class innovations and research in the university. The present patent which has already been published for

140 countries has further motivated us to perform better.” Realising the potential of the invention, an MOU has been signed between LPU and a pharmaceutical company called Rhydburg at Dehradun in India. Rhydburg is a manufacturer and exporter of pharmaceuticals—tablets, injections, beta lactam, syrups, capsules etc. Illustrative, a patent for the development of Targeted Release Microsphere of 5-FU had been filed vide International patent application No.PCT/IN2011/000642. EH News Bureau

BUSINESS STRATEGY

Trivitron Healthcare shifts focus to critical life support solution segment Already an existing distributor of CLSS products, its now focussing on realigning its sub divisions, with its own manufactured products under one division rivitron Healthcare aims to become the most respected and admirable global leader in medical instrument and devices segment with a focus on emerging markets. In order to achieve this goal, Trivitron has marked its presence to the critical life support solution (CLSS) segment which includes solutions and products for intensive care, operating room, dialysis care and cardiac care solutions like ventilator, patient monitor, defibrillator, ECG machine, stress test sys-

tem, holter system, operating room design and execution, pendants, dialysis machine etc. The medical technology market is ever growing due to healthcare requirements, changing life style and disease factored to it, increase in purchase power, medical tourism etc. The total market size of medical equipment and devices is approximately Rs 17,000 crore of which critical life support solutions’ share is approximately Rs 3,000 crore. Thus, CLSS forms almost one-third of the

total market the segment is expected to grow at 15-20 per cent per annum during next five years. Trivitron has been present in this segment since 1999, wherein it distributed products like ventilators from Hamilton; patient monitors and defib from Nihon Kohden; dialysis m/c- by Fresenius. By introducing its new segment CLSS, Trivitron now focuses on realigning its sub divisions, with its own manufactured products under one division.

“Critical Life support solution (CLSS) segment is a long-term prospect for us, as operating room and intensive care are the most essential and basic needs for any corporate hospital. Trivitron has always worked towards building affordable and accessible healthcare in India. This initiative only enables us to focus on the most crucial solution requirement for healthcare,” says Dr GSK Velu, Founder and MD of Trivitron Healthcare. EH News Bureau

INITIATIVE

Indraprastha Apollo’s seminar to promote voluntary blood donation The seminar is to commemorate World Blood Donor Day 2012 he Department of Transfusion Medicine at Indraprastha Apollo Hospitals, along with State Blood Transfusion Council, Govt of NCT Delhi and Blood for All (B4A), recently organ-

ised a ‘National Seminar on Promotion of Voluntary Blood Donation’ to commemorate the World Blood Donor Day 2012. Dr AK Walia, Minister of Health, Govt of NCT Delhi www.expresshealthcare.in

was the Chief Guest at the seminar which was held at Desire, Hotel Le Meridien, New Delhi. The seminar revolved around the theme ‘blood donor is a hero’ and was attended by voluntary

blood donors, blood bank offices, officials from the Ministry of Health as well as various members of NGOs. EH News Bureau JULY 2012

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Rare surgery

10 kg tumour removed from patient at Fortis Malar Hospital

n a highly unusual medical case, a team of doctors at Fortis Malar Hospital recently saved the life of a 62-year-old woman with a 10 kg ovarian cyst or Mucinous Cystadenoma. The patient approached the hospital after experiencing post menopausal bleeding for a day. She also had severe abdominal distension for four months, eventually leading to an umbilical hernia. Senior Consultant Gynaecologist Dr Nithya Ramamurthy prescribed a CT Scan which showed a cyst measuring 21cm x 23cm x 26cm. Aside from abdominal distension due to the rapid growth of the tumour over four months, the only symptom experienced by the patient was gradual lower abdominal discomfort. The patient also had a known history of diabetes and hypertension. However, the patient showed no other abnormal symptoms like high fever, chills, sweat, fluid retention, loss of appetite and loss of weight. The medical case was deemed complicated due to the massive size of the tumour of the abdomen. After stabilising the hypertension and diabetes, total abdominal hysterectomy with bilateral salpingo oophorectomy (removal of uterus and both ovaries with the huge tumour) was conducted on the patient by Dr Ramamurthy. The team also included General Surgeon Dr Deepak Subramaniam who operated the umbilical hernia while the preoperative bilateral ureteric stenting was performed by Consultant Urologist Dr MR Pari to ensure the safety of the ureter. Commenting on this case, Dr Ramamurthy said,“While tumours in the ovary are relatively common, they very rarely reach these dimensions, especially at such a fast rate. The tumour proved to be benign and post surgery the patient has recovered well and is back in her hometown Tiruchirapally.” EH News Bureau

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PARTNERSHIP

BGI, GE Healthcare team up on pioneering stem cell science projects The collaborating parties plan to undertake two ground-breaking projects E Healthcare and BGI have come together for a multi-year research collaboration in stem cell science with an aim to help advance the potential global utility of stem cell-derived assays for use in drug discovery and toxicity testing by exploring the underlying genetic variation between ethnically diverse human stem cell lines. The collaborating parties plan to undertake two ground-breaking projects. Firstly, BGI is performing genome sequencing and epigenetic analysis on cardiomyocytes and hepatocytes supplied by GE Healthcare Life Sciences. The aim is to map out the genetic variation across an ethnically diverse range of stem cell lines and to examine the changes that occur during differentiation into specific cell types, in order to increase the understanding of cell models used in drug development research. Secondly, GE Healthcare is providing BGI

with an IN Cell Analyzer 2000 system, a research tool for high content cellular imaging analysis. Training on the IN Cell Analyzer will be provided to BGI, enabling it to investigate gene function for a library of previously sequenced cell types by overexpressing or blocking the activity of single genes and observing the effect in selected populations of cells. Dr Amr Abid, General Manager Cell Technologies, GE Healthcare Life Sciences, said,

“As the pharmaceutical industry seeks to reduce the cost of drug development and to bring more effective, safer drugs to market, the availability of more biologically relevant and predictive cell models is becoming increasingly important. Our long-term vision is to help this process by developing a broad range of Cytiva stem-cell derived assays, to include cell types from a wide diversity of ethnic backgrounds. This is a big challenge and we are delighted to

be working with such a prestigious institute as the BGI, with its significant resources and world-class capabilities in genomics and epigenomics. By working together, we will advance our understanding of different stem cell lines, which in turn may help in the future in the global drive to develop new, safer and more effective medicines.” Jian Wang, President of BGI, said, “The importance of high-throughput sequencing has been increasing rapidly in the areas of healthcare, agriculture, environment, and others. Genetic variation analysis of functional cells derived from embryonic stem cells may provide a promising cell model resource for drug development and cell therapy. We are grateful for this opportunity to join hands with an outstanding healthcare organisation to push the boundaries of understanding in the field of stem cells.” EH News Bureau

EDUCATION

MRCPCH exams, clinical tests in India MRCPCH has a prestigious value among Indian doctors looking to advance their clinical knowledge and achieve further qualification okilaben Dhirubhai Ambani hospital were appointed as the centre for clinical examinations for Membership of the Royal College of Paediatrics and Child Health (MRCPCH). The first such examinations at the hospital were held in Mumbai on June 16 and 17. Thus, for the first time, Indian doctors will not have to go to UK but can obtain an international qualification in India itself. They will be allowed to use the designation “MRCPCH (UK)” with their names in their practice once they clear the tests here. The first written examination for the MRCPCH was held in India in 2009 but candidates had to go to the UK to take the clinical examination. Dr Ramesh Mehta, the Principal Regional Examiner of South Asia for the Royal College said, “The MRCPCH is a prestigious international

examination that is recognised by the Government of India and gives Indian doctors the opportunity to get an international post graduate examination without leaving the country.” “The Royal College of Paediatrics and Child Health of UK is delighted that Kokilaben Dhirubhai Ambani Hospital, Mumbai have offered their excellent facilities to conduct this examination,” he added. Dr Santanu Sen, Consultant Paediatrician at KDAH and Host Examiner for the MRCPCH said, “We at Kokilaben Dhirubhai Ambani hospital are absolutely delighted to hold the examination for our students in India. We are proud to be associated with this prestigious event that forms part of our greater commitment towards medical education”. Talking about the examiwww.expresshealthcare.in

nation, Dr Sen stated that the MRCPCH is a rigourous examination where even the examiners had to train and be evaluated themselves before they are allowed to examine candidates. He also informed that communication skills forms a major part of the evaluation of doctors. “We found that while Indian doctors are very good in their clinical knowledge; their ability to communicate effectively with patients: explaining problems, breaking bad news, obtaining consent etc. was at times suboptimal. We hope that this examination will raise the awareness about the need for training and testing of this very important skill in all the young doctors in the country.” Dr Sen also stated, “We have candidates not only from all over India, but also from Singapore, Australia, Muscat, Brunei, Bahrain and Saudi Arabia, who are com-

ing to take the examination. We even have a large number of candidates from the UK itself who are very keen to take the examination here in India. There were desperate requests from candidates nationally and internationally that we could not accommodate this time.” Speaking about the examinations, Graeme Muir, the Examinations & Assessment Advisor of the RCPCH (UK), stated that there is much that the UK can learn from the depth of clinical practice in India. He hoped that they can complement medical knowledge of Indian doctors with the well known UK patientcentred care. He said that bringing the MRCPCH to India is intended to be an example of UK partnership working with modern 21st century India. EH News Bureau JULY 2012

M|A|R|K|E|T INITIATIVE

Jyot-Se-Jyot campaign reaches Mumbai The campaign is an initiative to increase awareness on the health and safety of healthcare workers n an effort to spread the message of healthcare safety, Indian Academy of Microbiologists (IAMM) and Haffkine Institute in conjunction with BD India launched a 51-day campaign “Jyot se Jyot – Safety First” (igniting the minds on safety and pledge to work towards healthcare worker safety) on May 12 International Nurses Day. This programme, focuses on increasing the awareness and drive the concept of ‘own safety’ of the healthcare worker in the hospital environment. Hence, several initiatives have been conducted including seminars, conferences, workshops and talks in various cities in Maharashtra to address the challenges faced by healthcare workers. The campaign was kickstarted at JJ Hospital in Mumbai where the healthcare workers will benefit from better training and opportunities to help them practice their profession safely. The Jyot-Se-Jyot campaign culminated on July 1 on Doctor’s Day when eminent doctors and healthcare providers pledged to increase the awareness and propel the concept of ‘own safety’ in the hospital environment while providing quality care to the patients. Dr Abhay Chowdhary, HOD of Microbiology, Grant Govt Medical College & Sir J J Hospital, Mumbai & Director, Haffkine Institute said, "The hospital and its milieu are increasingly being perceived as a package comprising of not only complex, costly treatment and care but also the dread of medical errors. Today is an era of high quality clinical care, skilled faculty and evident technological advances. Safety continues to be an elusive goal for the healthcare system and it is essential for a hospital to develop systems that can address patient needs and thus safeguard healthcare workers." Rajnish Rohatgi, Director, Medical Surgical Systems, BD India said, “Healthcare workers face many risks in their daily duties, including accidental needlesticks and exposure to bloodborne pathogens. We believe that safe health-

JULY 2012

care workers can deliver safer healthcare. BD is committed to make the health care delivery safer for patients and the healthcare workers and has pioneered

various public private partnerships worldwide for healthcare worker safety. We are happy to leverage our global expertise in improving capacity among

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healthcare workers in the state of Maharashtra.” Maharashtra is taking several steps to ensure better healthcare practices by imparting training

and creating the right awareness among healthcare workers. EH News Bureau

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M|A|R|K|E|T EXPANSION

Govt Initiative

Centre for Sight expands network in Chandigarh, Punjab and Haryana

Studies stress India's fight to reduce maternal deaths

tudies published in the May issue of Reproductive Health Matters highlight India’s fight to save the lives of women. A paper from Haryana1, and one from Madhya Pradesh2 look at ways in which activists and lawyers are using human rights legislation to hold governments to account and save women’s lives. Both papers include case studies of women who died unnecessarily in childbirth due to discrimination due to poverty and caste. Another paper looks at systems for registering women during pregnancy in Tamil Nadu3. The paper shows that registration schemes and the demands they put on village nurses, are burdensome and may reduce time spent with women, providing the care they need. A fourth article4 considers the success of voucher schemes to ensure poor women can deliver their babies in clinics. This article highlights the inequity in access across different states and asks whether clinics can always cope with increased demand for their services and whether the quality of services is suffering. References 1 Jameen Kaur.The role of litigation in ensuring women’s reproductive rights: an analysis of the Shanti Devi judgement in India. Reproductive Health Matters 20(39) 2012 2 Subha Sri B et al. An investigation of maternal deaths following public protests in a tribal district of Madhya Pradesh, central India. Reproductive Health Matters 20(39) 2012 3 Rakhal Gaitonde. Registration and monitoring of pregnant women in Tamil Nadu, India: a critique. Reproductive Health Matters 20(39) 2012 4 Kate Jehan et al. Improving access to maternity services: an overview of cash transfer and voucher schemes in South Asia Reproductive Health Matters 20(39) 2012 EH News Bureau

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Ties up with Mirchia’s Laser Eye Centre and Dr Monica’s Eye Clinic; plans 15 new centres in next three years entre for Sight, a leading network of eye hospitals continues to map an aggressive growth path in the ever growing vision care segment. Chandigarh-based Mirchia’s Laser Eye Centre, a renowned eye-care centre in Punjab, Haryana and Chandigarh region is now a unit of Centre for Sight group of eye hospitals. The partnership expands the footprint of Centre for Sight in this area from two centres to seven centres. Now, the total number of Centre for Sight super-speciality eye hospitals goes up to 40 across India. At the press conference, Dr Mahipal Singh Sachdev, Chairman and Medical Director, Centre for Sight said, “There exists a gap

in the eye care service standards in the metro and the non-metro areas. Through our network of super specialised eye hospitals, we are committed to bridge the divide, which is achieved with a mix of green field ventures, brown field mergers and acquisitions and departments in hospitals. Our partners are like-minded people with patient-centric values who are leading players in their geography and share our enthusiasm for growth and excellence. ” Speaking on the expansion plan, Dr Sachdev informed, “In the next three years, Centre for Sight will open 15 new centres in Punjab, Haryana, Himachal Pradesh and Jammu & Kashmir.”

“Driven by our commitment to adopt cutting edge technology in ophthalmology, we are introducing Femtosecond Laser technology for cataract surgery at Mirchia’a Laser Eye Centre in Chandigarh, now a unit of Centre for Sight. The launch of Femtosecond Laser technology is the first of its kind in the whole of Haryana and Chandigarh region,” announced Dr Sachdev at the conference. Dr Rajiv Mirchia, Chairman and Medical Director, Mirchia’s Laser Eye Centre said, “The partnership offers value to us in terms of augmenting our current technology and in improving the patient care service standards

at our centres.” Femtosecond Laser technology is being touted as an effective technology for cataract surgery since this blade-less, stitch-less technique delivers precise results. “While cataract surgeons are doing a good job now, Femtosecond Laser technology introduces the ability to be more consistent. It has the potential to, in the simplest of terms; help automate many of the crucial steps of surgery resulting in a safer operation and improved surgical outcome, added Dr Monica Jain, Senior Consultant and Director of Dr Monica’s Eye Clinic. EH News Bureau

INITIATIVE

Indraprastha Apollo's seminar to promote voluntary blood donation The seminar was held to commemorate World Blood Donor Day 2012 he Department of Transfusion Medicine at Indraprastha Apollo Hospitals, along with State Blood Transfusion Council, Govt of NCT Delhi and Blood for All (B4A), organised a

'National Seminar on Promotion of Voluntary Blood Donation' to commemorate the World Blood Donor Day 2012. Dr AK Walia, Minister of Health, Govt of NCT Delhi

will be the Chief Guest at the seminar was held at Desire, Hotel Le Meridien, New Delhi. The seminar revolves around the theme 'Every blood donor is a hero' and is expected to attended by vol-

untary blood donors, blood bank offices, officials from the Ministry of Health as well as various members of NGOs. EH News Bureau

EXPANSION

Philips' new greenfield healthcare manufacturing facility in India Development and manufacturing centre in Chakan, near Pune to provide locally relevant healthcare solutions for India and other growth geographies n line with its strategy to expand the company’s industrial footprint in India, Royal Philips Electronics has commenced operations at its first greenfield manufacturing facility for imaging systems in the country. Based in Chakan, near Pune, the Philips Development and Manufacturing Centre will locally develop and produce products and solutions that help improve access to healthcare for people in India and other growth geographies. The facility will focus on diagnostic and interventional imaging solutions, initially developed for the Indian

market and then for global markets. These solutions will primarily target cardiology (catheterisation lab) and radiology (general X-ray) applications. The first products to be manufactured in the facility will be diagnostic X-Ray systems and the Allura FC – Philips’ first India developed catheterisation lab which is used in the diagnosis and minimally-invasive treatment of cardiovascular disease. Both products are aimed at the value segment in India and abroad. “This plant is an example of how Philips can combine its technology strengths and market knowledge to manufacture products for a healthwww.expresshealthcare.in

ier India,” said Rajeev Chopra, Managing Director and Vice Chairman, Philips India. “The Pune facility is producing X-ray and cath-lab equipment backed by Philips quality that is affordable for tier-two and tier-three towns and rural markets.” The Pune facility was specifically designed with manufacturing flexibility in mind so that it can quickly adapt to changing market and product needs. Many of the products and components developed in Pune can also serve the needs of mature markets looking to replace or upgrade entrylevel diagnostic devices. Philips' in-depth

research to understand the on-the-ground requirements in India indicated that several factors, including low operating costs, energy-efficiency, easy serviceability and support for high patient volumes, are critical to increasing healthcare access in India and thereby improving patient outcomes. The Pune facility intends to deliver this type of ‘designed for India’ product, enabling healthcare providers in the country to provide care to those communities who have not had access to highquality healthcare in the past.. . EH News Bureau JULY 2012

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TB update

NEW LAUNCH

SRL introduces ‘Universal Genetic Test’ in India The objective is to control or avoid the birth of babies or children’s with devastating genetic disorders GoI bans use, import of blood test kits for TB

lmost a year after the World Health Organisation (WHO) issued a rare 'negative' policy recommendation urging countries to ban the use of serological (blood) test kits for active TB, the Ministry of Health & Family Welfare, Government of India issued a notification in early June prohibiting the manufacture, sale, distribution, use and import of such serodiagnostic kits. India as a country has one fifth of the global TB burden, with some estimates putting a total of 9.2 million new cases and 1.7 million deaths every year. In a notification dated June 7, the Central Government states that it is satisfied that the use of the serodiagnostic test kits for diagnosis of tuberculosis are giving inconsistent and imprecise results results leading to wrong diagnosis and their use is likely to involve risk to human beings and whereas safer alternatives are available. WHO's recommendation in July last year came after a year of rigorous analysis of evidence by WHO and global experts. Ninety-four studies were evaluated—67 for pulmonary tuberculosis (TB in the lungs) and 27 for extrapulmonary tuberculosis (TB elsewhere in other organs). Overwhelming evidence showed that the blood tests produced an unacceptable level of wrong results false-positives or falsenegatives - relative to tests endorsed by WHO. The impact of falsenegatives would be that a person needing TB treatment would not get it, and the disease would progress, with tragic consequences. Besides the stigma, such cases could also suffer from the side effects of anti-TB medication, which is actually not required. In both cases, it would mean a waste of financial resources. If the ban is properly enforced, the hope is that patients in the private sector will be protected from a test that confuses and misleads the patient. EH News Bureau

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uper Religare Laboratories (SRL) has brought the “Universal Genetic Test” to India to help check birth of children with genetic disorders. Invented by scientists from Stanford, Harvard and MIT, the Universal Genetic Test (UGT) is an innovative test based on customised microarray technology, which scans through a combination of serious and disabling genetic disorders such as SMA, sickle cell anaemia, beta thalassemia and TaySachs disease, along with less serious but equally important metabolic genetic disorders such as fructose intolerance, MSUDs, biotinidase deficiency and ataxias. The Universal Genetic Test has been exhaustively validated and is shown to have 99.9 per cent accuracy

for targeted mutations in more than 100 known genetic diseases. Announcing its launch, Dr BR Das, President – Research and Innovation, SRL, said, “As compared to infectious diseases or cancer the magnitude of genetic disorders is relatively low however they need equal attention due to their serious health implications and the worst genetic disorders are life threatening and incurable. We are happy to bring this unique Universal Genetic Test to India which we are sure will be of help to couples since it will help them to know the prospects of their offspring are inheriting genetic disorders.” Globally, about five per cent of children are born with congenital or genetic disorders. Indians, represent-

ing about one-sixth of the world population, comprise several thousands of endogamous groups with strong potential for genetic disorders. As per published data, a large number of infants with genetic disorders are born every year. Genetic disorders can be caused by a mutation in one gene (monogenic disorder), mutations in multiple genes (multi-factorial inheritance disorder), a combination of gene mutations and environmental factors, or by damage to chromosomes. Most of the mutations related to genetic disorders are inherited from biological parents. If both the parents are carriers, a child has a 25 per cent chance of being homozygous wild-type (unaffected), 25 per cent chance of being homozygous mutant (affected) or a 50 per

cent chance of being heterozygous (unaffected carrier). In each of the affected 25 per cent cases, quality of life is a serious cause of concern. Interested couples can undergo this test with appropriate pre-test counselling as per the standard norms. Those who test positive can plan ahead after receiving post counselling recommendations. They might choose in vitro fertilisation, combined with pre-implantation genetic diagnosis, or they might decide to adopt. Either way, the objective is to control or avoid the birth of babies or children with such devastating genetic disorders. Thus, UGT test is a good way of ensuring that fewer people are afflicted with genetic disorders. EH News Bureau

COMPANY WATCH

GE Healthcare technology unveiled at London 2012 polyclinic GE’s advanced MRI, CT, X-ray, ultrasound and ECG technologies will help to diagnose, treat and monitor athletes' health E Healthcare, alongside the London Organising Committee of the Olympic and Paralympic Games (LOCOG), showcased the broad range of medical imaging technologies they will supply for the care of competing athletes at London 2012. The equipment, housed at the main polyclinic based in the Athletes’ Village in the Olympic Park in Stratford, will provide up to 16,000 athletes and team officials staying in the Village during the Olympic Games and 6,200 athletes and team officials during the Paralympic Games with access to excellent healthcare services.

Technologies featured include MRI, ultrasound, Xray, ECG, IT and monitoring systems. GE Healthcare is working closely with medical leaders at the London 2012 Games to advance the use of advanced medical imaging technologies to optimise and improve athletic performance. John Dineen, CEO of GE Healthcare said, “We are delighted to be providing a broad range of our latest healthcare technology for the London 2012 polyclinic. In line with GE’s ‘healthymagination’ vision and its commitment to sports medicine, these technologies will provide insight into athlete

health, as well as offering wider benefits for the general public. The use of technologies that help monitor the health of Olympic athletes will be used before, during and after the London 2012 Games.” LOCOG Chair Sebastian ‘Seb’ Coe said, “We have always put athletes’ needs at the heart of the Games. When they are preparing for the most important moment in their sporting careers, it’s vital they are in peak condition with all the support they need. We aim to give that medical support to help them deliver their best performance. Our sponsors and our medical team who are

experts in their field will pay a vital role in achieving this and I thank them for their ongoing support.” By making a wide range of medical technology available for use within the Olympic and Paralympic Village and all of the sporting events being held at the Olympic Park, clinicians will be better able to diagnose potential injuries earlier or simply monitor treatment, with a view to ensuring athletes are able to return to their sport as quickly as possible, helping them to stand the best chance of winning a medal for their country. EH News Bureau

STEM CELL UPDATE

CordLife to store stem cells of Namrata Shirodkar's baby CordLife is a leading stem cell bank with a pan India presence ctress Namrata Shirodkar and her husband Mahesh Babu, who are expecting their second child, have decided to store their baby’s stem cells with CordLife. She has also decided to join hands with

CordLife in spreading the awareness on the benefits of stem cell banking. Mahesh Babu is also a strong advocate for cord blood banking. Speaking on the occasion the couple said, “We couldn’t be morea happier banking with www.expresshealthcare.in

CordLife for our baby’s stem cells”. Stem cell banking has lot of potential in curing critical diseases. Extracted from the cord blood and cord blood tissue, stem cells have have been able to treat conditions

like leukaemia, lymphoma, cerebral palsy and thalassemia major positively. The technology is also being used to treat many other diseases. EH News Bureau JULY 2012

M|A|R|K|E|T STUDY

Medtech industry survey highlights globalisation challenges Industry executives cite risk management, visibility and quality control as top concerns

JULY 2012

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reported moderate to high risk based on their level of visibility into critical suppliers,” he added.

of Axendia. “While Med-Tech companies are poised to capitalise on these opportunities, global expansion has industry executives on alert. Nearly seven out of ten executives

• Patient Safety Awards

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HIGHLIGHTS

An opportunity to reflect, think and learn the best from each other at Asia’s only Patient Safety Focussed Conference

Best Practices for Asia • 1-2 September, 2012 • Hyderabad International Convention Centre • Hyderabad, India

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2ND I N T E R N A T I O N A L

In this context, Emerging economies represent burgeoning marketplaces, with increased sales rates over those in Developed markets,” said Daniel R Matlis, President

ecosystem,” said Satish Joshi, EVP and head of product engineering services, iGATE. “Nine out of 10 Med-Tech Executives expect very strong growth in the next three years.

E T Y

GATE, a company providing business outcomesbased solutions, and strategic advisory firm Axendia, revealed the results of a medical technology industry survey which highlighted benefits and risks resulting from the rapid growth of the medical technology industry globally. The survey polled 125 medical technology industry executives from 89 companies across 16 countries. The report is titled: “Walking the Global Tightrope: Balancing the Risks and Rewards of Med-Tech Globalization.” Survey respondents reported that they must navigate three primary industry trends: ● Managing sustainable growth; ● Complying with tightening global regulatory environments; ● And, supporting changing healthcare delivery models globally Survey respondents anticipate strong growth in the medical technology industry in the next few years, with 88 per cent expecting increased sales in emerging markets and 69 per cent expecting increased sales in developed markets. The chief drivers for globalisation are improving the rate of innovation and the need to support emerging markets with locally produced products. Executives reported that their biggest concerns related to globalisation and outsourcing are the quality of products, raw materials and services provided. Nearly 60 per cent of executives who took the survey reported that the ability to maintain consistent quality and standards across internal and external sites keeps them up at night. Additionally, 90 per cent of respondents indicated they would like access to real-time and on-demand data from critical suppliers and contract manufacturers. “The increasing rate of globalisation has created significant opportunities as well as challenges for the medical technology industry. In order to reap the benefits of globalization, executives will need to proactively mitigate risk, improve collaboration, and increase their visibility into the medical technology

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P R O D U C T

Watch Thermo Fisher Scientific introduces PL6500 series of laboratory refrigerators hermo Fisher Scientific has launched the Thermo Scientific PL6500 series of laboratory refrigerators and freezers for general-purpose applications in non-regulated environments. The PL6500 series offers cold storage equipment that covers temperature ranges from +4 째C to -40 째C. With secure closing and effective temperature recovery following door opening, samples are protected against multiple freeze-thaw events. Delivering reliable, convenient sample storage, this range of equipment is easy to use and provides peace of mind for the safety and security of sensitive specimens. The importance of laboratory cold storage cannot be overstated; maintaining the integrity of valuable samples is an absolute requirement in any scientific setting. The PL6500

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series is designed to ensure that specimens in storage are subject to a constant, stable and uniform temperature range, with minimal variation across the storage compartment. To provide excellent return on investment, this equipment is engineered

with fluorine-free high-density insulation for effective heat rejection, which reduces energy consumption and noise levels. The Thermo Scientific PL6500 series comes with an intuitive user interface that includes audio and visual alarms to alert users to significant changes in compartment temperature. The addition of a number of access ports and dual-pane glass doors on laboratory refrigerator models allows the use of small instruments within the refrigerator compartment. Furthermore, a highquality finish and adjustable levelling castors make the PL6500 series easy to position and move within the laboratory. Contact details: Thermo Fisher Scientific Meenal Shinde Tel: +91 22 6716 2259 Email: meenal.shinde@thermofisher.com

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JULY 2012

M|A|R|K|E|T PRE EVENT

DIA's workshop: Improving imaging diagnostics DIA organises a workshop on imaging diagnostics to keep radiologists updated about the latest and evolving best imaging techniques and practices IA, a neutral, nonprofit, global, professional association of members who work in the discovery, development, and life cycle management of pharmaceuticals, medical devices, and related products, has planned an intense one-day workshop on imaging in clinical trials. Slated to be held on July 27, 2012 in Bangalore, this workshop is being conducted in collaboration with Image Core Lab and Teleradiology Solutions. The educational need addresses a combination of knowledge, competence, and performance gaps.

to the approval of PET for lung cancer and, more recently, other oncology and neurology applications. Newly approved imaging contrast agents will also

improve the ability to gain functional assessment of organ and tissue function and provide more direct measure of therapeutic effect within the target tis-

sue. The continuing need to shorten the drug and biologics development time continues to provide an impetus to use imaging endpoints in clinical trialsâ&#x20AC;&#x201D;

particularly in early phases of clinical development. Early assessment of safety and efficacy can also be accomplished with many imaging applications.

Growing importance of medical imaging Medical imaging has developed extensively over the last 30 years. It now plays an everincreasing role in the development of new therapeutics, either as a surrogate endpoint or an endpoint in its own right. Based on the objective nature of the measurements and the direct correlation to efficacy, medical research scientists are realising the impact this makes on the clinical trial process. Various criteria have been developed for objective interpretation of imaging studies. Additionally, there are emerging imaging techniques that have the potential for applications as surrogate endpoints for clinical trials. The increasing use of imaging in clinical trials is due to some major driving forces in the industry. First, there are the improvements in medical imaging technology and image quality, such as 3D Computerised Tomography (multi-slice CT) and standardised fast acquisition modes in MRI. Ultrasound has also seen major strides in improvement in imaging quality and increased use in cardiovascular applications. In addition, nuclear medicine has also made major strides in PET and SPECT technology, due JULY 2012

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M|A|R|K|E|T DIA's objectives Imaging techniques and read criteria continue to evolve, and it is important for investigators to keep current with the best practices. Hence, the DIA workshop's participants will be oriented with newer imaging modalities and latest imaging criteria with specific focus on quantitative imaging. Distinguished international faculty speakers from top medical schools will review the current practice of imag-

ing biomarkers in clinical trials in oncology, cardiovascular, metabolic, bone and joint diseases. The course content will focus on the need for consistency, accuracy and reproducibility of imaging data in clinical trials and how to achieve this. The workshop will also touch upon the added value of Core Labs and the role of technology in centralised imaging apart from examining how this can bring about efficiencies and

cost reductions in trials. The workshop is geared towards individuals from academic medical centres, pharmaceutical companies, contract research organisations, biotechnology companies and medical device companies that design and manage clinical trials. These individuals include medical directors, physicians, project managers and medical research scientists. In addition, this course will benefit radiologists who interpret

images and non-radiologists involved in imaging clinical trials. Participants will also learn appropriate analysis methodology. The workshop has been designed to enhance medical knowledge and patient care through better design of clinical trials and interpretation of imaging data. To know more about DIA's workshop and its initiatives in, log on to http://www.diahome.org/en -IN.aspx

PRE EVENT

FICCI Heal 2012: Lobbying for universal healthcare FICCI Heal 2012 revolves around the theme “Universal Healthcare: Dream or Reality?" ederation of Indian Chambers of Commerce & Industry (FICCI) is organising sixth FICCI HEAL, its annual healthcare conference from August, 27-29, 2012 at FICCI, New Delhi. The central theme of the conference is “Universal Healthcare: Dream or Reality?” The main features of the event are conference, master classes, B2Bs and poster presentation. India aims towards achieving universal healthcare by 2020. In spite of the increased public spending proposed in the 12th Plan, private out-of-pocket expenditures on health will remain high as compared to other countries in the

world. Global experience shows that universal health care is feasible provided there is sustained public finance. The government has proposed to provide universal health care in the 12th Plan by taking steps to provide free generic drugs at all public health facilities. But, will India be able to live its dream of ‘Quality Healthcare for All’ in the present context, is a question we need to ponder upon. The conference would be a conglomeration of policy makers and national and international leaders from healthcare and associated industries with participation of about 350-400 del-

egates from India and abroad. This conference endeavours to keep universal healthcare as the core theme of the conference and deliberate on the emerging opportunities, challenges and solutions. For more details contact Shilpa Sharma Assistant Director FICCI Health Services Division FICCI Federation House, Tansen Marg Tel: 011 23487438, 011 2373 8760– 70 (Extn. 438 / 513) Fax: 011 2332 0714, 011 2372 1504 E-mail: healthservices@ficci.com www.ficci-heal.com

PRE EVENT

Transforming healthcare with IT Technology and quality to provide twin fillip to the Indian healthcare sector yderabad is set play host to the third edition of International Conference on Transforming Healthcare with IT-2012 on August 31 – September 1, 2012 at the Hyderabad International Convention Center, Madhapur, Hyderabad. The Healthcare IT awards instituted by NASSCOM will be announced at the conference on ‘Transforming Healthcare with IT’. The 2nd International Congress on Patient Safety will be held on September 1-2, 2012 at the same venue. International Conference on Transforming Healthcare with IT 2012 is expected to bring together policy makers, healthcare providers and technologists from across the globe, combining the synergies of Healthcare IT. The focus of this year’s conference will be on cloud computing in healthcare, impact of hand-held devices in delivering healthcare, analytics and mHealth. Noted speakers at the conference include over 60 national and international speakers. The Second International Congress

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on Patient Safety will address critical issues in patient safety from patient safety experts across the world. The conference offers sustainable initiatives and ideas focusing on real time examples and best practices across the globe through presentations, panel discussions, patient safety awards and display of the most widely accepted patient safety tools. The Indian healthcare industry was estimated at $40 billion in 2010, and is expected to reach $280 billion by 2020. According to Frost and Sullivan reports, spending on IT by Indian healthcare players was estimated at $244 million in 2010 and is expected to grow at 22 per cent a year over the next 10 years. For further information contact:

Background Leading players from the healthcare and IT got together to create a platform to exchange and interact on issues related to these sectors. This resulted in the first International Conference on Transforming Healthcare with IT-2010

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which was held in New Delhi. The second International Conference on Transforming Healthcare with IT- 2011 was held in April 2011 in Hyderabad. It was attended by600 delegates, 66 national and international speakers and over 40 exhibitors. The first Patient Safety Congress was held in April 2011 and was attended by over 750 delegates, 66 speakers and 50 exhibitors. The main focus of the congress was on the four essentials of patient safety at all times - medication safety, infection control, surgical site safety and patient falls. Contact Transforming Healthcare with IT 2012 Suresh Kochattil, Organizing Secretariat Mobile: +91 98490 11006/+91 9818109181 Email: mail@transformhealth-it.org Second International Congress on Patient Safety 2012 Gaurav Loria, Organizing Secretariat Mobile: +91 9866072433 Email: patientsft@gmail.com JULY 2012

M|A|R|K|E|T POST EVENT

HospiArch 2012, Mumbai - A huge success HospiArch 2012, hosted at Mumbai and attended by an eclectic mix of healthcare professionals and several interesting sessions was a resounding success ospiArch 2012 is a unique platform for sharing knowledge, challenges, ideas and best practices amongst the various stakeholders in the domain of architecture, hospital projects, hospital operations, engineering and hospital administration. Mumbai hosted the 3rd edition of HOSPIARCH-2012, a multi-city conference on hospital planning, design and architecture. The event was organised by AMEN and HOSPACCX India systems. With over 120 delegates, the audience constituted a mix of professionals from architectural firms, hospitals, projects divisions and students. The success of the event was evident by the accolades received from the delegates, exhibitors, speakers and officials. Tarun Katiyar, Principal Consultant, HOSPACCX India Systems stirred the thoughts of the audience with the architectural challenges faced by the projects team in micro planning the areas while considering the statutory requirements of the local and national bodies as well as international accreditation bodies. He emphasised on the need to plan for the expansion of the hospital and incorporation of a futuristic design. He believes Vaastu has a scientific basis which aids in quicker recovery of the patient. Dr Vivek Desai, MD of HOSMAC, Mumbai engaged the audience by sharing his vast experience in hospital planning and operations. According to Dr Desai, a good hospital project implementation serves as an investment for 40 years. He explained in depth the stages in hospital planning viz. project conceptualisation, feasibility analysis, building design, project management and commissioning. Eminent architect and LEED accredited

JULY 2012

professional, Sandeep Shikre, Head, SSA Architects spoke on the hot topic “Planning a Green Hospital”. Shikre steered a multidisciplinary team at Kohinoor Hospital in

ensuring the world’s second and Asia’s first LEED Platinum rating for a hospital. The hospital has incorporated rain water harvesting, roof overdecking, utilisation

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of daylight and the many ways the hospital used the waste which was generated from landfills to intelligent utilisation and recycling of steel, furniture, etc.

Abhishek Singh, DirectorHealthcare of CRISIL stressed on the importance of financing and having an internal relook of existing hospitals. Singh discussed on the

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financial options like private equity, strategic partnership, structured term loans and Real Estate Investment Trust (REIT). A riot of colours and designs, as well as a nonporous, easily manageable flooring is an administrator’s delight. Bringing this to the fore, Naresh Duble, DGMBusiness development, Armstrong World Industries spoke on the topic “Hospitals are for people—Design Solutions” and enlightened the audience with Dr David M Sykes study on How Acoustics affect Human Productivity that 48 per cent of the workers were able to focus better, conversational distractions were decreased by 51 per cent, error rates decreased by 10 per cent and stress was reduced by 27 per cent. Chiranjib Dey, Head – Design (Healthcare), Edifice Consultants spoke on the space, equipment and engineering planning in a hospital. The hospital needs to be segregated and planned appropriately like the out patient, diagnostic, treatment, administrative, service, research and training functions. Space planning has to be done based on movement and communication between people, materials and waste. He explained that the essence of a successful master plan of is its expandability, modularity and flexibility. A central sterile supplies department (CSSD) is an integral part of the hospital and needs to be well planned. Anuradha Desai, Academy Manager – Getinge India Pvt Ltd, shared a few plans of CSSD so that the flow of the linen, consumables and the sterile trays did not cross with the unsterile/used trays. An interesting mix of panelists moderated by Dr Akash Rajpal, MD and CEO, Ekohealth Management Consultants, Mumbai answered queries of the audience related to planning of a new hospital, re-modeling of existing hospital, emergence of day care/short stay specialty hospitals, financing of hospitals, the role of technology in the smooth running of a hospital and how to meet the accreditation requirements in terms of infrastructure. According to the World Health Report 2006, India has only 0.6 physicians compared to 2.56 of US, 0.86 nurses compared to 9.37 of US and 0.02 lab technicians compared to 2.15 of US per

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Tarun Katiyar during a session

Dr Akash Rajpal addressing a panel

Participants came in from variuos parts of the country

Team Hospaccx

Dr Vivek Desai addresses the audience 1000 population. Ankush Gupta, Asst Director, Hinduja Hospital shared his experiwww.expresshealthcare.in

ence of manpower planning at Hinduja Hospital with a pragmatic approach with

respect to the functional areas, working hours, complexity of equipments used and the leave policy of the organisation. He stressed on the fact that human resources need to be planned well as 18-20 per cent of the cash flow is spent on the staff salaries and a surplus can lead to financial difficulties. Hospital IT received a special emphasis as Dr Amitava Dutta, MD and CEO, Ubq Technologies elaborated on the challenges in healthcare IT. The reasons for failure of a HIS is the lack of needed information, the technology partner fails to deliver or the belief in the solution is lost. Identifying the right information which is required by the end user is of utmost importance. There’s lots of data in a hospital, but if that data is not transformed into information it becomes a waste. Anooj Vakil, General Manager – Turnkey Designs, HOSMAC, elaborated on the challenges the architectural team faces when the founder/owner sets the ball rolling to expand horizontally or vertically an existing hospital, or convert a hotel or a mall into a hospital. Redesigning the flow of people, materials and waste needs an innovative approach. There would be challenges in designing the existing structure, shutting down or temporarily relocating for a short duration, sound pollution and patient safety. The floor map examples cited broadened the horizons of the audience in terms of thinking afresh about redesigning the existing hospitals. Patient safety has assumed high importance following the unfortunate incident at AMRI, Kolkata. Hence the topic “Hospital Planning, designing and architectural considerations with regard to fire safety” by Dr Swapnil K was the much awaited talk. Dr Swapnil dwelt on the fire detection, fire containment, fire fighting and evacuation methods and the regulations for buildings as per the National Building Code. “The momentum of HospiArch is tremendously increasing and we are extremely happy and motivated with its success. After Indore, Bangalore, Kochi and Delhi in 2012, we plan to take HospiArch to the international level”, shared Paniel, Founder and Chief Strategist of AMEN, who are the principal organisers of HospiArch. JULY 2012

M|A|R|K|E|T POST EVENT

Medical tourism workshop evinces wows Dr Premâ&#x20AC;&#x2122;s workshop on medical tourism receives an overwhelming response he recently concluded Medical Tourism workshop, conducted by world renowned speaker and trainer Dr Prem received an overwhelming response from the participants attending it. Organised by Constellation Communications & Events in Mumbai, the workshop was held on June 1-2, 2012. Delegates from across the country attended the workshop. They were from diverse industry sectors and included professionals like medical tourism facilitators, doctors and surgeons, dentists, healthcare consultants, tourism professionals, students etc. Despite being the first edition, the workshop managed to get significant number of delegates from the industry, which proves the demand of such knowledge driven courses in otherwise less explored, specialised fields like medical tourism. The first day of the workshop began with Dr Prem giving an in-depth analysis of medical tourism as an industry in India and across the globe. He emphasised on the importance of healthcare professionals getting out of the domestic boundaries and exploring opportunities that the global healthcare world provides. The further sessions were on impact, benefits, opportunities and challenges in medical tourism followed by a session on developing a success formula in medical tourism (with Indian perspective). Apart from his excellent training, Dr Prem also engaged the participants in various activities and short

in-house games. This varying methodology made every session more interactive, interesting, and fun. Post lunch session on the first day was on marketing and brand development, which signified the importance of building a brand not only for a company or a product but also for an individual. Dr Prem highlighted the fact that an individual in himself can be a brand. He explained the strategies in marketing medical tourism amongst the target audience, and building as well as managing brand reputation. He emphasised on the importance of online media in current times and how professionals can make the maximum use of online media for developing their business. The second day of the workshop focussed on few management related topics like lean management followed by discussing the role of facilitators in medical tourism and developing international patient department. Panel discussion was also organised on this day with Dr Pratiksha G Gandhi, a leading preventive cardiologist in Mumbai and Dr R Krishan Kumar Raheja, Healthcare Consultant and Surgeon Captain (Retd.), Indian Navy being on panel along with Dr Prem. Dr Gandhi being associated with IPC, one of India's largest chain of preventive and non-surgical cardiac care, spoke in detail on quality of healthcare for international patients and the necessary measures one has to take to develop international

A group presentation on medical tourism JULY 2012

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Delegates attending the workshop

Participants came from across the country patient department as per the global standards. Dr Raheja highlighted the importance of education in medical tourism and how such workshops can put

light on ongoing issues in the medical tourism industry and suggest solutions to overcome these issues. Post the panel discussion, Dr Prem spoke on evaluation of medical tourism destinations and identifying customer needs ad delivering customer services in global healthcare. This session was extremely well received by the participants, as it involved minute details on what customers look forward while selecting a medical tourism destination. At the end of the programme, participants were given the certificate of participation along with a copy of Medical Tourism Guidebook signed by Dr Prem himself. Conclusively, the workshop exceeded the expectations of the organisers not only in terms of number of participants attending it but also the response from all the attendants. EXPRESS HEALTHCARE

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EVENTS UPDATE Healthcare Quality (Clinical) Audit Date: July 7, 2012 Venue: Mumbai Organisers: Aum Meditec, Mumbai Participants Profile Hospital CEOs, Management Executives, Quality In Charge, Clinical Managers Medical Administrators, MHA/PGDHA/MBA (Hcm) Students Contact: Email: support@meditecindia.com Web: www.meditecindia.com

Corporate Governance & CSR in Healthcare Date: July 8, 2012 Venue: Mumbai Organisers: Aum Meditec in association with Integrated Social Development Consultancy (ISDC) Participants Profile: Hospital CEOs Hospital Administrators Medical Administrators Managers Marketing Managers/Executives MHA/PGDHA/MBA (Hcm) Students Contact: Email: support@meditecindia.com, Web: www.meditecindia.com

Green Lean Six Sigma Training For Healthcare Date: July 20- August 5, 2012 Venue: Ahmedabad/Baroda/Surat Organisers: Aum Meditec, Mumbai, India Participants Profile:

Hospital CEOs/COOs Management Executives Hospital Operations Managers Quality in Charge MHA/PGDHA/MBA (Hcm) final year students Contact: Email: meeta@meditecindia.com, meetaruparel@hotmail.com Web: www.meditecindia.com

HospiArch 2012, Indore Date: July 22, 2012 Venue: Lemon Tree Hotel, Indore Organisers: AMEN and Hospaccx India Systems Participants Profile: Healthcare Promoters, Managing/Medical Directors, CEOs, Administrators, Healthcare Consultants, Architects, Designers Contact: Paniel Jayanth, Founder & Chief Strategist AMEN Mob : + 91 9035189825 Email: hospiarch2012@gmail.com Website: www.amen-hospiarch2012. blogspot.in

Medicall 2012, 9th edition Date: August 3-6, 2012 Venue: Chennai Trade Centre, Chennai Participant profile: Professionals from various verticals of the healthcare sector Contact: Sundararajan, Project Director Email: sundararajan@medicall.in Yogita R Panchal, Manager - Corporate Marketing Mob: 09840326020, | 09360707022 |

+91 9360727424 Email: panchal@medicall.in,info@medicall.in

3rd International Conference on Transforming Healthcare with Information Technology Date: August 31 to September 1, 2012 Venue: Hyderabad International Convention Center, Hyderabad Participant profile: Professionals from various verticals of the healthcare sector Contact: Conference Secretariat Apollo Health Street, Apollo Health City Jubilee Hills, Hyderabad, Andhra Pradesh, India - 500 096 Mob: 98490 11006, 99633 60002 Email: mail@transformhealth-it.org

3rd Healthex 2012 International Date: September 7-9, 2012 Venue: Bangalore International Exhibition Centre Participant profile: Professionals from various verticals of the healthcare sector Contact: Suresh Babu P Bangalore International Exhibition Services Pvt. Ltd. Entry Plaza, BIEC, 10th Mile, Tumkur Road, Madavara Post, Bangalore-562 123. Mob: +91 80 6583 3234, Mob: +91 99729 29976 Fax: +91 80 6624 6661, Email: suresh@bies.co.in Web: www.bies.co.in

To tie up with

for Media Partnerships Contact tushar.kanchan@expressindia.com

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JULY 2012

The journey so far Medicall has grown from strength to strength since its inception in 2006. With Medicall 2012 in Chennai fast approaching, Express Healthcare recalls the journey traced by the premier event which is attended by crème le crème of the medical fraternity

Fashion Show at Medicall

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edicall—an event which gets top of the mind recall when it comes to naming successful events which bear a tremendous influence on the industry they represent. It is hailed as India’s premier medical equipment expo and the first real “supermarket” for hospital equipment and supplies. Thus, it has undoubtedly traced a success story, yet every story has a beginning.

Medicall team: Dr S Manivannan, S Sundarajan and Yogita Panchal

The beginning Eleven years back, a young man out of medical college and his friends dreamt of starting their own hospital. The dream became a reality and a 30-bed hospital was built, which later went on to become a 400bedded hospital in South India. The ambitious young man who dreamt of establishing his own hospital and managed to do it against all odds was none other that Dr S Manivannan and his hospital is known as Kavery Medical Center and Hospital. However, this path to this achievement was not easy and was strewn with lots of trials and travails. Dr Manivannan and his friends faced many hurdles in the course of their growth and these very hardships and challenges were the seeds from which Medicall emerged. It was born with the idea to share their expertise with the fellow medical fraternity. They realised that many of their problems were a result of limited knowledge about the medical industry and thus, thought of sharing their own experiences and learning with the young and aspiring healthcare professionals of the present day so that their paths to success would be less strenuous and more accessible. In his own words,

Dr Manivannan states, "I am the Promoter-Director of the 400-bed hospital group KMC hospital, Trichy, Tamil Nadu. I have undergone the pains of bringing up a hospital in a small Indian town where we rarely get an opportunity to know about latest developments in medical equipment industry. Big companies do not concentrate in such cities due lack of adequate sales force and feel that it is a small market. I wanted to share my experience which I gained over a period of a decade with my fellow colleagues and that prompted me to start Medicall expo."

Medicall – the rise over the years 2006: The first Medicall exhibition was introduced as a small medical equipment expo and was hosted at Chennai. It was very well received by the industry and there were more than 100 exhibitors and 3000 visitors. 2007: Medicall 2007 was bigger and better than its first edition. There were more exhibitors and visitors at the event. 2008: The third edition of Medicall attracted 5,400 visitors from across the country. Apart from hospital owners, hospital administrators, and people from other segments like dealers, architects, hospi-

Delegates attending seminars at Medicall www.expresshealthcare.in

tal consultancy, nurses, and biomedical engineers, exhibitors dealing with hospital flooring, lighting, energy saving equipment, storage solutions, ambulance fabricators, etc., also participated for the first time in this show. 2009: With more than 5700 visitors attending Medicall 2009, the expo bridged the gap between the buyers and users and managed to bring them together on one single platform. In this three-day expo, more than 250 exhibitors from all over India and China displayed their latest equipment. Medicall became a pan-India event than just a regional expo in Chennai. 2010: Availability of unique products, many exhibitors for the same product, international exhibitors were the USPs of Medicall 2010. It was bigger and more incisive in terms of content and participation. International participation increased and over 400 exhibitors from China, Germany, Taiwan, England and India displayed their latest medical equipment. It grew to become India's largest and Asia's third largest medical equipment expo. 2011: Around 7500 visitors from India and other countries like Sri Lanka,

Nigeria, Nepal, and Taiwan visited the three day show. The Healthcare Innovation Awards, instituted for first time in this edition of Medicall, attracted several applications from across the country. More than 430 exhibitors from India, Germany, China, Taiwan, Korea, Japan and Iran participated in the show and displayed A-Z requirement of hospitals. 2012: Medicall 2012 Chennai is expected to be an event to remember with huge participation from healthcare industry experts and professionals as well as several new and innovative segments like fashion show on hospital garments and “Hospital Property Mela”. Over 500 companies are estimated to exhibit at Medicall this year. It has seen an increase in exhibit space with a total of four halls this year. Representatives from Germany, China, Taiwan, South Korea, Pakistan, Malaysia and more are expected to participate.

The future path With its constant evolution and growth, it is to be expected that Medicall will continue to provide a big fillip to healthcare sector in general and the medical equipment industry in particular.

Visitors checking out the stalls at Medicall JULY 2012

Attractions at Medicall 2012, Chennai Medicall 2012, Chennai promises to be a fascinating event with several interesting segments to look forward to

B2B Buyers and Sellers meet: It will be organised during the expo. The first day of the expo will be named

“India-Sri Lanka Buyers Day” and the second day of the expo will be named “IndiaAfrica Day”. Exhibitors can

meet the delegation on a oneto-one basis by fixing a prior appointment. Hospital Property Mela:

Another value addition at Medicall Expo Chennai, this segment would be extremely beneficial in guiding doctors

edicall segments are a big hit with the medical fraternity. They are chosen with great care for their relevance to stakeholders of the healthcare industry. The major attractions at Medicall 2012, are as follows

JULY 2012

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who want to purchase or set up their own hospital or nursing home. Some of the key topics to be covered will include healthcare real estate investment opportunity in India, how to identify the right healthcare property and case studies from healthcare systems relating to in-and out-sourcing of real estate functions. The concurrent conferences on hospital constructions will throw light on important factors to be considered by doctors before setting up a hospital. Here top hospital owners and the small and medium size hospital owners will be invited for the VC Circle conference and Exhibition. Archimedes: There is also an expo dedicated entirely to healthcare infrastructure. Since there are hospitals mushrooming across the country, there is a growing demand for construction material used specially in the construction of hospitals and the expertise required to ensure compli-

ance with existing standards. The expo will cover the entire spectrum of material and related services that go into setting up a hospital/nursing home. Fashion show on hospital garments: It will invite all the top administrators and medical directors of hospitals of India. This imaginative show which was unveiled for the first time in India at the previous hosting in Ahmedabad which was a runaway success. This year's show will be based on the premise that patients like children and youngsters normally get bored of seeing the conventional white uniform of doctors and nurses in hospitals. Hence, the organisers have hit upon a novel concept of introducing a fashion show on hospital garments in cooperation with National Institute of Design, Ahmedabad (NID) at Medicall 2012. The Medicall Innovation in Healthcare Awards: These awards would be presented to

the most innovative manufacturers in the medical field. There are three categories of awards: Product Innovation, Process Innovation and Concept Innovation. Hospitals will be invited to be a part of this awards function. The leading rating agency, CRISIL, is the knowledge partner for the awards. Chain reaction: In order to take stock of the growth, discuss about the problems therein and identify opportunities for future in healthcare, Medicall 2012 has invited eminent speakers who are entrepreneurs, professional experts representing engineering, design, supply chains, turnkey consultants, medical administrators and top notch surgeons to share their experiences of setting up similar chains and also elucidate on the value proposition. Two days of immersion seminars focused on the whole gamut of a healthcare delivery chain are awaiting the visitors. Any doubts or questions relating

to the setting up of a new business, to the scaling up existing ones, any grey areas to be sorted out while planning to expand or strategise an acquisition will be addressed by professionals, who have been there and done that. The concurrent conferences: These will be held under the banner of “Everything They Failed To Teach You At Medical College” and help hospital owners to update their management skills. They will cover topics like ● Health vault - Wealth in clinical data ● Supply chain management ● Consumer branding of hospitals ● Eye, dental and oncology care, lifestyle diseases (diabetes) and chronic care ● Profitability of pharmacies and diagnostic centres ● Finance for chains ● Hospital infrastructure

● ●

Critical care Medical mall—the need for hour ● Recent trends in healthcare infrastructure ● Panel Discussion: Future for healthcare infrastructure —Single speciality or multispeciality hospitals Apart from all these attraction, over 500 companies are estimated to exhibit at Medicall Expo 2012 Chennai which has seen an increase in exhibit space with a total of four halls this year. There will be pavilions of hospital constructions named Archimedes, Medical Lab and Rehab. The organisers of Medicall have also invited the top 100 hospitals of India to visit the expo. Thus, it will also serve as a great networking platform and offer business opportunities galore. This, in turn, is expected to enhance international participation with representatives from Germany, China, Taiwan, South Korea, Pakistan, Malaysia arriving at the event this year.

INTERVIEW

Medicall is primarily aimed at creating a platform for the promotion of medical technology for hospitals Dr S Manivannan CEO, MEDICALL

What was the rationale behind the inception of an event like Medicall? How has it evolved and grown over the years? I had undergone the pains of bringing up a hospital from scratch in a small town. Like any other young medical graduate I came out with lots of dreams but little practical knowledge in setting up hospitals.The journey from a 30-bed family owned hospital to a 750-bed, professionally managed healthcare group was a rich learning experience. In order to share this

We have sought to further increase the level of overseas participation and accordingly taken the necessary steps to communicate and promote Medicall internationally. 42

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experience with doctor entrepreneurs like us, I started a consulting company called Medexpert Business Consultants Pvt Ltd, which in turn created Medicall in 2006; primarily aimed at creating a platform for the promotion of medical technology for hospitals.

How have you geared up for Medicall 2012? What preparations have been underway? Based on the response to last year’s staging of Medicall, we have sought to further increase the level of overseas participation and accordingly taken the necessary steps to communicate and promote Medicall internationally. Medicall is the only organiser in India who does extensive marketing campaign for visitors as well as the exhibitors. The visitors' campaign starts alongwith the exhibitors marketing. Medicall

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2012's visitor countries are Nigeria, Kenya, South Africa, Srilanka. The Medicall team personally visits these visitor countries and confirms buyers delegation from these countries visiting Medicall The visitors brochure (Doctors brochure) is sent four times in a year to over 75000 target audience. The brochure contains the updates of the show on the conference, exhibition participants, awards etc. VIP invitations are sent to all the hospitals of India. Concurrent conferences happening during Medicall are updated on regular basis through emailers, selected healthcare magazines of India and international, press releases etc.

What are the new additions to look for at Medicall 2012? This year we plan to organise an interesting seminar on healthcare chains. Leading

entrepreneurs from Indian healthcare industry will share their experiences with the delegates.This session is bound to attract hospital owners. Also, more than 120 international exhibitors from Pakistan, Germany, Taiwan, China, Malaysia, Iran, Singapore and Middle East will showcase their products. As part of Archimedes - an exclusive healthcare infrastructure pavilion - we will be organising a Healthcare Property Mela, wherein latest trends in healthcare real estate will be deliberated. The revolutionary Fashion Show on hospital garments is a major highlight. It is based on the premise that patients like children and youngsters normally get bored of seeing the conventional white uniform of doctors and nurses in hospitals. Medicall has concurrent seminars under the banner of Continued on Pg 44

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(Dr S Manivannan's interview contd...) Continued from Pg 42 “Everything they failed to teach at Medical College”, addressing a broad spectrum of topics. Besides, we have instituted the Medicall Healthcare Innovations Award to encourage and reward innovation in this industry.

Brief us on the exhibition stalls at the event this year, what kind of participation are you expecting at the event? In addition to stalls of leading Indian medical equipment manufacturers, there will also be international pavilions from Taiwan, Germany, China, South Korea and Pakistan.

Can you name some key participants at the event this year? Having been staged for the past six successive years,

Medicall has registered growing participation by some of the leading names in hospitals chains and medical equipment manufacturers in India. Philips India is the sponsor.

Are there any products and technologies slated to be launched at Medicall 2012? As can be expected of an event enjoying leadership in its category, Medicall forms the perfect platform for showcasing the latest and path-breaking products and technologies. Some of them include disinfecting reagents, advance life support ambulance, natural latex surgical rubber gloves, different types of floorings for hospitals, modular OT, medical gas, ENT equipment, laundry and kitchen equipment for hospitals, hospital software technology, special OT lights and UV lamps, laparoscopy, urology, gastroenterology and

opthalmic products, neonatal and paediatric products, anaesthesia and dental products etc.

What are the current trends driving the medical equipment market? Rising incomes and a growing elderly population are factors that have triggered the demand for high-quality medical care, transforming the healthcare delivery sector into a profitable industry. With the integration of world economies, high quality treatment at a fraction of the cost, in comparison to western countries, makes India an ideal healthcare destination for highly specialised medical care. In addition, changing demographics, disease profiles and the shift from chronic to lifestyle diseases in the country has led to increased spending on healthcare delivery. Medial tourism too is changing the face of traditional healthcare industry in India. It has necessitated the upgrading of India’s

hospitals, thus paving the way for latest technology and equipment to enhance both the efficacy and cost efficiency of services and treatment.

What is your message for the exhibitors and the participants expected at Medicall 2012? To the visitors Medicall has always offered new products, innovative seminars. This year, we have ensured variety in products for more international participation. You have always supported our seminars. This year's seminar on healthcare chains, property mela and innovation awards will satisfy your academic needs.

To exhibitors .. We have always ensured that quality visitors attend the show our innovative seminars and campaign is bound to attract the decision makers of the industry.

INTERVIEW

‘USP of Medicall is its ability to attract, primarily, the owners of small private hospitals and nursing homes’ Jitesh Mathur DIRECTOR, PCCI AND ULTRASOUND BUSINESS, PHILIPS HEALTHCARE

Philips is a leading player in the healthcare sector, tell us about the global trends in healthcare? Philips is a dominating player in healthcare industry. Over 40 per cent of Philips' revenue comes through healthcare, this emphasises the focus we have put on serving the industry and the same also gets reflected in our mission statement—“health and well being”. Globally, the demographic trend suggests that there is more aging population and it would require more efficient and more accessible healthcare infrastructure. Philips is tapping this opportunity by strengthening its home healthcare product line. The other trend is the move towards preventive healthcare. Worldwide, government and healthcare organisations are engaging in population screening programmes. Philips, with its wide imaging portfolio, is

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actively providing technology solutions to screen diseases like breast cancer, cervical cancer at a very early stage so that lot of social cost associated with disease treatment could be avoided.

How has Indian healthcare evolved vis-a-vis the global market, especially in the medical equipment segment? Indian healthcare market in medical equipment segment is very challenging. It constantly demands high performance at affordable prices. The challenge is to understand the unique needs of customers and offer them solutions that address these needs. Hence, for example, we have a formidable patient monitoring portfolio. We can offer state-of-the-art performance through our IntelliVue series and at the same time offer affordable

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solutions through our Suresigns and Goldway series. We understand this uniqueness about Indian market vis-a-vis other markets (Europe, US) and hence, emphasis is laid on bringing in right products at right prices for our customers. If I talk about the market opportunity, the matured markets of Europe and US are experiencing a slowdown. This has shifted the focus to emerging markets like China, India and Brazil. The Indian medical devices market is growing at a rate of above 12 per cent and this offers a huge opportunity for us.

What are the unique advantages and challenges in the Indian healthcare market for a company like Philips Healthcare? Indian market is dynamic and hungry for innovation. It is a market that keeps a company

like Philips on its feet. With a research centre in Bangalore, housing a research and development staff of over 1000 and with a strong manufacturing presence in India we are comfortably positioned to serve and strengthen our position in Indian market. The advantage of Indian market is the size of opportunity. According to our internal estimates, the Indian healthcare delivery market has significant headroom for growth with the country lagging on all key healthcare delivery metrics (hospital beds, physicians per 100,000 population, percent of Indians insured) when compared to countries like US and China. We, as Philips, recognise it as a big opportunity to bring in new products and solutions, work with various stakeholders (government, for profit, non-profit) and contribute in bringing quality healthcare to more people.

JULY 2012

Philips is the official sponsor for Medicall 2012, tell us about its USP? What makes it different from its counterparts?

in tier-II and tier-III cities. Going forward you will see lots of activities from our side in this space!

I think the USP of Medicall is its ability to attract, primarily, the owners of small private hospitals and nursing homes.We participated last year as an exhibitor and received a positive experience. So, we decided to be the official sponsor this time to reaffirm our commitment to serve the needs of small private hospitals and nursing homes. Medicall is different from its counterparts because of several reasons. First, it is organised in a very professional manner. Second, it is much more than a trade show. It provides a platform to enable holistic communication between doctors, entrepreneurs, medical device manufacturers, policy makers, thinkers and innovators. I hope that it will not lose its focus in future and will only build upon its merits.

Are there any plans to launch or showcase any new products at Medicall 2012? We already have a good portfolio of products to serve

the unique needs of small hospital setups and we are selling these products well in the market. We would be showcasing these products at Medicall. As far as new product release is concerned, we would request you to wait till Aug 3, the first day of Medicall 2012 at Chennai. You just might see a new product

release targeted specifically towards the small hospital set-up.

What are the goals/agenda set to achieved at Medicall 2012? We always aim to communicate effectively with our customers. Medicall provides a good platform to communicate

with owners of small private hospitals and nursing homes. We plan to showcase our products and solutions that we have been adding to our kitty, exclusively for small hospital setups. Our participation will be completely handled by our new sales and marketing team which has a mandate to serve the small hospitals segment.

GMP

What are Philip's Indiaspecific plans in the healthcare segment? We are a leading player in the Indian healthcare sector. We are the No 1 player in cardiovascular systems, cardiology and radiology ultra-sound systems, patient monitoring systems and defibrillators. We have also started gaining significant market share in MRI and CT business. Going forward we are committed to serve the Indian healthcare market by bringing the best in class technology and supporting it with best in class customer service. Here, I would specifically like to mention our increased focus on serving the needs of small private hospitals and nursing homes. Philips Healthcare is now committing resources worldwide to make the technology more affordable so that we could serve the wide spectrum of our customer needs. What it means for a market like India is that Philips will have more products which are best in class in terms of technology and yet affordable to serve the need of hospitals in tier-II and tierIII cities. We are building our sales and service footprint to take these products to our customers JULY 2012

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Key participants at Medicall 2012, Chennai Medicall 2012, as a brand, is expected to draw huge participation from not only the healthcare segment but also the allied industries

edicall 2012, slated to be held in Chennai, has invited eminent speakers, who have walked the talk of promoting healthcare chains. Entrepreneurs, professional experts representing engineering, design, supply chains, turnkey consultants, medical administrators and top notch surgeons will not only be sharing their experiences of setting up similar chains but they will also be elucidating the value proposition. Thus it is all set to be a resounding success and welcome visitors from across the world to participate in it. Some of the key participants at this event would be

Bayern Pavilion Bavaria, one of 16 federal states in Germany, is offi-

Godrej Interio W

e find organisers keen to understand unfulfilled expectations of all stake holders and try to accommodate as much as possible year after year.The integrated approach to conceptualising, organising, promoting and executing of the event, as well as active follow-up from organisers to ensure event objectives are achieved sets Medicall apart from its counterparts. — AI Buvaneswar, AVP and Business Head, Godrej Interio

odrej Interio is India’s leading furniture brand. Present across India through 50 exclusive showrooms in 18 cities and through 800 dealer outlets, they offer their customers home and office furniture, along with solutions for laboratories, hospitals and healthcare establishments, education and training institutes, shipyards and navy, auditoriums and stadiums. They have been attending Medicall for almost five years though they participates in the exhibition for the first time only last year. Expectations from Medicall 2012: To learn emerging trends in the health care sector as such and about new products and upcoming projects. Agenda at Medicall 2012: To exhibit some new products and showcase the company’s ability as a solution provider for hospitals nationwide

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ndia is a very interesting market and has vast potential. Bavaria was searching for the right platform to promote products from Bavaria in India. It seems we have found this platform during the last show, because we found Medicall Chennai a professionally organised healthcare exhibition. — Torsten Wagner, Head - Bavarian Delegation, Bayern International cially participating in Medicall 2012 with a joint company stand and an information center offering a professional brokerage service. This year, nine companies from Bavaria have decided to join the show. The

Bavarian delegation has been attending Medicall since 2011.

Expectations from Medicall 2012: To help establish contacts with Bavarian companies and comprehensive information on Bavaria as a business and high-tech location. Agenda for Medicall 2012: The nine companies participating in the Bavarian pavilion will showcase a wide range of products and services "made in Germany" which offer high standards in terms of technical innovation and quality. Most of them are seeking for a distributor. Others, such as Medi, already have a distributor in India so they already can push their sales efforts during the show.

Forbo Flooring Systems

orbo Flooring Systems is a global player in highhis is the first quality commercial and time Forbo residential floor coverings. Flooring participates it offers in this exhibition. We aim to understand ● Ultra-hard-wearing materimore about the als with excellent acoustic requirements of and slip resistant properties healthcare industries. ● Speciality floors for clean— Hardeep Singh, rooms and operating theCountry Head, Forbo Flooring Systems aters ● Ecological linoleum floors produced from natural raw materials sand existing products in healthcare industries related ● Flexible and easy instalto flooring system lation with our carpet tiles, Marmoleum tiles ● To know more opportuand vinyl tiles nity and new buyers ● Design floors such as Agenda for Medicall 2012: Forbo plans Marmoleum meets Mendini and to showcase two of their products at Marmoleum Dutch Design Medicall 2012. They are ● Vinyl floors which look like a real wooden floor but have the advantages ● Marmoleum: Marmoleum floor coverof strong and durable vinyl ing fits perfectly in sustainable building concepts and has been extensively used ● Applications for furniture and walls for the interiors of many hospitals all ● Entrance matting systems for minimizacross the globe. It also inhibits the ing maintenance costs and protection growth of methicillin-resistant staphyloagaints pollutants and dirt. coccus aureus (MRSA) bacteria through It is a part of the Swiss Forbo Group and out the life and hence makes the hospiowns 12 manufacturing plants and branchtal environment very hygienic. es in 32 countries worldwide. They are participating in Medicall for the first time. ● Flotex: This is the only sanitised textile flooring which comes with the seal of Expectations from Medicall 2012: approval from the British Asthma founThey are as follows dation and hence is used in many hospitals across the globe. It has highly ● To know the latest developments in the effective anti-microbial treatment and healthcare sector. offers constant protection against bacte● Map the upcoming projects and the ria, including MRSA, E-coli and the investments development of dust mites. ● To know more about the competition

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Premier Enterprises Sai InfoSystem (India)

e have been associated with Medicall for more than five years. Overall it has been very good.

— A Rajendramani, CEO, Premier Enterprises

remier Enterprises, Tamil Nadu, is a large manufacturer, exporter and supplier of surgical dressing disposables, medical dressing disposables, wound dressing disposables, etc., like medical gauze products, cotton products and other hygiene care products used in the healthcare industry. They have three manufacturing units spread across an area of 25 acres and carries high installing capacity of one million gauze swabs per day. They have attained following certifications which conform to Pharmacopoeia European and other internationally followed standards. Expectations from Medicall 2012: ● To gather good customer contacts ● To develop business contacts and interact with manufacturers and traders Agenda at Medicall 2012: ● To introduce international quality gauze products to all places in India ● To launch new products at the event

Czech Republic – MAXIS a.s. M

AXIS is participating for the first time in this trade show. We plan to tap newer opportunities at Medicall 2012. — Michal Jura, Director MAXIS a.s

AXIS ranks among the leading world producers of health compressive stockings and anti-embolism stockings as well as orthopedic supports and bandages. MAXIS a.s. is a member of "Quality mark Association for Medical Compression Hosiery" registered in Köln (Germany). Expectations from Medicall 2012: To find distributors for their products in India Agenda at Medicall 2012: To present their entire portfolio of products

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IS is a growing end-to-end ICT (Information and Communication Technology) solution provider and leading system integrators of India. Founded in 1992, by Sunil Kakkad, Electronics and Communication Engineer and a first generation entrepreneur, it was started to offer IT solutions to the SOHO segment. Today, SIS has expanded to hardware manufacturing, software development, system integration and telecom services with direct operations in 17 states and more than 100 support centers. SIS Health is a division of Sai InfoSystem India which offers IT solutions for the healthcare segment.

e participated for the first time in Medicall in February 2012. This is indeed the right platform to showcase our vertical strength as well as to leverage our brand strength. Its visitors’ and exhibitors’ profile sets Medicall apart from its counterparts — Samip Shah Principal Technology Officer, SIS Health (division of Sai InfoSystem (India)

Expectations from Medicall 2012: They are as follows ● To interact with prospective users of the company’s productproduct &ective users of oof ouInfosystem India which offers IT solutions for the s services and help understand their needs ● To get information about newly introduced technology pertaining to their business from various other participants/exhibitors ● To communicate with the other vendors by meeting them personally at the exhi-

●

bition Agenda at Medicall 2012: ● To highlight various health related e-solutions. ● Spread awareness about the tremendous possibilities of technology in the area of e-health Launch the company’s telemedicine solution along with Express ECG. This telemedicine solution can be integrated with various medical equipment and vital trackers through a web application. Solution will have a web portal for rural health solution and an application running on android operating system on Tablet PC.

Getinge Group

he Getinge Group is a leading global provider of equipment, systems and solutions for healthcare and e have been the life sciences. It has operaassociated with tions in the areas of surgery, Medicall from 2011. intensive care, infection conOverall it has been very trol, care ergonomics and good. wound care. it is organised in three business areas: medical systems, extended care, and infection control. It ranks among the leading providers of disinfectors and — Rahul H. Patil , sterilisers within the healthcare Business Head, and life sciences segments. For Healthcare GETINGE India Pvt. Ltd. over 100 years, Getinge has acted as a complete solution provider and one-stop detergents for heavy soiled, shop, one can trust to universal, enzymatic, provide products one neutraliser, rinse aid, can rely on to instrument lubricant and guarantee cleanliness. Getinge Clean is a complete and pre-treatment foam. comprehensive range of cleansing detergents, providing efficient and econom- Expectations from Medicall 2012: To gather good customer contacts ical throughput along with maximum performance for healthcare, pharmaceutical production and life science laboratory Agenda at Medicall 2012: To introduce Getinge clean range of applications. The Getinge Clean range includes disinfecting reagents.

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IndiSoft Consultancy Services for SME hospitals IndiSoft Consultancy Services specialises in providing niche technology solutions to the small and medium segment hospitals and nursing homes

tives. The key to success is the system of working in cohesiveness with clients, to create a flexible staffing plan that augments their core staff with the best experts avail-

IndiSoft professionals can staff the help desk, systems support and maintenance teams, whilst providing the advanced IT skills required for complex project initia-

able on a requirement oriented basis.

Array of products IndiSoft offers products that cater to a wide variety of

ndiSoft Consultancy Services commenced its operations in 1999 and has grown into an organisation with a wide array of off-the-shelf products for Indian healthcare and financial industry. IndiSoft HealthCare IT team comprises qualified and diligent professionals with more than 80 man years of experience in providing solutions in information technology to healthcare providers. IndiSoft specialises in providing niche technology solutions to the small and medium segment hospitals and nursing homes.

Mission Statement â&#x20AC;&#x201C; Quality and Excellence IndiSoft is a ISO9001:2005 certified company with a strong focus on customer satisfaction. The process driven approach and customer first attitude makes IndiSoft stand apart in the IT industry.

B u s i n e s s SolutionsIndiSoft has more than 80 man years of experience in designing and implementing software solutions for the hospitals. With more than 160 client base at different geographies and of different sizes (10 beds to 200 beds) gives IndiSoft an advantage of having workflows suiting to your needs. JULY 2012

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business lines such as: RxOffice- Health Care Management Suite : The product comes in three editions: Clinical Edition, Hospital Edition and Institute Edition. The Clinical edition has all the required features to function with hospital data along with features of drug list, reminders, financials, patient list of OPD, excellent GUI and a real-time assistant to doctors. The Hospital edition covers a comprehensive database of patients as well as computerised and integrated billing of radiology, pathology, operation and pharmacy departments. It also provides applications to automate a variety of healthcare facilities, customised features to meet the

unique needs of the organisation with robust reporting and interactive features that provide a high return on investment. The Institute edition caters for the trust hospitals. It has general and standardised health packages for the OPD and admitted patients. It covers mainly the MIS reports like department-wise collection, bed occupancy, service-wise collection, concession reports etc. Rx Office Pathology: The software provides test selection for patients, changing of test selection; entry of test readings and printing of test reports. It also provides

standard test format for blood, urine, sputum, biochemical etc. In addition, it allows the user to define their customised test formats with a provision for interface with different pathology equipment. Rx Office Radiology: The software facilitates the user in test selection for the patient, entry of test readings and printing of diagnostics reports. It also provides list of standard tests like X-ray, sonography, ECG, EMG. etc as a part of requirement by the leading diagnostic centers. In addition, it allows the user to define their customised test formats with a provision for direct imaging interface with sonography equipment. Rx Office Pharma: Rx Office Pharma is a product that understands the real

need of a chemist and offers simple, efficient and easy to use software that enables the users to save time and money while keeping track of the invoice, sales and the accounts.

Rx Office Wipeout: WipeOut ensures complete removal of sensitive data from the hard drive, when deleting a file. Windows retain data in disk clusters even after deletion, which may compromise confidential information. WipeOut prevents breach of confidentiality by securely removing traces of any sensitive files from the hard disk beyond all hope of recovery.

Superb studs from Studex Studex signifies trust and safety in ear piercing around the world with their medically sterilied piercing systems

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he human body reacts to inclusion of any foreign object and may initially try to repel it. This manifests itself in the form of allergies and infections, which are the two of the biggest concerns faced by us during piercings. Allergies are caused by sensitivity to certain metals like nickel and are easily avoidable. Use of jewellery and piercing instruments which are made of hypoallergenic metals prevents any allergic reactions. Infections on the other hand are a little trickier and proper

But now you can be sure of continuous supply of medically sterilied piercing systems and studs manufactured under the authority of United States Food & Drug Administrations (USFDA) with highest quality made medical grade steel. Studex is world’s largest manufacturer of one of the finest ear piercing system available today. Its unique instrument design and exclusive piercing cartridge system provides a simple safe and successful pierc-

care is required before, during and after the piercing to successfully avoid it. Choosing a safe and trusted piercing place like a medical clinic which is hygienic is the first step towards an infection free piercing experience.

ing experience. All Studex sterilised ear piercing studs meet or exceed FDA regulations and EC standards. The System 75 instrument from Studex is designed to fit comfortable in hands of all sizes. Its patented design

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provides a gentle linear action for quick accurate and virtually pain free piercing. The System 75 cartridge is designed to be loaded while still in its sterilised package, providing a touch free operation, which is a feature that is exclusive to System 75. This ensures that the first surface it touches after it is opened is the surface of your skin of the area to be pierced. This minimises all risks of infection that can be caused by improper sterilisation. Each cartridge contains one sterilised piercing stud or hoop and clasp for easy one step loading. Each piercing stud or hoop is always visible while positioned in the System 75 cartridge. This unique feature assures that the correct stud or hoop has been chosen. Also the visible point of the stud or hoop ensures accurate piercing alignment. Once the placement is marked, the automatic positioning feature of each System 75 cartridge provides exact alignment of the stud and clasp while piercing. The cartridge automatically positions the space between the stud and clasp, for optimal healing after the piercing is completed.

For over four decades the Studex name has signified trust and safety in ear piercing around the world. With over 30 offices worldwide Studex is recognised on six continents as the world’s largest manufacturer of ear piercing studs, instruments and aftercare products. Studex also offers aftercare products for your piercing to further prevent infections that may occur during the healing process. Piercing systems India is the exclusive importers and distributor of Studex Ear Piercing Systems, Medisept Nose and Belly Piercing Systems, X8 Body Jewellery directly from US, we have dedicated team of sales and training personal to provide best advice for your piercing needs. Studex has recently launched specialised ear piercing studs “Baby Line” range, short post earring studs designed for gentle baby’s ears in attractive mini daisies and crystals. JULY 2012

MORE COST-EFFICIENT. MORE UPTIME. MORE LONG-LASTING. UNRIVALLED PATIENT SAFETY. Empower your healthcare staff with Zebra HC100 – the reliable, easy-to-use all-in-one patient ID solution. It’s simple. Print and produce scannable, longer-lasting antimicrobial-coated wristbands quickly and conveniently. Enable optimum user efficiency with this direct thermal printer that automatically detects the wristband size, calibrates – and prints. Reduce maintenance costs with no toner, no ribbon required. For maximum performance and productivity, deliver unrivalled patient safety with absolute reliability – in one easy-to-use cost-efficient print solution. All-in-One Wristband Solution • Easy to use • Accommodates Zebra’s entire line of Z-Band® wristbands • Bar codes remain scannable for longer than the average patient stay • Small footprints fits well in crowded workstations For further enquiries, please email SGMarcom@zebra.com For more information about HC100 printer, please, visit www.zebra.com/hc100

Zebra Technologies India Pvt Ltd Boomerang A202 Near Chandivali Studio Main Chandivali Farm Road Main Andheri E Mumbai 400072 T: 022 67275555

30 MINUTE INTERVIEW

“GMP plans to take hospital infrastructure to a new level” Prashant Kavale DIRECTOR, GMP TECHNICAL SOLUTIONS

rashant Kavale - Director GMP Technical Solutions elaborates on his company's offerings and its future plans

What are GMP Technical’s offerings for the hospital sector? GMP Technical Solutions (GMPTS) specialises in turnkey solutions for the clean room industry. As a design-led company, we provide a range of solutions for hospitals - from operating rooms to various allied services involved, it is only the applications that vary from one situation to another. Our team has experience with practically every type of pharmaceutical company in the industry, not overlooking the many diverse smaller companies we have dealt with. This vast bank of knowledge puts us in a position of being able to provide clients with the very best that modern day medical turnkey solutions has to offer. We can offer clients complete turnkey solutions for hospitals if required, starting from the design stage right up to the finished product. Our experienced team of dedicated professionals are at the very peak of their chosen fields, with expertise including all aspects right from design, civil, mechanical, consulting, validation, and documentation up to training.

What are your specialised products/services for large and mid-sized hospitals? Our turnkey solutions offer clients the very best services available in the field of medical design and build today.We offer dependable services coupled with superlative rates and impeccable quality, all delivered within the customer’s time scales. Large as well as mid-sized hospitals demand the very best in terms of quality. GMP norms cater to this need in today’s fast moving technologically advanced environment by continually evolving and staying ahead in the game. Being clean

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room experts, we are in a position to build modular operating theatres in the literal sense of the term. We manufacture clean room modular partitions in various material of construction (MOCs)– stainless steel (SS), galvanised iron (GI), high pressure laminates (HPL) and glass reinforced polymer (GRP) in-house.These are used for walls as well as ceilings. Our partitions are free-standing structures designed and constructed in such a way so as to incorporate/conceal all utilities and services like pipes, conduits, etc. within the panels itself so that everything is flush with the modular surface. We also manufacture laminar air flows (LAFs) and pass boxes for operating theatres. These products are manufactured under one roof and subsequently all metal forming, finishes, extrusions and assemblies are completed in-house with the result that specific requirements can be incorporated into your design requirements. Other offerings of GMP include various components such as hermetically sealed sliding doors, conductive vinyl flooring, peripheral clean room lights, surgeon control panels, scrub sinks, X-ray view boxes, writing boards, electrical wiring, medical gas piping, HVAC ducting, etc. Where services are concerned, we have dedicated in-house teams of experts for all utilities – HVAC, electrical, plumbing, BMS, IBMS, IT and networking as well as civil and interiors. We conduct validation as per international guidelines such as USFDA & EUGMP, WHO, HTM 2025, NABH, etc.

What market opportunities lie ahead for GMP Technical in the healthcare space? The Indian healthcare industry is set for growth at a rapid pace and is expected to become a $280 billion industry by 2020. In this year itself, the healthcare industry is expected to increase to $60

billion wherein $20 billion is accounted for private spending. Firstly, current statistics point to the overall low number of beds, physicians and nurses as compared to other developing countries and international averages. In order to meet manpower shortage and keep abreast with world standards, India would be required to invest up to a tune of $20 billion over the next five years. This would translate into an additional requirement of 750,000 beds (from 1.5 million today to 2.25 million in 2012). So, the hospital infrastructure vertical is expected to grow by leaps and bounds. Secondly, hospital buildings are highly engineered. Adherence to engineering standards makes accreditation mandatory in India. Client understanding of the technicalities involved in smaller and most mid-sized hospitals is low. GMP being a highly specialised technical company foresees the huge market opportunity that remains to be tapped. Thirdly, percentage-wise, smaller hospitals in cities as well as rest of the country account for a much higher figure as compared to the bigger hospitals in metro cities. This fact needs to be worth considering as a unique marketing opportunity. Fourthly, medical tourism also necessitates compliance to global benchmarks. This translates into more hospitals requiring compliance with standards – yet another opportunity.

How to bridge the gap between price and quality while setting up hospital infrastructure? Every sector is priceconscious. More so in the case of hospitals with a very precious commodity at stake life of the patients! Doctors expect only the best for their hospitals, but there is a need to create awareness amongst the doctors that quality comes at a

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price. With advancements in technology, GMP takes special pride in offering an array of options to suit everybody’s budgets. GMP boasts of sandwich type panels that are free-standing; which mean that construction of civil walls is not required. These panels are double skinned, so that even SS panels may be offered at lower rates by constructing panels with SS sheets on one side and GI sheets on the other. GMP has on its offerings, glass reinforced polymer panels for larger hospitals, for which price may not be an issue. GRP is a superlative material, currently being promoted for OTs. The fascinating attributes of GRP are its light weight and durability. Its astonishing toughness makes it a favourable choice as constructional material. GRP is available in a wide variety of colours, is easy to erect and dismantle and very easily repaired in case of damage. GMP is very confident that once the material and its unique features are understood by the market, it will be the preferred choice in the hospital OT market.

What are the of GMP Technical?

USPs

We guide clients to make the right decisions for their hospital. We offer consultancy services for all possible parameters involved in building operating theatres or designing services for hospitals. It implies that the client has more time to take care of his core business, and GMP can ensure that the equipments are installed and maintained in compliance to international standards. We are a single point of contact for the implementation of all the equipment in your facility, both GMP and non-GMP. We manage the procurement, logistics, installation, commissioning and training throughout the duration of your project.

What are the industry challenges in your business?

The hospital infrastructure sector is still in its nascent stages and fragmented. There are many local players in the market who are technologically incompetent to design and erect an operating theatre. Small hospitals still follow conventional methods of constructing OTs. Doctors not conversant with engineering nitty-gritties are reluctant to invest in advanced technologies.We have come of an age where accredited hospitals are the norm to be met. The need of the hour is to educate them about technicalities and standards. All contractors are unable to meet stringent standards. There is a need to bridge the gap between the lack of knowledge on the doctors’ part and the lack of competency on the contractors’ part. Unlike bigger hospitals, where consultants are appointed for ensuring compliance to standards, midsized and smaller hospitals lack this privilege. This coupled with their lack of knowledge about infrastructure set-up technicalities makes it a cumbersome task to convince them about the need to go in for engineered and technically sound products like modular partitions, laminar air flows and hermetically sealed sliding doors to name a few.

What are the future plans for the company? In the years to come, GMP plans to take hospital infrastructure to a new level and enable affordable solutions at the doorstep of every hospital. Through consistent investments in R&D, an innovative approach to design and an emphasis on product quality and service, we aim to become the leading specialists in providing customised solutions in outfitting and refurbishment projects with the support of our esteemed clients. Our thrust on international business has seen overseas earnings grow significantly. Expanding our marketing and distribution network globally is next on our list of to-do things.

JULY 2012

30 MINUTE INTERVIEW

“ZHL offers end-to-end emergency management systems in the form of outsourced ambulance service to hospitals” Praveen M HEAD 1298, ZIQITZA HEALTHCARE

raveen M, Head 1298, Ziqitza Healthcare elucidates on their ambulance service and its role in improving EMS in the country

Please comment on the state of EMS in our country. How can we address the challenges in delivering prompt medical emergency services? EMS sector is growing at an exponential rate, few of the pivotal challenges which are being faced is the trust factor among people to recognise that a fully equipped ambulance can do wonders in saving their lives. There is a high demand for quality ambulance services in India. India is a very disaster prone country, 30 per cent of accident victims in India die due to delay in transportation to hospital. The existing system is fragmented and does not meet the demand. The main providers of ambulance services are private ambulance owners, hospitals, NGOs, and government agencies. Some services are free, while others are not.

EMS must have a “timely” response for each and every call. How do you achieve this? All our ambulances are equipped with GPS. This helps

in real time tracking of the nearest ambulance which can be dispatched to the patient. GPS-enabled ambulances are a huge support in delivering prompt medical support in medical emergencies.

What is the USP of your company? We have three core USPs which differentiates us: ● Our ambulances are available 24x7, 365 days ● Real time GPS tracking of all the ambulances ● We have trained medical staff on board ZHL offers end-to-end emergency management systems in the form of outsourced ambulance service to hospitals so that they can focus on their core competencies

What are the social initiatives taken up by ZHL to contribute to the society? ZHL truly believes in making difference to society, we have undertaken few social initiatives like organising free health camps across Mumbai, Kerala to sensitise people to take care of their health on regular basis. We believe that if people are equipped with the knowledge of first aid which they can use to handle medical emergencies this will be a huge achievement. We train people on first aid which not only

clears the myths they have but also equip them to be the responder before the ambulance arrives. We also run 1298 Women's Helpline and Senior Citizen's Helpline in Mumbai which is 24x7, 365 days operational. Through these helplines we have served over 30,000 calls.

How do you network with hospitals? We attend medical conferences, events, seminars, workshops which lead to build our network with hospitals and keep us abreast with the latest trends and happenings in the healthcare industry. We have a dedicated sales team that is responsible for engaging our hospital partners on a continuous basis.

What is ZHL's vision? How have you planned for it? Our vision is to save human lives by providing the leading network of fully equipped advanced and basic life support ambulances across the developing world. We plan to launch our services in metros in this financial year. Also we are in strategic talks with organisations in the developing countries to explore the possibility of starting the service of emergency medical response service

What is your view on the future of outsourcing of EMS? How do you see Indian scenario on global level? With the global healthcare business growing at an exponential rates, ZHL understands that the hospitals in India are feeling the pressure to prioritise on their core competency – ‘managing their patients and providing excellent treatments’. Most leading hospitals and nursing homes in India are now focussed on improving their core competence and have shifted focus on outsourcing other aspects of hospital

JULY 2012

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management like catering, housekeeping or pharmacy. One of the key management issues faced by hospitals is managing their ambulance fleet. To cater to the acute need of well equipped and maintained fleet of ambulances in hospitals, ZHL with its vast experience in life-support ambulance management has initiated the concept of outsourcing of advanced LifeSupport Ambulance service in Mumbai, Kerala, Punjab. Currently MGM Hospital, Fortis Hospital, Bhatia Hospital, SK Hospital and Umrao Hospital have tied up with us to manage and operate their ambulance fleet. It is this need that has prompted us to venture into management and operations support service for operating advanced life support ambulances of hospitals and other institutions in Kerala. We provide hospitals with custom designed ambulances and trained manpower for retainer and this will help hospitals to concentrate on its core competency of medical care facilities. Apart from offering pre-specified ambulances, Ziqitza’s package deal also comes with trained manpower. Our ambulance crew which includes emergency medical technicians and drivers are trained by Life Supporters Institute of Health Sciences (LIHS), the international training centre of American Heart Association enabling them to stabilise the patients and transfer with medical support. Another unique feature of our service is that we keep 24/7 live track of the ambulances and provide the hospitals with comprehensive report on every aspect of ambulances, right down to its speed. This also ensures 365 days uptime for the ambulance for hospitals. ZHL has specialised teams managing different responsibilities like operations, training, quality, control room, recruitment etc to provide a world class service.

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INTERVIEW

We are focussed on infection prevention by means of safe reprocessing of medical device Anant Agarwal PRESIDENT, GETINGE INDIA

Anant Agarwal, President, Getinge India talks about his company, its operations, products and future plans.

Worldwide, Getinge AB is a known listed entity in the healthcare segment. Briefly highlight the positioning of your company in India? Getinge is a leading global medical technology company with operations in the areas of surgery, intensive care, infection control, care ergonomics and wound care. The Group is organised in three business areas: Medical Systems, Extended Care, and Infection Control. All three business areas enjoy leadership positions in their respective areas of operations.

Our innovative solutions provide highest quality and safety at the lowest total cost. Getinge takes pride in offering products with exactly the same specifications that we offer to the European markets I can comment more from the perspective of “Infection Control” business area in India. Getinge has been present in India for more than three decades, and are the market leaders in India. Getinge is recognised as a trusted-partner and supplier of equipment and services for cleaning, disinfection and sterilisation of instruments. Our innovative solutions provide the highest quality and safety at the lowest total cost. Getinge takes pride in offering products with exactly the same specifications that we offer to the European markets. Being the flag-bearers of the “infection control” industry in India, we run an academy. The role of the academy is to spread the awareness about “infectioncontrol practices” among

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health care workers. This has immensely helped in raising the bar for the whole industry. In addition to above, our bi-monthly newsletter is circulated to 2000+ centres across the country. This newsletter is co-authored by industry “keyopinion leaders” - focuses on issues related to sterilisation and disinfection. This further spreads the awareness and cements our numero-uno position in the industry.

Tell us about your specialised infection control products/services. What is Gettinge’s USP? We, as an organisation, are focussed on infection prevention by means of safe reprocessing of medical devices, and our undivided efforts are directed towards achieving this goal. We take huge pride in the fact that we are the only company which offers a “complete solution” to our customers – ranging from architecture planning, equipments (low temperature sterilisation solutions, steam sterilisation, washer disinfectors, bed pan flushers in a huge range of capacities for various applications), after sales service, consumables and education and training. We offer a range of products suitable for dental clinics to day-care centres to theatre sterilisation units to full-fledged CSSDs of a multi super-speciality hospital. We have a very strong culture of – “We say what we do and we do what we say”. We believe in consistently surpassing the expectations that the customers have from us – be it in terms of product capabilities or service deliverables. This has helped us gain repeat business from customers.

According to you, what has been the level and state of awareness of infection control management in Indian hospital? What needs to done to evolve this stream? As far as big hospitals in

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big cities is concerned, there is a lot of awareness about infection control practices. These hospitals invest in latest products and technologies, and usually have world class SOPs which are regularly audited/updated. Today more and more hospitals are going for various accreditations – which force them to adhere to prescribed standards of infection control. Agencies like Hospital Infection Control Society of India (HISI), Hospital Sterile Services Association (HSSA) in Mumbai are actively involved in highlighting the issues faced by health care professionals and providing guidelines for the functioning of critical areas of hospitals. Beyond this I am afraid, the awareness is very limited. Infection control activities in most centres are viewed as a ‘cost-centre’ and are not perceived to give any “return on investment”. Guidelines – at best – are only a set of recommendations. What we need today is a strong regulation – This will force the system to implement the basic standards of hygiene and infection control. We have seen a similar development happening in the area of biomedical waste management a few years ago.

What are the market opportunities for business growth in India? I can mention a few recent trends in the Indian context.... a) We see an increasing number of “day care centres” chains coming up these days. These are relatively smaller facilities compared to multispecialty hospitals. They have very different requirements – much smaller floor spaces and they typically ask for very short time for delivery and installation. b) As the infrastructure develops and the awareness spreads, people in smaller cities are also

asking for, and investing in world-class products and technologies. c) Another model that is gaining popularity in the western world is the concept of a “Super CSSD” – which caters to a group of hospitals. One can achieve “economies of scale” and better quality control by better utilising the investments.

Tell us about your company’s latest product offerings which will help you retain your leadership position in the industry. To be successful on a sustained basis, we keep introducing new products and technologies to address current and emerging needs of the customers. Some of the recent new offerings include…… a) To increase the efficiency of the sterilisation department, we have recently introduced “Turbo” technologies. This not only reduced the cycle times significantly, but it also consumes much lesser amounts of energy and water per instrument. With increasing awareness about concern for the environment, these products are being very much appreciated by the customers. b) We have recently introduced traceability solutions and “On-line” diagnostics. We have tried to harness the power of “IT” to make our product offerings more beneficial to the customers. c) We have launched the endoscope reprocessor in the Indian market. d) We try to create an environment for the workers which are not stressful – Instead, they should enjoy the work. To achieve this objective, we have introduced more ergonomic equipments – height adjustable tables, trolleys etc.

JULY 2012

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JULY 2012

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BM Birla Heart Research Centre: The ultimate destination of heart care in East Kolkata-based BM Birla Heart Research Centre, a CK Birla Group institution needs no introduction. Today, it has become synonymous with being the ultimate destination of heart care in this part of the country. Since its inception, the centre has performed over 18,000 cardiac surgeries and more than 80,000 cath procedures with phenomenal success rate. Suyash Borar, COO of the Institute shares insights on the status of this worldclass institution and its future initiatives.

SUYASH BORAR COO BM Birla Heart Research Centre

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BM Birla Heart Research Centre has come a long way in providing quality treatment, how do you ensure that the hospital maintains its quality care? BM Birla Heart Research Centre has always emphasised on patient safety and quality of care. This constant emphatic emphasis on quality care has rewarded us, we are the first hospital in India to receive the National Accreditation Board for Hospital and Healthcare (NABH) accreditation and reaccreditation. In the pathology department, we were the first hospital in India to also receive NABL accreditation and CAP (College of American Pathology). So you can well realise that we ensure quality care as per national and international external agencies.

Can you throw some light on the type of facilities available at BM Birla Heart? BM Birla Heart Research Centre is a one stop solution for all heart related problema. Our centre has been incorporated with latest generation of cardiac equipment like Philips Allura F D 10 which is the latest cardiac care system comprising special features such as stent boost. It also has 3D reconstruction mapping DSA refraction facility which is the first in the eastern region and can be compared to international standards. We also have a rotablator system for TO calcified lesion. In our echocardiography department we have a three-dimensional echocardiography which can be done on adults, paediatric patients as well as on foetuses. Our centre also has a department of nuclear medicine which has a unique dual head “INFINIA” gamma camera which would provide economic and accurate non-invasive diagnosis of artery disease. BM Birla Heart Research Centre has set up a lifestyle clinic and rehabilitation clinic, the first of its kind in eastern India. Enhanced external counter pulsation therapy (EECP) is also available here. Our pathological department

is known for its advanced evaluation and accuracy of reports since we have the best pathological set up.

Could you please elaborate on the cardiac care packages. How economical are they, because there is a notion that caridac care and surgery are expensive ? BM Birla Heart Research Centre ensures quality of treatment and value for money. It is a “not for profit “hospital so the charges are reasonable. As the hospital is run by a trust which does not aim at profit we aim to provide quality cardiac care to all patients across all sections of the society. Our centre has subsidised cath package for Rs 9,900 and surgery package of Rs1,15,000. We have started a programme known as “Healing Little Hearts …” where every year we do around 100 heavily subsdised surgeries, in collaboration with Rotary and other organisations, on girl children having cardiac problems. Other than these, we offer subsidised packages in executive health check up schemes and free heart check up and health camps. We are totally transparent in our billing procedure and we have displayed our charges on the internet and in our reception counters. There may be some hospitals where the quality of heart treatment is not maintained, hence there is inferior treatment at cheap price. But we feel that every patient has one life and one heart, so we should make all efforts to give them the best that they www.expresshealthcare.in

deserve. I can say that all patients coming to BM Birla Heart Research Centre will be provided with quality and transparent treatment.

What kind of state-of-theart infrastructure does BM Birla Heart boast of? BM Birla Heart Research Centre is a super speciality hospital dedicated exclusively to the diagnosis, treatment and research related to cardio thoracic and vascular diseases. It was started more than two decades back to provide world class heart care to the people in India and neighbouring countries. We have increased the capacity of our coronary care unit for there was a demand for more beds. We had to add 25 more beds and have opened an intensive coronary care unit. Our cath lab department, which is technically one of the best in eastern India, has ultra-modern cardiac catheterisation of laboratories. There are several modern OTs where efficient cardiac surgeons, cardiac anesthesiologists and perfusionists are present round the clock. Some of the cases which are performed here are patients with extra risk factors (as per risk score) or CABG + ASD/VSD, double Valve +CABG, redosurgery, double valve replacement, single valve +CABG, CABG + carotid edarterectomy, aortaneurysm or aortic dissection.

What are the different awards and accolades won by BM Birla Heart Research Centre? I believe that nothing

succeeds like success, being a not-for-profit hospital, our drive is to excel in all aspects in healthcare. This year we have been awarded by CII – Quality Award 2011 – 2012 in S.S.I category. We have secured the 1st position in Total Quality Management amongst the various participating organisations from various industries. BM Birla Heart Research Centre was the first hospital to receive NABH accreditation and re accreditation. It is also the first hospital to receive Rajiv Gandhi National Quality award 2007 for its commitment to quality in health sector and 'Jamnalal Bajaj Award for Fair 'Business Practices'. The award is conferred on the most deserving enterprises with an outstanding record of promoting fair business practices. We also have received 'Express Healthcare Excellence Awards' for "Inspirational Workplace" category. It is also the first hospital to be awarded ISO 9001, ISO14001and OSHAS 18001 for highest standards in healthcare, environmental protection and occupational safety respectively. We are indeed proud to say that we have been ranked No.1 in India for “Value for Money “ in an independent survey of India’s best hospitals. My message – We are and remain committed to be the No 1 for your heart.

What are your future plans? We are committed to maintain the highest benchmarks which we have set for ourselves in the field of cardiac care. We would definitely like to sustain the quality standard. Our flag of achievement and success in patient care surely will fly high. To sum up, I would see the centre offering highest standards of cardio thoracic treatment and care to all sections of society at best value for money, to be the leading cardio thoracic care institution in India with world class standards of quality and service. JULY 2012

CMRI: Ensuring highest standards of quality healthcare Nearly five-decades old, The Calcutta Medical Research Institute (CMRI), today, has established itself as a leading multi-speciality healthcare and research institute in eastern India with world class standards of quality and service. We spoke to Rupak Barua, COO, The Calcutta Medical Research Institute to know more about the current state of the hospital and its future plans

RUPAK BARUA

COO The Calcutta Medical Research Institute (CMRI)

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he Calcutta Medical Research Institute (CMRI) has been caring for the citizens of the eastern region, for nearly five decades now. Established in 1969, by late BM Birla, a visionary and philanthropist, CMRI has always operated with a focus on patient, employee and physician satisfaction. 'CMRI continues its commitment to provide quality care at affordable price', emphasises Rupak Barua, COO, CMRI. CMRI is part of the CK Birla Group which has interests in diverse fields. The Group runs several charitable, educational and healthcare institutions on a 'no-profit, noloss' ventures, so its objective is not to make money or profits from CMRI but run it as the most efficient healthcare organisation and gain people's trust and confidence. It is a 400 bedded hospital, which includes 95 bedded critical care units. Shortly, it is planning to increase the bed strength by 50 to meet the increasing demand. Mission: To offer the highest standards of medical treatment with utmost Care, Compassion and Commitment to all sections of the society at best value-formoney costs. Vision: The vision is to be the leading multi-speciality healthcare and research institute in eastern India with world class standards of quality and service. Commitment: To constantly upgrade human and technological resources in order to keep pace with the best global developments in medical science. Accreditation: The CMRI is an ISO 9001: 2000 accredited hospital. It is only the second hospital in the country to have accreditation from College of American Pathologist (CAP) for its in house-lab. The lab also has NABL and Bio-Rad certification. The hospital is soon going in for NABH accreditation. Strengths and achievements Our biggest strength is the highest standards of medical treatment provided by us to all sections of the society at best

value-for-money costs,' Barua added. He said that CMRI, which was the first private corporate hospital of the city, has established itself today as the most advanced multi-speciality tertiary care hospital in the city offering the most advanced medical services. “We have selected few departments as Centre of Excellence as these departments are capable of doing any complicated surgeries, procedures or treatment. They are namely, the Institute of Neuroscience, Department of Urology, Institute of Gastroenterology, Emergency & Shock Trauma Unit, Critical Care Unit, Cosmetic & Skin Care Clinic, Institute of Orthopaedics & Joint Replacement and Mother & Child Care Department,” he added. Besides the regular multidisciplinary departments, it has introduced super speciality departments to combat new age diseases like sleep apnea, obesity and stress management. The city's first 'Stroke Clinic' was inaugurated at CMRI with a view to provide comprehensive stroke care with latest clot buster treatment or thrombolysis. The hospital has introduced eastern India's first sleep laboratory for conducting sleep study. Sustainability: “Our idea of making a sustainable hospital is a bit different. We believe that providing quality medical services at affordable rates is the best way to make a sustainable hospital,” Barua said. “This is also the motto of our hospital. So we are following this principle very rigorously,” he further added. Safety of patients is of prime importance: “Safety of the patient in the hospital does not only mean safe treatment but physical safety of the patients is also of primary importance to the hospitals”, he stated. He also informed that fire safety and security is an important aspect of organisation and that they have been putting much thrust on this aspect for years. “It is an ongoing process in the hospital and we have thoroughly revamped and strengthened our fire-fighting mechanism www.expresshealthcare.in

over the last couple of years,” he revealed. “You need to understand that 'patient-safety' has been accorded the utmost priority in our hospital and the Board of Trustees, has made it clear in no uncertain terms that the hospital will not compromise with safety and security of the patients under any circumstances,” Barua added. He also revealed, “In the last two years we have installed well-knit water hydrant system with outlets on all floors, a sprinkler system, sophisticated smoke alarms, fire hose/fire extinguishers and several other latest kits like 'air-handling unit – auto shut down' system in each and every floor of the hospital and also installation is in progress for the latest fire check doors (FCDs). We have already acquired more than 30 clearances and are in the process of acquiring more from different statutory authorities.” State-of-the-art technology: The 12 state-of-the-art operation theatres have been modernised to suit international standards and with the help of laminar airflow system they are now protected from any kinds of infection threat. The Radiology & Imaging Department is run entirely by picture archiving and communicating systems (PACS) system which allows it to access information in a highly efficient manner from almost any location, using secure webbased software. Shortly, the hospital will be introducing SAP-based ERP solution to ensure quality and bring about complete transparency in billing and other operating procedures. HR development: CK Birla Group is a very HR driven organisation. They conduct regular training sessions for the staff and paramedical staff and CMEs are conducted for medical professionals to improve knowledge, skills, attitudes and behaviour of health professionals

and also improve patient health outcomes. CSR activities: Since its inception, CMRI has always taken active participation in CSR programmes to serve the society in the best possible way. Suryodaya, the ophthalmology department of CMRI is actively involved in various CSR activities. It runs a ‘mobile eye care unit’ to cater to the needs of the downtrodden people of the society. Suryodaya, is also actively involved in free cataract surgery programme to eradicate cataract from a specific Kolkata Municipal Corporation (KMC) ward. Modular training programme in pre-hospital trauma care: CMRI is dedicated in its commitment towards the society. It has further extended the vision of 'corporate social responsibility' by educating the society towards trauma care where it matters the most - the pre-hospital scenario. Future plans: The Group is setting up another 200-bed state-of-the-art, multi-speciality hospital at Jaipur in Rajasthan which is likely to become operational by the end of this year. It also plans to set up a mid-sized 100-odd bed super-speciality hospital at Siliguri in North Bengal, the land for which has been already acquired. These hospitals will be equipped with the most modern fire-fighting systems and equipments. Future plan would be to further strengthen and improve the quality of medicare provided at CMRI keeping in tune with the changing times and technological advances and establish it as the 'most trusted' multi-speciality hospital in the country. JULY 2012

Woodlands Hospital: Unmatched service quality Kolkata-based Woodlands Hospital has grown up as a modern multispeciality hospital in diverse fields while retaining its heritage of unmatched service quality – with a truly 'home away from home' experience!

care unit' consists of 64 beds, headed by an Intensivist and his team of resident doctors and skilled nurses providing critical care of the highest level. There are separate sec-

tions for surgical, medical and cardiac cases. Isolation beds are available for specific cases. The urology department is well-equipped to handle complete management of urinary

tract problems starting from diagnostic cystoscopy, TRUS, treatment of stones by ESWL, PCNL to urethroplasty, nephrectomy, TURP and Continued on Pg 63

olkata-based Woodlands Hospital needs no introduction. Over the last five decades of its existence it has emerged as one of India’s most reliable healthcare institutions. Its enviable reputation as a leading hospital is because it has been keeping track with global advancements in medical science, investing in state-of-the-art equipment, attracting the country’s best talents, as well as supported by a dedicated team of nursing and paramedical staff groomed in the 'Woodlands' culture. Strengths and services: The hospital's much acclaimed 'integrated cardiac facility' comprises an advanced cath lab, a dedicated cardiac OT, a fully equipped non-invasive cardiology unit and an integrated intensive care unit. The state-of-the-art equipment like dual source dual energy CT Scan machine – 'Somatom Definition and a 3 Tesla MRI – Magnetom Verio', the best in cardiac imaging is available at the hospital. A cardiac ambulance (Toll Free No: 1800-345-9000) is available 'round-the-clock' to deal with any cardiac emergency swiftly and efficiently. The department is equipped with a panel of reputed interventional cardiologists and a full time cardiac surgeon with his team who are adept at performing LIMA RIMA bypass surgery on the beating heart, where no cut in the leg or hand is made and the success rate is excellent. The hospital's 'critical

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Fortis Hospitals, Kolkata - A legacy that stands tall Fortis Healthcare (India) is one of the largest integrated healthcare delivery networks in Asia Pacific

Overview Fortis Healthcare India has demonstrated a decade of high growth in scaling its operations from a single hospital in 2001 to a network of 74 hospitals with more than 12,000 beds, 580 primary care centers, 188 day care speciality centres, 190 diagnostic centres and a base of over 23,000 employees making it amongst the largest integrated healthcare delivery networks in Asia Pacific.

Fortis Hospitals, Anandapur

RICHA S. DEBGUPTA Facility Director, Fortis Hospitals, Kolkata.

Commissioned on January 9, 2011, Fortis Hospitals, Kolkata is a 400bed super speciality hospital located on EM Bypass Road. It is a part of India's leading healthcare providers - Fortis Healthcare, focussing on the tertiary care of super specialities like cardiology and cardiac surgery, orthopedics, neurosciences, digestive care, urology and nephrology, emergency care and critical care. Their amenities include a 24-hour accident and emergency service including trauma treatment, ambulance services, blood bank, fully functional operation theatres, cardiac catheterisation lab, preventive health check, diagnostic lab, critical and emergency care.

Services at Fortis After successful comple-

tion of one year, Fortis has extended its service to advanced specialities like interventional radiology, interventional broncho-thoracoscopy along with their existing super specialities cardiac care, bone and joint care, brain and spine care, digestive care, kidney care, lung care, emergency and critical care and many other associate specialities. “Fortis Hospital combines technological advantages and best in class clinical team providing tertiary care. Our team of clinicians across the area of cardiac care, orthopaedics, neuro sciences, minimal access surgery, uro & Nephro and Digestive care are some of the fine expertise who have contributed phenomenally in their respective fields in India and abroad,” said Richa S Debgupta, Facility Director, Fortis Hospitals, Kolkata.

Reach in eastern India: Fortis also has extensive geographical coverage in Eastern India with nine speciality clinics in Agartala, Silchar, Guwahati, Bongaigaon, Jamshedpur, Siliguri, Asansol, Durgapur and Chandannagar.

Speciality clinics To continue their patient centric support services Fortis has launched exclusive medical units like ● Headache clinic ● Epilepsy clinic ● Spine clinic ● Liver clinic and ● Fortis Heart Team

State-of-art technology at Fortis, Anandapur ●

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64-slide Siemens Somatom CT Scan and 1.5 Telsa 18 Channel Siemens Avanto MRI machine ICU is well equipped which includes MICU, CCU, recovery and isolation beds with separate high dependency units 64 beds in twin sharing cubicles for the attendants of ICU patients A nephrology department with 28 advanced dialysis units and chemotherapy beds www.expresshealthcare.in

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Advanced neurophysiology lab equipped with EEG machine of international standards

A good start In the past one year, Fortis has lived up to their promise of providing superior care to Kolkata ● First headache clinic in eastern India ● First custom fit knee replacement surgery in eastern India ● First radiofrequency ablation surgery in eastern India ● First comprehensive epilepsy care programme in eastern India ● Launch of exclusive clinics such as hernia clinic, liver clinic, sleep clinic, spine clinic, etc.

Best practices Patient Welfare

Prevention is better than cure and Fortis believed in prevention strongly. So to fulfill this mission they have taken “Step once a day” programme in every week, a bedside educational session on assessment of pressure sore. They also conduct “Braden scale”, training on accessories of specialised beds and for prevention of DVT.

Quality assurance ● ● ●

Prescription audit Clinical practice guidelines monitored Guidelines on medical management formulated

Human resource ●

FHL always strives to offer the best service to patient and their relatives. For this continuous training and development programme is being imparted to our customer care as

well as nursing department to enhance patient safety and quality care.

Did you know Corporate social responsibilities ●

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It has pneumatic chute system for quick horizontal and vertical transportation of medicines between floors. Marmolium flooring used for interior decoration The building has a rooftop garden on its 8th floor

Breakthrough surgeries In spite of being just one year old, Fortis Kolkata has conducted several breakthrough surgeries. Few of them are as follows: ● Implantation of CRT (Biventricular pacing) in a patient with previous two heart attacks and bypass surgery ● An exceptional case of Primary Angioplasty done at 80 year old patient ● Rare brain tumour (schwannoma arising from tentorium cerebelli) operation by Dr Amitabha Chanda – seventh case reported in the world literature. ● Removal of large hemorrhagic contusion from left frontal lobe through the supraorbital key hole surgery ● A rare case of “3rd time revision of knee joint replacement” ● Laparoscopic ultra low anterior resection for rectal cancer ● Combination of radiofrequency and chemoembolisation for a large liver tumour ● 18-year old student underwent awake brain tumour surgery. JULY 2012

Mercy Hospital – Ensuring ‘Healthcare for All’ Mercy Hospital, under the dynamic leadership of Sanjay Prasad, the Executive Director & CEO of the hospital, is working round-the-clock to deliver the 'best possible healthcare' in the region

SANJAY PRASAD

Executive Director & CEO Mercy Hospital

The journey Founded in 1977 by the late Rev Dr D Mark Buntain in 1977 as a small clinic, Mercy Hospital is now a 173bed general tertiary care hospital serving approximately 100,000 patients per year. The hospital has a variety of services including a complete surgical facility, three critical care centers, a paediatric centre, an emergency centre, and general medical and surgical centers. Mercy Hospital offers facilities of round the clock emergency, trauma care supported by more than 100 consulting doctors in 30 specialities, a state-of-the-art pathological laboratory and all other diagnostic facilities, 24 hours pharmacy, critical care ambulances, intensive care units and level-II neo-natal care unit. We have 40 intensive care beds, backed by trained and experienced medical offers and nursing staff. The refurbished and upgraded ICCU unit is preferred and praised by city cardiologists and cardiologists from CMC Vellore. Today, the hospital comprises more than 90 eminent consultants on panel and experienced support strength of more than 500 employees and paramedical staff.

Mission The mission is to improve the hospital to become the finest affordable medical facility in Kolkata. In line with our founder's vision, we are committed to serving the marginalised and disadvantaged even beyond Calcutta. The Mercy Clinic Network is the arm of Mercy Hospital dedicated to providing free healthcare services to individuals at the districts of West Bengal where the network of 15 clinics are operating and the two clinics that are operating in Orissa.

Key strengths Patient care is provided by a staff of highly qualified physicians and nurses. Their Mercy Hospital School of Nursing helps to maintain a better nurse-to-patient ratio. The nursing students graduating from our School of Nursing are among the best in the city and are well regarded by the medical

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fraternity. Mercy Hospital on Park Street has opened its new centrally air conditioned diagnostic centre with patientfriendly doctors out patient chambers which is backed by a state-of-the-art pathology, blood bank and pharmacy. Appointments for doctors can be made over phone or through the web here. This 5000 sq feet totally air-conditioned outdoor facility offers top of the line medical consultancy at an affordable price with a goal to reduce patient waiting time. 90 consultants have been taken on board across all disciplines to serve the patients better. In this centre, they are also trying to set up of speciality clinics like chest clinic, diabetic clinic, infertility clinic etc. The Department of Medicine observes the largest patient turnover for both indoor and outdoor patients. The hospital offers additional facilities like neurology, psychiatry, gastroenterology and endocrinology. The department of obstetrics and gynaecology prides in its ability to provide gynaecological cancer treatment, laparoscopic treatment, electronic foetal monitoring in labour with cardiotocographs, in addition to the services that are provided to an expectant mother and a new born baby. The hospital’s department of neonatology is the first national neonatology forum accredited level II - special care neonatal unit in West Bengal. Mercy Hospital has set up www.expresshealthcare.in

completely new state-of-the-art operation theatre complex with four ORs and one dedicated OR for eye surgeries with all modern facilities. Recently, the dental and eye unit at the hospital has been refurbished with modern medical equipments. Patients can get all sorts of treatment here. Imported eye power testing machines, non-contact tonometre (used for testing eye pressure) and automated field analyser to diagnose nerve damage by glaucoma have been installed. The latest dental chairs with modern X-Ray machines with RVG and intra-oral camera complete the dental department. The orthodontistry and maxillofacial surgery are also done here by reputed doctors. All these facilities are available at a reasonable cost and with extreme care.

Certifications/Accreditations The hospital has acquired ISO 9001: 2000 QMS, ISO 9001: 2008 QMS, ISO 14001: 2004 EMS & OHSAS 18001: 2007 certifications. It is also in the process of getting NABH and NABL. Acknowledging the hospital’s efforts and based on the continuous effort on improvement, West Bengal government has empanelled this hospital as a Class-I service provider. Mercy Hospital is also the only private hospital in Kolkata which has got the affiliation from West Bengal Health University for the research work.

Cost vs Quality The thrust on modernisation and upgradation is part of its commitment to set a new standard of providing best affordable medical services in the eastern region. While going through these advancements, the hospital continues to treat a fair percentage of patients free of cost, many of them being children who are in need of help.

The hospital wants the services to be the best in this region without going overboard with prices and remain affordable and relevant within the context that they operate in. Over 40,000 patients receive free treatment every year through their medical network.

Meeting safety standards The hospital considers patient safety and security as the most important agenda. To meet the safety hazards of the fast changing world, the hospital has implemented several non-medical safety and security measures in the last couple of years, like implementing fire check measures, deploying security personnel at vantage points, installing coded emergency system and adhering strictly to environmental policies. On medical safety and security measures, the hospital is maintaining standard operating procedures, which are updated at regular intervals, secured rooms and medical furniture are always under preventive maintenance. Besides, regular clinical and physical audit is carried on and staff training both technical and soft skill is carried on. An infection control committee is always alert to keep a check on HAI. The hospital is also following an antibiotic policy.

Road ahead Mercy Hospital is committed to creating a platform of healthcare delivery through 40 Mercy Clinics that will be set up over the next three years. These will function as small satellite facilities that deliver basic medical care at little or no cost to the patients where the medical officers and nursing staff provide basic care and health education at the clinics alongwith the consultants from Mercy Hospital who visit weekly to treat more severe illnesses. If a patient requires extensive treatment, they can arrange to visit the hospital in Calcutta. Mercy Hospital is working to implement a telemedicine system, which will enable the remote transmission of medical information and diagnosis, making travel less necessary. JULY 2012

Continued from Pg 59 various other urinary problems. It also offer special clinics on prostate and bladder cancer. The Revolix Continuous Wave Laser is a state-of-the-art vapourising and enucleating laser used for prostate treatment. Normal deliveries to most complicated high risk pregnancy cases and critical gynaecological surgeries are dealt with at gynaecology and obstetrics, neonatal management department backed by the service of a panel of leading gynaecologists. The neonatal unit takes care of critically ill babies. The nephrology and renal transplantation department offers round-the-clock facilities for both haemo and peritoneal dialysis and continuous ambulatory peritoneal dialysis (CAPD). Renal transplantations are carried out regularly with positive clinical results. All types of complicated orthopaedic surgeries including knee replacements are performed regularly at the orthopaedics department of the hospital. State-of-the-art infrastructure and facilities: All the specialised units are supported by round the clock services provided by the following: ● Pathology and blood bank - enrolled with RIQAS, the quality control program organised by NHS UK, accurate reports are ensured. ● Department of radiodiagnosis - with modern facilities in digital X ray, ultrasonography and mammography. CT and USG -FNAC as well as interventional radiology. A dual source multi slice CT (Somatom Definition) and a 3 Tesla MRI (Magetom Verio). ● Electrophysiology unitlatest technology for EMG, EEG, NCV and EP Study are available in this unit. The department of gastroenterology and bronchoscopy is equipped to take care of any gastro complicacies and surgeries. The outpatients' department of the hospital is open for 12 hours with speciality clinics in cardiology, cardio thoracic and vascular surgery, neurology, neuro-surgery, neuro-spine, general surgery, gynaecoloJULY 2012

gy, paediatrics, dermatology, urology, etc. The clinics are manned by the best physicians and surgeons of the above mentioned disciplines. Apart from this, the hospital also provides 'comprehensive health check-up' packages tailor-made for corporates and individuals. Besides, with

state-of-the-art infrastructure and experienced manpower in place, Woodlands has always stressed upon satisfaction of patients. Nursing education: Woodlands runs a school as well as a college of nursing, both of which are housed in a campus of 4.05 acres at Joka.

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The students of the nursing school have been bagging the top positions in the state for the last few years. Ensuring safety and security of patients: The hospital has taken all precautionary measures to ensure the safety and security of the patients. There is also a full time resident

Fire & Security Manager to monitor the safety and security arrangements. Future plans: “Plans are now afoot to expand our services in neurology, therapeutic gastroenterology, bariatric surgery and plastic and reconstructive surgery”, said Probir K Bose, Director, Woodlands.

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The Mission Hospital, Durgapur: The most ethical hospital in India The Mission Hospital, Durgapur, set up with the dream of providing healthcare to all at affordable prices, is on its way to realise this aim

nlike in the rest of India, super speciality healthcare in this part of the country has developed only within the city limits of

Kolkata. The demographic clinical flow of 'elective' healthcare would be a local consultation, followed by a referral to one of the tertiary

centers in Kolkata. Most of these hospitals are, unfortunately, not manned by full time salaried doctors, do not stress on quality, and treatment options are often guided by "fiscal" end points, rather than clinical. Patients have been quick to realise this, and it has

DR SATYAJIT BOSE Chairman The Mission Hospital, Durgapur

resulted in diversion of traffic more towards southern India. With so many hospitals coming up in Kolkata, with enhanced capex, they resort to a lot of strategies and promises to attract patients. More often, they are not able to adhere to the promises made. This creates an intense vicious cycle, wherein patients get diverted to distant destinations for healthcare, even for basic illnesses, and for more money. This results in a considerable drain in the state exchequer. Healthcare as an industry, alone, contributes maximally to the GDP of a state. Drainage of patients elsewhere, increases inconveniences and has resulted in significant negative fiscal implications. Emergency patients in far-flung areas, are at the mercy of their own pre-decided fate and God. Qualified doctors, with inadequate infrastructure, are left with no option but to refer them to Kolkata. This creates a serious gap in patient satisfaction, both in government sector as well the private. Moreover, many perish on the way. The Mission Hospital was set up in Durgapur in

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JULY 2012

2008 with the aim to provide futuristic infrastructure, and brilliant minds behind them, with kindness, ensuring transparency of cost, and clinical protocols in line with the best practices of evidence-based medicine. The stress has been on quality, kindness and endpoint based packages. The hospital has also encouraged a policy of cross subsidy, thereby benefitting poor people. It was ensured that a patient coming to the OPD was greeted with a smile, had minimal waiting times, was ushered to the right place by well mannered volunteers, their reports printed within two hours and sent home with a proper diagnosis and treatment options within three hours. 99 per cent of outpatients would fall within these benchmarks. Optimal patient information and communication has been the mainstay in Mission Hospital's success story as well. Implementation of the pneumatic chute and PACS system has also shortened the journey from the imaging and lab department to the clinician resulting in faster diagnosis and cure. The overall patient satisfaction has been excellent and that has led to the development of departments of excellence in the areas of cardiac surgery, cardiology, orthopaedics and joint replacement, neurosurgery, gastroenterology, nephrology, urology and kidney transplant, cosmetic and plastic surgery, critical care and pulmonology, emergency medicine etc. The Mission Hospital, Durgapur, in four years of existence has done 4000 heart surgeries, most of them being high risk, of which about 1200 have been complex cyanotic congenital heart diseases. The results have been at par with international standards. Similarly, cardiologists have performed close to 2200 angioplasties and pacemakers without any major fanfare and publicity. Cardiac surgeons and cardiologists collectively take a decision regarding the mode of revascularisation for the patients admitted under the Institute of Cardiovascular Sciences. Scores of patients who have been proposed urgent angioplasty or CABG JULY 2012

for improved clinical outcomes. There is an additional operation team who looks after the non medical needs of the patient. There is no incidence of unwanted procedures in this hospital. About 100 critical beds in The Mission Hospital cater to the entire community and this

elsewhere were advised medical management and they are doing well. Every evening, there is a cath meeting, where all cases are presented and clinical decisions are taken collectively. Preoperative team meetings, followed by patient counseling are given prime importance

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has changed the definition of critical and emergency care in the region. To maintain quality there is a training programme (Master in Emergency Medicine) in association with NSLIJU, New York. In our country, only 0.3 per cent of people have health Continued on Pg 72

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Medica Superspecialty Hospital: Touching lives in different ways Medica Superspecialty Hospital is enhancing the healthcare delivery in Kolkata with its innovative projects like KARMA, Project Buddha and Chiranjeevi

edica Superspeciality Hospital opened its gates to the people of Kolkata on April 14, 2010, with an aim to make a difference to the healthcare

scenario in the city. Its first and foremost commitment has always been to its patients; and the hospitalâ&#x20AC;&#x2122;s management has striven to contribute to the betterment

of the cityâ&#x20AC;&#x2122;s health through various innovative projects. Project Buddha and Chiranjeevi were started for the benefit of the people of its immediate locality and school children respectively. An EMI scheme, a first in healthcare, was offered to bring world class healthcare within reach of the economically weaker sections. Special health packages for indigent patients and discounted schemes for senior citizens were introduced. This year, Medica added two new schemes to its repertoire for the benefit of the people of Kolkata.

KARMA The first, in collaboration with the Kolkata Police, is for road accident victims. Kolkata has long suffered a lack of properly established and coordinated trauma and ambulance services that can come to the prompt assistance of road traffic accident victims. Kolkata Police had been working to bridge this gap with 18 ambulances placed at strategic locations in the city to ferry trauma victims to the nearest hospitals. However, their initiative lacked the technical expertise that could be provided only by personnel trained in trauma care. To overcome this short coming, all leading hospitals of the city were invited to support in running

the services. Medica Superspecialty Hospital, in association with Eastern India Healthcare Foundation, stepped in to bridge this lacuna and out of this collaboration was born KARMA: Kolkata Accident Rescue & Medical Assistance, a project that aims to provide 24 hours trauma care service to the people of the city. Continued on Pg 70

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Kalinga Hospital: Rendering super speciality health services in Odisha Set up with a mission to provide compassionate care in the region, Kalinga Hospital has pioneered state-of-the-art super speciality health services in Odisha

As an ISO 9001 – 2000 institution for rendering multispeciality healthcare services, KHL has also been declared as a referral hospital of

first choice for treatment of government servants and their families, by Ministry of Health & Family Welfare, Govt. of Odisha. KHL is also certified as

a centre to perform kidney transplantation by the Directorate of Medical Education and Training. Continued on Pg 69

DR MALA CHATTOPADHYAY

Managing Director Kalinga Hospital

et up by a visionary philanthropic group of Oriya NRIs, Kalinga Hospital Ltd (KHL), since its inception in 1990, has been serving the community by delivering preventive, curative and rehabilitative services to the patients from all the economic and social strata. With 250 beds and the spectrum of other services the hospital still serves as the most comprehensive, affordable and dependable healthcare institution to the community. Dr Mala Chattopadhyay has taken over as the MD of KHL since March 15, 2012. In an interaction with her, she said, “Today, Team Kalinga is thinking beyond horizon. Completely understanding the need of the hour, Team Kalinga is on a sincere endeavour to reach out to the patients. We are focussed towards patient service and patient satisfaction and are making continuous efforts to exceed the service expectation by delivering quality care.” This can only be achieved by building a 'bridge of trust' between the healthcare provider and community, so that the community can crossover to the hospital.”

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Apollo Gleneagles Hospitals, Kolkata: The only JCI accredited hospital in Eastern India A pool of highly accomplished doctors with international experience and exposure, dedicated and trained nurses and paramedics motivated by Apollo’s philosophy of excellence, latest technologies, complete infrastructure, judicious cost control and dedicated team of administrative and support staff help Apollo Hospitals to deliver the best to its patients

DR RUPALI BASU

CEO, Apollo Gleneagles Hospital, Kolkata & CEO, Eastern Region, Apollo Hospitals Group

linical finesse, sincere service, dedicated people, affordable price and unmatched quality are five pillars of excellence that reinforces Apollo Gleneagles Hospital, Kolkata's role as torchbearers of modern healthcare. Facilities and specialities are ● 510-bedded multi superspeciality tertiary care JCI accredited hospital ● More than 56 medical specialities ● 78-bedded critical care unit with designated cardiac, neuro, gastro, medicine, neonatal and burns unit. ● 64-slice CT (at Apollo Gleneagles Heart Centre, Gariahat) ● da Vinci robotic surgery system ● Dual head SPECT gamma camera ● Round-the-clock presence of consultants of all specialities ● Comprehensive emergency and trauma care system with emergency number (1066), hospital-on-wheels (fully-equipped ambulance), emergency unit, doctors, paramedics and nurses trained to handle any emergency ● 24-hour diagnostic services, pharmacy, blood bank ● NABL-accredited laboratory services ● Dedicated daycare centre ● Preventive healthcare ● Telemedicine facility with group hospitals ● Complementary therapies like pranic healing and ayurveda ● Corporate helpdesk ● International patients services ● Travel desk ● Apollo Gleneagles Nursing College ● Telemedicine facilities ● DNB courses in various super specialities

Apollo Gleneagles Cancer Hospital (AGCH) Apollo Gleneagles Cancer Hospital (AGCH) is a first of its kind, 100-bed super speciality cancer care destination in the eastern region offering multimodality treatment under one roof. Some unique features of AGCH are:

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Perform adult live donor liver transplant Perform stereotactic radio surgery for brain tumour

International and national accreditations ●

State-of-the-art technology with two linear accelerators including the world’s most versatile technology in radiotherapy - Novalis Tx with BrainLab and Clinac iX. ● Complete range of diagnostics required for cancer treatment including dual head SPECT gamma camera ● Dedicated bone marrow transplant unit ● Paediatric cancer unit ● Women’s cancer unit Services offered at AGCH: ● IGRT ● IMRT ● Frameless radio surgery ● Stereotactic radio surgery ● Radio frequency ablation ● Strontium therapy for pain management ● Bone marrow transplant ● Daycare chemotherapy

The 1st hospital in eastern India to: ●

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Launch 64-slice CT angio scan to assess the coronary health and predict heart diseases Launch MRI with PET technology for early detection of malignancy Introduced radio frequency ablation for gastrointestinal malignancies Perform minimally invasive hip replacement surgery Perform articular surface replacement for young arthritis patients Introduc narrow band imaging (NBI) and Fujinon intelligent contrast enhancement (FICE) for treatment of gastrointestinal ailments Introduce 3-D mapping in electrophysiology study for treatment of cardiac arrhythmia A dedicated unit for daycare surgeries Implant dual chamber (ICD) - latest gadget to prevent sudden cardiac death www.expresshealthcare.in

JCI: Apollo Gleneagles Hospitals, Kolkata is the only hospital in Eastern India receive with Joint Commission International (JCI) accreditation, the international benchmark for quality. It was earned after going through a stringent evaluation process covering vital aspects like patient safety and consistent quality. NABL: Apollo Gleneagles Hospitals, Kolkata is the only hospital to receive NABL in six separate categories. ISO 22000:2005 - HACCP Certification: The Food and Beverage Department of Apollo Gleneagles Hospitals (AGH), Kolkata is the first F&B department of any hospital in India to get the coveted ISO 22000:2005 - HACCP certification. It is certified by British Standards Institution (BSIUK). The ISO 22000:2005 - HACCP final survey was conducted recently and the AGH F&B conformed to all standards and guidelines. The ISO 22000:2005 - HACCP certification is valid for three years. Cost effectiveness: The treatment costs at Apollo are at par with the major private sector hospitals in the region. Vision: Envisioning Apollo Gleneagles Hospitals’ future as - The most trusted healthcare brand in the country and beyond. Truly touching lives…

Responsible corporate citizen Apollo is fulfilling its corporate social responsibility in multiple ways. It is actively involved in organising regular free health checkup camps, health talks and public forums far and wide. It is also associated with the Kolkata Police for its ‘Pronam’ programme, meant for the safety and well being of senior citizens. Imparting training to Kolkata Traffic personnel on management of medical emergencies, undertaking a number of health-related service in association with Rotary and Lion’s

Club are some of the services offered. Setting up of emergency medical booth in strategic locations and offering the service of mobile 'Hospital on Wheels' during major festivals like Durga Puja are other highlights. It also supports organisations like Welfare Society for the Blind. 'Save a Child’s Heart (SACH), an Apollo Group initiative for the treatment of under-privileged children born with heart defects is the largest voluntary organisation in Asia. Some other major ongoing CSR activities are: AGHL runs two mobile medical units (MMU) which are fully equipped with advanced technology with on board doctor and paramedics at Barrackpore constituency. The objective is to bring the healthcare services to the doorsteps of the needy and reach the underserved areas. The MMUs have facilities and personnel to provide both diagnosis and treatment to the citizens. AGHL also runs a free Malaria & Dengue Screening & Testing Centre in South Kolkata.

Patient safety Patients safety and security is a top priority at AGHL. “Apollo Group has pioneered the concept of organised private healthcare. Over the past 29 years, it has established itself as the numero uno brand in terms of quality, service, innovation and patient care. While introducing our services in Kolkata, those established values took the prime position in our priorities. Keeping true to the vision of our Chairman Padma Vibhushan Dr Prathap C Reddy, we have been committed to offer international standard of services at an affordable price to our own people. A vision as noble as this definitely generates a passion, dedication and zeal that keep on driving the whole organisation. The year 2012 has started with a great accomplishment. AGHL has been re-accredited by JCI of USA. We also introduced the first robotic surgery system in the region. Our team is working very hard to provide the best in healthcare to our people and we see a great future ahead.” said Dr Basu. JULY 2012

Continued from Pg 67 Their centres of excellence includes upgraded 24X7 emergency and trauma care unit to meet tertiary healthcare standards. They also have a track record of 300+ successful kidney transplants. There is also a well equipped cardiology and cardiac surgery department (private) established in the hospital. State-of-the-art medical surgical gastroenterology department with modern machines – hemoclip, APC, ERCP etc and the largest number of dialysis machines under one roof in Odisha are also the high points of KHL. Advanced orthopaedic surgeries – endospine and total knee or hip replacement etc are also available under one roof along with the most modern diagnostic and therapeutic investigation as EP study, CT guided FNAC, mammography and 1.5 Tesla MRI. With their team of highly qualified and skilled doctors, many of whom have come back from abroad leaving lucrative offers, KHL is trying to prepare a suitable platform by giving infrastructural support, so that these specialists can give their best to the people of the state of Odisha. Under the vision of the new management, steps are being taken to inculcate the culture of dealing with empathy and compassion combined with competency. The change in the behaviour of staff through counselling and constant training and development will be done to bring change from “Healing Touch” to “Touch Technology”. KHL is obliged to discharge its corporate social responsibility towards the well-being of the society. Very recently, Team Kalinga has collaborated with Puri Administration for providing emergency and trauma care services to the pilgrims of Rath Yatra – 2012. Team Kalinga is proud to have played an instrumental role for saving a few lives in Puri this year. Team Kalinga has devised an outreach programme and will be launching its first satellite information centre cum superspeciality clinic soon, which will be followed by more such set ups depending upon the gap analysis. JULY 2012

Health check-up camps, awareness programmes, talk shows and open house are being arranged at different districts and corporate houses with a structured approach. Patients come to the hospitals, hoping against all hopes that they will be saved from their critical diseases. Team Kalinga is well aware of its responsibil-

ities towards the safety and security of its beneficiaries” said the MD. KHL is trying to conform to the state led direction for the safety and security of the patients. “We already have a laid plan for the response to Code Blue, Red and Green. On the second level, KHL is planning line of action to Code Grey, Orange

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and Pink”. Evacuation routes, emergency response team, mock drills, the latest techniques like surveillance camera, smoke detectors, fire alarm, and most importantly the awareness, preparedness, and alertness of the staff who can be deployed to the rescue action are being addressed. Dr Mala Chattopadhyay is

looking forward to serve the state of Odisha with her sincerity, dedication and perseverance. She also said, “Though the state is observing an inflow of the healthcare facility providers, the KHL remains the hospital of the people, for the people and by the people of Odisha.”

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Continued from Pg 66 The ambulances at the disposal of Kolkata Police were handed over to Medica to be pressed into 24-hours trauma care service. This initiative was officially launched by Commissioner of Police, Ranjit Pachnanda from the Police Headquarters

at Lal Bazar on March 5, 2012. The effort has put Kolkata on the coveted list of cities in India where this service is currently available. The ambulances are manned by skilled and highly-trained paramedical staff, backed by an ever-vigilant command centre and the network of

hospitals giving expert medical care. The ambulance services to the trauma patients are free. All calls for accident-help are received by the Central Command Centre (03366070707), located at Medica, or Kolkata Police toll free no (1073). The Command Centre

is staffed by call receivers and ambulance dispatchers. Ambulance movements are tracked through GPS, with simultaneous monitoring by Kolkata Police Control Room and the Command Centre. A database of all Kolkata hospitals has been established so that patients can be taken to

the nearest hospital, for immediate care.

Welfare scheme for caddies The second is for the caddies, the often unsung heroes behind a golfer’s perfect drives. For an avid golfer who is up and ready to tee off every morning by 5 am, there is no person more important than his caddie. Be it superstition or a perfect understanding, the golfer and his/her caddie share a very special relationship on the greens – the outcome of a game often depending on this. Yet caddies, particularly in our country, barring a special few who have conquered the game itself, are a nameless, faceless lot, who accompany the golfers on the greens and are forgotten off it. Recognising a need to do something for the welfare of these people, Medica Superspecialty Hospital has launched a special Health Scheme for the caddies of the Royal Calcutta Golf Club. Formally inaugurated on January 6, 2012, this health scheme will benefit the 200 odd caddies who accompany golfers at the RCGC. Under the scheme Medica will be providing the caddie, his wife and two children a health insurance cover. The hospital’s doctor will visit the Club twice every month to attend to the minor ailments of the caddies and dispense over the counter (OTC) medicines. In case of any emergency or any other healthcare requirement in between the doctor’s visit the caddies can come to the hospital for free check-ups and treatment under insurance coverage. Medica has also pro-

vided the caddies with uniforms (two sets each, including caps and shoes) to give them a parity while on the job. This first if its kind scheme in India, has been launched with support from the RCGC officials, and hopes to be a pioneer in more such projects around the country.

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A corporate with a humane touch Dr Arunangshu Ganguly, Vice-Chairman, The Mission HospitalDurgapur, outlines the ambitious 'healthy heart for all' project initiated by The Mission Hospital, Durgapur

them to achieve it by sharing their burden of initial payment for which most Indian middle class is still not prepared as medical insurance is still at its

infancy and only a handful has medical facilities provided by their companies. We have already catered to more than 200 beneficiaries

and the need for this is growing with the inreasing awareness. The repayments have been adequate with quite a few loans closed with prepay-

ments. We hope to extend it to other departments encompassing as many patients as possible – setting an example to the world to replicate.

an higher purchase be implemented in curative medical care in some way? After much deliberations we came together and formed “The Healthy Heart for All” group and the project was named “Healthy Heart For All” [HHFA]. Dr David Green, the renowned social entrepreneur was with us in formulating the modus operandi for the project. We launched the pilot in April 2011. Initially, we started with offering a small amount of down payment followed by remaining payments on equated monthly installment basis for ill affording patients who came in for pacemaker implantation. The response initially was guarded but in last few months this has increased phenomenally. It has helped many patients to get this life-saving device who would could not have afforded it. When we found it workable with pacemakers we extended the same to angioplasty and stents. It was an organised effort to help the underprivileged adults, and not just a few anecdotal gestures, where underprivileged adults requiring pacemakers can go home with one spending as low as Rs 37500/- all inclusive, and which can be paid onetime or in easy monthly installments. If they need an angioplasty then with a nondrug stent the cost is only Rs 67500/and with drugs it is Rs 97500/- all-inclusive, and again which can be paid onetime or a part as easy monthly installments. Today, any body stepping in at the hospital can get the best treatment in cardiology. The hospital helps

JULY 2012

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Health insurance in India - recent developments Nandita Banerjee, Deputy Manager at National Insurance Company, Kolkata elaborates on recent trends in health insurance

Need for health insurance Healthcare expenses in India are increasingly going up. A one time heavy expenditure or a recurring cost of treatment of a chronic disease can erode all the savings and even drive people into debt. In India, people are now receptive to insurance as a costeffective method of risk-mitigation to take care of possible health care expenditure.

Available health insurance covers

NANDITA BANERJEE Deputy Manager National Insurance Company, Kolkata

Today, the customer has the option of selecting a health product from a variety of options made available by private and public insurers. The different types of cover are: The standard individual health policy which can be availed of by individuals along with their spouse, children and parents, is available from a number of insurers, for an age profile which includes children from the age of three months and adults up to 70 years of age, for Sum Insureds varying from Rs 50,000 to Rs 10 lakhs. Renewals normally take place up to survival of the Insured. It covers hospitalisation expenses (in India) for accidental injuries and diseases. Claims are settled on the basis of incurred medical expenses. As corollaries, the attendant Income Tax benefits under Section 80 D of the Income Tax Act, 1961 as well as cumulative bonus and health-check-up facility are usually available in most of the standard policies. A new concept is the family floater policy. A single sum insured is placed at the disposal of the entire family and Continued from Pg 65 insurance. For the rest of the people, there is no health budget. When faced with an acute emergency, they do not have enough to pay up huge bills involved in complex procedures like primary and elective angioplasty, pacemakers and valve replacements. For this, it has also set up a strategy, wherein one could make some part payment and pay off the remaining in equal monthly installments, of even less than Rs 1000/- per month. In case the patient expires, the heirs do not have to continue paying thereafter. This has

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one or more family members may avail of the same, as per their requirement. Many employers have a group health policy in place, which covers the employees along with their dependents. A standard product of the Insurer is usually modified and then customised to suit the requirements of the employer-insured. Some insurers have also introduced high value covers marketed as top-up covers for specified critical ailments, with high costs of treatment, such as cancer or organ transplants.

levels of performance originally envisaged. Complaints about delays in settlement and lack of adequate monitoring of hospital charges which contribute to high claims ratio, abound.

Current trends

Most insurers have outsourced some health services such as issuance of photo ID cards to insured persons, provisioning of cashless treatment facility at networked hospitals and maintenance of a 24-hour help-line to third party administrators (TPAs). This facility is optional and is available at a nominally higher premium under many health policies. Contrary to expectations, this arrangement has fallen short of the

The health insurance sector is one of the fastest growing sectors in general insurance not only in terms of persons covered, but also in terms of evolving concepts. Diseases which were conventionally considered to be outside the scope of insurance are now being covered. Eg., AIDS is now being covered by Star Health. Pre-existing diseases such as diabetes and hypertension can now be covered after an upfront declaration by applicants and claims are allowed after a stipulated waiting period. Another new trend is that prospective customers are being drawn towards the health policies marketed by life insurers. Some of their interesting features include the provision of pay-outs, by way of defined benefits, which is paid as compensation and thus go beyond the standard indemnification of incurred hospitalisation expenses. However, the availability of a wide variety of products have now made the selection of a suitable cover quite a difficult task for a prospective customer. 'Read the offer document carefully before investing' holds good as much for insurance as for investment in shares, as only a well considered decision will provide the required financial buffer, in a crisis.

enabled many patients to save lives. Gradually, the hospital plans to extend this facility to other departments as well. Till now, it has facilitated more than 800 procedures in this scheme (christened, 'Healthy Heart for All'), and there has been no defaulters. One of its key CSR activities have been heart surgery for children. The hospital operates on 300 kids per year absolutely free of cost, as a "give back" to society. The motto, is not to say "no" to any child suffering from congenital heart disease. â&#x20AC;&#x153;We feel very empowered when we look back and

realise the smiles that we've been able to bring in so many people's lives in such a short time,â&#x20AC;? says Dr Bose. Though the hospital is committed to providing healthcare to every individual irrespective of socioeconomic back ground, it is also one of the best in the industry when it comes to financial indices. Buoyed by the financial models and success, the hospital is venturing in new geographical areas. It is on the verge of constructing another hospital in Siliguri, where similar commitments will be fulfilled. There are plans to start

Problems of senior citizens Many senior citizens do not have any existing health insurance cover, and the ageing population are viewed as potential claimants by their insurers and therefore discouraged. Pursuant to the intervention of the IRDA, some policies have also been designed specially for them like Nationalâ&#x20AC;&#x2122;s Varistha Mediclaim for Senior Citizens, etc.

Outsourcing of health services

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Health insurance and social security Governmental concerns as to provision of social security for the dis-advantaged sections, with the insurance companies acting as facilitators are reflected in the recently launched Rashtriya Swasthya Bima Yojana.

Changes - anticipated and required Some important insurance reforms expected in the near future include a hike in FDI cap from 26 per cent to 49 per cent. Another proposed change is that the minimum capital requirement for exclusive health insurance ventures would be restricted to Rs 50 crores vis-a-vis Rs 100 crores for life and non-life ventures. It is anticipated that a lower capital requirement will attract more entrants in the health insurance sector, stimulate competition and improve penetration. The insuring public can also expect a wider selection and a greater variety of products.

Conclusion The need for health insurance as an essential aspect of financial planning and security is being felt even in developing countries such as India, given the continuous increases in costs of medical treatment. As a result of policy changes in the past years, new players have emerged and all are offering new products in competition with each other. (The views expressed in this article are the personal views of the author) another hospital in Ranchi and a "transplant" hospital in Andal, Sky City with Bengal Aerotropolis. In Durgapur, a cancer hospital will also be set up with two linear accelerators and PET CT, whose necessary permissions have been obtained and work will start soon. To summarise, the Hospital is driven by clinical excellence and quality, and not by numbers and financial end points. Innovative strategies, association with NGOs and organisations have enabled it to reach out to even the lowest economic strata. JULY 2012

Knowledge Fighting CVDs with fractional flow reserve (FFR) measurement technology

â&#x20AC;&#x2DC;Asthma, in absence of proper treatment, can lead to 100 per cent mortality rateâ&#x20AC;&#x2122;

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Regulating ART Dr Milind Antani, Head, Pharma & Life Sciences, Nishith Desai Associates alongwith colleagues, Gowree Gokhale, Partner and Aditi Jha, Associate, Nishith Desai Associates stresses that it is the need of the hour to regulate fertility clinics in India

he birth of Louise G Brown, the first child born by the technique of in vitro fertilisation is regarded as one of the most important medical advances in the 20th century. With the enormous advances in medicine and medical technologies, today 85 per cent1 of the cases of infertility can be taken care of through medicines, surgery and/or the new medical technologies such as in vitro fertilisation (IVF). It is estimated that 15 per cent2 of couples around the world are infertile. This implies that infertility is one of the most highly prevalent medical problems. The magnitude of the infertility problem also has enormous social implications as infertility widely carries with it a social stigma. Artificial Reproduction Technologies (ART) includes those technologies that allow couples to have children in ways other than natural conception. These range from artificial insemination to IVF techniques. In some cases, a surrogate mother is engaged, who is not the genetic mother of the child but bears the child for other couples.

Different possibilities of ART The chart titled, Different possibilities of ART, depicts various possibilities of ART that people may resort to. All the possibilities mentioned are performed at ART clinics and involve various stakeholders who are responsible for their performance.

Laws and regulations Since there is no Indian law that regulates ART, any medically qualified person can establish infertility or ART clinic in India, without any specific permission. This JULY 2012

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K|N|O|W|L|E|D|G|E has led to an exponential growth of infertility clinics (that use techniques requiring handling of spermatozoa or the oocyte outside the body, or the use of a surrogate mother) throughout the country. In view of this, it has become important to regulate the functioning of such clinics to ensure that the services provided are ethical and that the medical, social and legal rights of all those concerned are protected. Therefore, the Government of Health and Family Welfare has proposed Assisted Reproductive Technologies (Regulation), Bill in the year 2010. The bill details procedures for accreditation and supervision of infertility clinics (and related organisations such as semen banks) handling spermatozoa or oocytes outside of the body, or dealing with gamete donors and surrogacy, ensuring that the legitimate rights of all concerned are protected, with maximum benefit to the infertile couples/individuals within a recognised framework of ethics and good medical practice.3 Unfortunately, the ART Bill is still in draft form and only regulation that governs ART currently are the ART Guidelines (“ART Guidelines”) proposed by the Indian Council of Medical Research (“ICMR”). Pending the adoption of the ART Bill, the ART Guidelines are the only framework available to regulate ART. While the ART guidelines undoubtedly are necessary for preventing possible misuse of such technologies and for ensuring safe and ethical practice of ART, currently they do not have any legal enforceability. It is very important to adhere to the provisions of the ART

DR MILIND ANTANI

GOWREE GOKHALE

ADITI JHA

Head, Pharma & Life Sciences, Nishith Desai Associates

Partner Nishith Desai Associates

Associate, Nishith Desai Associates

guidelines by ART clinics in India; especially for surrogacy.

in the number of donors who have come forward to donate semen mainly as a revenue stream. It is very important to have a robust regulation to avoid donations from unqualified donors.

ed as her own legitimate child. In India, the laws of adoption and succession are religion driven. i.e. each religion have their separate adoption and succession laws; hence, each case will have to be examined in the light of relevant facts and circumstances to ascertain, the rights of the child born out of ART.

Unknown sperm donor Prime matters of concern are the donor’s health and necessity to avoid donors who are infected with venereal diseases, hepatitis B or C, hypertension, sexually transmitted diseases or HIV. Hence, under the ART guidelines and ART Bill, every male willing to donate semen must undergo thorough clinical investigations to rule out various infections including syphilis, HBV, HCV and HIV and their appropriate management. The donor should be of the age between 21 and 45 years and must undergo detailed semen analysis as per the WHO method for semen analysis. Further, the sperm donor is obligated to relinquish in writing all parental rights concerning the offspring. He would have no parental rights or duties in relation to the child. It is observed that recently there has been significant increase

Unknown egg donor Female egg donor too has to qualify as described above in case of male sperm donor. However; the age limit in case of female egg donor is 35 years.

Single male father The ART guidelines and ART Bill are silent on whether single male can opt for surrogacy technology for having children. However, there are examples of such cases4. It has been claimed on some websites that “individuals from many countries fly to India” for this purpose5.

Single female mother A single woman is also permitted to take benefit of surrogacy technologies6 and a child so born may be treat-

Surrogacy The incidence of children born through the practice of surrogacy is on rapid rise in India and it is fast becoming a hub for the same. Commercial surrogacy is legal in India but safeguards are provided under the ART guidelines against exploitation by ART clinics. The guidelines provide for the need for a surrogacy agreement between the couple and the surrogate mother. Once the agreement is entered in to the agreement is binding between the parties and can be enforced. Under the agreement, the

Different possibilities of ART

Child-seeking couple

Sperm and egg of couple

Child-seeking singl

Unknown sperm donor

Unknown egg donor

Male

self

Surrogacy

Female

Unknown egg donor (Surrogacy)

Unknown sperm donor

Surrogacy

self

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couple must undertake to bear all the expenses related to the pregnancy of the surrogate mother including post-delivery expenses and insurance. Under the provisions of the ART guidelines, a woman acting as a surrogate mother, who is not above the age of 45 years, is required to obtain the consent of her husband, in case she is married, and is to relinquish all parental rights concerning the child. This is required even if the sperm or egg doesn’t belong to the adopting couple. There is a requirement of adoption of the child by the couple unless they can prove that the child is genetically theirs, i.e. the egg and sperm are that of the couple, in which no formal adoption is necessary. It is also provided in the ART guidelines that no woman may act as surrogate more than thrice in her lifetime. As stated earlier, the religion of the couple will also determine what process needs to be followed so that the child is treated as the child of the couple and is granted the inheritance rights. The couple may have to carefully draft their will in case there is a lack of clarity on the succession rights.

The ART Bill The ART Bill is still in draft form. The important features of ART Bill are as follows:-

General Provisions: 1. Lays down infra-structural requirements such as space, standards of sterilisation etc. 2. Lays down number of people to be employed along with their basic qualifications and the roles to be played by them. 3. Lays down circumstances and conditions in which different ART procedures are to be used. 4. Lays down cautions and precautions to be takenovarian hyper stimulation, indiscriminate use of ICSI, prevent sale and misuse of embryonic stem cells. 5. Lays down the parameters of patient selection— the protocol to be followed in infertility management. 6. Lays down three types of infertility clinics—primary, secondary and tertiary. The primary clinics can undertake preliminary investigation, history taking and correcting minor defects. Secondary JULY 2012

clinics carry out in-depth investigation and treatment, except treatment of oocytes outside the body. The tertiary clinics engage in the highest level of diagnostic and therapeutic specialisation. 7. Lays down a code of practice for physicians dealing with the issues of sex selection, pre implantation genetic diagnosis, DNA fingerprinting, payment to surrogate mother, choosing whom to give ART procedures, provisions for detailed consent forms etc. 8. Setting up a National Accreditation Committee to monitor such clinics. 9. Since ART is not part of any medical curriculum, separate training institutes to be set up. 10. Research to be done in this area to make ART accessible to the economically weaker sections of the society. 11. The ART clinic must not be a party to any commercial element in donor programs or in gestational surrogacy 12. No ART procedure shall be done without the consent of the spouse 13. Sex selection at any stage of embryos of any particular sex should not be permitted, except to avoid the risk of transmission of a genetic abnormality. 14. Use of sperm donated by a relative or a known friend of either the wife or the husband should not be permitted. It will be the responsibility of the ART clinic to obtain sperm from appropriate banks. 15. No relative or a person known to the couple may act as surrogate. 16. Surrogacy by assisted conception should normally be considered only for patients for whom it would be physically or medically impossible/ undesirable to carry a baby to term. 17. The genetic (biological) parents must adopt a child born through surrogacy. 18. After a specific consent, the embryos may be stored for five years and stored embryos may be used either for another couple or for research after taking the consent of the couple to whom the embryos belong. 19. The sale or transfer of human embryos or any www.expresshealthcare.in

part thereof, or of gametes in any form and in any way to any party outside the country must be prohibited. The government may also consider amendments to the personal laws to give the children born out ART the same rights as that of the naturally born children.

ART Facility The ART clinics are categorised as Primary (Level 1), Secondary (Level 2), and tertiary (Level 3) infertility / ART clinics. They are specified in Schedule I, part 1 of “Draft The Assisted Reproductive Technologies (Regulation) Rules – 2010”7. An institute, hospital, nursing home or any other place providing infertility/ART services should also conform to these requirements. The physical infrastructure for the aforementioned infertility/ ART clinics should conform to the requirement as specified in Schedule I, Part-3 of ART rules. The appointment of staff and their qualification for various types of infertility clinics should conform to the requirement as specified in Schedule I, Part-2 of the ART rules. The employees should consist of gynecologists, andrologists, clinical embryologists, counselor and a programme co-ordinator/director, among others. One of the primary concerns of all ART treatments is the safety of the patients and of their gametes and embryos which constitute the very beginning of a new individual’s life. The basic tenets of any medical treatment mentioned in the Helsinki Declaration of 19648 as received from time to time, clearly spell out the ethical concerns of treating patients. These basic tenets are also applicable to ART. The clinic must ensure that a particular ART being offered has been appropriately tested according to the norms of scientific practice, or—if experimental has a sound scientific basis as adjudged by peers, and is fully in consonance with the diagnosis made of the cause of infertility. More particularly, the clinic must make sure that patients are well informed about the treatment being offered to them, the reasons of suggesting a particular form of treatment, and alternative therapies available if any.9 Every potential patient of an ART clinic must undergo clinical investigations10 to check whether they are

physically capable of having a child naturally. Based on the results of these investigations, couples or singles should be selected for treatment at different levels of infertility care units. The ART clinic is also required to sign a confidentiality agreement, which prevents it from revealing the identity of the parents to the surrogate or vice-versa unless asked explicitly by a court of law. Most importantly, the ART guidelines also specify that ART clinics are not to provide a couple with a child of desired sex.11

Conclusion Given the facts, it is clear that ART are being utilised by a large number of people in India. In fact, a multinational study carried out by WHO12 places the incidence of infertility between 10 and 15 per cent. Out of the population of 1020 million Indians, an estimated 25 per cent (about 250 million individuals) may be conservatively estimated to be attempting parenthood at any given time. By extrapolating the WHO estimates, approximately 13 to 19 million couples are likely to be infertile in India at any given time. This is a large number of people that are likely to approach ART clinics. Thus, due to the sheer potential size of the industry and the chances of possible foul play being of a high risk, and commercial angle it is extremely important that laws and regulations be formulated at the earliest to ensure that everybody can have their little bundle of joy.

References 1. Assisted Reproductive Technology (Regulation) Act (Bill), 2010 of India hereinafter referred to as ART Bill 2. ibid. 3. ibid. 4. First surrogate child of single father to evolve ethics debate. <rediff.com> Oct 03, 2005. 5. <http://www.surrogacyclinics.com/tag/surrogacysingle-father-india/> 6. Supra 7. hereinafter referred to as ART Guidelines 8. http://www.wma.net/ en/30publications/ 10policies/b3/ 9. ART Guidelines 10. Infra 11. ART Guidelines 12. Diagnosis and Treatment of Infertility, ed. P. Rowe and E.N. Vikhlyaeva, 1988 EXPRESS HEALTHCARE

K|N|O|W|L|E|D|G|E INSIGHT

Fighting CVDs with fractional flow reserve (FFR) measurement technology Kaustav Banerjee, Country Manager, St Jude Medical elaborates on the importance of fractional flow reserve (FFR) measurement technology and the need for its economic study in India

ardiovascular disease presents an expensive and burdensome global challenge, impacting millions of people. It is the number one cause of death globally, and the World Health Organization (WHO) estimates that in 2008 more than 2.3 million people died from the disease in India. While cardiovascular disease presents a challenge, medical management and medical devices in many instances are viable treatment options for patients. As more people are diagnosed with the disease and healthcare costs escalate, it has become increasingly important to find treatment options that can improve patient care in a cost effective manner. One way this can be done is to provide a treatment that is ideally suited to each individual patient. There are technologies available that help physicians to do just this. An example of a technology that helps physician to better understand the severity and nature of a patient’s cardiovascular dis-

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Clinical studies have demonstrated that Fractional Flow Reserve (FFR) improves patient outcomes and can reduce the cost burden on health care systems around the world

ease is Fractional Flow Reserve (FFR) measurement technology. It helps in the diagnosis and treatment by indicating the severity of blood flow blockages in the coronary arteries. FFR provides a physiological measurement that identifies which coronary narrowings are responsible for obstructing the flow of blood to a patient's heart muscle (called ischemia). Knowing this measurement helps physicians to determine the best course of action for his or her patient, which could range from medical managewww.expresshealthcare.in

ment, to a stenting procedure or a coronary artery bypass graft (CABG) procedure. Specifically, if a physician determines stenting is the best course of action, FFR will help guide the physician in determining which specific lesions need a stent. Several recent studies have demonstrated that having this knowledge can improve care and also reduce costs.

How FFR measurement works: Measurements are taken by placing the PressureWire across the lesion of interest

and pharmacologically inducing maximal hyperemia, a state of maximum blood flow. In this state, the ratio of distal to proximal pressure allows the physician to physiologically determine if the narrowing is tight enough to cause ischemia. It is expressed as a fraction of the normal blood flow in an artery compared to the maximum achievable blood flow in the same artery. ● An FFR measurement of 1.0 indicates an artery with normal blood flow; ● An FFR measurement above .80 indicates that ischemia is very unlikely, as demonstrated in the FAME study; and ● An FFR measurement below .75 is 100 per cent specific in identifying that the blood flow blockage caused by the narrowing is responsible for a patient’s ischemia FFR measurement technology is also compatible with other diagnostic technologies, specifically those that provide imaging that enables the JULY 2012

K|N|O|W|L|E|D|G|E physician to see the plaque inside the arteries. Whereas FFR can be used to provide a physiological measurement that helps physicians to better identify which specific lesion or lesions are responsible for a patient’s ischemia, imaging technology (such as optical coherence tomography) OCT can optimise treatment so that physicians know where to best place the stents, and also see if stents have been correctly placed.

What we know about FFR measurement Much of what we know about FFR measurement has been learned from the landmark fractional flow reserve vs angiography in multivessel evaluation (FAME) study. The study compared outcomes for patients whose treatment was guided by FFR to those patients whose treatment was guided only by angiography using PressureWire technology. The 12-month results, published in the January 15, 2009 issue of the New England Journal of Medicine, demonstrated that instances of major adverse cardiovascular events (MACE), including death, myocardial infarction or repeat revascularisation, were reduced by 28 per cent for patients whose treatment was guided by FFR rather than by standard angiography alone. Two-year results from the FAME study demonstrated that patients who received FFR-guided treatment continued to experience improved outcomes over time, including a 34 per cent risk reduction in death or heart attack. Additionally, only one out of 513, or 0.2 per cent, of deferred lesions resulted in a late myocardial infarction (heart attack), which demonstrates that FFR results are reliable over time. FFR-guided treatment was also demonstrated to be cost-saving, with a difference per patient of more than $2,000, or 14 per cent, between total health care costs for the FFR-guided group and the group treated by angiography alone after a year. The reduced health care costs were a result of reduced procedural costs, reduced follow-up costs for major adverse cardiac events and shorter hospital stays. These results were measured in the context of the US health care system. The positive outcomes of the FAME study resulted in JULY 2012

the level of evidence for FFR to be upgraded to an “A” from a “B” by the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions. Level of evidence “A” is the highest level available, requiring the most clinical evidence and is awarded only when data is derived from multiple populations and multiple randomised clinical studies or meta-analyses. In the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) 2010 guidelines on myocardial revascularisation, FFR measurement was awarded the strongest recommendation with the highest level of evidence. Additionally, the guidelines recommend measuring FFR before deciding PCI or surgery for multivessel disease.

Coronary Interventions (PCI) ● Cumulative savings for the health care system annually ● Impact on health for the population undergoing PCI The detailed analysis will be based on the results of the initial FAME study (was a randomised, prospective, multi-center trial with 1,005 patients), statistics from India’s PCI registries and from published literature. India’s cost effectiveness study is being led by Professor Uwe Siebert, a FAME study co-author. Prof Upendra Kaul, the Executive Director and Dean Cardiology at the Fortis Escorts Heart Institute and Fortis Vasant Kunj and Dr J Balachander, Head of the Cardiology Department at the JIPMER Institute Pondicherry will also participate by validating the data modeling to

Given that FFR assessment showed such a strong and clear benefit to patients in the interim analysis, an independent Data Safety Monitoring Board recommended that investigators stop patient enrollment in the FAME II trial FFR research in India As evidenced by the FAME trial, cost effective technologies such as FFR measurement that improve patient care can make a significant difference in patient care while also help remove the resulting cost burden on health care systems. Though cost-saving results have primarily been demonstrated in the US and Europe, it is important that we also learn how the technology can help impact those in need of health care in India. To that end, in February 2012, a study was initiated that will evaluate the incremental cost-effectiveness of FFR-guided treatment for patients with multivessel coronary artery disease in India and several other Asian countries. The analysis will also determine the potential health and budget impact that FFR-guided treatment provides. Specifically, as it relates to our own health care system, we expect to learn: ● The cost savings from using an FFR-guided approach to Percutaneous www.expresshealthcare.in

ensure that the study calculations accurately represent patient experiences in India. Similar research conducted in Europe last year revealed that FFR-guided treatment using the PressureWire technology can improve health outcomes while also delivering significant costs to health care systems. In Germany, the UK, France, Italy and Belgium, the FFR-guided approach has the potential to reduce deaths and heart attacks and save between 500 and 950 per patient, depending on the country.

Other important FFR research Clinical studies have demonstrated that FFR improves patient outcomes and can reduce the cost burden on health care systems around the world. The fractional flow reserve (FFR)-guided percutaneous coronary intervention plus optimal medical treatment vs optimal medical treatment alone in patients with stable coronary artery disease (FAME II) trial was

designed to further study the role of FFR in the treatment of stable coronary artery disease by comparing percutaneous coronary intervention (PCI) guided by FFR plus optimal medical treatment (OMT) to OMT alone. The interim analysis found that there was a significant reduction in the need for patients to urgently seek treatment at a hospital when FFR-guided assessment was used in stenting procedures in patients with coronary artery disease. This means that, patients receiving OMT alone experienced a highly statistically significant increased risk of hospital readmission and urgent revascularisation. Given that FFR assessment showed such a strong and clear benefit to patients in the interim analysis, an independent Data Safety Monitoring Board recommended that investigators stop patient enrollment in the FAME II trial. Therefore the FAME II trial will continue following patients currently enrolled according to the trial protocol and will not enroll any new patients. Additional data are expected to be revealed later this year. The trial’s clinical investigators noted that observations to-date regarding urgent revascularisations validates the profound role that FFRguided therapy has in improving patient outcomes. Further, that this provides evidence that FFR should be considered the standard of care for patients with coronary artery disease.

Summary of Research While the specific economic impact of FFR in India is the subject of ongoing clinical study, research in other countries has demonstrated its clinical and cost benefits. The original FAME trial demonstrated that FFR guidance improves outcomes in patients with stable coronary artery disease and two or three vessel disease. The FAME II trial interim analysis found that PCI is beneficial for patients with one, two and three vessel disease whose ischemia has been documented by FFR. Companies interested in improving patient care will continue to conduct research on the benefits of clinically compelling and cost effective technologies such as FFRguided therapy. As new technologies are developed and launched, it is important to understand the broader economic and health impact these therapies provide. EXPRESS HEALTHCARE

K|N|O|W|L|E|D|G|E INTERVIEW

Asthma, in absence of proper treatment, can lead to 100 per cent mortality rate’ Dr Agam Vora ASST HON & INCHARGE, DEPARTMENT OF CHEST & TB AT DR. R. N. COOPER MUNI. GEN. HOSPITAL, MUMBAI

lthough asthma is a condition which can be managed with proper care and precautions, lack of adherence or compliance with treatment often results in poor asthma outcomes. This is mainly seen in cases of severe asthma such as brittle asthma. Experts are of the opinion that this situation poses a major challenge to healthcare providers and patients due to the lack of awareness amongst asthma patients and medical practitioners on the same. In relation to this, the Global Asthma Physician and Patient (GAPP) survey revealed a direct relationship between the quality of physician-patient communication, the level of treatment side effects and the extent of patient compliance highlighting a clear need for improved patient—focused care in asthma. Dr Agam Vora, Asst Hon & In charge, Department of Chest & TB, Dr RN Cooper Municipal General Hospital, Mumbai, in conversation with Raelene Kambli, provides further valuable insights on brittle asthma and ways to manage it

What is brittle asthma? What are its causes? Brittle asthma, also known as difficult asthma, is a variant of asthma which is difficult to treat. It’s a condition which arises due to failure in achieving asthma control when maximally recommended doses of inhaled therapy are prescribed for at least 6 -12 months, under the care of an asthma specialist. Most patients of brittle asthma are essentially under-treated asthmatics who will benefit by proper guidance and adherence to treatment. It can be unstable and unpredictable with frequent severe attacks and hospital admissions. Often no consistent trigger factors can be identified, hence, there is lack of awareness amongst sufferers of this severe form of asthma. Few common causes of brittle asthma are atopy, food allergy, psychological factors, allergic cold and steroids resistance.

How fatal is this condition? Does it lead to any other respiratory disorders?

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General asthma is often diagnosed under normal cases and is usually considered curable. However this severe type of asthma, if undiagnosed, can even prove to be fatal. In absence of proper treatment given it can lead to 100 per cent mortality rate. In my opinion, about 30 to 40 per cent of the difficult asthma patients die inspite of being in the best possible centres.

inform their physicians at the earliest.

Are medical practitioners in India well informed about this fatal type of asthma? Unfortunately, there is much written information about the disease but very little is available on the seriousness of brittle asthma or difficult asthma. A lot of practitioners are unaware of this condition

With the present Indian population estimated to be one billion plus, brittle asthma still remains under-recognised, underestimated and under treated in India Asthma can also lead to respiratory failure and eventually respiratory arrest. Initially, they may have low oxygenation which eventually results into elevated carbon dioxide levels.

What is the prevalence of brittle asthma in India? Can you give us some statistics? With the present Indian population estimated to be one billion plus, the disease still remains under-recognised, underestimated and under treated in India. Approximately, about three per cent of the Indian population suffers from asthma, out of which 0.05 per cent of all asthmatics are difficult asthma patients. Despite varied therapeutic options available, many asthmatic patients with moderate – severe persistent asthma continue to experience symptoms even after therapy with inhaled or systemic corticosteroids. In fact, these account for 217000 emergency room visits and 10.5 million physician office visits every year. In India, asthma is a low public health priority and a significant proportion of patients receive only basic care and are not able to benefit from therapeutic advances. There is a dire need for asthma patients in India to identify the symptoms of this severe disease and

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and may not diagnose it. It may even lead to deaths. We need to make our patients and medical colleagues aware of this type of asthma. Regular continuing medical education (CME) activities and articles on the disease can help spread awareness amongst medical practitioners and the patients. There is a dire need for patients to understand the seriousness of the disease and the need for regular therapy.

What kind of awareness should the medical practitioners provide about brittle asthma to their patients? If you thought lack of sleep, uneasiness, persistent breathing difficulties, multiple hospitalisations and faster consumption of inhalers in spite of consuming regular asthma medication was part of your disease, you’re wrong. You could be suffering from difficult asthma which can be fatal. Two of the major challenges witnessed in the treatment of difficult asthma in India are the lack of previous treatment records of the patients while getting treated by a new doctor and the lack of fear amongst patients as it’s considered to be controllable. Lack of adherence or compliance with treatment is the most common cause of poor asthma outcomes. India is best

equipped with medication for the treatment of asthma; the treatment only needs to be taken seriously by the patients.

Which is the best way to manage such kind of asthma? What are the ways to prevent it? Lack of adherence or compliance with treatment is the most common cause of poor asthma outcomes. In the treatment of asthma it is essential that at the outset, an accurate diagnosis is established by performing a pulmonary function test (PFT). Treatment should be in the step ladder manner outlined by Global Initiative for Asthma (GINA). Subsequent visits should monitor the progress of the patient along with accurate assessment of asthma control as outlined by the GINA guidelines. If at the completion of three to six months of therapy the patient achieves good control, the treatment can be continued. In the event of sub optimal control a systematic protocol should be adopted to exclude the above causes of poor control. Hygiene measures in lifestyle, food intake and exercise can cut down the risk of brittle asthma drastically. If a patient is diagnosed with asthma, one should avoid eating food with preservatives as that aggravates asthma; always opt for food with greater shelf life. Alternate therapy such as yoga has proven to be very beneficial to prevent as well as keep asthma in control.

What are the other causes of brittle asthma? Other causes of brittle asthma are ● Asthma mimics such as COPD, hiatal hernia, ABPA, heart failure, vocal cord dysfunction syndrome ● Presence of co morbidities - allergic rhinitis, GERD, psychiatric illnesses, sleep apnea ● Unidentified exacerbating factors – rare causes such as mutations in the beta 2 receptor gene or mutations in the steroid receptor gene. raelenekambli@expressindia.com

JULY 2012

Strategy MAIN STORY

Mending marketing mistakes in healthcare Ratan Jalan, Founder & Principal Consultant, Medium Healthcare Consulting outlines the top five mistakes in hospital marketing and recommends steps to rectify them

JULY 2012

n a usual hospital setting, marketing, unfortunately, happens to be one of those functions, which is not adequately understood and, hence, not appreciated. It is often viewed as something not even desirable (You can’t exploit the sick!), cosmetic in nature (It’s all about colours, clever headlines, and pictures.) and non-productive (You don’t even know whether it works). To make matters worse, a large number of hospitals, in the name of marketing, simply stop at creating and maintaining an incentivised referral network and chasing a few corporates or TPAs. Ironically, all that is not even marketing! Here are the top five mistakes that hospitals make. I would also like to suggest some ways to address these challenges. Customer un-friendly communication: Think about the hospital advertisements you usually come across. They boast of stateof-the-art equipment and highlight plush interiors. I find it ridiculous that a cancer hospital talks about tumour boards. Or a large hospital talks about 16 micron HEPA filters in their OTs or 128-slice CT scans. Hospital marketers frequently forget that people do not live and work with the highly technical jargon that pervades hospital atmospheres. Those poor souls don’t understand HEPA filters, non-invasive surgeries, or intrauterine fibroids. Is oncology really a better term than “cancer”? It is important to focus on what the new technology, procedure or an accomplished physician means to the patient in terms of end-result or benefit. For those who find merit in being incomprehensible, since they may believe it helps in cueing expertise, I would request them to analyse Intel’s advertising campaigns. It is the sheer simplicity of messages (a microprocessor can be no less complex to talk about!), which makes even the kid in a small town insist on buying a PC that has ‘Intel Inside.’ Not focussed on high margin segments: A hospital

usually focusses on high-profile specialities. Similarly, marketing or sales efforts are largely directed towards customer segments, which are relatively easier to acquire, be it corporates, TPAs or through referral route. There is a certain amount of disconnect between the financial impact and the strategic priorities of the marketing plan in many hospitals. Different specialities and procedures yield very different margins, which may be on account of high consumable cost, for example. Also, a walk-in patient is likely to be a lot more profitable than a corporate or an insurance patient, since the effective tariff will be much higher with no account receivables (and hence, no bad debt either). It is vital that the marketing function is equipped with in-depth analysis of margins across different services and different customer segments. To capitalise on such disparities, a truly efficient marketing plan would prioritise and focus on increasing volume for those areas that will have the highest impact on the bottom line. Lack of an effective outreach programme: A hospital, whether it is a large hospital or a mid-sized hospital, will have a catchment area much larger than the town in which it is located. While Medanta Health City receives patients from almost everywhere in the country (or, in fact, anywhere in the world), smaller hospitals may be catering to areas within 200300 km of their location. An effective marketing programme needs to ‘take the www.expresshealthcare.in

hospital’ to such outreach locations. A wellexecuted marketing programme will achieve high visibility and recall among the target audience in such locations. It needs to be done through a judicious mix of physician visits/camps, CMEs, PR and mass media, in select cases. It also needs to be done regularly, and more importantly, monitored closely to assess impact to help fine tune strategy. Some hospitals have effectively leveraged out-reach programmes to promote and build equity for their lesser known physician pool. Given Apollo Hospital’s vast network, the Apollo Clinics initiative was a strategic attempt to address the need for institutionalised outreach across the country. Inadequate PR: PR in a hospital context not only offers much higher credibility, but is also much less expensive. A large number of times, PR gets into a hyper-active mode as a crisis management exercise when something goes wrong, be it a messed-up surgery or a natural disaster. One also comes across PR centering on new equipment or extraordinary procedures, like separating Siamese twins or performing cardiac surgery on a 93-year old patient. While such PR initiatives, if executed well, can help in reinforcing expertise and enhancing brand visibility, there is a lot more which could be attempted as a planned strategy. It is important to keep the journalists engaged on a proactive basis, be it around certain burning healthcare issues like infant mortality, hypertension or patient-friendly initiatives, or physician accomplishments and newer approaches. However, it is important to understand that you should not paint a picture which is far from reality! It is equally important to have a strategy ensuring consistency in messages. Narayana Hrudalaya, for example, has managed to leverage PR extremely well to drive home the message of affordability with a singleminded focus. Not-in-time marketing:

Hospital marketing usually starts only after the hospital becomes operational. There is an incredibly frenzied pace of activities during the last few months before the launch, be it equipment installations, physician recruitment, training, software glitches, licenses, outsourced agencies or interior finishes. And marketing somehow goes unnoticed. It is disappointing to witness a hospital willing to incur high fixed expenses as minimum guarantee for a large number of surgeons, but not invest enough in marketing or sales to promote these very assets! In almost all other industries - marketing and sales activities get initiated well before the new facility becomes operational. The objective is clearly to generate enough footfalls and revenue in the first few months. Unfortunately, in a hospital which has extremely high fixed costs, the first few months are normally quite bleak. It is a well-institutionalised myth that hospitals suffer from long gestation periods and it takes time to move up the occupancy levels and revenues. I believe it has largely been a result of poor and inadequate sales and marketing efforts put in by hospitals over the years. The reality, can be very different. This list of five mistakes, by no means, is exhaustive. My objective is to sensitise managers and promoters about how marketing can leverage produce results. Hospitals aren’t the only ones who lose out from ineffective marketing. Patients deserve and, in fact, crave information about their healthcare options. They scour the internet, talk to relatives, coworkers, and friends, read the papers, watch television and call hospitals with questions, all in the hopes of learning enough to make a good decision. They trust what they learn at outreach events or read in newspaper and they place deep faith in what fellow patients say. Ignoring this reality doesn’t really help them or your hospital. EXPRESS HEALTHCARE

IT@Healthcare Indian healthcare sector is gradually moving from preventive to curative healthcare” Wipro and Dun & Bradstreet (D&B) have recently come out with a study identifying some of the likely trends in healthcare over the next decade. Sairaman Jagannathan, Vice President, Business Solutions, Wipro shares some insights from the report with Viveka Roychowdhury, as well as Wipro's recommendations to tackle these issues

Page 82 MAIN STORY

Need for clinical research informatics H Use of electronic information exchange have been slow in clinical research studies and potential efficiencies available through IT solutions for clinical research are largely undermined. Niladri Majumder, Project Analyst, Sidra Medical and Research Centre speaks about IT techniques which can help in clinical research activities

NILADRI MAJUMDER Project Analyst Sidra Medical and Research Centre

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ealthcare providers having a ‘Research Centre/Institute’ tag suffixed to their display name has been a widespread phenomenon in our country. But in reality only a handful of them actually engage in active clinical research while the others often mistakenly use this to reap commercial benefits. The fact that clinical research is the lynchpin that connects innovative technologies from basic discovery research to their application as breakthroughs in patient care is deeply undervalued by healthcare centres. Most care providers treat clinical research as a byproduct of clinical care and the former is more of an afterthought/ add on to the later. The flow of research from bench to bedside and back again, through review in practice, necessitates a comprehensive research strategy aligned to the organisational vision. Many organisations falter with their research programmes in absence of an appropriate strategy and leadership commitment. Developing the right informatics infrastructure through provisioning relevant IT solutions is a vital cog to a comprehensive research strategy. Moreover, with the correct business model healthcare institutions derive additional research value from a sophisticated IT infrastructure. But improvements through the use of electronic information exchange have been slow in clinical research studies for many reasons, including the lack of informatics infrastructure, exemplified by low electronic medical records (EMR) adoption, inconsistent data standards and database architecture, and insufficient analytic tools. Even though our healthcare leaders are being increasingly aware of the need for digitis-

ing the hospital operations, potential efficiencies available through IT solutions for clinical research are largely undermined. Studies indicated that over 75 per cent of information obtained for support of clinical trials was entered on paper[1]. Use of electronic solutions can reduce the cost of data collection by 55 per cent over paper[2]. Furthermore, the information once collected is typically entered for various needs from four-seven times by clinicians. Additionally, three main fields in science and medicine that are currently disconnected: 1) basic research, which tries to understand the fundamental principles and phenomena that drive cells, organisms and systems in both normal and pathological conditions (such as cancer); 2) translational research and applied medicine, which represent the application of basic research to solve specific problems, aid in diseases and help society at different levels as well as 3) EMRs that have been developed as a new technology to facilitate both patient care and research by collecting and archiving patients’ history. The key bottleneck is how to efficiently integrate these three independent “parts” of medical and scientific areas in a single solution to improve patient care. A robust clinical research informatics platform enables: ● Integration of patient and research data ● Sponsors to understand the progress of their research projects ● Institutions to ensure ethical and regulatory compliance ● Robust data collection, processing and reporting ● Capturing and leveraging IP generated ● Enable collaboration www.expresshealthcare.in

among partners and others in research fraternity

The clinical research workflow

Clinical research study might be stated as an overarching terminology which envisages sponsored or investigator initiated clinical trials or other survey-oriented non interventional studies. A typical clinical research study lifecycle consists of the following steps. The study originates from a hypothesis, and then is detailed in a study protocol. The protocol documentation includes study design and operational details such as the duration of the study, type of participants, inclusion and exclusion criteria for subjects, patients’ schedule for assessment and interventions, medications and dosages. Following this, the protocol is assessed by an Institutional Ethics Committee (IEC) or Institutional Review Board (IRB) to ensure the appropriateness of the clinical trial protocol as well as weigh the risks and benefits to study participants. It also reviews all study-related materials before and during the trial. After the study is approved and site selection done, patient/subject are screened and recruited based on pre-determined inclusions and exclusion criteria. Thereafter all enrolled study subjects/patients undergo series of assessment, investigations/interventions in compliance to the protocol schedule. The clinical research staff ensures appropriate documentation, de-identification of data per relevant standards and archiving of data. Collected data are analysed and interpreted by researchers to derive inferences which form the basis for biomedical discoveries. At the heart of clinical research is the immense data

collection and analysis that determines the efficacy and safety of medical therapies. Currently, the processes for identifying subjects eligible for research, collecting study parameters, assembling information from multiple study sites, conducting oversight of study protocols, and analysing results involve manual operations which are time consuming, labour intensive, and expensive.

Capabilities of an integrated clinical research informatics model Historically, research and healthcare information technology systems have been disconnected, supporting separate, but sometimes redundant, processes and workflows. Unfortunately, the use of disparate systems can result in patient safety concerns, inefficient processes, data quality issues and challenges. Most Clinical Research Organizations (CROs’) and pharmaceutical companies engaged in clinical trials rely on commercial off-the-shelf Clinical Trial Management System (CTMS) solutions for digitising the trial process. A CTMS package is an integrated suite of applications sharing a common database designed to help manage clinical trails activities at different levels. But a hospital-based clinical research presents unique informatics requirements that are amenable to solutions supported by EMR systems which might be already deployed. Such scenarios solicit an EMR integrated comprehensive informatics solution which extends beyond the scope of a traditional CTMS solution. The solution should enable: ● Proactive identification of potential research subjects from the EMR database ● Help screen and recruit research participants JULY 2012

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Research data collection through electronic data capture methods (EDC) from the EMR including web, hand held devices, and phone-based Interactive Voice Recognition (IVR) IRB document management, amendment and milestone tracking Randomisation and blinding of participants in a randomised control trial De-identification of data according to HIPAA standards Trail reporting and identify data queries that needs to be addressed Adverse events reporting Easily move valid data from EMR into research registries Facilitate secure EMR access for research auditors/ monitors Appropriately billing for research visits to the sponsor unlike the normal visit Tagging hospital patients enrolled in research studies for easy identification Capture rich structured data from the EMR (phenotypic) and combine with bio-informatics data (genotypic) Enable export data in format (for eg: CDISC )for initial statistical purposes or downstream integration with other tools Provide coding methods for fields such as pathology or medication data

The clinical research informatics model The desired capabilities of an EMR integrated clinical research informatics solution, as discussed in the previous section, has been mapped to the enabling core IT systems functionalities. More often all these functionalities might not be met by a single software solution but an integration of multiple systems, which might be necessary to achieve the desired research outcomes. This model also might form a basis for negotiations with the EMR vendor to include additional functionalities in the solution package to support clinical research. Moreover, this lays a longterm foundation for accelerated discovery, extensive outcomes research, and ultimately a ‘learning health system’ in which a ‘bench-to-bedside-tobench’ cycle of information will support continual improvement in knowledge, care and health. The model is split in two distinct zones meant for patient care and clinical research intersected by a pseudonymisation wall. JULY 2012

Research specific functionalities within EMR The EMR is the centerpiece to all patient care activities in the hospital. It is capable of capturing and archiving all information (for eg: charts, orders, results, medications, diagnosis, interventions etc) generated during patient care. For a hospital engaged in clinical research, EMRs can be optimised to envisage pro research functionalities like: ● Study feasibility and screening – The EMR has potential to be an ideal system to search for patients that are eligible for an ongoing or potential study. All patient records from the EMR is maintained in a EMR Data Warehouse (EMR-DW), a system that enables the patient records to be stored and used for analytical purposes. With advanced search capabilities, it’s also possible to retrieve a series or records to retrospective chart reviews. ● Recruitment alerting – Inclusion criteria for clinical research studies can be programmed into the EMR, which can proactively alert the attending physician that a patient is eligible for enrolment into a study when they are in the clinic. Failure to recruit a sufficient number of eligible subjects presents a major impediment to the success of clinical trials. This can be addressed if the EMR has the capability of a real time Clinical Trial Alert (CTA). Without the assistance of IT solutions, recruitment is extremely slow, expensive, and low-yield. ● Patient tagging and participant tracking – Identification of hospital patients involved in a research is crucial to protecting the safety and rights of participants. The EMR should be capable of flagging (a sort of identification on the patient’s record) the patient enrolled in a clinical research study with information about clinical trials/studies in which he/she is participating. This would help clinical staff, investigators, study coordinators, clinicians, and oversight bodies such as the IRB to follow participants throughout the research process and ensure that their safety and rights are protected. An integrated participant tracking enables better management and elimi-

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nates need for multiple data entry Protocol document management – The system should have document management capabilities for support grants, peer review, IRB continuing review, ethics approval, adverse event reporting, etc and support the informed consent and reconsenting processes. Organisations of a larger scale prefer dedicated Enterprise Content Management (ECM) systems to fulfill this need.

Research study management system: Core functionalities eCRF & Electronic Data Capture: Traditionally paper based Case Report Forms (CRF) have been used to transcribe relevant data manually from the medical record of a clinical research study subject. In a paper system, data are entered first on the clinical report form and second by the data entry group into an electronic system. An eCRF is a pre configured electronic form that eliminates manual data entry/re entry and fetches the data from the medical records through electronic data capture. The Electronic Data Capture (EDC) is a system that electronically transcribes clinical data from the EMR into the electronic case report form (eCRF). EDC replaces the traditional paper-based data collection methodology to streamline data collection and management. Since data are entered into a data collection tool only once, processing time for data entry is reduced, and transcription errors are less likely. EDC can help clean and lock data faster than traditional paper CRF systems. Pseudonymisation: Research studies must use deidentified patient data according to relevant standards (for eg: HIPAA). This is not only a legal requirement but is essential for protecting patients’ rights. With that in effect, the patient data flow from clinical to research domain should channel through a data pseudonymisation system. This system will enable de-identification of patient identifiable data to accepted standards such as HIPPA, assign codes to the data as well as support re-identification of patients in case of medical emergencies. Following pseudonymisation, the de-identified data is expected to reside in a separate research domain where can be used by researchers who cannot identify which patient the data is particular www.expresshealthcare.in

to. This includes having the capability to handle cases of very small populations. The de-identification system needs to integrate with any system where Personal Health Information (PHI) is collected and will then be used for research purposes. Randomisation and b l i n d i n g : Randomisation capability enables locally sponsored interventional clinical studies for systematic assigning patients to different study arms in a statistically robust fashion. It needs to interface with clinical systems including, but not limited to EMR, the pharmacy system, and the research systems and its associated electronic data management systems. For blinded clinical trial that involves providing a blinded drug-based intervention the hospital pharmacy system needs capabilities to un-blind in an emergency the study treatments and to manage the resupply to the patient on the behalf of the study. Data management: Accurate, reliable, usable data — it’s the lifeblood of clinical research. The method an investigator chooses for collecting, storing and analysing data can mean the difference between a study that advances the science and improves patient care, or a study with inconclusive results and no publications. Typically the data management functionality will capture all of the structured and unstructured data that is captured in study documents. This can be used to provide a warehouse of all research data that has been captured from the research activities. Also there should be a role and site level access, which allows users from other institutions to contribute data to the studies. The system should not only be able to support studies requiring low to medium data collection complexity but also should be able to manage regulatory compliance (for eg: 21 CFR Part 11), sophisticated data management and quality control, for multi-site trials. Data marts and knowledge management: A project data mart is typically project specific collection of data that enables clinical and research data to be extracted from their primary data management systems and combines and curates the study data into a system that enables researchers to explore and analyse their data according to the study design. A knowledge management system is a searchable repository of research results (or

facts) that capture the published and published findings of research activities. This includes statistical relationships between patients and their biology and integrates entities across patients, literature, markers and drugs. Data collected from across the research activates needs to be analysed to make inferences about the specific research hypothesis.

The way ahead India is being touted as one of the fastest growing market globally for clinical trials with more than 15 per cent of global clinical trials expected to be carried out in the country [3]. With increasing market size and complexity there is a need of better ways to transfer and access patient information electronically. A clinical research enterprise that is configured around such electronic information systems will yield more rapid scientific discovery and will provide significant support of related activities including: comparative effectiveness of clinical trials and other outcomes-related research; quality of care measurement; public health and safety monitoring, and post-marketing surveillance. With a widespread EMR adoption, the interface is gradually becoming more porous and productive, while providing the required oversight. These improvements will positively affect patients, physicians, researchers, entities which invest in clinical research, and ultimately all who look to scientific discovery to propel medical advancement. References: [1] Alschuler L, Bain L, Kush RD. Improving data collection for patient care and clinical trials. Sci Career Mag Mar 26 2004 [2] Pavlovic I, Kern T, Miklavcic D. Comparison of paper-based and electronic data collection process in clinical trials: Costs simulation study. Contemp Clin Trials 2009; 30: 300-16. [3] http://www.outsourcingpharma.com/ClinicalDevelopment/India-tippedfor-15-share-of-clinicalsector-by-2011 Literature Review: http://www.indianexpress.co m/news/crackdown-two-hospitals-lose-research-institutetag/842869/1 http://ctri.nic.in/Clinicaltrials/ login.php www.epic.com www.cerner.com EXPRESS HEALTHCARE

I|T|@|H|E|A|L|T|H|C|A|R|E INTERVIEW

‘Indian healthcare sector is gradually moving from preventive to curative healthcare’ Sairaman Jagannathan VICE PRESIDENT, BUSINESS SOLUTIONS, WIPRO

airaman Jagannathan, Vice President, Business Solutions, Wipro shares some insights from a recent report with Viveka Roychowdhury Wipro and Dun and Bradstreet (D&B) have recently come out with an explorative study titled ‘Future Thought of Business (FTOB): Healthcare'. What were the objectives behind this study? The Future Thought of Business for Healthcare report aims to identify those trends likely to emerge in the coming decade that could significantly influence the future of business in the Indian healthcare sector. This report is an initiative to provide the healthcare sector with a tool to apprehend, strategise and tackle future challenges. Possible recommendations to address the issues so identified have also been detailed in the report. The report has been developed based on quantitative and qualitative information. Data and information collection was conducted through secondary research and interviews with industry experts.

What are the key findings? Demand for preventive healthcare services: ■ The Indian healthcare sector is gradually moving towards preventive healthcare from curative healthcare. With rising awareness levels both in the urban and rural areas and increasing disposable incomes, the coming decade is expected to witness increased demand for preventive healthcare. ● Need for preventive healthcare is expected to become even more crucial in the coming decade due to the rising incidences of lifestylerelated diseases.The incidence of lifestyle-related diseases such as diabetes and cardiovascular diseases, and the associated risk factors such as hypertension, high cholesterol and blood pressure, obesity etc are increasing at an alarming rate in India. ● This, in turn, can be attributed to urbanisation and changing corporate environment (rising stress levels and sedentary lifestyles), among others. Though, this phenomenon is no longer restricted to urban population. ● The corporate sector will play

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a critical role in driving growth in the preventive healthcare market. More and more corporates have now made it mandatory for regular health-checks and drive several wellness programmes to ensure a productive and healthy workforce. Increasing penetration of both private insurance and Government health insurance schemes will bring more people under the healthcare net and will drive growth: ■ With increase in penetration of health insurance, healthcare is likely to become more affordable for a larger proportion of the country’s population. Further, expansion in the health insurance segment would also have a positive rub-off impact on demand for health checkups/preventive healthcare, which is a mandatory part of health insurance coverage. ● The liberalisation of the insurance industry in 2000 has resulted in the entry of several private and international insurance companies, ● Many state governments have also launched health insurance schemes like Employee State Insurance Act (ESI) targeted at specific sections of the population, which have been successful in improving access to healthcare. ● Social and community health insurance schemes have also been rolled out in the country. ● However, the overall level of insurance penetration continues to be low. In India, any form of insurance including the Central Government Health Scheme (CGHS) and the Employees State Insurance Scheme (ESIS), other Government sponsored schemes and private health insurance cumulatively covered only 25 per cent of the country’s population in 2010. And over three-fourths of the coverage is through the Rashtriya Swasthya Bima Yojana and other statesponsored health insurance schemes. ● From about 75 million people covered in 2007, the estimated number of people covered by health insurance has surged to about 302 million. ● In the coming decade, driven by rising healthcare costs and the government’s increased www.expresshealthcare.in

thrust on improving access to healthcare, the penetration of health insurance is expected to increase significantly. ● Further, an increasing section of the domestic workforce is being covered by corporate health plans. The Indian market will entice more foreign players through capital investments and technology tie-ups across various segments ● The attractiveness of the growing and under-penetrated healthcare sector is drawing foreign players into this market, through capital investments and technology tie-ups across various segments such as hospitals, diagnostics, medical equipment, etc. ● FDI in this sector between April 2000 and August 2011 stood at $1.08 billion. However, to meet the expected increase in demand for healthcare services, both from domestic population and international patients, the healthcare sector needs to scale up considerably in terms of both availability and quality of the physical infrastructure and human resources. ● . As per D&B’s estimates government expenditure on healthcare is expected to remain low at 1.5 per cent of GDP in FY20. In such a scenario, private and foreign investments would have to increase substantially to ensure overall improvement in health infrastructure.

Expansion in tier-II and tier-III cities: Large number of single specialty hospitals will come up in India, driven by the rise in local income and increased awareness of specialised treatment available ■ Single speciality hospitals require less manpower, equipment and infrastructure, and are easier to operate and manage. ■ The higher margins enjoyed by uni-specialty vis-à-vis multispeciality hospitals, on account of better economies of scale and cost optimisation, is increasing the attractiveness of this segment. ■ Growth in tier-II and tier-III town and cities: ● there is demand for quality and specialised healthcare services, since it saves time and money spent in travelling

to bigger cities for treatment. lower rentals and manpower costs associated with smaller towns enable healthcare companies to offer services at lower rates compared to those offered in the big cities. ● Healthcare players who have set up specialty centers in tierII and tier-III cities also attract patients from neighbouring small towns. ■ The coming decade is expected to see more super specialty centres in heart care, cancer, eye, maternal and child care, and cosmetology. Role of IT in the healthcare sector: The need to optimise costs and increase efficiencies will make IT an integral part of hospital management ■ One of the major trends to have emerged in the Indian healthcare sector in the last decade is increased adoption of IT in hospital management. Healthcare providers are increasingly adopting technology to: ● improve patient satisfaction (through reduced turnaround time at points of care); ● enhance patient safety (through improved decisionmaking); ● enhance productivity and elimination of human error (by way of seamless integration with medical device/equipment); ● reduce operational costs (through reduction in staff needed for back-office tasks); ● improve inventory management (by way of accurate demand estimation and timely procurement and distribution of materials ●

What has been the response of stakeholders to the report? Industry leaders have appreciated the findings of the report. We recently had executive briefing where leaders of more than 30 healthcare companies visited Wipro. There we had a dedicated slot to discuss this report findings where the leaders from the industry had a vibrant discussion and exchange of thoughts on the same. Many leaders have requested for additional copies of the report or have requested to share the power point presentation. Our Linkedin campaign also got an overwhelming response with more than 40 per cent of our target group accessing the report. viveka.r@expressindia.com

JULY 2012

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Safeguarding medical records with digitisation Jay Mehta, Founder, CEO, ViDoc Healthcare Solutions talks about the benefits of digitisation of medical records

here has been highly increasing interest with hospitals, clinics and medical fraternity as a whole, to get medical records digitised. The interest has been spurred for several reasons like a. Threat from fire and other hazards b. Regulatory and accreditation mandate c. Space constraints d. Research or e. Simply make the medical records department (MRD) more organised for better practice. Whereas some people do understand the intricacies involved in the digitisation of medical records, most people mistake it for just simple scanning of documents and saving it on a computer. While scanning and saving the records are part of the digitisation process, one must note, that there only “small” parts. Simply scanning and saving the records, is only as good as ‘photocopying.’

7 Q’s For example, if a hospital wants to digitise all its inpatient medical records; then the hospital must ask the following seven questions to the service provider – 1. What is the modus JULY 2012

operandi of scanning the records? 2. Where and how is the information going to be stored? 3. How will the records be classified and archived? 4. Is the retrieval software adapted for hospitals, clinics, doctors and other related entities? 5. What if the software fails? 6. Can we generate any reports from the system? 7. Is it scalable? Can the same system be used to record in other divisions of the hospital? If the exercise of digitisation is correctly implemented, it leads to incorporation of a systematic electronic medical records (EMR) system – which consists of two major parts such as: 1. Records of the patient 2. Details of the patient visit (information on demographics, attending doctor, next of kin, insurance, ailment, etc). The seven questions, listed above must be answered keeping in mind, the best practices to be followed for both parts of the EMR system.

EMR = Profit Centre An appropriately done cost-benefit analysis will quickly tell you that an EMR www.expresshealthcare.in

is actually not a cost-centre but a profit centre. There are several reasons – Systematic Storage: Over time, the centralised system literally reduces the number of papers that go in a patient’s files. Moreover, it leads to standardisation of record keeping – improving operational efficiency. The question “Where is the patient’s file lying?” will never arise. Quick Search: The records available online, can be located and retrieved in seconds, at the click of a button. So turn-around-time, from actually asking for a particular patient’s medical records, locating it and then finally getting it reduced drastically. It is particularly helpful in medico-legal cases (MLC) Secure: Apart from becoming damage-proof, once in the EMR system, the medical records never get lost or misplaced. The audit logs can help the hospital to monitor each access to who retrieved the records and when. Easy sharing: A patient record in an EMR system can be easily viewed by the designated authorised users, concurrently. Apart from that, records can be also be shared with other depart-

ments, doctors and patients. Efficient use of resources: The space and people can be put for better use. In many old hospitals, MRD occupies important space in the premises; downsizing of the MRD has freedup space to open new departments such as AKD, Cath Lab, etc. Higher patient loyalty: A cumulative effect of the all the improved processes due to the implementation of the EMR system, transcends not only into better operational efficiency but also enhances the care culture in the hospital, leading to repeat visits of patients. With a short-term sight, only scan and save option selected due to marginal cost saving by the hospital will not be able to answer all the required needs of the hospital. In fact, in all probability it may turn out be counterproductive. Hospital may later realise the deficit and land up spending twice as much.

Knowledge > Information What often goes unnoticed, is that an implementation of the EMR system forms a fantastic patient database – where in the patient admission details and medical records are connected to each other. A vast pool of information – that can provide great knowledge to understand the key functional areas in the hospital and their progress. Most hospital information system do contain the patient registration information, but in an isolated manner, which often renders unproductive. When analysed together, the admission information together with medical records, highlights specific parts of healthcare delivery which need attention.

In summary Hospitals and clinics opting to digitise their medical records should not make a decision in haste, to simply scan the records. Rather they should look to implement the more beneficial EMR system, that will save them time, effort and money in the longer term. The author can be contacted at info@vidoc.in EXPRESS HEALTHCARE

Hospital Infra Reinventing innovation strategy Meeta Ruparel, Director, AUM MEDITEC elaborates on her perception of innovation strategy in the design and use of medical equipment, why she feels that innovations are not always inventions and the rationale behind her philosophy: Innovation Matrix for Medical Equipments (IM ME)

Page 86 MAIN STORY

Medica Synergie : Ushering new trends in hospital infra with Sankara Nethralaya Ayanabh Debgupta, CEO, MedicaSynergie, Projects & Consultancy Division and Abirami Elangovan, Associate Consultant, MedicaSynergie, Projects & Consultancy Division, talks about what Medica Synergie adhered to while designing Sankara Nethralaya, a G+5 structure in Kolkata

AYANABH DEBGUPTA

CEO, Projects & Consultancy Division Medica Synergie

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ccording to the 2011 fact sheet of World Health Organization, 285 million of the world population is visually impaired, 39 million are blind and 246 have low vision, and about 90 per cent of these people live in developing countries. In India, it is estimated that there are between 15 – 18.6 million people with blindness, which amounts to about one fourth of the world’s blind population. The prevalence of blindness is higher among population belonging to lower socio-economic status. Super speciality ophthalmology hospitals play a major role in the reduction of visual impairment. Stalwarts in India who contribute in eradication of visual impairment, like Aravind Eye, LV Prasad, Sankara Nethralaya, cater to people belonging to any economic strata through their cross subsidisation model of eye care delivery systems and also improve the quality of eye care through community outreach programmes, teaching, training, research and consultancy. Sankara Nethralaya, a unit of Medical Research Foundation, Chennai, one of the most renowned eye care delivery systems in India has been receiving patients from the eastern and north eastern region of India, seeking eye care, since its inception in 1978. To serve more people from eastern and north eastern India, Rotary Narayan Sankara Nethralaya was built in Salt Lake, Kolkata in December 2002. As the awareness for eye care increases, so does the demand. Realising the ever increasing gap for more num-

Dr Badrinath, Chairman, Sankara Nethralaya & Dr Alok Roy, Chairman and MD, Medica Group during inaugural function of Sankara Nethralaya ber of eye care hospitals in eastern India, Sankara Nethralaya envisioned building a modern state-of-the art eye hospital in Kolkata,

Pond adjacent to the proposed site

During construction

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wherein MedicaSynergie’s visionary chairman, Dr Alok Roy and his team facilitated the turnkey development of this unique hospital, thus

making the dream of Dr Badrinath a reality. MedicaSynergie, as the principal project consultants with its experience of planning and designing over five million square feet of healthcare space carried out the entire spectrum of work from assessing the demand, paying capacity of the people, determining the project cost, planning, design development, construction management and commissioning assistance of Sankara Nethralaya’s flagship hospital in the east. As the age old adage says, any healthcare business is all about creation of right service in the right place, at the right price and the right time. Market survey and feasibility study guides in spelling all these elements right, which can otherwise be disastrous. MedicaSynergie initially started with a detailed market study to assess the demand, existing disease profile, competitors’ profile, catchment area and identification of site for the proposed hospital. Since Kolkata is the gateway to east India, one fourth of the country and even patients from the neighbouring countries like Bangladesh, Nepal, Bhutan and Myanmar come down to this state for treatment. However, our survey revealed that there is less eye care delivery systems in Kolkata, which in turn caused people from the eastern part of the country to travel to South India for better treatment. MedicaSynergie then identified site for the proposed hospital in Kolkata. It divided Kolkata into four quadrants and studied the demographics, socioJULY 2012

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ABIRAMI ELANGOVAN

Associate Consultant, Projects & Consultancy Division MedicaSynergie

KOMAL DASHORA

MedicaSynergie

economic profile, density of eye care delivery systems, connectivity and modes of communication. Then it performed a comparative analysis to identify the best suitable locality within the city. Later, study and analysis of each site identified within the choosen locality was undertaken to understand the topography, connectivity, climatology, water body options, seismic zone considerations and statutory requirements. Following the analysis, the site was finalised at EM bypass in consensus with the Government of Bengal and Sankara Nethralaya. EM bypass, running along the eastern rim of the city, is one of the most important economic lifelines of Kolkata. Planning and designing sustainable hospital buildings which accomodate present day requirements and cater to future needs is definitely a challenge formodern day hospital designers and planners. Continuing advances in medicine and ever changing needs of the society impose great demands on the planning

The reality - Sankara Nethralaya, Kolkata

Entrance lobby, Sankara Nethralaya, Kolkata

Consultation room, Sankara Nethralaya, Kolkata JULY 2012

The concept design for Sankara Nethralaya team. With our enriching experience in planning and designing state-of-the-art multi-speciality hospitals across the country, our hospital planning team developed evidence-based design for the proposed hospital under the guidance of Col Raghavan of Sankara Nethralaya. Alhough the site had its own competitive advantages, there were two major constraints which posed a challenge to the planning team. The site area was small to accommodate all the requirements of a state-of-the-art ophthalmology hospital and there was ingress of water into the site since there was a pond adjacent to the site. Consolidation with fly-ash and piling (deep foundation) was accomplished to overcome ingress of water and concerns because of damp soil and high water table of the site. Also, Medica Synergie did not plan for a basement in the proposed hospital considering the high water table. Apart from designing the buildings and their architectural appearance, the architects experienced in healthcare, provided adequate attention to the internal planning including accommodation of medical and non-medical equipment, creating support spaces, etc. The hospital planners of MedicaSynergie coordinated with the architects right from master planning stage till interior designing and signage development (complete architectural design development), resulting in aesthetically appealing hospitals in sync with functional efficiency. At the outset, the hospital planners created architect’s brief, reflecting the requirements of Sankara Nethralaya, medical programme and facility mix, space functionality addressing flexibility and future growth, functional adolescences and flow patterns of stakeholders. Based on the architect’s www.expresshealthcare.in

brief, the architectural team initiated their ideation processes to incorporate hospital planning concepts in their zoning and stacking plans before developing detailed architectural plans. Zoning plan portrayed blocks representing various hospital departments along with departmental gross square feet (DGSF) and the stacking plan defined the stacking of various departments of the different levels within the facility. On completion of this assignment, the clinical and hospital planning teams reviewed the hospital from the perspective of clinical and operational excellence. After receiving feedback from the clients on the conceptual plans and incorporating their suggestions, our architects went ahead with detailed drawings, municipal submission drawings, service drawings and construction drawings. The core principles which MedicaSynergie adhered to while designing Sankara Nethralaya, a G+5 structure are as follows: Evolution of form and design optimisation – In connection to the vision of Sankara Nethralaya and continuation of its standing as a world class eye care hospital, the elevation and the form was designed to look like a grand institutional delivery system. The elevation has been designed to attract people belonging to all socio-economic strata. It was created keeping in mind the site profile and topography and simple geometrical form to make the design user-friendly. Community service – To make the free patients comfortable, separate floors and entrance were planned in the proposed hospital (30 per cent of free patients are treated by every unit of Sankara Nethralaya) Ensuring functional efficiency - Space requirement for every department has been decided keeping in

mind the functionality, comfortable functioning of the staff and provision for accommodating all the medical as well as non-medical equipment ideally required for efficient operations. Maximising operational efficiency – Separate movement patterns for patients, staff, patient relatives and materials to avoid confusion and improve efficiency. Zoning – The hospital was divided into three major zones namely patient, staff and research area to ensure comfort to stakeholders. Smooth flow has been ensured through adjacency and minimisation of traffic congestion, even during the peak hours. Minimisation of hospital infections - Proper zoning of seven OTs and CSSD, restricted access to critical areas. The Septic OT is segregated from other OTs to prevent infections. Low cost and vernacular architecture model – Optimisation of space to ensure judicious and minimal use of built up area to reduce the cost of construction, use of local materials for construction, etc Green approach – The design has been planned to ensure adequate ventilation and day lighting to most of the functional areas of the hospital. In sequel to completion of construction within the planned period, Medica Synergie also assisted the commissioning of the hospital. A team headed by Komal Dashora of Medica Synergie commissioned and effectively managed this 'centre of excellence' while implementing various systems and processes for standardisation and efficient delivery of world class eye care at Sankara Nethralaya, Kolkata. MedicaSynergie is an integrated healthcare organisation offering turnkey healthcare consultancy services, and is presently working across six countries other than India. Medica Synergie effectively fills in the huge gap by being a one-stop shop for all healthcare entrepreneurs/doctors/promoters by providing end-to-end solutions across the healthcare facility—from planning and design, finance syndication, to commissioning assistance and operational management—taking away all woes of prospective hospital owners. The author can be contacted at ayanabh.debgupta@ medicasynergie.in EXPRESS HEALTHCARE

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Reinventing innovation strategy Meeta Ruparel, Director, AUM MEDITEC elaborates on her perception of innovation strategy in the design and use of medical equipment, why she feels that innovations are not always inventions and the rationale behind her philosophy: Innovation Matrix for Medical Equipments (IM ME)

MEETA RUPAREL

Director, AUM MEDITEC

o my perception, 'innovation' means a new way of doing something or maybe a new invention. In other words any change in a process, product or a system for improvement and customer satisfaction by an idea or an invention or a new concept or even maybe a new application of an existing set-up can be termed as innovation. This change may be based on voice of customer / process / stakeholders. I am sure we all agree; that “Change is constant”. Hence, we can say every organisation that has an ongoing improvement process; driving to improve their productivity / customer satisfaction / business excellence approach is in a constant mode of innovation. Incremental Innovation is also an approach that many organisations follow to increase efficacy of a product or service. The traditional approach of an organisation towards ideation and concept development begins with the idea developed in-house and then evaluated or validated through the process of concept screening and testing. I suggest an approach that is customer oriented to evolve with the ideation process; i.e. understand the needs and ideate to solutions in the form of innovations.

Are all Idea generations done by Engineers / Technocrats? I feel, all idea generations are not necessarily done by technocrats. We observe many innovations in our day to day life, which may be a concept evolved out of need, necessity and availability of resources, just plain innovative use of resources in a slightly different manner for the intended use by the user and not by any special technical head. For example, we may have seen many housewives use add a layer of sand to a pressure cooker and then use it as an oven. The other day I came across a photograph of a coffee stall owner using a pressure cooker with a hollow pipe and a screw driver, to brew expresso coffee! All such makeshift uses evolve out of availability of resources and a desire to meet customer demand motivates these users with such alternative solutions. These users are all not necessarily technical knowledge heads;

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they are users who understand the nuances of the product’s intended use and ideate to innovative solutions.

Innovation = Invention? I would like to share an interaction I had with a doctor from the north western part of India, who had come to a medical equipment exhibition in Mumbai to explore some equipment purchases for his clinic. (See illustration 1) (On a lighter note; to my fellow colleagues and peer groups of medical electronics: hope our medical equipment production sponsors and senior heads back in office don’t chase us out after reading this illustration!) The illustration shows how a prospective sale of a product can be affected with such influencing interactions with a buyer! The highlight can be that there is an accomplished sale of another version of the product, instead! In this doctor's case, we see that the doctor in spite of being in general practice wants to be well equipped and at the same time keep in mind his budget. An honest admission on his part and on understanding his constraints, I suggested a solution. I did that by virtue of my profession as a technical consultant, although this was suggested impromptu at the exhibition venue, without any commercial interest. Further, it is again not an invention but an innovative use (in this case, to an extent, a compromise?) of an existing product. 10 electrodes or 12 lead ECGs are very cumbersome and at times many patients exhibit discomfort with so many chest electrodes on them. Therefore, to my perception, this isn’t a compromise, as we see many ECG manufacturing companies suggest this option to clients who have constraints in terms of budget, convenience, comfort, etc. Today about 30 to 40 per cent of the users use five lead ECG with alternating use in a sequential form; as a solution for Vector ECG whenever required, although our cardiologists still prefer the conventional ECG for analysis and detailing purpose. What I would like to point out here is that innovations are not necessarily www.expresshealthcare.in

inventions. Innovations are also not necessarily ideation of the retrospective technical knowledge heads. They are basically an expression of the needs, desires of the users and feasible solutions of the retrospective technical knowledge heads, who further give shape to these ideations.

Innovation, but is the MRP appropriate? Another aspect of innovation that I would like to share here with an example of a medical disposable product innovation is; the price factor of an innovation. (See illustration 2). This is a classic example that we observe in the innovation arena. The innovation maybe an excellent application, a world class technical invention, but when it comes to its price, it may not match the market economics and so is largely disapproved or maybe accepted after intensive marketing strategies. An exercise of aggressive and intensive marketing becomes a mandate to get acceptance of the product and to sustain the research and development cost. At times a brand attitude establishes or enforces a higher price tag exhibiting an arrogance of monopoly and at times the price tag is a derivation of comparison of competition and status quo. More often it is the financial sensibility to meet the product development costs. In any case, it is assumed that the price so derived is a perfect fit and would or rather be imposed onto the market as an accepted price tag, as it is an innovation. In such cases the product failure / non acceptance dawns only after it reaches the market or the product acceptance testing phase. Even if identified in the product acceptance testing phase, not much can be done to reduce the production cost and pass the benefit to the market, because in this haste, the tendency to compromise on quality becomes high. One more outstanding example that would leave this article incomplete if not mentioned is the predicament our design engineers or innovators face when they come across a situation of demand by management or other stakeholders that brainstorm to impose a change in label of the product after its regulatory approval; which

invariably changes the intended use of the product and thereby the certification recognition and its validity! Imagine you have a cardiac monitor with defibrillator approved after all the clinical trials process required as regulatory norms and then some stakeholder imposes to market the product as “defibrillator” and not as cardiac monitor. The goal of such a move is to get the product under life saving category and reduce its price to the market. In such situations, the R&D and production and QA department have a long task at hand; of repeat processes for approvals, not that a cardiac monitor with a defibrillator doesn’t go through the necessary testing and trials but finally the certificates and approvals are based on what you pitch the product as; in the document that intents the use of the product in the market. Just as we observe a difference in labelling and its intended use of a product with same ingredients i.e. “drug” and a “dietary supplement” of a pharmaceutical product which impacts FDA approvals, the same way such labelling issues and claims impact a medical device too. A product designer and developer need to be conceptually clear with the intended use of the product and aware of such regulatory requirements well in advance. To change such files or documents at a stage after approvals is not as easy as erasing some words and revising the same. It requires repetition of many tasks and modifications (at times in product design as well) resulting in quality wastes, more poor quality costs (COPQ) and delay in bringing the product to market.

Innovation Matrix for Medical Equipments (IM ME!) Based on project experiences, I observe that a customer driven and business process voice oriented innovation strategy is the key to successful innovations. Exploring the innovation strategy that we all may have read about in management books, I suggest a revision in the strategy with a customer focus, or shall we say quality focus, because by and large quality tends towards optiJULY 2012

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ILLUSTRATION 1

Any particular reason for a 12 lead ECG machine? Do you require frequent, 12 lead diagnosis?

You can use a 5 lead ECG as a 12 lead machine, provided you know the lead configurations & get comfortable with its use this way...

Not at all! Just the routine user training & knowledge of ECG waveform! This is an alternative solution, but you surely can do with it till you are ready to budget for a 12 lead ECG

ILLUSTRATION 2 No! In my view; a 12 lead ECG is the conventional one, but I have a budget constraint & this looks cumbersome, on a second thought, I think I must explore something else...

Rs.200/- per piece

We can do that?? Does it require intensive training?

Great! Thanks for the alternative suggestion; it has given me a new insight to this purchase.

mal customer satisfaction and safety too, especially in healthcare. So who are these customers that we need to focus on? Is it the end user? For us; the pharmaceutical and/or the medical device manufacturing who is the customer? Is it the doctor/ hospital, which uses our equipment/prescribes medicines or the patient who consumes/uses the product? I am sure we all agree both are our customers whom we need to focus on. But this JULY 2012

Interesting product, what is the cost?

Oh! That is a bit costly for a disposable product! No doubt, good for patient safety… but if hospital’s approximate consumption is 1000 such pieces in a day; means RS 200,000/- Per day! Additional recurring expense!!

It saves you wear & tear & maintenance cost of the non-disposable type.

But that is comparatively less! 1 piece costs about RS 70/-, which can be reused for years, with proper laundering & sterilization; the goal of patient safety is still met effectively. Cost of Laundry, sterilization & packaging maybe about RS 20/- per piece, which is 10 times less running expense, daily!!

isn’t the end, for need/ demand analysis, we have other stakeholders that need to be considered with equal focus and a balanced weight score; these are our standards, regulations, business investors, competition and technology demands. Let us understand this in more detail. This revised strategy is not challenging or contradicting our management theories but it is complementing the innovation strategy; it is re-inventing the innovation strategy with a www.expresshealthcare.in

##....uhh.. hmm!# ...

slight twist in the application focus. This strategy suggests not only design and market research before the start of an innovation project but strongly recommends evolving the design questions based on ideations derived from customer needs, demands and projected requirements. Arriving at an idea based on customer requirements is not the ultimate step. The idea so derived needs to be identified as a perfect fit in the IM ME (I enjoy terming

this matrix as a command “I am Me!” because this matrix commands us to meet the criteria that invariably needs to be met for a higher success rate of an innovation, especially of medical devices/ equipment.) Although this matrix is congruent and can be used for other innovations too with a slight modification in the set criteria, I formulated this matrix whilst working on a few medical equipment innovation projects with a value addition research on the innovation strategy to be followed, thus the befitting term “IM ME” These criteria of “IM ME” are prominently based on medical device requirements and other customer strategic requirements; a combination of to be met (a mandate set) and would (can) be met (opportunities to improve set). “IM ME” has a rigid score to be achieved as a guiding benchmark; at the same time it has its elasticity within; on a continuum of parametric and non parametric scores; based on applications. The matrix is still evolving with due diligence of its applications in on going medical equipment innovation projects. It is currently verified as an effective tool, however I shall share more on this soon, after its validation. As a Certified Six Sigma Master Black belt trainer, practitioner and as a quality management professional, I believe that “Quality is a journey to customer delight”. Customer demands are dynamic, we must constantly listen to the ‘voice” of our customer, business and the identified process to assure quality product/service and thereby gain more loyal customers. We must ensure that we keep up with the trends and pace of competition. I often come across a project/process demand that calls for innovation and adaptable application solutions. As a bio-medical engineer and as a hospital planner, I aspire to innovate and introduce new designs/ equipment/applications in the system. Providing best applicable solution at affordable costs is a driving passion for me in this journey of customer delight. In my work I have constantly observed creativity and innovation as a key enabler of this passion of mine. (The author can be contacted at meeta@meditecindia.com) EXPRESS HEALTHCARE

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We are building our hospital in Ghana. We are at the foundation level and considering drywall partitioning Q although the design of the hospital did not take drywalls into consideration. Do you think we can just substitute drywall for cement blocks? Drywall partition systems are a lightweight drywall system consisting of GI (galvanised iron or wood or A aluminium) frame with plasterboard fixed on either side with

TARUN KATIYAR Principal Consultant, Hospaccx India Systems

Express Healthcare's interactive FAQ section titled – ‘Ask A Question’ addresses reader queries related to hospital planning and management. Industry expert Tarun Katiyar, Principal Consultant, Hospaccx India Systems, through his sound knowledge and experience shares his insights and provide practical solutions to questions directed by Express Healthcare readers

the drywall screws. The drywall partition is used extensively in areas such as consultation rooms, patient rooms, administrative and back office areas etc. Drywalls can be substituted for regular walls since a drywall is thinner than a brick wall. Hence, a drywall can be used at any time during construction and this will in turn reduce the load. The using of drywall as a substitute to masonry walls will not affect the structure of the building at all. Using a drywall results in flexibility in creating and dividing spaces according to your needs. Moreover, the speed of installation is 3-4 times faster than masonry work. It also results in less of dirt at the time of installation and the finish is much better with drywall. The other major objectives of using dry wall are: ● Fire resistance from one hour to four hours ● Limited combustibility ● Systems with glass wool / mineral wool insulation can provide STC ratings up to 60 ● Can take any type of surface decoration Recommended for drywall partitions in areas like server rooms, corridors, spandres, industrial partitions, room to room partitions in hospitals — Theresa Augustt, Ghana

What are the steps to be taken for energy conservain a hospital? Q tion One of the major consumers of electricity within the hospital environment is the ventilation system. A Hospitals often require 100 per cent ventilation of fresh air to reduce the risk of microbial contamination. The HVAC system accounts for 45 per cent of the total energy used in hospitals. Lighting is another area of energy consumption accounting for at least 25 per cent. Other operations such laundering, sterilisation, and cooking account for another 30 per cent of energy expenditure. Energy management systems help in controlling airhandling units, HVAC and lighting from a centralised location. This will help in the reduction of unnecessary lighting and cooling of areas that are not being actively used. Hospital cooling costs can be reduced by using a refrigerant additive like Permafrost to air conditioning systems and food service-related cooling equipment. This helps in reducing the amount of time that the compressor has to run and save energy which in turn, increases the compressor’s life. Heat recovery coils, when installed in exhaust air handlers, can help in capturing waste energy without the risk of contamination. Heat recovery can also be done for sterilisation equipment, laundries, dishwashers and cleaning equipment. Hospitals should also be equipped with direct digital controls. Equipment such as televisions, computers, lamps that give off heat should not placed near thermostats. The heat generated from this equipment can affect the thermostats leading to increase in the energy spent on cooling.

While planning a hospital (new facility), what are points that one needs to consider? Q the Constructing a hospital is more complex than any other building we have to incorporate all the facilities A and services and face many constraints. When a hospital facility is planned, there are few important points to be considered from the various aspects of hospital building. For convenience, these may be classified into the following categories: ● Functional aspects ● Architectural aspects ● Patient safety aspects These aspects would have significant impact on the entire facility. Some of the important factors which fall under these categories and need to be considered while building a hospital facility are as follows: ● Understand the traffic flow (patients, visitors, staff) and adhere to the fire exit plan ● Access to the hospital such as – ramp and stretcher lifts ● Facility mix and service mix of the hospital ● Sufficient parking for ambulance and patient visitors and staff ● Space/provision for biomedical waste management ● Radiation/radiology unit location — Puneet K Jain, Jaipur

There are few parameters which one can use to rate a hospital’s performance financially. But, what would Q be the most critical operational parameters which we should look for while distinguishing efficient and not so efficient hospitals? Some benchmarks would help. The operational efficiency of the hospital can be measured through several parameters such as rate bed A occupancy (BOR), bed turnover rate/ratio (BTR), average length of stay (ALOS), inpatient-outpatient ratio (IP/OP), discharge against medical advice, leave against medical advice etc. However, quality in providing service would also be a parameter that one can think of. These indicators are related to various areas such as human resource, laboratory, equipment, medical records, nursing, stores, infection control. Some of the other indicators are: percentage of mortality rates, percentage of hospital acquired infection rates, nursepatient ratio in ICU and wards, number of incidence of protocol deviations, percentage of wrong medication, percentage of cases wherein screening for nutritional needs has been done, percentage of adverse anesthesia events, percentage of unplanned return to OT, percentage of re-scheduling of surgeries etc. In terms of equipment, some points to be considered are – equipment downtime, number of procedures done on the equipments, the workload etc. There are in total 63 indicators of quality which are given in detail in the new edition of NABH quality indicators. These would serve as some of the benchmarks for operational efficiency. — Punit Malik, Mumbai

— Sravanthi Karlapudi, Andhra Pradesh

Readers can send in their questions or feedback to us at email: tarun.faq@gmail.com

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JULY 2012

Radiology MAIN STORY

Interventional radiology: Coming of age Dr Rohan Sonawane, Clinical Marketing, Healthcare Sector, Siemens outlines the various aspects of interventional radiology including the important procedures and various innovations

DR ROHAN SONAWANE

Clinical MarketingHealthcare Sector, Siemens

nterventional radiology (IR) is a highly advanced and comparatively newer speciality in the field of medicine. It combines the power of cutting-edge technology for high-end imaging with applications that help in treatment planning, navigation and guidance to improve clinical workflow efficiency and enhance procedural outcomes. The concept behind IR is to diagnose and treat patients using ‘minimally invasive’ techniques, so as to improve treatment quality and also offer solutions to people who are otherwise ‘unfit’ for open surgeries. The basic aim of IR is to bring down the intra and post-operative morbidity and mortality, improve patient comfort during the procedure, reduce complications and thus enhance clinical outcomes of the treatment. Using modalities such as fluoroscopy, CT and ultrasound, interventional radiol-

ogists perform complex cardiac, neuro, onco and other procedures under direct image guidance. Direct imaging improves physician confidence for diagnostic as well as therapeutic procedures. Smaller incisions, better patient compliance and shorter hospital stay make these procedures attractive for hospitals as well as for patients. The field of IR can be broadly classified into four main categories: 1. Interventional Cardiology 2. Interventional Neuroradiology 3. Interventional Oncology 4. Interventional Vascular procedures Some common IR procedures and their brief descriptions are given below: Coronary Angiography + Balloon Angioplasty with stent: Angiography is imaging the coronary vessels

Fig: Endovascular aneurysm repair

to look for life threatening blockages (cholesterol plaques). Clinically significant plaques can be treated with angioplasty and stent deployment. This is undoubtedly the most commonly performed IR procedure. Endovascular aneurysm

Fig: Colour-coded image from dynamic information, showing the history of contrast media movement through the vessels and providing a better understanding of the flow within the pathology.

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repair (EVAR): AAA (Abdominal Aortic Aneurysm) can now be treated through percutaneous approach by passing the stent under continuous image guidance through femoral artery. There is no need for open abdominal surgery with this innovative technique. Trans Arterial Chemo Embolisation (TACE): Delivering cancer treatment directly to a tumour through its blood supply requires exact identification of the tumour feeding vessel. This vessel is then blocked with chemoembolisation agent. Due to a selective and specific blocking of the tumor feeding vessel, surrounding normal tissue is spared. CT guided real time biopsy + Radiofrequency Ablation: This involves taking a tissue sample from the area of interest for pathological examination under real time guidance. It is now possible to get real time 3D guidance with coronal, sagital and axial views to give interventional radiologists the exact location and depth of needle for precise biopsy and ablation treatments. Siemens is currently the only one to provide this unique solution. Inferior vena cava (IVC) filter: This involves metallic EXPRESS HEALTHCARE

R|A|D|I|O|L|O|G|Y filters placed in the inferior vena cava to prevent propagation of deep venous thrombus into pulmonary vasculature. Ve r t e b ro p l a s t y : Percutaneous injection of biocompatible bone cement inside fractured vertebrae under image guidance. TIPS: Placement of a Transjugular Intrahepatic Porto-systemic Shunt (TIPS) for management of select patients with critical endstage liver disease and portal hypertension. Endovenous laser treatment of varicose veins: This is placement of thin laser fiber in varicose veins for non-surgical treatment of venous insufficiency.

Latest innovations in IR: 3D imaging in the angiography suite: 3D acquisition is now possible in angiography suite, assisting the clinicians in planning the interventional procedures. It enables decision making at the point of diagnosis with additional CT like information and virtually avoids patient transfer to CT/MR. The interventionist gets immediate anatomical information helping him in quick post procedural evaluation. Also, due to less patient handling, there is lesser risk of hospital acquired infection (HAI) and improved patient comfort. Siemens’ unique and flagship application Syngo DynaCT Cardiac™ is a 3D application that creates both 3D and 4D images of heart by rotational angiography right on the interventional procedure table. The acquired 2D images are then

reconstructed to provide the complete 3D view of the cardiac anatomy. syngo DynaCT Cardiac™ is useful in the interventional procedures for the treatment of ventricular arrythmias, visualisation of aortic root and coronary ostia in aortic valve replacement procedure and in few paediatric applications (visualisation of lung vessel tree after fontan surgery for hypoplastic left heart syndrome, visualisation of 3D anatomy of coarctation of aorta, assistance for ASD device closure etc.) Dynamic Flow evaluation for Interventional Neurology: It is now possible to avail visualisation of a complete Digital Subtraction Angiography (DSA) run in full colour as a single image in the interventional suite. This imaging is particularly useful in comparing pre- and post-treatment acquisitions where clinicians are trying to see how flow has changed not just through arteries, but also in the brain parenchyma. This info will also be of help in analysing complex flow patterns often seen in obstructive diseases with complicated collaterals as well as in arterio-venous fistula and malformations.

Neuro PBV Neuro Parenchymal Blood Volume (PBV) allows for quantitative measurements to be undertaken and thus allowing the visualisation of the whole brain in 3D. Benefits of Neuro PBV are: ● Visualise the PBV for the whole brain

● ● ● ●

● ●

●

Compare regions of interest within different lobes Specific acquisition protocol Images available in under 40 seconds Functional monitoring during endovascular treatment Covering the entire brain Important monitoring tool in stroke treatment, vasospasm treatment, stent follow-up Valuable for direct tumour punctures

TACE, SIRT and RFA for Interventional oncology Good image quality is indispensible for visualising fine vessels and devices during interventional oncology procedures, particularly as devices such as guide wires and catheters become increasingly smaller and harder to see with fluoroscopic imaging. Excellent 2D image quality as well as advanced 3D planning and navigation technologies to support interventional oncology procedure is thus a necessity. A lineup of highly progressive imaging systems and advanced applications to support minimally invasive cancer treatment such as transarterial chemoembolisation (TACE), selective internal radiation therapy (SIRT) and radiofrequency ablation (RFA) are now frequently used for cancer treatments. TACE involves selective injection of the embolising agent through exact identification of tumour-feeding vessel. Improved planning of embolisation procedures and immediate knowledge of procedure status is possible

Fig: Structural and functional imaging with Neuro PBV in one place: Diagnosis- Evaluation- Treatment- Check

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in IR suite. By clearly highlighting marked vessel as a graphical overlay in the live fluoro image, embolisation is quick and precise. SIRT is a complex therapy that involves selective administration of radioactive microspheres under imaging guidance. In RFA treatment, pinpoint needle placement plays a crucial role for successful tumor ablation. Cutting-edge 3D guidance tools such as syngo iGuide from Siemens provide superb assistance for accurate needle navigation in RFA treatments. For all these interventional procedures, there is no need to transfer patients to CT for imaging if the hospital is equipped with an IR suite. Hence, these solutions make the oncology procedures minimally invasive and maximally effective!

Future Roadmap: merger of surgery and interventions through hybrid approach! Medicine is witnessing a fascinating trend of merger of cath labs with surgical suites i.e. hybrid operating rooms (OR). Surgery is progressively becoming less invasive and ORs are increasingly adapting to these changes. The growing convergence of surgery and imaging is particularly evident in fields such as cardiac, vascular and neurosurgery. More and more healthcare facilities are installing hybrid ORs capable of supporting both minimally invasive surgical as well as interventional procedures. Equipped with highly advanced surgical management and imaging technologies, these modern ORs create unprecedented opportunities for improved surgical treatment and workflow optimisation. They also make good economic sense by decreasing post-operative hospital stay. Siemens was the first in the world to introduce Hybrid OR system with a robotic arm. Concurrent bypass surgeries with angioplasty in one sitting are being performed in India as of now. Soon, we will also have TAVI (Trans Catheter Aortic Valve Implantation) procedures being conducted in India in Hybrid OR! JULY 2012

TECHNOLOGY FOR HEALTHIER LIVES

Healing the heart GE Healthcare's Innova 2100IQ (Optima Edition), a cardiac cath lab finds favour in the eyes of Dr Jaspal Arneja, a reputed cardiologist who finds it to be a great interventional tool in the battle against heart ailments

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JULY 2012

TECHNOLOGY FOR HEALTHIER LIVES

one are the days when doctors had to don the mantle of an omniscient god and make their prognosis based on their far-from-perfect intuition and half truths. Thanks to the advent of interventional medicine, today the doctors can heave a sigh of relief and safely diagnose as well as treat their patients based on rocksolid evidence. Thus, interventional medicine has been a tremendous milestone in the history of medicine. Its progress has been furthered by the marvels of technology.

A timely intervention Cardiology is one area which has benefitted tremendously with the help of interventional technologies. The rise in the cardiovascular disease rate in our country is alarming. As per the World Health Organisation, cardiovascular disease would account for the deaths of five million people will by 2020. Hence, cardiologists are arming themselves with the best weapons available, which would help them battle this growing menace threatening to destroy the well-being of our country. Dr Jaspal Arneja, a veteran cardiologist from Nagpur with 20 years of experience in his field has chosen an interventional cardiology cath lab, Innova 2100IQ (Optima Edition) from GE Healthcare to side him in the battle against cardiovascular diseases. He has been using this product for a mere sixeight months but he is completely sure that he has found the right ally to fight heart ailments. He justifies his choice by stating the various benefits he has enjoyed since he incorporated this machine into his practice. They are as follows:

Points-in-favour Easy-to-use: One of the main reasons that wins Dr Arneja's approval is the easeof-use offered. He informs that Innova 2100IQ (Optima Edition) is a very user-friendly product and explains how he mastered the use of the cardiology cath lab with minimal training. Good image clarity: The doctor is very impressed with the quality of images offered by the interventional cardiology cath lab. He states, “Both, acquired images and fluoroscopic images offered by Innova 2100IQ (Optima Edition) are excellent. This is of great help in angioplasty.” He also informs that earlier poor visibility was a problem JULY 2012

Pre-PTCA faced while screening obese patients whereas with Innova 2100IQ (Optima Edition) this issue doesn't arise at all since the quality of images produced by the machine is extremely good. Reduced procedure time: Dr Arneja also informs that Innova 2100IQ (Optima Edition) has been very useful in ensuring the convenience of his patients. This factor has earned the cath lab a lot of favour in his eyes. He says that the machine’s technological prowess has reduced the time needed to screen a patient. He cites the example of the machine’s ability to give many projections in a single shot (Innova Spin) and informs that it enables medical practitioners to diagnose the problem correctly in lesser time. www.expresshealthcare.in

Reduced radiation dosage: Another point which finds favour with Dr Arneja is that Innova 2100IQ (Optima Edition) requires reduced dosage of radiation. He informs that the good clarity of the fluoroscopic images produced by this machine helps the cardiologist to avoid taking cine images which need more radiation dose. This, in turn, is very beneficial for the patients since it also minimises the side effects of radiation. Accuracy in diagnosis: Dr Arneja is also very happy with the diagnostic abilities of the cardiology cath lab. “The stent visibility of Innova 2100IQ (Optima Edition) is excellent. It also offers optimal stent placement and stent expansions. These factors, coupled with great image clar-

ity, have really optimised angioplasty and related procedures,” states the cardiologist. This, in turn, is of great help in diagnosing the problem correctly, he further states. Best line of treatment: The heart specialist also states that Innova 2100IQ (Optima Edition) can be useful in providing the best line of treatment for the patients. Its interventional capabilities help the doctor in making accurate prognosis, and recommend the best future treatment measures to be taken for the patients’ well being. Thus, Dr Arneja also says that the machine’s role in providing the best possible treatment is also one of its attributes and elucidates how the machine can be put to good use use while treating a person real time and deciding on the best measure to adopt at that point of time.

The final verdict Thus, Dr Arneja shares his experience of using the cardiology cath lab to optimise his expertise for the benefit of his patients. He is a fully satisfied user of the machine and says that he would recommend it to all his fellow cardiologists as well. However, would the rest of his colleagues also be of the same opinion about the machine? Well, given the advantages that Innova 2100IQ (Optima Edition) offers it would be safe to conclude that it might turn out to be the interventional tool which would be able to play a vital role in revolutionising and optimising heart treatment. EXPRESS HEALTHCARE

Trade & Trends WEP-5200: Nihon Kohden’s terrific telemetry system

Carestream Health ships DRX-Revolution Mobile X-Ray system to healthcare facilities

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Allengers: Foraying into digital radiography With DR systems becoming increasingly popular and finding acceptance in medical imaging domain, Allengers successfully forays into this domain with a range of digital radiography systems hough X-rays having been in existence for a long time, digital radiography has just been around since last two-three decades. In the past few years, something radically different has emerged in the medical imaging domain, offering a new standard for digital X-ray image capture. And that is the emergence of digital radiography. Digital radiography (DR) systems have currently caught the notice of many healthcare/medical centres as the most in demand equipment to use it as an urgent care system. The DR unit, coupled with its software, has converted many medical facilities into state-of-theart digital radiography centres. Earlier, the process of digital radiography involved radiographs being scanned and sent from one computer to another where

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the images were then stored in PACS. After that, computed radiography (CR) and DR followed. In CR, the phosphor plates were used to store along with a reader for reading those images and a laser printer to print them. As this method was slow, DR made its entry with full throttle. The DR, being totally cassette-less, is much more efficient because the image is available immediately. The current practice of radiology, across the world, involves extensive handling of digital images. In recent times, there has been a growing trend towards adopting digital radiography mobile systems due to its convenience and speed despite its cost. DR is the fastest digital imaging available at this time and speed is a very important aspect to improve the efficiency, a distinct advantage, especially while performing

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bed-side X-rays and in trauma cases.

Allengers’ DR systems Allengers, a Chandigarh-based medical equipment manufacturing company, has also successfully forayed into this segment of manufacturing a range of digital radiography systems like: ● DR system with auto-tracking ● DR system with U-arm stand ● Mobile DR system, which has been the most sought after system. Seven of such systems have been successfully installed at PGIMERChandigarh in their trauma and advanced paediatric departments ● Full field digital mammography (FFDM). Although this technology is at a very nascent stage, it would also be the technology of the future as it would address the needs of the radiologist in the screening of breast cancer in a more efficient manner. A fully isocenteric motorised gantry and state-of-the-art selenium detector with high resolution would makes this equipment the most sought after. The largest motivator for healthcare facilities to adopt Allengers FFDM is its potential to reduce costs associated with processing, managing and storing films. Not to mention the other advantages like higher patient throughput, increased dose efficiency and greater dynamic range of digital detectors makes DR the most sought after technology. The advantages of DR outweigh that of all other imaging modalities. So, the future of radiography will be digital and Allengers, an Indian MNC, which has been revolutionising the medical world since last 25 years with it’s wide diagnostic range of medical equipments is further striding fast to make its mark in the digitalised technology based medical equipments, says Ajay Mohan, Head-Strategic Marketing at AllengersChandigarh. For more info contact: www.allengers.com JULY 2012

T|R|A|D|E & T|R|E|N|D|S

WEP-5200: Nihon Kohden’s terrific telemetry system Nihon Kohden, Japan's leading manufacturer, developer and distributor of medical electronic equipment, offers a new-age telemetry system comprising several advantageous features apan's bestselling telemetry central monitor, nurse oriented patient monitoring system is ideal for the step-down unit, ER, CCU and ICU, cardiac rehabilitation, general ward and other areas. A wide variety of patient transmitters are available.

Flexible system configuration ANIL SRIVASTAVA

Head - Sales and Marketing Nihon Kohden

Four-patient and eightpatient options, configurable display are available depending on the room plan and patient management plan. It can be combined wirelessly with different types of transmitters or multi-parameter bedside monitors.

Compact and movable solution Its compact body contains the display with alarm indicator, main unit, receiving unit

and built-in thermal recorder.

Highly reliable telemetry UHF digital telemetry with dual diversity antenna provides a reliable and stable signal. The frequency is different from wireless LAN, so there is no interference or data loss.

Easy operation Five types of alarm notification help to ensure that one deosn’t miss any alarms.

High quality arrhythmia detection Nihon Kohden’s advanced ECL arrhythmia analysis from the high-end Life Scope J bedside monitor

is also included central monitor.

this

Large data storage 96 hours of full disclosure

ECG for all patients along with arrhythmia recall, trend, tabular trend and alarm history are standard in this telemetry system.

Carestream Health ships DRX-Revolution Mobile X-Ray system to healthcare facilities New system delivers major improvements in conducting bedside x-ray exams arestream has commenced shipping its DRX-Revolution Mobile XRay System and several healthcare facilities around the world have already placed orders for this new system. The new mobile X-ray system delivers good image quality, exceptional maneuverability and rapid access to patient medical images. The DRX-Revolution offers a solution for specific needs voiced by several radiology professionals who were involved in the product’s design. For example, a unique software tool creates comp a n i o n images from the original exposure: one image is optimised to show tubes and lines so p hys i c i a n s

JULY 2012

can verify placement, and another optimised image accentuates the appearance of free air in the chest cavity for easier visualisation of the pneumothorax. The DRX-Revolution’s long, extendable tube head helps radiographers easily capture X-rays despite the presence of bedside medical equipment. The system’s two monitors (the main 19-inch monitor and an 8-inch tube head monitor) allow a technologist to capture and review images without moving away from a patient’s bed. The DRX-Revolution also uses the same software and graphic user interface as other DRX products, which makes it very easy to use, improves productivity and allow technologists to use the mobile X-ray system with minimal training. All digital X-ray systems in Carestream’s DRX family, including the DRX-Revolution, share the same DRX1/DRX-1C wireless detector, which offers flexible positioning and image availability in less than five seconds. Carestream’s product family includes:

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CARESTREAM DRX-1 System, CARESTREAM DRX-Mobile Retrofit Kit, CARESTREAM DRX-Evolution modular DR suite, CARESTREAM DRXTransportable System and CARESTREAM DRX-Ascend System. EXPRESS HEALTHCARE

T|R|A|D|E & T|R|E|N|D|S

Pneumatic power from Unison Narula Group The dawn of the pneumatic age at UNISON Narula Group, through its partners Sumetzberger (Austria) and TransVac – USA Evolution of sample distribution system in hospitals by Sumetzberger (Austria)

PRASHANT NARULA Director Unison Narula Group

HARSHIL NARULA

Director Unison Narula Group

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Hospitals are highly complex systems, which perform a great variety of tasks. All of these are urgent since the health of people is at stake. Sumetzberger’s hospital pneumatic tube system is the means of transport, which combines speed and reliability. While doctors and nursing staff dedicate themselves to the patients, the pneumatic tube system transports a multitude of small and medium-sized items. This system saves not only time, but also space - laboratories can be centralised and stocks of the medicines in the decentralised medicine storage depots (like the nurse stations) can be reduced. Furthermore, the pneumatic tube system helps increase efficiency since the staff is no longer busy running errands, allowing the wards to stay occupied all the time. Since a hospital is not a typical working place, its pneumatic tube system has to fulfill a series of high demands: ● In order to guarantee a safe transport of laboratory samples, the carrier speed may be modified. Low-speed transport is selected manually or automatically by choosing a certain dispatch or receiving station. ● The carriers can be adapted to hold different types of insert pockets or test tube holders. ● Arriving carriers brake carefully upon arrival and

are sent directly into the tube without any shock. ● The system functions silently and is patientfriendly. ● Transport loads with restricted access can be secured by means of a code ● Thermo chemical sterilisation of the carriers to be carried out manually or automatically. ● The system is hermetically sealed. Pneumatic tube systems do not necessarily have to be installed at the outset of construction. Even in an already operating hospital, a pneumatic tube system can be easily integrated. Depending on the various structural conditions, the system can be

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laid inside or outside the walls. Other factors, for instance system capacity, load size or weight, are taken into consideration as well.

Ing. Sumetzberger GmbH (Austria) is clearly the most advanced system with the following technologies available: 1.

Automatic unloading stations: This facilitates the laboratory technicians to concentrate on their core activity and not be worried about the carrier management. 2. “Easy Touch” touch screen panel: Easy Touch is a 7 inch touch display with multifunctional operation screens. The touch panel can be oper-

ated with finger, safety gloves or styluses. It features - shortcut keys to sub-menus quick dial, multi information, RFID user identification reader, customised hotkeys, customised background colour to suit individual requirements. 3. Power transfer system (PWT): Sumetzberger’s PWT combines different zones for intra-zone transfers. With one of its kind in the industry, the PWT has the highest throughput and allows high priority samples to over take the normal priority samples. In over 50 years, Sumetzberger has done hundreds of unique systems and some of the partners in growth in the healthcare sector are: Tan Tock Seng Hospital (Singapore); Khoo Teck Puat Hospital (Singapore); Hospital San Raffaele, Milano (Italy); King Faisal Specialist Hospital & Research Center (Saudi Arabia); Sri Balaji Action Medical Institute, Action Cancer Hospital, Jai Prakash Narain Trauma Centre, New Delhi (India); BGS Global Hospital, Sagar Hospital, Bangalore (India); and CDKD Global Hospital, Mumbai (India).

Evolution of waste and linen removal in hospitals by Transvac - US Many hospitals today, continue to use an antiquated and arcane system for the removal of waste, recyclables and linens - manual disposal, overflowing roller carts,

JULY 2012

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Krishna Medi Equipments: Climbing the success ladder Krishna Medi Equipments (KME), with its range of new-age products for the healthcare systems, has set forth on a path to growth and success rishna Medi Equipments (KME) is a professionally run organisation, serving healthcare industry since last several years. KME is promoted by a group of qualified professionals with rich experience in the healthcare industry. The promoters have expertise in the fields of medical industry, medicine, as well as finance and business management. The company is being directed by the vision of addressing the needs of physicians and providing them with high quality, reliable and cost effective medical equipment and supplies. Serious efforts are being made to provide excellent after sales support to its customers. Further, the company is also directing its focus on cardiology, gynaecology and critical care products to develop expertise in these product segments on long term basis.The present product range of KME consists of ECG machines, patient monitors, pulse oximeters, foetal monitors, colposcope, infusion pump, ambulatory blood pressure monitors, ECG event recorders etc. The company is also in process of finalisation of distribution rights for various other innovative prod-

waste bins gravity chutes, trash closets and dump trucks. These systems are highly inefficient, labourintensive, environment nonfriendly, and potentially unhealthy in terms of disease and infection control. In evaluating the current traditional logistics for removing waste and soiled linen, hospital team leaders are finding a number of problems including: ● Increased exposure time of infectious disease to patients, staff and the public during transport of trash and contaminated linens through hallways and elevators. ● Increased costs due to required labor for transporting waste and soiled linens. ● Environmental and cleanliness concerns. However, with the development and deployment of automated waste and recycling management systems powered by air technology, we are at the dawn of a new age – The pneumatic age. These new systems are quickly becoming the waste, linen and recycling infraJULY 2012

ucts in the near future. KME has tied up with many good quality manufacturers to distribute their product range across India. It is engaged in the promotion of their innovative product range. KME is promoting their full range of ECG machines, like the single Ch machine. It has two models, one is the basic 10 lead ECG machine and the other model is being offered with display and interpretation. KME is one of the leading companies offering single Ch ECG machine with display and interpretation. KME is also offering 3 CH ECG Machine, which has display and interpretation. Aesthetic look of the unit makes it one of the best available 3 Ch ECG machines at a very economical price. KME is also marketing 12 Ch ECG from Bionet. This Korean FDA approved 12 Ch ECG machine is very economical and has a good installation all over India. KME is also offering foetal doppler and foetal monitors, KME has tied up with Bionet to market its foetal monitor. KME has recently launched a colposcope. Colposcope is used by gynaecologists for the diagnosis of

structure system of choice in new and up-to-date facilities. They keep waste where it belongs -- out of sight -- and provide the hospital with significant improvements to operating efficiency, cost-savings, infection control, and sustainability. Systems for automated removal of waste, soiled linen and recyclables are cleaner, greener, safer, hygienic, environment friendly, and more economical than these traditional systems. Automated systems transport the materials in a separate, air tight closed pipe system from every department/floor to a single collection point, which can be located in a discrete location. The inlets are positioned optimally to keep manual handling to a minimum. The materials are then transported via a computer-controlled pneumatic system that moves the soiled linen, waste and recyclables quickly, safely -and out of sight. This results in a quiet, hygienic, environmentally friendly setting for staff and patients. These automated www.expresshealthcare.in

cervix cancer. It is very good tool for gynaecologists and very popular nowadays. KME is providing full support in terms of demonstration to its customers. Company is also offering patient monitor, pulse oximeter, syringe infusion pump and vol infusion pumps. KME is also marketing Meditech, Hungary-make ambulatory blood pressure monitoring systems. Gradually and steadily more products are being added to provide cost effective solutions to the physicians and gynaecologists in India. Recently, KME has tied up for marketing blood and infusion warmers as well. KME is in regular process of appointing nationwide dealers in all strategic locations in India for distribution of its products and also providing efficient support to its valued customers. Good marketing support, regular trainings, efficient after sales support etc to its dealers and customers is the major strategy of KME to achieve great success. Products are available to dealers on OEM basis, dealers can contact directly at kme@bol.net.in or info@kmeindia.com

systems have other huge benefits also. A study analysing exposure time of hazardous materials through hospitals compared the exposure of manual collection vs an automated pneumatic solution such as from TransVac. Exposure time by manually removing waste was 1,344 minutes compared with 132 minutes for an automated process in a 200-beded hospital. Automated transportation of trash, linens and recycling minimises patient, staff and guest exposure time by nearly 90 per cent since transport time is limited due to automating and sealing the removal process. Other quantifiable benefits of an automated system include: ● Reduction in hospital FTEs. ● Vital part of the “green building” technology. ● Increased management tools via secure log-ins for system access. ● Detailed management, reporting, and control over the working of the staff and required areas etc.

Leading hospitals such as the Rush Medical Center and the Mayo Clinic in US have discovered that this technology can greatly improve material transport performance and also lower operational costs, improve cleanliness and aesthetics while also limiting exposure to waste. Since over 40 years, TransVac through its automated waste and recycling management provides an opportunity for hospitals to ensure sustainability, improve efficiency, and reduce costs. It is the dawn of the pneumatic age. This system is also used in infrastructure projects, hotels, stadiums, airports, and all the areas with a large public footprint. Sumetzberger and TransVac partner with Unison Narula Group (India) in the Sub-Continent. For more details contact Unison Narula Group Phone: +91-11-4545 9999/ +91-921277808/92125 77818 Email: pts@medikraft.com/ hrn@narulaexports.com EXPRESS HEALTHCARE

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Technomed’s growth trajectory Technomed India is on a growth path with an eclectic mix of products and well-satisfied clients

echnomed India is one of the prominent companies manufacturing operation theatre equipment (OT lights and OT tables) and hospital furniture in India. They design and distribute, for well over two decades, the most sophisticated and technologically the latest products in the service of medical profession. The professionals using the company’s products are highly satisfied with their quality, workmanship and after sales service. Technomed’s quality products are being supplied to many renowned government and private medical institutions in India. It has not only emerged as leaders

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in the domestic market but their products are enjoying a good market reputation in adjoining foreign countries also. Technomed’s quality and after sales service has made it a company of repute in the hospital equipment manufacturing industry. The company is empowered by an efficient workforce of skilled and dedicated staff, who is ready to offer their customers a broad range of products which is wider than that offered by many other companies in this field. The effective marketing activities and specialisation in specific sector, enables them to meet the requirement of their customers in different markets. www.expresshealthcare.in

As a result of continuous research and development process, they satisfy a wide range of requirements and offer design and technical solutions at the required standard. Technomed’s manufacturing facilities are located in Delhi, equipped with latest machineries. They strictly control the quality in the light of ISO 9001:2008 and CE backed with trained and experienced staff. The R&D department is continuously involved in designing and developing better ways to serve hospital industry. They have the expertise to design according to their special requirements. Being technically sound and

boasting of the highly experienced and dedicated staff, all the work is done in house and that adds to effective utilisation of all the resources. The company strictly adheres to timely delivery and prompt after sales services as well.

Contact: Technomed IndiaB-142, Sec-3, DSIIDC Industrial AreaBawana, Delhi110039Phone: 01127761155Mobile: 09999956733, 09899862532Email: technomed4life@gmail.comWeb: www.technomedindia.orgwww.technomedindia.inww w.technomedindia.net

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CENTRALIZED MEDICAL GAS PIPELINE SYSTEM

Main Activities z Execute turnkey project of centralized medical gas pipeline system (CMGPS) for hospitals z Undertake annual maintenance contract of CMGPS for Hospitals z Undertake complete design and manufacture and installation of single / double arm O.T. Pendants and single arm ICU pendants z Manufacturer of Hospital Furniture z Conducts safety audit of CMGPS in Hospitals z Render consultancy services on CMGPS Hospital Furniture

ICU BED

Stretcher Trolley

ICU BED

Having Strength of Qualified Highly Experienced Personnel & Having own well equipped workshop

B. S. MEDICAL INTERNATIONAL An ISO 9001 : 2008 Certified Company

21/3, Central Park, Jadavpur, Kolkata 700 032Tel : 033 2425 0036 M : 98319 46352 Email : info@bsmedicalinternational.com Website :www.bsmedicalinternational.com

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Express Healthcare Business Avenues Medical Grade

SILICONE TRANSPARENT TUBING

To Advertise in

Business Avenues Please Contact: ■ Mumbai: Tushar Kanchan 022-67440519 / 502, 09821459592 ■ Delhi: Ambuj / Dinesh 09999070900 / 098102 64368 ■ Chennai: Samuel Dhanraj 044-28543031, 09841457936 ■ Bangalore: Khaja Ali 080-22231923, 09741100008 ■ Hyderabad: A K Shukla 040-23418672, 09849297724 ■ Kolkata: Ajanta / Prasenjit 033-22138586, 09831182580, 09830130965

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REGD. WITH RNI NO.MAHENG/2007/22045. REGD.NO.MH/MR/SOUTH-252/2010-12, PUBLISHED ON 8th EVERY MONTH & POSTED ON 9, 10 & 11 EVERY MONTH, AT IND.EXP.PSO.