Express Healthcare December, 2012 by Indian Express

INDIA’S FOREMOST HEALTHCARE PUBLICATION VOL. 6 NO.12 PAGES 90

December 2012 ` 50

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INSIGHT INTO THE BUSINESS OF HEALTHCARE

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INDIAâ&#x20AC;&#x2122;S FOREMOST HEALTHCARE PUBLICATION VOL. 6 NO.12 PAGES 90

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Hospital Infra HBII 2012 Special Page 41

IT@Healthcare Janette Benett Clinical Director, BT Health Page 54

Hospital renovations are expensive and necessary. Ageing hospitals need the occasional brush-up or a entire reconstruction to stay competitive within their market. Express Healthcare looks closely at the renovation and remodelling process as they are picking up pace in India PAGE 13

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VOL 6. NO 12, DECEMBER, 2012

Chairman of the Board Viveck Goenka Editor

Market

Hospital Infra

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

Patient safety during renovations ........................ ..33

Kunal Gaurav PRODUCTION

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General Manager B R Tipnis Production Manager Bhadresh Valia Asst. Manager - Scheduling & Coordination Arvind Mane Photo Editor Sandeep Patil DESIGN Asst Art Director Surajit Patro Chief Designer Pravin Temble Senior Graphic Designer Rushikesh Konka Layout

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Vivek Chitrakar CIRCULATION Circulation Team Mohan Varadkar

Express Healthcare 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,

'India is very receptive to new technologies'............................18

UID: Collaborative model for better healthcare insurance in India ......................................51 'It is important to include ICT planning at the design stage of hospital construction'..............54

Radiology

‘We will do our best to increase recognition and penetration in India’ ..............................................................20 Trivitron Healthcare partners with Diasorin Group ..................22 Indraprastha Apollo conducts ‘Basic Life Support’ training for Tihar Jail inmates and staff ....................................................23 Healthcare stakeholders join hands to bring down MMR in Maharashtra ..........................................................................24

Nariman Point, Mumbai - 400021)

Yashoda Hospitals conducts international live *Responsible for selection of news under the PRB Act.

surgery workshop ..................................................................25 FIT India and BD India launch insulin injection guidelines ......26

Probing legalities of ultrasound ..............................56

DECEMBER 2012

Regulars Letters ...........................................................................................................................................................12 www.expresshealthcare.in

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Editorial

Meeting the MDGs s the sun sets on 2012, India finds itself left with only two years to meet the next Millennium Development Goals (MDG). Though there is improvement, the country still lags on all basic parameters. For instance, the target for under five mortality rate (U5MR) for MDG 4 is less than 38 per 1000 live births but we are still at 59 per 1000 live births as per latest data available from the Sample Registration System (SRS 2010) of the Registrar General of India. In fact, the UNICEF Progress Report 2012 titled `Committing to Child Survival - A Promise Renewed' has damning statistics that India contributes to 24 per cent of total global child deaths and ranks 49th in descending order of U5MR in the world. The good news is that these parameters are improving. The bad news is that the rate of improvement is too slow. For instance, U5MR has shown a 5 point decline from 2008 to 2009 and 2009 to 2010. If this rate of decline is sustained, India is on track to achieve MDG 4 goal. Similarly, while the MDG target is to immunise more than 80 per cent of one year old children against measles by 2015, the latest District Level Household Survey (DLHS-3) showed that the coverage for the first dose of measles vaccine in the country was 69.5 per cent which further improved to 74.1 per cent in 2009 as per the Coverage Evaluation Survey, 2009. As per MDG 5, Maternal Mortality Ratio (MMR) has to be reduced by three quarters between the 1990 and 2015. With the target for MMR set at less than 109 per one lakh live births, India lagged at 212 as per the SRS 2007-09. More recent data, like the Maternal Mortality Estimation Inter-Agency Group report 2010 (MMEIG), does show an average annual decline of 5.2 per cent between 1990 and 2010. Playing catch up is tough but better late than never. The Ministry of Health & Family Welfare has set in motion many schemes under the National Rural Health Mission (NRHM) focused on maintaining the decline in these parameters and improving neonatal, child and maternal health. For instance, a catch-up measles immunisation campaign has been initiated in 14 states to provide a second opportunity to improve coverage. But the problem is too monumental and we cannot rely on government push alone. Therefore it is heartening to hear of NGOs and private sector entities collaborating with the Government and working towards these same goals. For instance, NGOs like the Rotary Club of Mumbai and Pragati Pratishthan with industry groups like the Organisation of Pharmaceutical Producers of India (OPPI) and the Indian Medical Association (IMA) collaborated with the state government to organise patient screening programmes as well as conduct training programmes for general nursing midwifery (GNM) and auxillary nurse midwife (ANM) who will work in primary healthcare centres within designated rural areas. Anaemia was detected as the biggest cause of maternal deaths among women living this area so medicines will be provided as needed once detected. OPPI member companies have supported this objective by donating medicines and providing volunteer support. Let's hope that the new year sees many more such initiatives and we move faster towards achieving the MDGs.

A The good news is that India is improving on the parameters set as MDGs. The bad news is that the rate of improvement is too slow

Viveka Roychowdhury viveka.r@expressindia.com

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Letters REMOST INDIA’S FO

care.in www.expresshealth

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ATI RE PUBLIC

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VOL. 6 NO.11

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HCAR ESS OF HEALT O THE BUSIN INSIGHT INT

Coming Soon a Special Hospital Infr & cial In Imaging Spe e December issu

the areas like vector control, provision of immunisation and contraception to urban slum dwellers. Its the focus on public health that shall make this renaissance a reality.

Hospital Infra Flooring facts

Page 33

Dr Sanjeev Sood NABH Empaneled Assessor, Certified Healthcare Qlty Mgt & IT ConsultantHospital & Health Systems Administrator Chandigarh

Knowledge

agement – Diabetes man future trends

Page 37

Focus on public health – need of the hour

Well researched article

our lead article-'Mumbai -In need of a Renaissance', makes an interesting read. While tracing the evolution of healthcare sector since the British era, the article clearly identifies the issues and challenges facing the contemporary healthcare sector and offers possible solutions. With the public health sector lagging behind, it would have been a good idea to take stock of public health activities and initiatives by Municipal Corporation in

ery interesting and well-researched (Ref to article: ‘Reused pacemakers: Socially correct, ethically wrong’ published in the October 2012 issue of Express Healthcare). This is where government can come in by funding studies to judge the relative benefits and risks of reusing med tech.

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DECEMBER 2012

UPFRONT

Market

India lends a hand to fight polio in Nigeria

‘Good national and local information about diabetes and diabetes care is vital'

'Reaching out to smaller towns and districts is important and critical'

Dr Rowan Hillson MBE represents UK's publicly funded healthcare system, NHS in the Department of Health.

Ravinder M, National Head - Rural, Accident & Health, Tata AIG General Insurance Co

he global Polio Eradication Initiative (GPEI) – a spearheading group of Rotary International, UNICEF, WHO and CDC – along with national governments across the globe are close to wiping out polio from the face of the earth, but the dreaded disease in endemic countries like Nigeria still remains a big concern for India. Despite being geographically far from India, the fact that a large number of Indians live in south Nigeria, for trade and employment, there is a possibility of polio being transmitted back to India. Nigeria has seen an upsurge in polio cases, where cases of polio increased from 62 in 2011 to 101 in 2012, with the continuous risk that people in neighbouring polio-free countries become infected again. According to Raja Saboo, Past President of Rotary International, "Certain sections of the population in Nigeria are resisting immunisation for their children. The refusal is on grounds like religion and some just misconceptions. Also some areas in northern part of Nigeria, access and reach is still a big challenge and hence a big concern for the neighboring polio-free countries and those with ties”. A team of 24 Indian doctors and volunteers – from across the country - will soon fly from Mumbai on a 10-day mission to Abuja in Nigeria, to conduct surgeries to correct deformities arising from polio. Earlier this year, a team of polio experts (of WHONPSP) - from India visited Nigeria to support polio surveillance and monitoring facilities, lessons that finally helped India eradicate the virus. The number of polio cases in India saw a steep fall with no cases reported in the last two years, one case and the last so far reported in 2011, 42 cases in 2010 and 741 in 2009. India remains cautious despite strong and continued progress against the polio virus in the light of emerging cases and outbreak in endemic countries like Nigeria and Pakistan.

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Hospital renovations are expensive and necessary. Ageing hospitals need the occasional brush-up or a entire reconstruction to stay competitive within their market. M Neelam Kachhap looks closely at the renovation and remodelling process as they are picking up pace in India

EH News Bureau

DECEMBER 2012

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M|A|R|K|E|T enovation and remodelling is unavoidable at a present day hospital. Be it a simple project of cosmetic changes in patient rooms or complex project like structural repairs at the OT; renovating and remodelling have become fairly common. Nowadays, hospitals have budgets assigned for planned R&R activity every year. Hospitals have architects, planners, project officers, interior designers on their role. In fact, some hospitals have a whole construction project department to look after such activities. Today, hospitals realise the importance of periodic renovation and remodelling and thus it is an integral part of operations planning. Regular up-gradation of the facility results in better indoor environmental quality, improved patient safety, more efficient and flexible facilities, and higher patient and staff satisfaction.

Renovation rationalities From increasing space to upgrading to the norms of NABH or JCI; there are many reasons for renovating and remodelling a hospital. Besides, hospitals are high traffic areas and are bound to wear and tear more quickly than any other infrastructure. Dr R Chandrashekhar, Chief Architect, Central Design Bureau for Medical & Health Bldg.(CDB), Ministry of Health & Family Welfare, Govt of India, New Delhi says, “Hospitals must renovate to achieve optimisation of existing infrastructure which results in achieving functional excellence required for the healthcare needs of public and service provider.” Many hospitals are housed in structures which were build 20 years ago, or brownfield projects that are housed in structures which were not intended for a hospital. In these scenarios, everyday operation may be limited due to unfixable flaws thus prompting the hospital management to renovate. “A hospital build 20 years ago may not have some specific requirements of present day like the JCI or NABH specifications. These are recent requirements. Thus, a facility needs to be upgraded accordingly,” explains Dr Nagendra Swamy President, & Chairman- Quality Council, Manipal Health Enterprises, Bangalore. Additionally, periodic

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renovations help the growth of the hospitals. “A decade back most cities in India were serviced by small hospitals or nursing homes. Growth at these facilities; if any; was sporadic and unplanned. However, for optimal benefit and longterm success these facilities must go in for regular, planned, renovations,” opines Dr Alexander Kuruvilla, President & CEO, Medica Synergie, Bangalore. Hospitals also need to renovate to accommodate evolving medical technologies. As treatment modalities develop, hospitals need to match the pace of these developments. “When the ‘patient density’ increases or the patient-to-space ratio turns adverse and when the existing structures provide insufficient space and support for latest clinical technology the hospital should plan for renovation and remodelling,” opines Mayank Madhani, Chief Operating Officer, Neev Group, Mumbai. Says Dr Kuruvilla, “One cannot just accommodate equipment wherever space is available but have to think about the larger picture and plan. If an ultrasound is to be bought you cannot just place it in a vacant room, in say the third floor, without thinking about how the patient would reach there.” Above all today's informed patients demand better facilities which is one of the main reasons to R&R which helps the hospitals to stay competitive within their market.

Renovation realities Renovating may be inevitable for a hospital but it is easier said than done. Since hospitals are high traffic areas and a vital service they cannot shut shop for renovation. Closing down would also mean revenue loss. Thus most hospitals are renovated while operational. This creates many challenging situations for the hospital and the contractor. Besides, different areas of the hospital have their own challenges when it comes to renovation. “Shifting ward from one area to another unoccupied area may be simpler than shifting a radiology lab,” explains Swamy. “In case of a radiology lab there are room specifications, equipment specification and patient safety specifications, which need much time and consideration before shifting or taking up renovation,” he adds. Added to this, patient www.expresshealthcare.in

Renovation should be based on a well laid out plan of remodelling with a complete understanding of the effects of such a venture Ashok Kumar C SENIOR VICE PRESIDENT, BGS GLOBAL HOSPITALS BANGALORE

flow and volume management becomes a challenge. Renovation projects also leaves the clinical staff stressed to manage better clinical outcomes in an environment of noise pollution, debris and dust.

Considerations Weighing the pros and cons of renovating a hospital takes medical perspective, experience and creativity. Central to this decisionmaking process is the feasibility study. “Accurate analysis of existing infrastructure is the key to renovating any hospital,” says Dr Chandrashekhar. “Meticulous planning, viability analysis, precise project planning and commissioning process are the basics of good renovation plan,” he adds. Quite simply put, a feasibility study helps establish if renovation of a hospital’s ward, lab, OT is possible, practical and whether it can meet the proposed needs. Not simply a cost-benefit analysis, a feasibility study evaluates technology needs and barriers, scheduling to complete a renovation project from start to finish, options and alternatives, and potential implications of decisions to the operations of the hospital. An inadequate analysis leads to a number of problems like hidden costs, increase in basic budget and delay in project completion. “Problems include studies being conducted by architects unfamiliar with renovation, inflated cost estimates for renovation, limited or no staff input, hidden costs not accounted for, and minimal consideration of patient impacts,” elaborates

Meticulous planning, viability analysis, precise project planning and commissioning process are the basics of a good renovation plan Dr R Chandrashekhar CHIEF ARCHITECT, CENTRAL DESIGN BUREAU FOR MEDICAL & HEALTH BLDG.(CDB), MINISTRY OF HEALTH & FAMILY WELFARE, GOVT.OF INDIA NEW DELHI

Dr Swamy. Feasibility analysis helps in meticulous planning for the renovation project. Other than this judicious use of existing technology and resource is required. “Utilisation of existing technology and manpower is also important,” says Dr Chandrashekhar. Capital for renovation if a financial barrier that needs to be be addressed with some thought. Hospital management should know the financial options available to them. Moreover, renovation is a capital cost and should be looked at as an investment. “Most hospitals find it difficult to source money to finance the renovation need,” says Kuruvilla “A cost benefit analysis then becomes necessary and renovations need to be budgeted,” he adds. Says Ashok Kumar C, Senior Vice President, BGS Global Hospitals, “Renovation should be based on a well laid out plan of remodelling with a complete understanding of the effects of such a venture. The critical point in a hospital set-up is that every square inch of the hospital should be utilised for better patient care, good patient outcome and revenue generation. Cost benefit ratio of remodelling, how it affects the top-line revenues and EBITA should be worked out.” Engaging the staff in the renovation project is also very important. “The management should hold meetings with doctors, clinical staff and all other employees to keep them involved as they would be the ones using the renovated facility.” says Dr Swamy. DECEMBER 2012

M|A|R|K|E|T Challenges Working on a busy, fully functional hospital is not easy. There are various challenges like infection control, noise and vibration problems, disruptions to patients, staff, and visitors, emergencies, staging, parking etc,. “Site health, quality and safety along with hospital’s hygiene and infection free environment are always at the forefront of any phase of planning and execution,” reveals Madhani. “Timely handover of the space, as planned, by the hospital authorities for renovation is a major challenge,” he adds. Patients are central to a hospital function and the renovation projects should not inconvenience patients. While renovation happens patients are exposed to construction dust, they can develop nosocomial or hospital-associated infections which can be fatal. Planning for new construction or major renovation requires early consultation and collaboration to ensure that infection prevention is not only adhered to, but built into the design. Noise and vibration control is another challenge. Work has to be done during normal daytime working hours so that patients have their rest time to recover. “There should be least disturbance caused to the patients during the process of renovation/remodelling,” suggests Kumar. “Hospitals should ensure that there are adequate measures taken for infection control as well as measures for dust control. Areas where patients are housed should be adequately cordoned off. There should be redistribution of beds and measures to ensure that normal healthcare services are not hampered. The restructuring during the renovation should not affect patients and the housekeeping services - cleanliness in particular,” he adds. Agreeing to this Madhani says, “Major challenges during hospital renovations are patient and visitors (traffic and movement) management, sequential phase wise planning for the renovation, keeping all the aspects/departments of the hospital fully functional. Sound and noise decibels should be kept at a minimum as the other hospital facilities are functioning even during the renovation period.” DECEMBER 2012

Adding to this Dr Chandrashekhar says, “Challenges while renovating hospitals are timely completion of project, operational vs redundant facility, vertical and horizontal circulation, structural stability and local regulations, resistance to change vs clash of culture.” The challenges are in terms of financial, infrastructure, technology, and human resource, which are: accurate valuation of infrastruc-

ture, identification of upgradation needs, availability of trained manpower, resistance to change vs clash of culture, identification of training needs, upgradation of technical know-how, and managing change process. Another challenge is to keep up with the present norms of building construction. “The latest construction technology like pre engineered building or light gauge steel frame structure (LGSF) are

advised for adding additional facilities in existing structures. Also called PLUG and PLAY, it has different models like courtyard-in-fills, wrap-around, overroof or on gantries. For larger projects we must have meticulous planning of the complex, in terms of phasewise demolition, and phasewise construction, without interrupting even a single day of functioning of hospital,” explains Dr Chandrashekhar.

Public push In India, both private and public sector is engaged in renovation and redevelopment activities. The government is making efforts to upgrade its facilities so that it will be able to match steps with the corporate sector. Recently, at the foundation stone laying ceremony for the redevelopment of Lady Hardinge Medical College, Health Union Minister of Health and Family Welfare,

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M|A|R|K|E|T Ghulam Nabi Azad elaborated on government’s plan to augment healthcare services in India. In the 11th plan period 40,000 new constructions and renovations of health facilities were taken up under NRHM, out of which 20,000 have already been completed and the rest are under various stages of completion. To further strengthen tertiary healthcare delivery in the government sector, the Ministry also took up 19 state government owned medical colleges’ for upgradation under the Pradhan Mantri Swasthya Surakhsha Yojana. Six institutions have been completed and rest are likely to be completed by March-April 2013. In 2013, the six new AIIMS and 19 upgraded institutions together would provide speciality and superspeciality care in all disciplines with a net addition of 11,390 beds covering 27 locations spread across the country.

Private projects Recently, Manipal Hospital in Bangalore added a new ren-

ovated emergency care centre to the hospital. Max Super Specialty Hospital, Patparganj has launched five institutes within the hospital, each with a specialised area of focus. The newly launched institutes are the Max Institute of Cardiac Sciences, Max Institute of Neurosciences, Max Institute of Renal Sciences, Max Cancer Centre and Max Trauma Centre. Care Hospital, Hyderabad is also planning to double the bed capacity during next two years. The growth plans are mainly aimed at renovation of some of the existing hospitals, creation of additional capacity in existing cities, and upgrading infrastructure to elevate certain specialities to centres of excellence. Sir Ganga Ram Hospital, New Delhi has undertaken phased renovation of old blocks and will soon start construction of the new four blocks and a 11 storey car parking building in around five lakh sq feet area. Fortis Healthcare, Executive Chairman, Malvinder Mohan Singh had said that Fortis will add 950

Most hospitals find it difficult to source money to finance the renovation. A cost benefit analysis then becomes necessary and renovations need to be budgeted Dr Alexander Kuruvilla

Site health, quality and safety along with hospital’s hygiene and infection free environment are always at the forefront of any phase of planning and execution

PRESIDENT & CEO, MEDICA SYNERGIE, BANGALORE

CHIEF OPERATING OFFICER, NEEV GROUP, MUMBAI

beds by March 2013, that will include three new hospitals and capacity addition at the existing facilities as part of a big expansion drive. Earlier in the year, Apollo Hospitals had said that it will add 500 beds by the end of this fiscal, taking the total bed strength of the group to over 9,000. “BGS Global

Mayank Madhani

Hospitals, Bangalore is currently remodelling the hospital to expand bed strength,” Kumar said. Other corporate hospitals are also in expansion mode and taking up redevelopment and renovation projects. mneelam.kachhap@expressindia.com

INTERVIEW

‘Good national and local information about diabetes and diabetes care is vital' Dr Rowan Hillson NATIONAL CLINICAL DIRECTOR (NCDS) FOR DIABETES, NHS, UK

s National Clinical Director (NCDs) for Diabetes Dr Rowan Hillson MBE represents UK's publicly funded healthcare system, NHS in the Department of Health. As NCDs, these experts oversee the implementation of a National Service Framework (NSF) and spearhead change, by working with policy and delivery teams, clinical networks and the NHS management community to achieve joined-up action. She is scheduled to speak at the IndoUK Diabetes Summit on January 18-19, 2013 in Chennai. Viveka Roychowdhury asks her about her experience with diabetes care, her role on the policy front, and what she feels should be the roadmap to tackle the looming diabetes epidemic in India

You have been involved with diabetes care initiatives for many years. As a clinician, what worries you most about the progression of

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this disease condition? Diabetes is common, chronic, complicated and costly. Costly for the person who has it in distress, disability and premature death. Costly for the patient and the nation financially. I worry about the increasing numbers of people developing diabetes – 400 a day in England. Many people don’t know they have diabetes. In 2003 there were 1.3 million people with diagnosed diabetes in England. In 2012 there are nearly 2.6 million. It is increasing by about one million every eight years. Diabetes is a silent killer. Most people with diabetes are recorded as dying from something else – but the diabetes is the underlying cause. In England there are 24,000 excess deaths among people with diabetes a year, compared with the general population of the same age and sex. Many of these deaths are potentially preventable. Diabetes complications may not be noticed until they are www.expresshealthcare.in

very advanced. So people with diabetes and healthcare professionals need to ensure annual checks for risk factors and early signs of complications so they can be treated.

What have been the policy changes that you have since you were appointed as the NCD in 2008? What are the healthcare outcomes from these changes? I believe that good national and local information about diabetes and diabetes care is vital. Information about local care allows good care to be celebrated, and poor care to be improved. I established the National Diabetes Information Service (NDIS) and chair the partnership board. NDIS provides a comprehensive range of diabetes data, tools and information via one web portal. We published a geographical Diabetes Atlas of Variation to highlight improvement need. NHS Diabetes, established

in 2009, is our national improvement body for diabetes. With the Department of Health, I set their priorities. They provide national, regional and local support to improve care. In 2009 they worked with all stakeholders to publish integrated commissioning guidance (Diabetes Without Walls) for primary care trusts (local organisations responsible for primary care and for commissioning specialist care). They are doing the same for the new Clinical Commissioning Groups (CCGs). Built into this is the recognition of the need to tailor commissioning to local communities – for example, those with many people from South Asian backgrounds. Much work has been done on this in Leicester and Birmingham, for example. There are 23,000 children and young people with diabetes in England. We introduced a best practice tariff for specialist paediatric diabetes units – paid if they provide all the standards DECEMBER 2012

M|A|R|K|E|T of good care. We aim to improve diabetes management in primary care. An NHS Diabetes team is working with CCGs, focussing on areas with poor NDA results. My personal campaign to increase urine albumin testing has been accompanied by an increase from 63 per cent in 2007/8 to 75 per cent of patients in 2010/11. We are working to improve diabetes care in hospital. Inpatients with diabetes stay longer and are more often readmitted than nondiabetic patients. The National Diabetes Inpatient Audit showed that 37 per cent of diabetic inpatients had an error related to diabetes medication. The NHS Diabetes Inpatient Network has reduced this to 32 per cent in a year but much more improvement is needed. A national programme called ThinkGlucose is helping. We know that having diabetes increases the risk of dying in hospital by 10 per cent. Best practice tariffs for hospital diabetes care are being introduced. I established the safe use of insulin campaign. 92,000 healthcare professionals have now used the NHS Diabetes e-learning course. Other safety courses are receiving enthusiastic uptake. We must reduce amputations. The NHS Diabetes Footcare network, working with Diabetes UK, are driving foot risk assessment, and prompt, appropriate referral to multi-disciplinary specialist diabetes foot teams. Some English services have reduced their amputation rate by 80 per cent. We use health economics to focus attention on diabetes. NHS Diabetes published the economic case for improving hospital care and foot care. We must improve pregnancy outcomes in women with diabetes. Competencies for diabetes midwives were published and now most hospitals have one. A national audit starts next year. NICE guidance states that 12-15 per cent of people with type 1 diabetes should have an insulin pump. About eight per cent do now – an improvement. Our Older People’s Network with the Institute of Diabetes in Older People supports the

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majority of people with diabetes, including those from South Asian and other communities, and help meet their needs. Ongoing work aims to improve diabetes management in care homes. We have linked with the dementia team to improve care and diagnosis of dementia in people with diabetes, and vice versa. I chaired the expert group that published a consensus permitting diagnosis of diabetes using HbA1c in the UK (with advice

about where this should not be used).

What should be the action plans of clinicians, hospital promoters and decision makers in the healthcare delivery arena in India to meet the challenges posed by diabetes care? There is already much impressive activity to improve diabetes care in India. Delivery of diabetes care in any country should be tailored to the needs

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of their different populations. A benefit of integrated diabetes care is to encourage all providers – primary, community, secondary; government and private – to work together to pool their resources and expertise. All of us around the world face ever-increasing numbers of patients and need to make best use of the resources and expertise we already have for diabetes care and prevention. Individual care providers in any nation should

work to national standards of diabetes care, and measure whether they are achieving these. People describe the increasing numbers and problems of diabetes as a tsunami. But a tsunami is wall of water that comes, does damage, and goes away. Diabetes comes, does damage, and stays. Much of the damage is preventable. viveka.r@expressindia.com

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

'India is very receptive to new technologies' Dr Norbert Gaus, GLOBAL CEO, HEALTHCARE CLINICAL PRODUCTS

r Norbert Gaus, Global CEO, Healthcare Clinical Products talks about his division's offerings for the Indian market, their role in enhancing healthcare delivery in the country and its future plans for India, in an interaction with Lakshmipriya Nair

What are the current trends in healthcare clinical products, both in India and global market? Our Clinical Products Division comprises X-ray and ultrasound systems, which account for a majority of medical examinations all over the world. Among others, we’ve identified two aspects that are vital in this field: quality and accessibility. Talking about quality, just look at our recently introduced ultrasound system Acuson S3000: It allows for the automated fusion of ultrasound and 3D computed tomography images. A few years ago, this was simply unthinkable. Our customers even had to struggle with reading clinical images, which then were of shady grey. The second aspect, accessibility, is a topic that has significantly improved. I’m quite proud of the fact that today, millions of people, for instance in emerging markets like India, have access to our X-ray and ultrasound machines, which is also a result of our strategy to broaden our portfolio of affordable products. However, there is still a very significant proportion of the population that still has no access to clinical imaging as a means of diagnosis. On a global level, we see that the debt crisis in Europe and the US is asserting additional cost pressure in the healthcare systems, calling for more efficient clinical workflows, thus more productive products and solutions. To cater for this trend we introduced our initiative ‘Agenda 2013’ in November 2011 to further strengthen healthcare sector's innovation power and competitiveness. As a result, in the past 12 months alone, we introduced an X-ray and an ultrasound system as well as a CT and MR scanner that offer a very compelling balance between image quality,

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investment budget productivity targets.

and

How has technology in healthcare clinical products evolved to assist effective healthcare delivery, especially in India? Talking about effective delivery, due to its sheer size, the Indian market is a challenge in itself. Moreover, the Indian market is highly diversified. On the one hand, we’re talking about high-class hospitals with the same requirements as any teaching hospital in Europe or the US. On the other hand, we see a vast and fast-growing market for entry- and mid-level products. We serve both markets with innovations that equally cater for quality, effectiveness and price-efficiency. And our manufacturing site in Goa, which has been up and running since 1996, serves the local market needs with systems such as the Multimobil family for X-ray.

located in Gurgaon.The previous one was donated to Smile Foundation in Madhepura, Bihar and more than a dozen of these buses are already on their way through rural India. Apart from our corporate citizenship programme, we are fostering our R&D efforts to come up with highly innovative and at the same time more cost-efficient medical equipment.

How receptive is the Indian market to new technologies and innovations?

How has Siemens' Healthcare Clinical Products Division played a role in enhancing healthcare delivery?

India is very receptive to new technologies. From what I observe, high-tech has a very positive connotation in India. Which I – being an engineer myself – fully understand. What we see in India maybe more than anywhere else on the planet is that our customers are very demanding in terms of what innovation is able to contribute to the solution of a problem. In this sense the Indian market is very challenging. However one can say: If you make it there, you make it everywhere.

In India, Siemens has started the initiative Sanjeevan mobile clinic to bring healthcare

Which technologies have gained popularity and

In India, Siemens has started the initiative ‘Sanjeevan mobile clinics’ to bring healthcare to the people. These socalled buses of hope bring basic medical care to people who otherwise would have to walk many miles to receive any kind of medical care to the people. These so-called buses of hope bring basic medical care to people who otherwise would have to walk many miles to receive any kind of medical care.They feature Xray, ultrasound, mammography and electrocardiogram equipment and there’s even a darkroom for developing X-ray images! Just one year ago, Siemens’ President and CEO Peter Loescher proudly donated another Sanjeevan mobile clinic to Medanta, one of India's largest speciality institutes www.expresshealthcare.in

acceptance in the past few years? From a high-end perspective, I want to mention Acoustic Radiation Force Impulse (ARFI) imaging or automated quantification of heart volumes and in the area of mammography, our Mammomat Inspiration. Siemens is the only company in India to provide the solution of ARFI, which comes with our ACUSON S2000 ultrasound system. The technology has remarkably helped in accurate

and early diagnosis of liverrelated disorders – where the number of victims is increasing in India. Furthermore, automated ultrasound technologies are poular, for instance the Syngo Auto Left Heart (Auto LH) technology. This feature automatically generates left heart volumes and ejection fractions. It works with pattern recognition technology that is based on learning from a database of expert contours on thousands of cases, so the quantification is very accurate and consistent. Finally, our high-end digital mammography platform for screening, diagnostics, stereotactic biopsy, and 3D tomosynthesis has also gained acceptance in India.

What are the most notable innovations in the past decade as far as healthcare clinical products are concerned? I just touched on the highend innovations. At Siemens however, we expand the definition of innovation to midrange products also. And here I’d also like to mention two great successes of the recent years: One is our new digital Xray system that fits the needs of the entry-level segment perfectly and that is the Multix Select DR. It can be used for virtually all clinical radiography applications, is easy to use and comes with an outstanding price-performance ratio. A second innovation benefiting the Indian population was the development of a smart camera for the C-arm system MM5E that is manufactured in Goa. This camera was designed with the Indian customers in mind. And at the same time, we did not compromise on the overall output and that is highquality images. By developing this special camera, we were also able to reduce the total cost of the C-arm system considerably.

Tell us about the new technologies and innovations that Siemens' Healthcare Clinical Products Division has introduced in the past few years? How well have they been received? Just last year, we launched the ultrasound system Acuson DECEMBER 2012

M|A|R|K|E|T S3000, I’ve mentioned earlier. I think this system is definitely the best money can buy as for instance it is the only system that offers fusion imaging for routine clinical use. Just imagine that, with a single click, you can fuse 3D CT volumes with realtime ultrasound! Customers have been very pleased so far, praising the faster work-flow they’ve achieved and the 25 percent bigger field of view. In the field of X-ray, as I’ve just mentioned, we introduced the new digital Multix Select DR. So far, a fully digital X-ray system was only available in the higherlevel price segment. With the Multix Select DR we are now able to offer this fast, more precise and environmentally-friendly technology for a price, which is about one-third below than that of comparable predecessor products of Siemens. As such the Multix Select DR becomes attractive for customers who could so far only afford analogue radiography systems. Other innovations in the high-end and mid-range, I have just touched on.

plans of the Healthcare Clinical Products division for India? We want to grow in India. And we want to grow for India! We will achieve this also through healthcare sector’s initiative Agenda 2013, which entails objectives like expanding our regional presence in the fastgrowing emerging markets and further extending our portfolio of systems in the middle price segment.That is, our site in Goa will play a very important role

We want to grow in India. And we want to grow for India! We will achieve this also through healthcare sector’s initiative Agenda 2013, which entails objectives like expanding our regional presence in the fast-growing emerging markets

for our product development and manufacturing – we will surely see some interesting systems coming out of Goa in the next few years. I believe it is vital for our strategy to involve local engineers and incorporate their know-how about the market. Only then can we be sure that our products for India do really meet the local requirements and can support good healthcare delivery. lakshmipriya.nair@expressindia.com

Siemens fine-tuned its ultrasound segment, last year. What has been the result of that step? Has it given the boost needed for Siemens' ultrasound products? Our ultrasound business unit is growing nicely due to the many exciting developments in the past quarters! The products we introduced will further enhance Siemens’ participation in the rapidly growing compact ultrasound segment worldwide. We have also successfully expanded our portfolio of products in the middle price segment, for instance, with the Acuson S1000 ultrasound device. The system enables a c c e s s to premium imaging performance at an exceptional cost of ownership. With this system we now have a scaleable portfolio where the customer can upgrade his system from an S1000 to the S2000 and even the S3000. In other words,the capabilities of the system grow with the challenges of the customers. This is investment protection at its best!

What are the future DECEMBER 2012

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

'Reaching out to smaller towns and districts is important and critical' Ravinder M, NATIONAL HEAD - RURAL, ACCIDENT & HEALTH, TATA AIG GENERAL INSURANCE CO

he Indian health insurance sector has registered phenomenal growth in the past few years. Experts are of the opinion that in the coming few years the health insurance sector is poised to reach new heights as public and private insurers are coming up with various schemes to cover the untapped insurance market. However, lack of penetration still remains a huge detriment. Raelene Kambli catches up with Ravinder M, National Head - Rural, Accident & Health, Tata AIG General Insurance Co to understand the current market scenario for the health insurance sector in India

How would you broadly characterise the health insurance industry in the last five years? Are there a lot of changes within the sector? The health insurance industry constitutes about 24 per cent of general insurance market and has the fastest growing portfolio with a CAGR in excess of 30 per cent in the last six years. This portfolio is expected to report a CAGR in excess of 25-30 per cent over the next five years. Where the changes are concerned, I would say that the industry is currently experiencing changes in terms of product innovation and

next level customer servicing standards.

What kind of operating models are viable in India for health insurance? There is more focus and demand for indemnity based products. The demand for benefit products, critical illness products are also increasing. The companies offering health insurance products are constantly trying to introduce better designed products, more appropriate pricing, additional innovative underwriting techniques as well as more stringent risk and claims management initiatives. All the above is taking place while driving forward on service standards to meet the increasing demands of consumers.

Lack of insurance penetration remains the biggest challenge that the industry faces. How are insurance companies tackling this industry situation? Many companies offering health insurance policies are choosing to advertise for creating awareness about good health and the importance of buying health insurance. Also, contacting customers through different channels of distribution is being initiated to

ensure that all sections of society and geographies are contacted. Different channels of distribution include bancassurance, direct marketing and online.

What are the government's initiatives in this regard? Government has taken many initiatives to increase the health insurance penetration levels in India. It has launched the Central Govt Health Scheme, Rashtriya Swasth Bima Yojana (RSBY), Rajiv Gandhi Arogyasri, etc. RSBY has been launched by Ministry of Labour & Employment in 2008 for below poverty line (BPL) families. It entitles to hospitalisation coverage up to Rs 30,000. There is no age limit and covers up to five members in the family. Premium funding pattern includes Government of India’s contribution of approximately 75 per cent, State Government’s contribution of 25 per cent and the beneficiary’s contribution of Rs 30 as registration fee. Selection of the insurer is done by the State Government on the basis of competitive bidding. The RSBY has been one of the most successful schemes, having a reach in 26 states, covering 378 districts. RSBY cards have been issued to 27.6 million BPL families, covering

7.5 crore lives. Almost 3.2 million claims have been registered.

What else needs to be done to address the lack of penetration problem? Reaching out to the smaller towns and districts where the real India belongs is important and critical. Platforms such as medical camps, vaccination camps and Panchayat can be used to create awareness about maintaining good health and importance of buying health insurance. The industry looks forward to the government launching more health insurance schemes and health insurance companies launching more health insurance products catering to all segments of the society. This may help in improving the penetration levels.

How do you see the market shaping up in the coming years? Customers in India are used to being offered a single type of health insurance product as the market is in a relatively infant stage of evolution.With time we expect the market to mature and the insurance companies to come out with new age products which will cater to the increasing and diverse needs of the customers raelene.kambli@expressindia.com

INTERVIEW

‘We will do our best to increase recognition and penetration in India’ Shinya Tomoda, MANAGING DIRECTOR, ASIA PACIFIC OMRON HEALTHCARE

ndia is one of the world's most lucrative healthcare markets, and is expanding rapidly. Omron India, the Indian arm of a Japanese company offering control and sensing technology sees immense scope for the medical technology and device market to thrive in India. Currently, the company is moving rapidly to reinforce operations in India by increasing the number of industrial

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automation and healthcare equipment sales bases and boosting the number of system engineers and sales personnel. Shinya Tomoda, Managing Director, Asia Pacific Omron Healthcare shares his view on the Indian market and the company’s plans for India in an interaction with Raelene Kambli

What is your perspective about the Indian medical www.expresshealthcare.in

device industry? Where does the industry stand on the global map? Globally the medical technologies used in devices are very much advanced, even at grass root levels. However, India has also leapfrogged in this arena. Along with the rapid growth of the Indian economy, the potential demand for such medical technologies is steadily growing.

Take cue from recent industry studies - The medical technology equipment market in India is pegged to touch $5 billion (around Rs 23,300 crore) by 2012, growing at an annual rate of nearly 15 per cent, on rising demand from urban customers. According to the report, ‘Medical Technology Industry in India’, by industry chamber CII and consulting firm Deloitte, the medical DECEMBER 2012

M|A|R|K|E|T technology equipment market in India was valued at $2.76 billion in 2008, a growth of about 14 per cent over 2007. According to Associated Chambers of Commerce and Industry of India (ASSOCHAM), the size of Indian medical equipment supplies industry is likely to touch $7 billion by 2012. In its paper on healthcare services, the ASSOCHAM has stated that the current domestic medical equipment suppliers size is estimated around $3 billion. The projections are based on the fact that medical equipment supplies have already started stretching their plans since a substantial number of healthcare facilities are likely to be added in metros and more so in satellite town adjoining the metros since such townships are being promoted for industrial development. Thus, we can safely say that there has been exponential growth in the healthcare field in totality and medical device industry per say in India. Better information leads to better decisions. This is true for every industry, and healthcare is no exception. Now, Indians are sitting up and putting a lot of emphasis on their health. Better connected research represented by national and international studies, better diagnostic devices and healthcare facilities coupled with better connected care represented by public health efforts as well as individual care practices are the hallmark of globalisation and India is not far behind.

and now we have a complete range of healthcare products. With this, our target for FY12 is $14 million in India. We will do our best to increase recognition and penetration in India.

Tell us about Omron's contribution in the Indian healthcare sector? How has the company positioned itself in the healthcare sector? Omron is a major supplier of homeuse healthcare devices and talks with big hospitals are on to supply our products. We plan to better understand our client

needs in the Indian market and build new products or services that will help healthcare organisations have better information. This will lead to better decisions and healthcare outcomes. We are keen to contribute to areas such as patient safety, increasing quality and efficiency of care, and making it affordable to a larger section of society.

What is your current market share in the industry? How do you plan to penetrate and increase your share? We have a current market share of

57 per cent (blood pressure monitors in unit base) and we aim to achieve growth as quickly as possible by expanding our business in emerging markets- the explosive growth of which is now driving the global economy. India has sustained a 30 per cent growth over the last three years. We have managed to penetrate the market exceptionally well. The superior technology and competent pricing has helped us to achieve this position.

What are the innovative products

What is the most exciting development on the horizon? Steering wellness through technology is catching up.Technology is the enabler for empowering patients to take better care of their health. We can also accelerate early diagnosis for earlier detection and treatment of diseases. Advances in the diagnostic facilities, particularly non-invasive ones are leading to new treatments that improve health outcomes and quality of life with remarkable ease and convenience. Diagnostic technologies and disease monitoring are hence two big areas which will continue to see innovation in healthcare management. We recently launched our blood glucose monitor DECEMBER 2012

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M|A|R|K|E|T and services that Omron offers? What growth potential do you foresee for Omron in the medical device market in India with your new line of products? Omron’s propriety sensing and control technologies allow conversion of gathered data into valuable information for people and machines thereby providing pioneering technologies, products and services that can meet the social needs of the future Our Omron glucose monitor completes our range of healthcare products and through these months, we will do our best to increase recognition and penetration in India. With 50 million diabetic patients and an equal number of people estimated to be diabetes-prone, India is emerging as a major market for blood glucose monitoring solutions. The concept of self blood glucose monitoring was introduced in India only a few years back and the industry has already grown to over Rs 150 crore, with a growth rate of 1518 per cent in the last three years. However, out of the 50 million diabetics, only half a million currently check blood glucose levels on a regular basis using these solutions, say industry sources. In the US, people having the disease check their blood glucose levels even up to six times a day, whereas in India, the patients don't even check their blood glucose levels on a regular basis unless directed by their doctor. Studies say that diabetes induced death can be brought down by 52 per cent if the insulin levels in the body are regularly monitored and controlled. Some of our other products include blood pressure monitor, nebuliser, body fat monitor, pedometer, thermometer and blood glucose monitor. Also, we have the most comprehensive

healthcare portfolio and our products are priced very economically as compared to the competition. For blood pressure monitor alone in India, we owned 57 per cent market share. We are bringing a number of new technologies to India. Some of them are: body composition monitors which

knowledge on the appropriate role of instruments in health management. We have collaborated with the Indian Society of Hypertension to support a large scale clinical study involving leading doctors from Japan, Canada and India. Omron also provides digital blood pressure monitors and

People in India are sitting up and putting emphasis on their health now, and we like to contribute to the Indian society on prevention and treatment by providing devices of monitoring, treatment and medical information accurately analyse body fat and muscle conditions.

What strategies have you adopted for achieving efficiency and a competitive advantage? Our group brand strategy is to promote the Omron brand through mass media advertising, sponsorship of marathon events, and businessrelated marketing. To connect with masses directly, we have been sponsoring marathons since 2009. Besides, we introduced our brand and healthcare devices at booths alongside these marathons. Free health checks were also conducted at these booths. Our booths received an overwhelming footfall of 40,000 people. Around 30,000 people tried out our healthcare equipment, allowing us to make a direct appeal to consumers about our products. We have been conducting seminars to demonstrate to heads of pharmacies on how to use our devices, augment their understanding and disseminate

other measurement equipment to be used in clinical study. We have collaborated with Farhan Akhtar to drive awareness on significance of health and care.

How different are the demands of the Indian healthcare market as compared to other countries with respect to your products? Singapore and Hong Kong are developed countries and people are aware of the importance of healthcare. India is an emerging country where there is a lot of emphasis on healthcare and education on healthcare is of importance. In addition, the potential in these emerging markets is huge: hypertension – 130 million; obese - 100 million; diabetes 50 million; asthma – 50 million. Thus, people in India are sitting up and putting emphasis on their health now, and we like to contribute to the Indian society on prevention and treatment by providing devices of monitoring, treatment and medical information. We are

also educating and placing emphasis that with Omron healthcare, it is easy and convenient to start monitoring your own health at home.

Are there any investment plans for the Indian healthcare industry? If yes, what are the kind of investments that you are looking for? Our products are currently offered through ‘over the counter’ channel. Omron also conducts seminars for demonstrating to heads of pharmacies on how to use our devices, augment their understanding and disseminate knowledge on the appropriate role of instruments in health management. We have also collaborated with the Indian Society of Hypertension to support a large scale clinical study involving leading doctors from Japan, Canada and India. Omron provided the medical personnel with digital blood pressure monitors and other measurement equipment used in clinical study.

What are Omron's expansion plans in the Indian market? Any new merger/acquisition in the pipeline? In the coming years, we look forward to enhance our client base and increase our presence. Omron Corporation, is looking at over three-fold increase in sales here to touch $43 million (over Rs 235 crore) by end of FY15, riding on new product launches and network expansion. The sales target would be achieved by increasing the number of retail outlets across the country from the current 15,000 to 33,900 by the end of FY2014-15. We are also planning to extend our reach to Tier-II cities as a part of our growth strategy in India. raelene.kambli@expressindia.com

PARTNERSHIPS

Trivitron Healthcare partners with Diasorin Group Trivitron-Diasorin alliance will cater to the Indian invitro diagnostics and immunodiagnostic markets rivitron Healthcare has entered into a strategic partnership with Diasorin Group to enter the immunodiagnostic market in India. The DiaSorin- Trivitron partnership has formed the capital company DiaSorin Trivitron Healthcare Private Limited, in which the parties will have 51 per cent and 49 per cent stakes respectively. The company will directly operate in the Indian diagnostics market.

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Dr GSK Velu, Founder and MD, Trivitron Group of Companies said, “The joint venture with Diasorin is an important milestone for Trivitron to achieve market leadership position in the Indian IVD segment. We are confident that the venture will provide unique positioning for Trivitron. Trivitron has enjoyed a leadership position in immunoassay segment with an innovative and extensive immunoassay www.expresshealthcare.in

platform using CLIA/ E L I S A / R I A / M D x . Combining the strengths of Diasorin and Trivitron, in the next three years we attempt to reach leadership position in Indian immunoassay segment.” Trivitron has been a contributor in this segment wherein the company installed immunoassay analysers in almost 70 per cent of labs in India. It is the first company to launch the CLIA (Chemi

Luminescence Immuno Assay) platform in India. Carlo Rosa, CEO of DiaSorin Group, commented that the JV agreement with Trivitron is really important for the success of DiaSorin Group in such relevant market as India, and represents an important pillar of the current and future expansion strategy of DiaSorin Group in Asia Pacific. EH News Bureau DECEMBER 2012

M|A|R|K|E|T TRAINING

Indraprastha Apollo conducts ‘Basic Life Support’ training for Tihar Jail inmates and staff The two-day programme educated 2,000 prisoners and 150 staff about saving lives in emergencies

draprastha Apollo Hospitals, New Delhi, conducted a two-day training programme on Basic Life Support for the inmates and staff of Tihar Jail in the city. It helped them to learn how to save lives, in a setting where no medical help is accessible. Indraprastha Apollo Hospitals has taken an initiative to provide Basic Life Support training to the community as part of its community outreach programme. In the past, through this initiative, the hospital has provided Basic Life Support training to PCR van constables, NSG commandos, students in various schools and colleges, resident welfare associations, members of local community and many others. Dr Priyadarshini Pal Singh, Head of Department, Accidents & Emergency, Indraprastha Apollo Hospital said, “Through

DECEMBER 2012

Basic Life Support training, we would like to educate everyone with the do’s and don’ts in case of an emergency situation and help them become more responsible citizens to help save lives in times of crisis. It is very important that every person in the community knows about Basic Life Support skills to improve the quality of community health. For example, it is important that

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those who are present at the scene of cardiac arrest know appropriate resuscitation skills and be able to put them into practice.” The training was organised for 2,000 inmates, 150 staff and Tamil Nadu Police personnel posted in the prisons. Director General (Prisons) and Deputy Inspector General (Prisons) were also present at the sessions. The programme included treating patients in patient/casualty handling, soft tissue injury, musculoskeletal injury, some common emergency situations and emergency delivery, and proper cardiopulmonary resuscitation for children and adults. The hospital is piloting this programme in prisons to give prisoners the basic skills to save lives and become dependable human beings. EH News Bureau

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M|A|R|K|E|T

Expansion INITIATIVE

Suburban Diagnostics launches new diagnostic centre in Thane uburban Diagnostics has launched its 10th centre in Thane on November 4. Headquartered in Mumbai, the NABL-accredited lab chain, is a technologically advanced diagnostic centre providing multi-speciality facilities. Spread across Mumbai and Pune, Suburban Diagnostics is a premier diagnostic centre, housing full-time doctors, technologists and STAR executives. Equipped with top-of-theline diagnostic equipments, the spacious 4,000 sq ft Suburban Diagnostics centre in Thane will offer advanced diagnostic services including high end pathology and microbiology, digital X-ray, ultrasonography, mammography, BMD (DEXA scan), ECG, stress test, 2D echo, and many more with a focus on preventive health checkups. Elaborating on the healthcare services offered at Thane centre, Dr Sanjay Arora, MD, Suburban Diagnostics said, “With preventive healthcare being the major objective of Suburban Diagnostics, our priority lies in creating topnotch patient friendly centres. Our mission is to make patients “want”to visit us and not “have” to visit us and make us the most preferred diagnostic service provider. This will be achieved through a focus on quality testing dependant on customer service,creating the best team and use of best technology.” “Wellness is increasingly becoming a part of the corporate agenda worldwide. Almost 80 per cent of the employee population in the corporate sector is prone to stress over mismatched income and aspiration levels. Thus to provide healthcare benefits to the employees associated with the corporate sector, Suburban Diagnostics provides a complete employee wellness plan inclusive of pre-employment and annual medical checkups, on-site health checks, health talks coupled with lifestyle modification plans that will help reduce chronic lifestyle diseases in the corporate world,” added Dr Arora.

EH News Bureau

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Healthcare stakeholders join hands to bring down MMR in Maharashtra Medical camps to be organised in different parts of the state to offer collaborative action and training on basic emergency obstetrics and new born care Raelene Kambli, EH News Bureau otary Club of Mumbai, Government of Maharashtra, organisation of Pharmaceutical Producers of India (OPPI), the Indian Medical Association (IMA) and NGO Pragati Pratishthan have joined hands to initiate a pilot project for reducing Maternity Mortality Ratio in the rural areas of Thane district in Maharashtra. This campaign aims to reduce maternal and new born child mortality through collaborative action and training at all levels, from basic emergency obstetrics and new born care (BemONC), following the World Health Organisation (WHO) standards. So far, five medical camps have been organised in the areas of Jawhar , Mokhada and Vikramgarh. The project began with a pilot study that highlighted anaemia as the biggest cause of maternal deaths among women living in these areas. Dr Anuja Purandare, Trustee, Pragati Pratishthan— NGO informed Express Healthcare that while conducting their research they found

out that the haemoglobin levels among women living in these rural areas of Maharashtra was between 6-9 grams per decilitre of blood. Further explaining the projects and its activities, Dr Purandare informed that the project is being implemented through medical camps that include screening and treating patients. It will move on to conducting training programmes for general nursing midwifery (GNM) and auxillary nurse midwife(ANM) by the end of January 2013, working in the primary healthcare centres within these areas. Volunteers and professionals from Rotary and IMA will be conducting these camps. After receiving vocational training, they will travel to the target areas and offer hands-on skills training as well as assistance with the time bound plan for correction of deficient resources. Adding to this, Dr Bharat Mahale, Gynaecologist, Patangshah Cottage Hospital, Jawhar said, “Anaemia is the biggest cause of maternal mortality. Nearly 70 per cent of women die during child birth due to lack of haemoglobin levels. Being a government run

hospital, our duty is to bring in patients from their homes to the PHCs in order to examine them clinically and also by conducting lab test. Once we know that a particular patient has a haemoglobin level of around eight grams per decilitre of blood we provide them with iron rich medicines and if it is less than eight we have to provide them with injectables. These medicals are provided by OPPI”. Rotary International, who is the main initiator of this project has many plans for this project. Says, Dr BM Inamdar, Rotary Governor, Rotary International, “This initiative has been started with the intention to reduce maternal mortality rate in India. We have targeted rural areas since the mortality rates are higher than those in urban areas. Apart from reducing the death toll, we also aim to bring down the number of home deliveries within rural areas of India”. He also informed that as part of their project, Rotary will provide training facilities and also look out for refurbishing OTs and PHCs run by the government within these areas. “We have planned to

conduct medical camps in these rural areas of Maharashtra for a period of three years after which we will move to other parts of Maharashtra. After Maharashtra, Rotary also wishes to target other states of India”, he added. OPPI is of the opinion that initiating such programmes is the need of hour. Vivek Padgaonkar, Director and the one leading the MMR project on behalf of OPPI stated,“Statistics reveal that every year 200 out of 1000 pregnant women die during child birth. Moreover, the Millennium Development Goal (MDG) 5A of the UN aims at three-quarter reduction of maternal mortality ratio between 1990 and 2015. Slow progress in this effort has plundered many initiatives. Therefore, a well organised effort in this regard is a must. We are glad that our member companies have been supporting this healthcare objective by donating medicines and providing volunteer support. We hope that with this effort we will be able to bring down MMR in our rural areas.” raelene.kambli@expressindia.com

NEW LAUNCH

Bharti Airtel launches unique queue management system for hospitals The service is specially designed to issue the tokens to patients via SMS or Internet Raelene Kambli, EH News Bureau harti Airtel which ventured into the healthcare space with the launch of mHealth – SMSbased health alerts in June 2011, has recently introduced a unique management system Airtel Toky service that would help hospitals make their patient engagement methodology systematic. The service is specially designed for hospitals, clinics and doctors to issue the tokens to patients via SMS or Internet. The benefits of Airtel Toky is not only limited to the hospitals alone, but extends to the patients who can now manage their time

easily and manage their doctor's visits from the convenience of their homes. Sukesh Jain, Head - VAS & Content, Bharti Airtel informed Express Healthcare that this services is introduced with a view to address the lack of systematic queue management services within hospitals. He says, “At Airtel, it is our constant endeavour to enrich the lives of our customers and Airtel Toky has been launched in line with this. The service has been launched for the healthcare initially given the acute need for an efficient queue management solution in hospitals and clinics on a daily basis. Also, the basic utility of this product is queue managewww.expresshealthcare.in

ment and hence it will be applicable to a lot of different sectors like banks, service centres etc. With this service, private practitioners and hospitals can use it to issue tokens to patients and send reminders to them about their turn, giving the patients an opportunity to plan their visits accordingly. He says, “Airtel Toky is an end-to-end solution, consisting of a display board, a handset and an annual subscription pack, which enables a doctor to set up an automated information system to keep their patients informed about their appointment status.” He further goes on the say that Bharti Airtel has already started promoting the service

to the end customers by providing live demos and educative sessions for doctors and hospitals. The strategy to first tap Tier-I cities within the country and then branch out to other cities. When asked about any tie ups made so far, Jain replies, “Since we have just launched this service we have not made any tie-ups. We have already started our promotional activities and are looking forward for tie-ups.” Speaking about the future plans for Airtel Toky, Jain also informs that the company will also introduce this product in other sectors such as, restaurants, banks etc. raelene.kambli@expressindia.com DECEMBER 2012

M|A|R|K|E|T SURGERY WORKSHOP

Study

Research report on ‘Indian Immunization Programme’ released on Children’s Day Commemorating Children’s Day, Imprimis Research and Advocacy released ‘Indian Immunization Programme – A Literature Review’ to highlight the key challenges affecting universal vaccination for kids in the country and provide a plan of action for improvement in the future. The report provides insights pertaining to vaccination under one cover, presenting a fresh perspective on the Indian immunisation programme. The report shares the lessons, challenges and solutions to reach the desired goal of the universal immunisation programme. The report also highlights the main strategies to increase immunisation coverage which includes: improving access of large populations in rural areas and socially-weaker sections in urban areas, educating people about benefits of immunisation in preventing illness, disability and death, increasing awareness about available immunisation services in both urban and rural areas, expanding vaccine delivery system and cold chain equipments such as voltage stabilisers and vaccine carriers as well as, developing transportation, supply chain logistics, service delivery data and records for reporting mechanis. the report additionally, includes information on drafting state-specific action and micro plans identifying objective, strategy, expected output and budget for the activity—to facilitate achievements of statelevel immunisation coverage parity in India. Aman Gupta, CEO, Imprimis PR said, “Vaccines are a crucial and economically viable instrument for any country to manage its disease burden. This study breaks new ground in identifying strategic action plans to increase the immunisation coverage in India.”

EH News Bureau

DECEMBER 2012

Yashoda Hospitals conducts international live surgery workshop It was the first ever live workshop on on minimally invasive spine surgery and world renowned German Spine Surgeon, Prof. Jörg Franke led the workshop as a faculty ashoda Group of Hospitals organised an international live surgery and hands-on workshop on minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) in Hyderabad. Distinguished International Surgeon Prof Jörg Franke, Director, Clinic for Spine Surgery, Klinikum Dortmund, Germany, presided over the workshop as a faculty. The goal of the international workshop was to bring the benefits of minimally invasive spine surgery (MISS) including its safety and efficacy. MIS TLIF is performed to relieve intractable back pain,numbness, tingling and weakness, restore nerve function and prevent or stop abnormal motion in the spine.While traditional lumbar fusion surgery involves a long incision, significant blood loss and injury to the back muscles, MIS-TLIF is performed through smallhole incisions resulting in a faster recoverywith less tissue damage and less pain. This results in fewer infections (surgical) and decreased intake of pain medication, and patients can usually resume all normal activities

two to three months after surgery.The workshop featured live surgery, interactive lectures and sessions and trutrainer workshop on minimal invasive TLIF and percutaneous fixation. The workshop also opened up discussions on the epidemiology, risk factors and management of spine diseases. More than 250 orthopeadicians, neurologists, spine surgeons from all over the country attended the

workshop. Live MIS TLIF and MIS Discectomy were performed at Yashoda hospital, Secunderabad and relayed to all the participants who watched the procedures and interacted with the faculty. Besides this, doctors attending the workshop had the opportunity to attend TruTrainer workshop on MinimalInvasive TLIF and Percutaneous Fixation. Speaking on the occasion, Spine Surgeon Yashoda

Hospital, Secunderabad, Dr Sanjay Kalvakuntla who is the Organising Secretary and Faculty of the workshop said, “Having matured as a completelyindependent field of surgery, spine surgery is now blossoming into the realm of minimally invasive spine surgery (MISS). This scientific session provides the latest and greatest in the field of MISS related to Lumbar Discectomy and Transforaminal Lumbar Interbody Fusion with P e r c u t a n e o u s Instrumentation. These are two of the most common procedures in spine surgery and should be the very first procedures to be learnt by any specialist spine surgeon. Dr. Franke from Germany is a world renowned spine surgeon in this field and this session is bound to be a highly instructive and educative exercise.”Using this interactive platform that combined live surgery presentations and break-out discussions, all the attendees discovered the latest surgical techniques available to improve patient care and optimize outcomes. EH News Bureau

MEDICAL TECHNOLOGY

Accuray brings CyberKnife VSI Systems to India Medanta - The Medicity Cancer Institute, and the Roentgen-BLK Super Speciality Hospital are the two institutes to acquire this system for full-body radio-surgery ccuray Incorporated's CyberKnife VSI System, for full-body radio-surgery has been recently acquired and adopted at Medanta - The Medicity Cancer Institute, and the Roentgen-BLK Super Speciality Hospital. By enriching their therapeutic offerings in radiation oncology, Medanta - The Medicity Cancer Institute and the Roentgen-BLK Radiation Oncology Center can now provide patients treatment with the CyberKnife System and expand the patient population that can now benefit from CyberKnife radiosurgery and stereotactic body radiation therapy (SBRT) in the region.

“The CyberKnife System is increasingly being used as an alternative to conventional radiation therapy in situations where its targeting accuracy allows a shorter and more intense course of radiation, including radiosurgery for brain tumors. We are pleased to have introduced this innovative technology at Medanta and look forward to witnessing the benefits that the System offers, including real-time tracking with automatic correction of tumors that move throughout the body. The CyberKnife System comes as a significant development in cancer therapy for patients as well as doctors as it offer the most precise treatment option for a wide range of www.expresshealthcare.in

patients,” said Naresh Trehan, MD, Chairman and Managing Director of Medanta - The Medicity. “We are always refining radiation oncology treatment methods to deliver the highest-quality patient care possible, while working to also reduce or eliminate the side effects that accompany radiation treatment. Using the CyberKnife System allows our radiation oncologists to provide the most up-to-date technology available to accurately target tumors, deliver treatments with pinpoint accuracy and ensure that tumors get the most effective ablative dose while healthy tissues and critical structures are spared,” said Praneet Kumar, MD, CEO of

Roentgen-BLK Radiation Oncology Center. Building upon the foundation of accuracy and precision in radio-surgery, the CyberKnife System extends these benefits to fractionated high precision radiation therapy with robotic intensity-modulated radiotherapy (IMRT) that can be delivered anywhere in the body, including intracranial, head and neck, spine, lung, liver and prostate. The enhanced spectrum of treatment options allows for more customised treatment plans based on patient-specific situations and conditions, such as patients requiring re-irradiation of previously treated area, or patients requiring partial breast irradiation. EH News Bureau

EXPRESS HEALTHCARE

M|A|R|K|E|T

Research GUIDELINES

Quintiles study confirms validity of data from patients recruited over the Internet’ new pilot study from Quintiles’ Digital Patient Unit (DPU) confirms the reliability of patient-reported outcomes collected via patients recruited over the internet, demonstrating the viability of a new method for observational research that combines patient-reported outcomes and medical record data (PRO+MR). Findings demonstrate that patients can be recruited, screened and enrolled directly from online patient communities for observational studies that collect patient-reported-outcomes and clinical data with 75 per cent of physicians contributing medical record information. A Quintiles-authored article on the PRO+MR study, “Conducting Research on the Internet: Medical Record Data Integration with Patient-Reported Outcomes,” has been published by the peerreviewed Journal of Medical Internet Research.The study profiled in the article found that patients can be recruited directly for observational study designs that include patient-reported outcomes and clinical data with ~75 per cent of physicians contributing medical record information. In the study pilot, nearly all charts confirmed patient-reported diagnoses. “Results of this pilot study are a positive step forward in confirming the viability of the PRO+MR direct-topatient study approach,” said study co-author and Quintiles DPU Vice President Elisa Cascade. “Utilising direct-to-patient techniques for real-world data collection not only work in pilot, but we are also leveraging in practice,” added Rich Gliklich, MD, President of Quintiles Outcome. “Given the widespread demand for rapid data collection, directto-patient studies will become an increasingly important component of real world evidence development for understanding appropriate cohorts from treatment patterns to safety information.”

EH News Bureau

EXPRESS HEALTHCARE

FIT India and BD India launch insulin injection guidelines Guidelines to promote best practices in injection technique for diabetes patients and healthcare professionals etc.

Raelene Kambli, EH News Bereau

So far, no recommendations or consensus statements have addressed such issues prevailing in developing countries such as India. A scientific advisory board of well-known endocrinologists and diabetes experts compiled the FIT India guidelines based on clinical evidence, implications for patient therapy and the judgement of a group of experts. Speaking to Express Healthcare, Dr A Sundaram, Retd HOD, Department of Endocrinology, Ambedkar Institute of Diabetes, Govt Kilpauk Medical College, Kilpauk, Chennai and one of the members of FIT advisory board said, “It is important to inspect and palpate the sites of injection. As a teacher I

orum for Injection Techniques (FIT India) and BD India have come together to launch the first Indian clinical recommendations for best practices in insulin injection techniques. This was done in order to promote best practices in injection technique for diabetes patients and healthcare professionals. The recommendations include several factors, such as: the method of administration, dosing, compliance, selection of injection site, depth of the injection, time lapse before withdrawing the needle and misconceptions about insulin therapy, influence the success of insulin injection therapy

feel there is a need for insulin injection guidelines for doctors during/after graduation as it is not a part of their curriculum. It was my dream to set such guidelines to be followed by doctors, practitioners, diabetes educators and nurses. These recommendations will bring uniformity in insulin injection technique throughout the country and help discipline healthcare providers to follow a set of rules thereby help people living with diabetes. Moreover, it will help the doctors and HCPs to impart right knowledge about insulin injection techniques which in turn will help the patients to lead good quality of life by achieving normoglycemia”. Adding to this, Dr Manash P Baruah, Department of

Insulin injection recommendations Needle length

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For children and adolescents, a 4, 5, or 6 mm needle should be used.A1 Adults, including obese patients, can use 4, 5, and 6 mm needle length. A1

Site rotation

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An easy-to-follow rotation scheme should be taught to the patients from the onset of injection therapy. A2

Needle/syringe hygiene

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Do not reuse needles. A2 Use a new needle for each injection. A2

Lipohypertrophy

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Injection sites should be inspected at every visit. Patients should be taught to inspect their own sites and should also be given training on how to detect lipohypertrophy. A2 The best current strategies to prevent and treat lipohypertrophy are to rotate the injection sites with each injection, using larger injecting zones and non-reuse of needles. A2

●

Injection sites

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Injection should be given at a clean site with clean hands. A2 Prior to the injection, the site has to be palpated for lipohypertrophy and inspected for wounds, bruises, or blisters. If the injection site shows any signs of these, then a different site should be selected until the problem has been resolved. A3

Safety issues

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Safety needles should be recommended whenever there is a risk for a contaminated needle-stick injury. B1

Endocrinology, Excel Center, Guwahati stated, “Correct insulin injection technique is critical for optimal control of diabetes. Improper use or reuse of injection devices, such as needles, may lead to undesirable consequences including pain with bleeding and bruising, breaking off and lodging under the skin, contamination, dosage inaccuracy and lipohypertrophy. Appropriate injection technique is thus an indispensable part of diabetes management. The FIT India guidelines have been developed based on these facts, and more so at a time when the government is taking every step to manage the disease in India.”Additionally, Dr Laurence Hirsch, VP Global Medical Affairs -Diabetes Care, BD Medical , said, “The India recommendations for doing the insulin injections are simple. These should help diabetes educators, nurses, or practitioners who teach people how to give injections." Speaking about BD's association with FIT guidelines, Dr Hirsch added, “Living with diabetes is a challenge. Until a cure is found, BD’s goal is to make disease management as comfortable as possible for people with diabetes, which increases the likelihood that they will adhere to their treatment. Injecting insulin every day can cause discomfort for patients and is particularly challenging for parents of children with diabetes. BD is committed to improving the injection experience, as demonstrated by our long history of innovative firsts, including the first insulin syringe in 1924 and the first 5mm pen needle in 1999”. raelene.kambli@expressindia.com

DEALS

Skanray Healthcare to buy L&T's medical equipment business Skanray Healthcare is into diagnostic imaging products &T is set to sell its medical equipment business known as L&T Medical & Systems to Skanray Healthcare. L&T's medical business segment includes a

range of products and equipment, including patient-monitoring systems such as ECG, pulse oximetry, invasive BP, capnography and anaesthesia gas monitor. www.expresshealthcare.in

Skanray Healthcare, owned by Skanray Technologies, is involved in the business of diagnostic imaging products and primary healthcare devices and spe-

cialises in high frequency Xray imaging systems, critical care devices and primary healthcare and telemedicinecompatible devices. EH News Bureau DECEMBER 2012

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

International Fellowship on Health Technology Assessment The event will offer training on selection and use of health technologies for optimum results mrita Institute of Medical Science is organising first International Fellowship on Health Technology Assessment from December 9-16, 2012. It is being organised in association with Joanna Briggs Institute of Evidence Based Medicine, University of Adelaide, Australia and faculty from University of Toronto as well as University of Liverpool. IIT Madras is the technical collaborator for the event. The Fellowship is empanelled with NABH. Experienced international and national faculty have agreed to participate and share their expertise during this week long international fellowship programme, which is first of its kind in the country. The objective behind organising this fellowship was to impart training to the future torch bearers of healthcare professionals on the basics of impact assessment (IA) in selection and use of health technologies by methodological approach, systematic reviews to measure clinical effectiveness, economic modelling and harm-benefit assessment through an integrated patient

safety approach. Health technology assessment (HTA) is a multidisciplinary activity that systematically examines the safety, clinical efficacy and effectiveness, cost, cost-effectiveness, organisational implications, social consequences, legal and ethical considerations of the application of a health technology—usually a drug, medical device or clinical/surgical procedure. It acts as ‘a bridge’ between evidence and policy-making and seeks to provide healthcare policy-makers with accessible, useable and evidence-based information to guide their decisions about the appropriate use of technology and the efficient allocation of resources.

Rationale for HTA The cost of new technologies, the allocation of available resources and the ethical questions involved are topics of major concern to policy makers, health care practitioners, and researchers.

Technologies examined at HTA 1. Medical and surgical procedures and other inter-

ventions and techniques 2. Devices, drugs, instruments, and other equipment 3. Structure and organisation of healthcare services 4. Supportive services to the healthcare processes

Importance of HTA to healthcare decision-makers In contrast to the licensing processes for drugs and medical devices, which assess quality, safety and efficacy, HTA focuses on ‘the value’ (clinical and economic) of the technology relative to current (or best) clinical practice—the so-called ‘fourth hurdle’.

What are the goals? Ultimate aim: Potentiate the capacity of a health system to reach its goals ● Respond to people’s expectations by providing high quality essential services on the basis of efficacy effectiveness cost and social responsibility ● Provide financial protection against the cost of ill health ● Improve the health of the population it serves

HTA broadly focuses on two questions: 1. Clinical effectiveness: how do the health outcomes of the technology compare with available treatment alternatives? 2. Cost-effectiveness: Are these improvements in health outcomes commensurate with the additional costs of the technology. HTA can help policy-makers decide which technologies are effective and which are not, and define the most appropriate indications for their use. HTA can reduce or eliminate interventions that are unsafe and ineffective, or whose cost is too high compared with the benefits. That said, to date, most international HTA activity has been directed at quantifying the use of new and expensive pharma products. Technology is a key driver of healthcare costs. Health technology assessment (HTA) plays an essential role in modern health care by supporting effective decision making in health care policy and practice. There is a

vibrant and growing community around the world of those who undertake and use HTA. HTA's mission is to support their work in promoting the introduction of effective innovations and effective use of resources in healthcare.

Specific parameters ● ● ● ●

●

Technical properties and safety Efficacy/effectiveness Efficiency (cost effectiveness; cost benefit) Impact on health system: health related, organisational and economic Social acceptability (Ethical and social aspects)

Contact Dr Sanjeev Singh, Organising Secretary, HTA & Medical Superintendent Amrita Institute of Medical Sciences Tel: +91-484-6681234 Ext 1836, 1835 Email: sanjeevksingh@aims. amrita.edu / htafellowship@aims.amrita.edu Website: www.aimshospital.org

PRE EVENT

IRIA 2013: Official meeting ground for Indian radiologists It promises to be an event that will bring together distinguished international and national radiology experts he Indian Radiology and Imaging Association (IRIA) is organising its 66th annual conference from January 4-7, 2013 at Daly College, Indore, Madhya Pradesh. The event will be hosted by the Madhya Pradesh State Chapter of IRIA. The annual conference of IRIA has become the official meeting ground for the Indian radiologists to exchange their professional experiences, discuss the recent advances, know about the state-of-the-art technology in radiology and imaging sciences and educate the young radiologists and residents. IRIA has been growing continuously by integrating new developments and involving more and more radiologists, not only from

DECEMBER 2012

India but from all over the world. An excellent scientific and educational programme covering various fields of diagnostic imaging, interventional radiology and molecular imaging, is being prepared to meet the expectations of the visitors to IRIA 2013. It promises to be an event that will bring together distinguished international and national experts from the radiology field, who will present their experience on topics covering all spectrums of radiology. In this regard, a comprehensive scientific programme is also designed. This event will be an opportunity for the participants of all sub-specialities to attain knowledge about cutting edge technology. In addition, this event

Last year’s visitors being informed about IRIA 2013 will be an ideal forum for networking and building lasting relations with participants from different parts of the country. www.expresshealthcare.in

Highlights of the scientific programme: ● ●

A galaxy of National and International faculty Accreditation by M.P.

Medical Council and Royal College of Radiologists ● Symposia on Radiology Journalism ● PG Teaching Course by American Institute for Radiologic Pathology, a programme by the American College of Radiology ● Pre-conference workshops ● Daily plenary sessions ● Orations, debate and image interpretation sessions by International faculty. ● "Meet the Professor" sessions for residents and students ● ESR Presents, AOSR Presents, Case of the Day ● Posters, Exhibits, Competitive Scientific Papers EXPRESS HEALTHCARE

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

MEDICALL 2013 Gujarat: Beyond Hospital & Medical Equipment MEDICALL 2013's focus is on taking Indian medical technology to the next level and will be held at Gujarat University Exhibition Hall, Ahmedabad, Gujarat

The MEDICALL Team : Yogita Panchal, Dr S Manivannan and S Sundararajan at Medicall 2012 in Chennai

MEDICALL Innovation awards recognised healthcare players for their innovatiions at Medicall Chennai he hospital industry is an important component of the value chain in Indian healthcare industry, rendering services and recognised as healthcare delivery segment of the healthcare industry, which is growing at an annual rate of 15 per cent. The size of the Indian healthcare industry is estimated to be a whopping $280 billion by 2022 and slated to grow at 15 per cent CAGR. According to a WHO report, India needs to add in excess of 80,000 hospital beds each year for the next five years to meet the demands of its growing population. Rising incomes and a growing elderly population are all factors that have triggered the demand for highquality medical care, trans-

EXPRESS HEALTHCARE

forming the healthcare delivery sector into a profitable industry. 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. India’s excellence in the field of modern medicine coupled with its ancient methods of physical and spiritual wellbeing make it the most favourable destination for good health and peaceful living. India’s cost advantage and explosive growth of private hospitals, equipped with latest technology and skilled healthcare professionals has made it a preferred www.expresshealthcare.in

destination for medical tourism. The above has served as a perfect backdrop and initiated the need for a comprehensive insight on hospital industry. When it comes to naming successful events which bear a tremendous influence on the industry they represent, Medicall gets top of the mind recall. It is India’s premier medical equipment expo and a “supermarket” for hospital equipment and supplies. Its comprehensive range of exhibits include hospital information systems and solutions, surgical and examination furniture, rescue and emergency equipment, diagnostic/laboratory, OT equipment, refurbished equipment, hospital linen and laundry, nurse alarm systems, ambulance, hospital flooring, housekeeping equipment, liquid oxygen and central pipeline, physiotherapy equipment, autoclave and steriliser, dental/ophthalmology equipment, medical disposables and cleaning equipment. Medicall continues to draw the highest percentage of hospital owners, doctors, medical directors and purchase heads in addition to being a proven and highly successful platform for attracting affluent producers, dealers and suppliers. The previous Medicall attracted over 430 exhibitors and over 8000 quality visitors mostly from the its core target group, which speaks volumes about the credibility of the event. Now in its tenth edition, Medicall 2013 Gujarat will be hosted from February 8-10, 2013 at Ahmedabad. It will bring together the best in the business of ICU and operation theatre equipment, refurbished equipment, trolley, wheel chairs, cots and other furniture, hospital linen and laundry, hospital charts and stationary, office automation equipment, printers dealing with pamphlet and file designing, communication equipment, medical disposables etc. Special products at display will be ambulance, mannequins and other teaching aids for nursing, hospital management software, energy saving equipment, hospi-

tal flooring, housekeeping equipment, nurses alarm system, liquid oxygen and central pipeline, physiotherapy equipment, autoclave and sterilisers etc. Gujarat is the venue of choice because the state government is taking several initiatives to make Gujarat a global healthcare destination. Through use of latest technical equipment, increased health insurance, major corporate investments and services of highly skilled medical personnel, the Gujarat healthcare sector is poised well for a sustained boom. Medexpert, the organisers of Medicall, are a known name in events and trade shows for the healthcare industry. Hence, the total number of exhibitors will be 300 companies for the second time at Gujarat - mainly medical equipment manufacturers. With such an impressive showing, the organisers expect close to 5000 quality visitors including those from countries like, Srilanka, Bangladesh, Africa, Nigeria and Ghana. Conferences at Medicall 2013 Ahmedabad is on the theme 'Good to Great' where sub topics like family owned hospital to a professionally managed hospital brand, person dependent to system dependent hospital, panel discussion on buying a doctors practice. other interesting seminar is on hospital material management – vendors management, how to prevent pilferages, panel discussion on best practices in material management. There is also a seminar on internal audit on the last day. Thus, Medicall 2013 promises to be bigger and more incisive in terms of content and participation. In turn, it will provide a big fillip to the healthcare in general and medical equipment industry in particular. Medexpert also is organising a show in Srilanka from March 15-17, 2013 and Chennai from August 2-4, 2013. Contact: Yogita Panchal, info@medicall.in, panchal@medicall.in www.medicall.in DECEMBER 2012

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

IHP hosts expert roundtable for improving healthcare access Experts stress on the ‘shake-hand’ approach and opine that there is a need for technologically and human resource-driven delivery, along with partnerships among different stakeholders rom diagnostics to patient safety groups; representatives from Indian and global pharmaceutical companies to specialist doctors -- a varied and distinguished panel represented all aspects of the broad healthcare spectrum at the recently concluded roundtable hosted by India Health Progress in New Delhi. The roundtable titled, ‘Making Access to Healthcare a Reality: Role of Stakeholders in Ensuring Continuum of Healthcare’, was organised to discuss measures to overcome various bottlenecks in providing quality as well as cost-effective medical services to each person in India, even in the remotest corners of the country, and outlined the role each stakeholder can play in making this valuable objective a reality. Dr YK Gupta, Professor and Head, Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), New Delhi delivered the keynote address while highlighting the state of affairs and health issues in India. “Healthcare accessibility has to be technologically driven so that good health reaches the remotest of areas

in the huge landscape of the country. The preventive aspect of healthcare has to be emphasised with a grassroot change of mindset. An understanding about maintaining good health and lifestyle management needs to be developed. It requires an enormous effort in the right manner to provide accurate, fast and quality diagnosis; and also put an end to sub-standard spurious medicines. Health policies must be implemented besides fresh introductions. A ‘Shake Hand’ or cooperative approach and an end of the blame game are the

The roundtable discussed measures to overcome bottlenecks in providing quality and cost effective medical services to each person in India

needs of the hour to make each and every Indian get access to good health,” said Dr Gupta. IHP’s Principal Advisor, Aman Gupta said, “Inaccessible healthcare is a bitter reality in India and this is now increasingly being recognised as the underlying cause of all health concerns in the country. Since its inception almost two years ago, IHP has successfully acted as a catalyst in highlighting the essentiality of ‘healthcare access to all’ at all times. Such an expansive mission requires a collaborative effort involving all stakeholders in the healthcare industry as each has a distinct role to play in achieving this all-inclusive goal. Discussions like these are more about solutions rather than the problems and chalking out a roadmap of how to reach the desired objective of enhancing the accessibility of medical services.“ Besides accessibility, issues related to affordability and quality were emphasised by Brig Dr Arvind Lal, Chairman, Dr Lal Pathlabs; he stressed that the government must connect with the private sector and work with it in an effective manner to reach out to the masses. Dr

The IHP roundtable discussed the role of each stakeholder in reforming the healthcare industry in India DECEMBER 2012

www.expresshealthcare.in

Nimesh Desai, Director, Institute of Human Behaviour and Allied Sciences (IHBAS) affirmed the openness for partnerships by various stakeholders involved as well as prioritising appropriate empowerment of healthcare personnel such as pharmacists, nurses and social workers. Gupta added, “A collective effort will only help develop the deficient aspects of human resource, technology, economic viability, quality and sustainability in the healthcare sector. IHP believes that solving the access problem will need a combination of regulation and innovation in terms of service delivery, medical education and healthcare financing.” The experts who participated in the contemplative discussion include: ● Brig Dr Arvind Lal, Padma Shri, Chairman & Managing Director, Dr Lal PathLabs ● Dr AK Jhingan, Delhi Diabetes Research Centre ● Ameesh Masurekar, Founding Director, AIOCD Pharmasofttech AWACS ● Dr Nimesh Desai, Director, IHBAS ● Dr Pervez Ahmed, Founder Chairman & Managing Director, Apka Urgicare ● Ranga Iyer, Independent Expert ● Ratna Devi, Independent Expert on Public Health ● Dr Usha Shrivastava, Public Health Expert ● Vishal Gandhi, Managing Partner & CEO, BioRX Venture Advisors ● Viveka Roychowdhury, Editor, Express Healthcare ● Dr YK Gupta, Professor and Head-Department of Pharmacology, AIIMS ● Aman Gupta, Principal Advisor, India Health Progress ● Amiee Adasczik, Assistant Vice President, PhRMA The event was supported by PhRMA as part of the ongoing commitment of global, innovative pharma companies to be a solution partner in advancing a safe and effective healthcare system in India. EXPRESS HEALTHCARE

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

HospiFinMark highlights marketing, financing strategies for mid-size hospitals It was attended by around 250 delegates representing various segments of the healthcare spectrum admashree Dr DY Patil University, Department of Business Management (DYPDBM) in Navi Mumbai hosted the 4th National conference on Health and Hospital Management - Hospi - Fin – Mark (Hospital Finance & Marketing....Secrets Revealed..!) on November 24, 2012. It was an interesting event which dealt with the current trends and changing patterns of hospital financing and marketing. Nearly 250 delegates ranging from hospital promoters, managing/ medical directors, hospital administrators/managers/exe cutives, clinicians/consultants/doctors, other healthcare professionals, students (MHA/PGDHA),etc benefitted from this mega conference. The session was inaugurated by Dr Sanjay Oak, Vice Chancellor, Pad. Dr. DY Patil University and Varun Khanna, Regional Director for Western & Eastern India, Fortis Healthcare. Speaking on hist topic, “Healthcare Financing: Vision for tomorrow”, Dr Oak stated, “The role of health economists should be recognised. Health financing cannot be dealt with separately as it has got to do with good governance, economic growth, education. Social inclusion and financial protection needs to be provided through community based financing.” He also threw the light on importance and rationale for the focus on health financing, the different mechanisms of financing, community based financing and health financing in India. Enlightening the delegates on the principles of hospital finance and marketing, Khanna mentioned, “Gone are the days of typical marketing strategies of reference and plain advertisements. We witness a lot of newer trends namely, social marketing, e- marketing, media utilisation, etc”. He also reviewed the various marketing strategies used by Fortis Healthcare including the recent Guinness World Record of most number of children sanitising their hands in one minute.

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The panel discussion

Welcome address by Dr Nitin Sippy, National Convener, Hospi - Fin – Mark Delivering the welcome address, Dr Nitin Sippy, National Convener, Hospi Fin – Mark opined, “Good treatment is good business but it is not vice versa. For proper patient care and good quality treatment to be delivered by any healthcare institution, irrespective of its size, it needs a strong financial partner and a splendid marketing face. We intend to highlight these core areas of hospital administration for the small to medium healthcare providers from various parts of country.” Setting the theme of the conference, Dr R Gopal, Director & HOD, DYPDBM stated, “The healthcare sector in India is a booming market, offering a wide array changing pattern of hospital financing and marketing. Hospi - Fin - Mark 2012 aimed at providing a platform to the participants to interact with the best and the brightest hospital and healthcare experts. Apart from this, it gave a platform to the participants to showcase their ideas and talents.” Narendra Karkera,

Dr Sanjay Oak

Varun Khanna

Director, Operations, HOSMAC India spoke on costing and budgeting for hospitals encompassing the methodology of costing, operational budgeting, expenses, etc. This in-depth analysis gave a deep insight on the financial aspects of any hospital regardless of its size. Post lunch, Sandeep Sinha, Director, Southeast Asia & Middle east, Frost & Sullivan gave a exemplary session on “Vision 2020: How can a mid size hospital be part of growth in Indian

healthcare”. He mentioned, “There is an increasing interest among private equity funds , domestic and international financial institutions, venture capitalists and banks to examine the investment opportunities across the extensive range of healthcare segment”. The panel discussion on “Varietal Branding and Marketing Strategies for Small to Midsize Healthcare providers” was moderated by Dr Shirish Patil, Dean, Pad. Dr.DY Patil Medical College.

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Gaurav Malhotra, MD & CEO- Patni Healthcare mentioned the various changes in healthcare marketing strategies and his varied experiences right from Baush & Lomb to Medfort Hospitals and the present Patni Healthcare. Viveka Roychowdhury, Editor, Express Healthcare and Express Pharma gave a perspective that the branding, financing and marketing efforts of small and mid-sized hospitals should strategically highlight certain aspects to differenciate themselves from their larger counterparts so that they can identify patient categories unserved by larger players. Dr Sanjit Paul, Managing Trustee, Platinum Hospitals mentioned the marketing process and its impact when implemented by Platinum Hospitals. It was interesting to note his comments on how marketing influenced the growth of this group. Dr Rajendra Patankar, Sr GM, DM Healthcare commented on the strategies used by their upcoming hospitals namely Aster Aadhar Hospital, Kolhapur and Aster Eye care in NCR. Dr Yasmin Shaikh, GM, Marketing & Corporate Communications, Gleneagles Khubchandani Hospital, Juhu shared her experiences with conceptualising and implementing branding strategies in Aditya Birla Memorial Hospital, Pune and then as Head Marketing of Umrao Hospitals. She was also asked to compare them with the marketing strategies of hospitals in the Middle East region, which threw up some intriguing insights. Dr Bipin Chevale, Medical Superintendent, Fortis Vashi compared the different marketing strategies of Bombay Hospital (as he has been associated with both the Mumbai and Indore facilities) and Fortis Vashi and concluded that though each hospital used a different strategy, they both achieved their objectives. With this mammoth success, the organising team has promised a larger scale edition of HospiFinMark next year. EH News Bureau DECEMBER 2012

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EVENTS UPDATE EyeStrat12 CHENNAI

Health Technology Assessment

Date: December 1, 2012

Date: December 9-16, 2012

Venue: The Raintree Hotel, Anna Salai, Chennai

Venue: Amrita Institute of Medical Science

Summary: A one-day conference on strategic management and marketing for eye hospitals & ophthalmic professionals. The event will be organised by AMEN & Pranav Healthcare. Participant profile: Eye hospital promoters, CEOs/COOs, administrators, managers, executives, healthcare management consultants, ophthalmologists Contact details: Mob: 09035189824/25 Website: http://eyestrat.blogspot.in/

PeopleHosp CHENNAI Date: December 5, 2012 Venue: Hotel Marina Towers, Egmore, Chennai Summary: A one-day conference on strategic human resource management for hospitals Participant profile: Hospital/Healthcare promoters, CEOs/COOs, administrators, HR managers, HR executives, healthcare management consultants Contact details: Mob: 09035189824/25 Website: http://amen-peoplehosp.blogspot.in/

HospiArch VIZAG Date: December 8, 2012

Summary: Amrita Institute of Medical Science is organising the first International Fellowship on Health Technology Assessment in association with Joanna Briggs Institute of Evidence Based Medicine, University of Adelaide Australia with faculty from University of Toronto& University of Liverpool. The technical collaborator is IIT Madras. The Fellowship is empanelled with NABH. Participant profile: Hospital and healthcare administrators and CEO's, MS, COOs, decision makers, finance officers, medical professionals, fresh graduates in medical/bio-medical/pharma/hospital management Contact details: Dr Sanjeev Singh Amrita Institute of Medical Sciences +91-484-6681234 Ext 1836, 1835 Email: sanjeevksingh@aims.amrita.edu / htafellowship@aims.amrita.edu Website: www.aimshospital.org

FICCI Health Insurance Conference-2012 Date: December 10, 2012 Venue: FICCI, New Delhi Summary: Federation of Indian Chambers of Commerce & Industry is organising 5th FICCI Health Insurance Conference, on the theme 'Getting Behind the Numbers.'FICCI’s endeavour, through this conference, is to identify key areas where data analytics can be meaningfully used and its benefits to achieve objectives of growth and expansion of the health insurance sector for both the private and government sponsored health insurance schemes.

Venue: Vizag Summary: A one-day conference on hospital planning, design and architecture will be organised by AMEN & Hospaccx India Systems Participant profile: Hospital/healthcare promoters, CEOs/COOs, administrators, managers, executives, Healthcare Management Consultants, Architects Contact details: Mob: 09035189824/25 Website: http://amen-hospiarch2012.blogspot.in

DECEMBER 2012

Participant profile: Representatives from the health insurance industry, life insurance industry, non- life insurance industry, healthcare providers, MHIs, NBFCs, insurance brokers, agents, clinical experts etc. Contact details: Sidharth Sonawat/Sudhiranjan Banerjee FICCI Federation House, Tansen Marg New Delhi-110001 Tel: 011 23487246, 23487220, 011 2373 8760– 70 (Extn. 246/220) Fax: 011 2332 0714, 011 2372 1504 E-mail: healthservices@ficci.com, www.ficcihic.com

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Green lean six sigma certification training for healthcare Date: January 4 - 20, 2013 (Fridays, Saturdays and Sundays only) Venue: Mumbai Last date to register: December 28 2012; Friday 5:00pm Venue: Bangalore Date: 6-8 February, 2013 (Yellow belt training) 11 – 16, 2013 (Upgradation to green belt training) Last date to register: 18 January, 2013; Friday 5:00pm Venue: Delhi Date: 1-17 March, 2013 (Fridays, Saturdays and Sundays only) Last date to register: 6 February 2013; Wednesday 5:00 pm Summary: This programme module is specially designed for hospital managers and other healthcare professionals and shall focus on six sigma methodologies, lean concepts in healthcare systems and service delivery. The programme smoothly integrates healthcare service delivery with six sigma, lean management concepts and in its ability to build six sigma professionals to cater to three most important aspects of healthcare service delivery (safety, efficiency and efficacy) and maintain an equilibrium with customer satisfaction, costs and sustain the quality achieved. Organisers: AUM MEDITEC, A hospital planning and management consultancy organisation Participant profile: Hospital CEOs /COOs, management executives, hospital operations managers, quality in charge, MHA/PGDHA/MBA (Hcm) final year students Contact: Meeta Ruparel. meeta@meditecindia.com,

Medicall 2013 Date: February 8-10, 2013 Venue: Gujarat University Exhibition Hall, Ahmedabad, Gujarat Participant profile: Doctors, hospitals owners, diagnostic centres, medical directors, biomedical engineers, medical colleges, health care services, investors for health care industry, purchase managers Contact details: Medexpert Business Consultants C-3, Shree Vidya Apartments, 14 Balakrishna Street, West Mambalam, Chennai - 600 033 Tamilnadu, India Phone: 91 44- 24718987 Contact:Yogita R Panchal (panchal@medicall.in) Mob: +91 9360727424

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Hospital Infra MAIN STORY

Patient safety during renovations Meeta Ruparel, Director, AUM MEDITEC gives an insight on the various measures that must be enforced to ensure patient safe practices during renovations/ expansions in healthcare set ups

MEETA RUPAREL,

Director, AUM MEDITEC

ealth and safety of all; patients, visitors, staff and society in general is of utmost importance. Health and safety programmes must therefore be in place to protect patients, property, society as well as the environment, and at the same time also comply with applicable regulations and safety norms at all times. In general, good hospital designs insist on considerable measures in the design aspect for safe practices. However, it is often observed that these safety designs and systems eventually are questionable when a hospital is under renovation or in for an expansion. It so happens that during such an activity, there is a tendency to neglect certain protocols and maybe even overlook certain opportunities of risks which may be bold and underlined but still submerged under the sea of additional renovation activities. These renovation/expansion activities have strong properties of being less visible and hence are overlooked or ignored, thereby presenting a greater risk to patients and staff and making the facility vulnerable to various safety issues.

Some examples of activities that impact the environment: ● Renovation of patient rooms or a running facility. ● Adding network cabling for fire control systems, nurse call/communication systems, TV systems/electrical system updates, etc. ● Installing or removing cabling above drop ceilings ● Adding new space/expansion – construction work ● Adding/repair/replacement of equipment with electronic cabling, plumbing and pneumatic systems. ● Removing ceiling tiles to access plumbing and cabling networks. ● Maintenance work like replacing ceiling tiles, etc. ● Demolition work like removal of pipes, electrical cables, etc. ● Remedial work like removal of asbestos or moulds, etc. DECEMBER 2012

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Furniture repairs. Painting Any kind of work of construction/renovation induces a noticeable percentage increase of dust particles in the environment, debris and other multiple wastes on floor and an impact full increase in the work population. All these are instrumental to many a risk opportunities for patient safety. Some examples of possible impact due to repair/construction/renovation activities in hospital facilities: ● Renovation/construction/repair activities are generally executed by external parties (outsourced contractors). This results in an increase in number of people in the premises in comparison to the average population in a normal situation. Often these contractors assign workers on a daily basis tending to complications in identity and access security systems. ● Prolonged work results in ignorance of presence of these external workers in the routine systems and so the employees tend to be less alert, exhibiting another risk of easy access by an unidentified person and inducing risk opportunities like thefts, abduction, etc. www.expresshealthcare.in

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These workers by and large work without health protective gears; they may be using protective gears against physical harm in terms of injuries/ accidents, etc.; but not following any measures to protect themselves from hospital acquired infections (HAI), etc. Thereby becoming an important open channel of HAI and health risks thereof. Some renovation/construction/repair activities are likely to create particles that tend to remain suspended in the air (aerosolised). For e.g;. a commonly found fungus Aspergillus spp in indoor environments feeds on dirt and dust particles and cellulose-based building materials, resulting in patients with suppressed immune systems susceptible to developing a potentially life-threatening infection “aspergillosis” Construction/renovations results in additional noise in the environment that discourages patient comfort and employee stress levels too. Renovation/repair activities generate a negative impact on smooth functioning of daily activities and may result in negli-

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gence in following important safety protocols. For e.g. skipping a routine housekeeping/cleaning protocol or handling of waste protocol, information management and confidentiality protocol, etc. Often there are temporary shifts of departments or services during renovations/repairs that creates confusion amongst patients, relatives and staff thereby inhibiting traffic control within the hospital. Extra work hours and changes in shifts tend to stress the employees and create employee dissatisfaction scenarios. Renovations and repair jobs often leave a lot of unwanted objects on the floor or by the wall that effect the transportation and internal mobility of the hospital. Spills, plumbing breaks, water leaks/gas leaks, etc also affect similarly. There may be a risk of disruption of a particular service like electrical failure/ water supply (water contamination) or food contamination/medical gas supply issues, etc., and impact smooth functioning. Any power fluctuations and load impacts due to ongoing work may damEXPRESS HEALTHCARE

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age the medical equipment or computers installed. Finally all renovations/ repairs/expansions during care delivery in a running and occupied hospital does have an unfavourable impact on the image of a hospital.

Exploring some safety determinants during renovations/expansions in a running hospital; I identified 10 crucial safety considerations: ✦ Infection control ✦ Dust and debris control ✦ Waste disposals ✦ Drug pilferage control, theft and abduction control ✦ Health hazard control ✦ Noise control ✦ Information management ✦ Employee safety ✦ Infrastructure damage control ✦ Image damage control. Steps that can be taken to control dust and airborne particles that impact an environment and infection control: ✦ Execute work methods that minimise raising dust from construction/repair work. ✦ Install barriers to prevent dust from entering patientcare areas. ✦ Ensure that these barriers are in compliance with local fire codes and are impermeable to fungal spores. ✦ All windows and outside doors should remain closed, to preclude the bypass of unfiltered air. Windows or openings to the work area may be open if the windows are within the site barriers and the bypass of air to other patient area is prohibited. ✦ Use prefabricated plastic c o n t a i n m e n t systems/plastic sheets to control dust, wherever necessary. ✦ Use HEPA vacuums to clean surfaces. ✦ Take adequate measures to prevent airborne dust from dispersing into HVAC and the atmosphere. ✦ Instil enclosures with negative pressure to control dust within and HEPA filtration in work areas adjacent to patient areas for proper air filtration and use exhaust systems to directly exhaust air outside. ✦ Implement measures to ensure full particle containment. ✦ If an activity involves the possibility of exhuming fumes or vapours in or

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near the patient area the contractor should notify the hospital engineering team and safety team to preclude the exposure of patients, visitors, and staff. ✦ Ensure immediate repairs of openings/breaks in walls, window frames, etc., to preserve fire/smoke protection barriers and a clean environment. ✦ Ensure optimal maintenance of all engineering controls. ✦ Ensure immediate repairs of water leaks if any because it can become reservoirs for fungus. ✦ Document, record and monitor pressure conditions between contained work areas and adjacent atmospheres. Instil a system to measure and monitor airborne particle counts before, during and after the activities. ✦ Air scrubber can be installed in large containment areas to control airborne particles and environmental dispersions. Hospital employees understand infection control policies and are trained in methodologies and measures to be taken for infection control in a hospital environment, to not only ensure patient safety but also personal health safety. However, the construction workers/external labourers that work during construction/repair/renovation work may not be trained nor sensitised on issues like HAI / health and safety /patient safety, etc. Ways and measures to take to address this specific safety issue: ✦ Implement effective infection control monitoring systems. ✦ Deploy an inspection team that inspects the area to determine possible infection risk to construction workers prior to the start of the project and instils adequate measures to remove these hazards prior to initiation of the projects. ✦ This inspection team should continue to monitor and control the risk assessments defined and identified. ✦ Emphasise that construction workers, if sick with a potentially contagious sickness, do not report to duty. ✦ Explicitly specify and encourage use of PPE (personal protective equipment) by construction workers wherever necessary for their health safety. www.expresshealthcare.in

✦

Encourage a system of monitoring radiation impacts and safety precautions for workers exposed to radiation while working in such areas. ✦ Sensitise and orient workers on safe handling of needles or sharps or medical devices found during construction. ✦ Instil a system of reporting and precautions thereof for any potential risk exposure (for; e.g. needle prick/sharp injury/cold and flu at work, etc.) ✦ Implement a friendly atmosphere for effective communication of problems and issues pertaining to the project to ensure efficient and safe practices. ✦ There is no harm in conducting a two hour sensitisation workshop amongst these workers prior to the project start to orient them to safe practices in line with hospital safety practice, to not only ensure an effective project execution but also safety of workers, staff, patients and the hospital environment. The above steps for workers' health safety and dust control measures, address the major concern of hospitalacquired infections (HAI) and dust free hospital environment, to ensure good infection control and patient safe practices during construction/renovations/repairs in a running hospital. Some other aspects of safety concerns can be addressed by taking the following steps: ✦ The infection control team with the kitchen team and the engineering team must ensure safe water supply and clean cooking areas and take adequate measures to avoid any water/food contamination. ✦ Safety aspects like security for thefts/abduction, pilferage, etc. can be addressed by instilling a tight security system with CCTVs and worker identity badges, gate passes for entry and exit of materials/equipment, etc. ✦ Encourage contractors to deploy the same work force every day to avoid any identity confusions and variations. ✦ High technology use like RFID can also be installed for efficient tracking and alert systems. Tech-savvy hospitals have also installed biometrics for appropriate identification of patients, staff and other workers. ✦ The infection control team with the housekeeping

team can sensitise and implement an additional waste disposal system during renovation / construction/repair activities; that specially take care of the additional waste generated and also ensure the routine practices of hospital waste management systems, by all. ✦ The hospital engineering team must also implement an inspection plan for infrastructural damage and repairs if any during the project execution. ✦ Implement an additional medical equipment maintenance plan to ensure regular cleaning, maintenance and safe use of medical equipment for optimal uptime. ✦ Noise control is also an important aspect to consider for patient comfort, necessitating the engineering team to take adequate measures for the same. ✦ All employees including construction workers should be sensitised on confidentiality and information security steps to be followed in advent of coming across/handling any patient record/ information. ✦ The hospital engineering team, safety team, infection control team and the contractor’s representative should deliberate a risk mitigation plan before the initiation of any renovation/construction/maintenance project. This plan can indicate the task to be done, the area of work, the impact/potential risks and precautions to be taken. ✦ The safety team can then continuously measure, monitor, evaluate and control all safety issues that may arise. If the precautionary steps were already identified, it can be evaluated and improvised and if any unpredicted event occurs, the plan could be revised for further improvisations. ✦ Document, record all occurrences and corrections and comply with all applicable regulations at all times. With such an active initiative the hospital management/administration not only portrays a sense of responsibility and accountability but also besets safe practices to ensure patient safety, employee safety and infrastructure safety at all times. The initiative positively influences image damage control and also sets an example of responsible business citizens. DECEMBER 2012

H|O|S|P|I|T|A|L|I|N|F|R|A INSIGHT

Getting mechanised in hospitals! Mohana M, Virtual Info Systems, Organisers of Clean India Show 2012 gives the mantra of 'Clean Sterilise- Disinfect' to maintain hygiene in hospitals and elaborates on the how mechanised cleaning can make the process easier

DECEMBER 2012

t is a well-known fact that hospitals are a place where people go to get themselves or their families treated of various diseases; but they have also been known to cause difficulties as people still face an overwhelming assault from germs and bacteria in hospitals. Mopping and swabbing is definitely not the only selection in today’s day and in an age where the world is advancing and medical tourism growing at 30 per cent in India alone. An industry which is booming and contributing to two billion through medical tourism alone, no chances can be taken whatsoever. India is known to offer world class healthcare treatment that costs substantially less than those in developed countries and surgeries are performed by qualified, experienced and renowned doctors. When there are no compromises made on technologies and treatments then why a delay or negligence in upgraded standards in cleaning mechanisms? Hospitals are mushrooming in India as they are being built and operated by leading industrial houses like Tatas, Hindujas, Birlas, Hiranandanis, Wockhart etc. Today people are visiting India for medical tourism not only to visit hospitals, but also diagnostic centres, medical centres, pathology laboratories, dentists, ophthalmologist etc. There is a need for advancement in cleaning technologies in these areas as well. Specialised technologies and cleaning techniques have become more essential to battle the newest strains of virus and diseases found in hospitals. So, is there a need to combine basic and traditional modes of sweeping and mopping in hospitals? Every patient visiting a hospital carries a host of viruses which need to be prevented from spreading to other patients, doctors and visitors. How one can put an end to this activity if the cleaning procedures are basic and mundane? Therefore, the need for expert and mechanised cleaning arises out of the necessity to maintain an organised and clean environment in hospitals. This provides a strong foundation for quality communication, effective management and increases work efficiency of any business. Tt is important for facility

heads to primarily understand the need for professional cleaning equipment, tools and chemicals as an essential prerequisite for better work environment and efficiency; and secondarily, to know whether the products engaged by the end users or the service providers are the right ones. There is also a constant need to continually adapt to newer approaches and means to combat the most deadly pathogens found in healthcare facilities. Moving with the trend for better and specialised technologies help facility managers locate the areas where these pathogens reside and the best procedures for eradicating them that causes illness and infections. The cleaning crews in hospitals should espouse and modify various cleaning methods across hospitals and every chamber and every bit of equipment’s that is being cleaned. Traditional cleaning in rooms where patients are being treated day and night could cause serious problems to them due to lax of professional cleaning.

Need for high level of cleanliness within hospitals When an estimated 150,000 people from world over travel to India for healthcare procedures every year, can health experts take any chances? When class and quality sets in can one have a casual approach towards something as critical and important as cleanliness in hospitals? Today, cleanliness has gained top importance with medical professionals to curb the spread of numerous diseases and protect patients from life threating infections. Hospital safety is one of the most important factors in the medical field, it is vital to ensure safety and sterilisation in hospitals every day and every time. Hospital safety and cleanliness is significant for all patients as well as the staff working at the hospital. Effective care is needed to clean out hospitals because everyday patients bring in germs, which may be dreadful if not, dealt with on time. Today, there is a pressing need to enhance the awareness about the sector specific cleaning needs. In hospitals every single thing needs to be cleaned up hence giving immediate attention needs to be given to cleanliness. Apart from this, there is a need to provide disposal refuse collecwww.expresshealthcare.in

tion products, washroom hygiene facilities, cleaning agents, cleaning tools, cleaning equipment and machinery most required for hospitals safety.

operated machine, it does not fall slack of its wired cousin in any aspect. It gives an operator the freedom of movement as there are no cords attached.

Technologies and innovations

Healthcare infection control through cleaning and sterilisation

One of the most common equipment used for commercial application in any premises is the vacuum cleaner. A hospital will not prefer vacuums with high noise levels or people tripping over cables of vacuums or wet floor owing to improper suction power. Spending on right cleaning solutions is as essential for a healthy environment as much as the right food is for the healthy functioning of the body. Recognising its importance and the need for newer technologies and innovations, Clean India Show has created a platform to bring forth latest innovations in cleaning technology, industrial cleaning, hygiene solutions, sanitation and professional cleaning in pest management, waste management, environment management and washroom hygiene management. Power-saving, low noise vacuum: Clean India Show displays dry vacuum cleaners which are eco-friendly and make less noise. While most of the cleaning requirements can be met with the low power option, the operator can switch the suction motor to high performance, if required. When switched off the unit always starts in the esave mode. Water saving and energy efficient scrubber driers: Scrubbers come in varied models like scrubber-drier, ride-on, walk-behind, batterypowered, industrial and so on. These machines breaks water economy and detergent saving barriers, allows the reuse of washing solution after the first cleaning cycle, with a series of benefits from greater run time, shorter loading-unloading of water and rationalised use of water and detergent necessary to wash. Walk behind scrubber: It enables removal of deep dirt and grouts between tiles. The positioning of the brushes and its contra rotational movement help in self propelling the machine, so that it can be moved with ease without any breaking sweat. The special inbuilt “hopper pre sweep feature” eliminates the need to sweep before running the machine. Being a battery

It is now being widely accepted that efficient cleaning is essential in the sterilisation process. Mishandling and improper sterilisation of the instruments can be fatal. Safe and effective disinfection and sterilisation can be guaranteed with clean medical products. The World Health Organization (WHO) estimates that at any time, more than 1.4 million people worldwide are affected by infections acquired in hospital cleaning. Disinfection and sterilisation saves lives and improves patient outcomes. Less frequently cleaned, contaminated surfaces in healthcare facilities may contribute to the spread of healthcare-associated pathogens. Contaminated surfaces can act as sources from which healthcare workers contaminate their hands, and in some instances, patients acquire pathogens following direct contact with contaminated equipment or other surfaces. Providing patients with a safe environment of care requires a high level of compliance with recommended hand hygiene policies and appropriate cleaning and disinfection of medical equipment and environmental surfaces

Right use of chemicals for maintaining hygiene and infection control in hospitals Though mechanised cleaning with just soap and water will remove visible dirt, the efficacy of the cleaning will be optimal with the use of anti-bacterial chemicals to prevent cross contamination and hospital acquired infections. In general use of chosen disinfectant at the accurate measure and appropriate concentration is needed to kill pathogenic microorganisms rendering an object safe for use by patients and visitors. Recognising the need for newer technologies and innovations, the annual Clean India Show has created a platform to bring forth latest innovations in cleaning technology, and hygiene management. The Clean India Show 2012 will be held in Bangalore from December 13-15. EXPRESS HEALTHCARE

H|O|S|P|I|T|A|L|I|N|F|R|A OPINION

Anti-microbial copper to conquer HAIs H

Dr Anu Kant Mital, Spokesperson, Antimicrobial Copper – International Copper Promotion Council (India) elaborates how anti-microbial copper can serve as an effective weapon against hospitalacquired infections by using it in hospital infrastructure

DR ANU KANT MITAL

Spokesperson, Antimicrobial Copper – International Copper Promotion Council (India)

ealthcare-associated infections are of important wide-ranging concern in the medical field. They can be localised or systemic, can involve any system of the body, be associated with medical devices or blood product transfusions. Hospital-based programmes of surveillance, prevention and control of healthcare-associated infections have been in place since the 1950s. The Study on the Efficacy of Nosocomial Infection Control Project (SENIC) from the 1970s showed nosocomial rates could be reduced by 32 per cent if infection surveillance were coupled with appropriate infection control programmes. In 2005, the National Healthcare Safety Network (NHSN) was established with the purpose of integrating and succeeding previous surveillance systems at the Centres for Disease Control and Prevention (CDC): National Nosocomial Infections Surveillance (NNIS), Dialysis Surveillance Network (DSN) and National Surveillance System for Healthcare Workers (NaSH). Both developed and resource-poor countries are faced with the burden of healthcare-associated infections. In a World Health Organization (WHO) cooperative study (55 hospitals in 14 countries from four WHO regions), about 8.7 per cent of hospitalised patients had nosocomial infections. A six-year surveillance study from 2002-2007 involving intensive care units (ICUs) in Latin America, Asia, Africa,

and Europe, using CDC's NNIS definitions, revealed higher rates of central-line associated blood stream infections (BSI), ventilator associated pneumonias (VAP), and catheter-associated urinary tract infections than those of comparable United States ICUs. The survey also reported higher frequencies of methicillin-resistant Staphylococcus aureus (MRSA), Enterobacter species resistance to ceftriaxone, and Pseudomonas aeruginosa resistance to fluoroquinolones. A study of bacteremia in African children found distinct differences in the microbiological causes of nosocomial bacteremia compared with community-acquired bacteremia. Nosocomical bacteremia resulted in a higher rate of morbidity and mortality and longer hospital stay. Because it is largely unrecognised in low-income countries, nosocomial infections are likely to become public health priorities as their occurrence increases. Premier hospital ICUs of India show that HAI rates are high varying from around 1415 per cent. With increasing recognition of burden from healthcare-associated infections, national surveillance systems have been developed in various countries; these have shown that nationwide healthcare-associated infection surveillance systems are effective in reducing healthcare-associated infections, continued surveillance, along with sound infection control programs, not only lead to

decreased healthcare-associated infections but also better prioritisation of resources and efforts to improving medical care. Healthcare-associated infections are of important wide-ranging concern in the medical field. They can be localised or systemic, can involve any system of the body, be associated with medical devices or blood product transfusions. Methicillin-resistant staphylococcus aureus (MRSA) has become a prevalent cause of infections. Traditionally, communityassociated MRSA infections have been associated with USA300 or USA400 strains and healthcare-associated infections with USA100 or USA200 strains. However this distinction is becoming less clear with USA300 strains now increasingly identified as a cause of HAI. A populationbased study showed MRSA USA300 was not associated with mortality for either central line–associated bloodstream infections or community-onset pneumonia. Surgical site infections (SSI) occur within 30 days after the operative procedure or within an year if an implant was placed. Criteria for the diagnosis of SSI include purulent drainage at the site of incision, clinical symptoms of infection (such as pain, redness, swelling, etc), presence of an abscess, isolation of organism from the site culture, and clinical diagnosis of SSI by the surgeons. Clostridium difficile is the most important bacterial cause of healthcare-associated

gastroenteritis. Associated clinical conditions include asymptomatic carriage, diarrhea, and pseudomembranous colitis. Diagnosis is suspected in a patient with diarrhea and recent history of antibiotic use (especially cephalosporins and clindamycin). The drug-resistant Gramnegative bacteria, for the most part, threaten only hospitalised patients whose immune systems are weak. They can survive for a long time on surfaces in the hospital and enter the body through wounds, catheters, and ventilators.[2] Contact transmission is divided into two subgroups: direct-contact transmission and indirect-contact transmission. Contact transmission: The most important and frequent mode of transmission of nosocomial infections is by direct contact. It is well established fact that proper practices such as Hand washing , Barrier nursing etc with the concomitant use of good disinfectants in cleaning the TOUCH surfaces helps in reduction of many Infections Droplet Transmission: Transmission occurs when droplets containing microbes from the infected person are propelled a short distance through the air and deposited on the host's body; droplets are generated from the source person mainly by coughing, sneezing, and talking, and during the performance of certain procedures, such as bronchoscopy. Airborne transmission: Dissemination can be either

Routes of contact transmission

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Route

Description

Direct-contact transmission

This involves a direct body surface-to-body surface contact and physical transfer of microorganisms between a susceptible host and an infected or colonised person, such as when a person turns a patient, gives a patient a bath, or performs other patient-care activities that require direct personal contact. Direct-contact transmission also can occur between two patients, with one serving as the source of the infectious microorganisms and the other as a susceptible host.

Indirect-contact transmission

This involves contact of a susceptible host with a contaminated intermediate object, usually inanimate, such as the Touch surfaces in the wards, including the bed rails and dressing trolleys as well as the IV Poles, side tables, contaminated instruments, needles, or dressings, or contaminated gloves that are not changed between patients. In addition, the improper use of saline flush syringes, vials, and bags has been implicated in disease transmission in the US, even when healthcare workers had access to gloves, disposable needles, intravenous devices, and flushes www.expresshealthcare.in

DECEMBER 2012

H|O|S|P|I|T|A|L|I|N|F|R|A airborne droplet nuclei (smallparticle residue {5 µm or smaller in size} of evaporated droplets containing microorganisms that remain suspended in the air for long periods of time) or dust particles containing the infectious agent. Microorganisms carried in this manner can be dispersed widely by air currents and may become inhaled by a susceptible host within the same room or over a longer distance from the source patient, depending on environmental factors; therefore, special airhandling and ventilation are required to prevent airborne transmission. Microorganisms transmitted by airborne transmission include Legionella, Mycobacterium tuberculosis and the rubeola and varicella viruses. Common vehicle transmission: This applies to microorganisms transmitted to the host by contaminated items, such as food, water, medications, devices, and equipment. Vector borne transmission This occurs when vectors such as mosquitoes, flies, rats, and other vermin transmit micro-organisms. However if the reservoirs of infection are reduced or eradicated in the close ward environments then the scope

for all the other forms of infection to spread are reduced. The reservoirs are normally formed on the touch surfaces like bed rails, IV poles, dressing trolleys, towel rails, overbed tables and the bed side cabinets. Decontamination of touch surfaces:

incubation at 370 C. the results have been encouraging showing that 99.9 per cent of the bacteria ( including MRSA. VRE, Pseudomonas etc. as well as the HINI virus) were dead by 90 minutes of exposure on these coupons made of copper alloys.

Touch surfaces made by alloys of coppercan help in killing 99.9 per cent of all bacteria in the hospitals The recent studies done by well known experts of Hospital Infection control around the globe have found that by a simple process of replacing the touch surfaces made of currently popular materials like plastics or steel by alloys of copper that contain at least 60 per cent copper can help in killing 99.9 per cent of all the bacteria that colonise these objects. These studies have been done in Laboratories with plating coupons of all these materials like Stainless Medical steel, Plastics, Brass and Copper alloys, with

These studies were then conducted to determine the reduction in bio-burden in the Hospital settings in countries like UK, US, South Africa, Japan and Chile, the results were the same – the bio burden on the identified touch surfaces like bed rails IV Poles and side tables etc. dropped by 99.9 per cent on the surfaces that were retrofitted with copper alloys. Then the final test- to check if this reduction in bioburden in the hospital would translate into reduced infections rates in the wards. The landmark study done in the

US over 43 months in three major hospitals including the Memorial Sloane Kettering Cancer Hospital have shown that depending on the number of surfaces that are replaced with copper alloys ( ie Anti Microbial Copper) the infection rates in the ICU have dropped by 47-69 per cent. As compared to similar adjacent ICU which did not replace any items with anti microbial copper. To check the validity and efficacy of these studies results in Indian setting the newly Built ICU of the Iconic Tata Memorial Hospital. Mumbai has been chosen to conduct a similar study recently. The results should be known by the early weeks of January 2013. In the meantime many hospital equipment manufacturers and suppliers have seen the potential demand for these anti microbial touch surface equipment and have started manufacturing many items that are used in high risk areas in the ICU and the operation theatres. We hope that soon the healthcare service providers will see the benefits of his simple changes in their practice techniques and switch to using more of these anti microbial copper touch surface equipment.

Critical Care: Taking the pain out of piping systems in healthcare facilities Pankaj Soni, Victaulic Country Manager, India gives an insight on various piping systems, the processes involved and the benefits of using piping from Victaulic.

DECEMBER 2012

n today’s healthcare facilities there is no time for downtime, especially when it comes to vital systems such as HVAC, plumbing and fire protection. In recent years, time-scales for construction and repair have become increasingly tight with patient needs at the forefront.

Different approaches A full range of pipe-joining solutions can be found in healthcare facilities across India and globally – including welding, flanging and mechanical grooved systems. Whilst the history of techniques varies considerably – flanging was employed by the Romans whilst mechanical pipe joining is a relatively recent 20th century development – pipe joining remains a critical area where choice of method can have a great impact on installation times and system maintainability, particularly crucial in this environment. Skill levels, ease and speed of operations are

The anatomy of a grooved mechanical pipe joint www.expresshealthcare.in

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H|O|S|P|I|T|A|L|I|N|F|R|A a facility. For instance, work can continue safely with patients still in beds, and only the need to empty the most nearby wards.

key factors that determine not only installation costs but also maintenance costs over time. For instance, in a traditional flanged system, multiple bolts are needed to create a joint. Even after installation, this can create maintenance issues, as removing these bolts is a manual and timeconsuming process, and there must also be sufficient space around the joint for this operation to take place. A traditional welded piping system is labour intensive to install and to maintain. To repair a system, workers have to cut out a damaged pipe section, which is time consuming, and can cause operational concerns and safety hazards, particularly in existing facilities and occupied spaces.

Lifetime benefits

Alternative joints Mechanical piping systems are used in a variety of different areas in the healthcare sector, including cooling and heating water, compressed air, fire protection systems, potable water, vacuum lines and waste water. The design of a mechanical pipe joint is inherently easier to work with during installation and maintenance activities. The mechanical joint, also known as a coupling, is comprised of three elements: the pipe groove, the gasket, and coupling housings, along with its nuts and bolts. The pipe groove is formed by cold forming or machining a groove into the end of a pipe. The key section of the coupling housing engages the groove. Within the housings is a resilient, pressure-responsive, C-shaped elastomer gasket that provides a triple seal. The coupling housing fully encloses the gasket, reinforcing it and securing it in position. All components are extremely safe, quick and simple to handle and very flexible for use in new installations, reconstructions and renovations. Maintenance and inspections of systems can be carried out easily and quickly at any time. With mechanical pipe joints, only two bolts need to be removed to access the system, allowing more time-efficient maintenance procedures. Additionally, unlike a flanged joint, a two-bolt coupling can be “free floated” around the pipe for quick alignment adjustment and easy access. Since mechanical pipe joining systems are easier to assemble and disassemble they require less labour and are installed much faster than other methods. For example, a traditional welded system is

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Mechanical piping systems are used throughout the healthcare sector, including cooling and heating water, as well as fire protection systems.

The design of a mechanical pipe joint is inherently easier to work with during installation and maintenance activities than traditional systems. labour-intensive, taking up to 45 per cent more time than grooved systems. Welding pipework is also potentially hazardous, creates toxic fumes and is a fire risk. Entire systems are required to be drained and dried prior to performing maintenance work since a pipe could burst when flame comes into contact with liquid. For example, if a welder accidentally opened the wrong pipe or if a system www.expresshealthcare.in

is not fully drained, the worker can suffer from molten metal splatter. An area where work is being carried out needs to be evacuated and costly fire-watch is necessary. Grooved piping system assembly requires no hotworks and eliminates many of the risks traditionally associated with joining pipe, and allows healthcare or other activities to carry on unhampered in surrounding areas of

The design of the mechanical joint reduces maintenance requirements because there is a union at every joint, providing quick and easy system access during routine or repair work, as well as system expansion and affords a safe environment for workers and patients. Other inherent benefits from installing a mechanical pipe joining system include the accommodation of noise and vibration and movement within the system without the need for periodic product repair or replacement. Vibration in a piping system can result in noise that becomes cyclical and droning, or that arrives in sudden bursts when equipment switches on. Increased noise levels increase patient anxiety and stress, which may lead to slower healing times or additional ailments. With a thorough understanding of the stringent requirements in hospital construction, Victaulic products have a variety of approvals such as; VDS, DVGW, VGW, SVGW, SSIGE, UL, ULC, FM, PED, DNV, Bureau Veritas, Germ, Lloyd and ISO. Healthcare facilities also benefit from the Victaulic Construction Piping Services department (CPS) which offers a comprehensive estimating, pre-planning support, project management and coordination service. CPS also provides software solutions for any size project, helping to reduce both time and costs. Recently, SSA Acoustics in Seattle, US, conducted field measurements at the request of a client that showed “three Victaulic couplings placed in series in a pipe section have a comparable performance to twinsphere neoprene connectors and a superior performance to braided metal hoses. Victaulic couplings dampened the overall vibration amplitude by 80 – 90 per cent.”As the pace of the healthcare construction industry continues to meet market demands there is a growing necessity to look to building methods like mechanical piping systems that decrease maintenance difficulties and make facility expansion easy to implement with little disruption to the peaceful healing environment. For further information, please visit www.victaulic.com DECEMBER 2012

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Ushering sustainability in hospital infra H Sheila Sri Prakash, Founder and Chief Architect, Shilpa Architects, Planners, Designers, emphasises that well designed, holistically sustainable infrastructure facilities are imperative for enhancing the healthcare scenario in India

SHEILA SRI PRAKASH

Founder and Chief Architect Shilpa Architects, Planners, Designers

DECEMBER 2012

ospitals and healthcare facilities exist to preserve the human condition and spirit. Philosophically, these buildings and spaces must be designed for society's long term health, well-being and sustainability. It is very well understood that our health depends directly on the quality of our environment. This fact therefore makes the strongest case for hospitals that are designed to make a positive impact on the environment, or at least leave the smallest possible ecological footprint. While India has a heritage of sustainability, the new development and break-neck pace of development is generally resulting in unsustainable environmental damage. I have had the opportunity to be involved with the design visualisation of one of the largest LEED silver certified children's hospitals in the world at the C S Mott Children's and Women's Hospital in Ann Arbor, Michigan, US and am currently working on several large-scale healthcare projects in India that are setting new standards for ecological impact and socio-economic growth by delivering holistic sustainability. I developed the Holistically Sustainable Reciprocal Design Index, with an aim to serve as a design methodology, during my term at the World Economic Forum’s Design Innovation Council. The principles within the framework can ensure that hospitals in India can minimise their environmental footprint while serving as socio-economic engines for the societies that they serve, by incorporating strong themes of culture, art, tradition and vernacular materials. Hospital design is among the most complex design process of all building types and is therefore subject to a set of unique criteria. This is because the services required for the efficient functioning of a hospital are numerous. There is no way in which any of these services can fail, as it involves the lives and care of people who need medical aid for their survival. Some of the parameters in hospital design that result in exacting design standards are mentioned below. Consumption of water and power is maximum in hospitals. Total power back-

ups are an absolute must. Clean areas account for a substantial percentage of the total built up areas in buildings that are designed for providing healthcare, and treatment of patients. The areas catering to the critically ill and surgical areas warrant a more stringent HVAC system requiring more air changes per minute and directional flow of conditioned air, which follow the clean room mandates. The load on the requirement of water increases in order to accommodate the water requirement of the HVAC system. While conditioned air is definitely crucial to healing, care must be taken to ensure that the conveyance mechanism to conditioned air does not convey infection as well. The requirement for water per user is maximum in hospitals is as much as 150 to 250 gallons per user daily. In comparison, a hotel only needs around 70 to 150 gallons per user daily while homes need anywhere from 50 to 100 gallons per user daily. Disposal of radioactive and medical wastes are a critical component of hospital design. Three per cent of medical wastes are toxic and infectious. Safe disposal of body parts and surgical wastes are an environmental challenge. The safety of the health workers from over exposure to harmful chemicals is unique to healthcare as these chemicals are required for maintaining hygiene and well being of patients. Interestingly, there is no widely accepted global standard yet, that defines a ‘green and healthy hospital’. According to Global Green and Healthy Hospitals Network, a green and healthy hospital “promotes www.expresshealthcare.in

public health by continuously reducing its environmental impact and ultimately eliminating its contribution to the burden of disease. A green and healthy hospital recognises the connection between human health and the environment and demonstrates that understanding through governance, strategy and operations. It connects local needs with environmental action and practices primary prevention by actively engaging equity and a green economy”. While there are no specific LEED certification norms from the Indian Green Building Council pertaining to hospitals, as a building typology, hospitals can be rated by the norms for new construction of buildings. It is worth noting that GRIHA also offers a template to green certification. As a designer, a collaborative effort with the services consultants is necessary. Before starting on the design, orientation studies, contour studies and resource availability studies, have to be made. This can ensure efficiency in energy consumption. However, it is crucial that hospital design is approached in a manner that optimises the use of resources and ensures efficient movement of patient, supplies, staff and waste. It is very often the case where the patient care givers take the toll through inadequate facilities while the patients are getting the best of care. Out-patient and inpatient facilities should be designed to accommodate the patient care givers as well. Waiting areas with connectivity to nature, can destress the people attending to the patients. Whether certification is obtained or not, it is impera-

tive that buildings designed for the healthcare industry would do well to optimise their expenditure, which will eventually benefit the patient, by lowering the cost of healthcare. It will also enable the hospital to be more profitable. The use of renewable energy, to replace the use of grid power, can result in a substantial saving in expenditure and running costs. The energy requirements for heating water, can be met by the use of solar power. Good design can ensure day lighting for public areas and corridors as well. Research studies have shown that visual connectivity to nature can accelerate recovery in a recuperative environment, strengthening the case for landscaped gardens and vegetated spaces. Many of my own projects are achieving this in hospitals that are space-constrained in urban centres, by creating landscaped roof-tops equipped with solar gazebos. In the recently concluded World Economic Forum’s India Summit in Gurgaon (NCR), I served as a panelist to shed light on insights regarding the impact of architecture and urban design on global health. It is becoming obvious to the world that the direct impact of architecture, design and sustainability within hospitals is a reflection of the societies that are served by them. The fact is that India’s healthcare infrastructure has an unprecedented issue with the scale of the demand for health are. However, well-designed holistically sustainable architecture will ensure the long term health of society and our environment, while lowering the cost for upkeep of infrastructure. EXPRESS HEALTHCARE

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We are from the service line industry and would like to start a the project on the concept of baby birth Q boutique, in tier 2 cities. I would like to know about the approximate costing per bed, area requirement for the project and whether it is feasible to start with multiple centres at different cities ? Sumit Sarawagi

trend analysis to estimate staffing needs based on sales projections and historical sales to manpower. We are planning to new set up a dialysis centre in our hospital, what would be the structure quality Q requirement? DrGodwin Thomas, Mumbai

To start a baby birth boutique, the approximate costing per bed would be Rs 24-30 lakhs, approximate area would be 700 sq ft per bed and starting off with multiple centres in different cities is a good ideas but a a project market and financial feasibility survey report is suggested before investing a lot on the project. To initiate a project tier II and tier III cities are preferred locations.

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

I am a gynaecologist by profession and wanted to start a new hospital for women. How to go-ahead Q with the project from scratch? Dr Jayashree Sheth, Ahmedabad

To initiate with any assignment the thumb rule is to go for a market and financial feasibility survey report A where you will get an idea about the existing market scenario, overview about healthcare, profile of the targeted area ,demographics, market research, financial feasibility, etc. It would also give a give a clear idea about land acquisition, whether to invest in a property by buying it or leasing it. As a rule of the thumb, what should be the plot dimenfor a 50-bed nephrology–urology hospital ? Q sion Dr Dhananjay Ookalkar, Nephrologist, Nagpur

Approximately a 700 sq ft/bed is an ideal area requirement for a single bed. So, for a 50-bedded hospital it A would be 35,000 sq ft.

How to proceed with manpower planning for a new project ? Dr Tejas S, New Delhi

It depends on your service mix and facility mix. Manpower planning depends on services, area, bed A strength, expected work load, futuristic planning and demands, processes of the hospital etc. It also depends on the number of projects which are going on, and whether you will be able to fulfill the present project requirement with the present work force. If not then estimate assignment, business and plan for recruitment and if yes, then assess future business assignments and plan accordingly. It should address issues like: What level of staff should be planned for hire? What should be the ratio/percentage/level of hiring at all levels? What will be the turnover ratio for the same? How much time would be required for training of new resources? All these factors are required to do manpower planning. The most common manpower planning approaches involve the use of simple techniques like relationships ratio analysis or

Following things should be taken care of while setting up a dialysis centre. A Building: Dialysis centre should be located near ICU, adequate space should be 14sq m/bed, no of beds should be as per the workload, separate equipment or room for HIV /HBSAG patients should be allotted, good storage space for equipment and materials is a must, there should be separate space for cleaning and safe keeping of artificial kidneys of every patient, there must be space for consultation and counselling as well as waiting space Equipment: High efficiency dialysis machine per bed and different equipment for infectious patients, centralised O2 and suction, cardiac monitor, defibrillator, electronic weighing machine, crash cart, multinosal cleaners, high efficiency artificial kidney, racks for storage, etc are essential for equipment Engineering: Stable uninterrupted power supply, RO water plant ,drainage outlet near each bed, AC, adequate ventillation, dialyzer, dialysis fluid as per specification no compromise in quality Staffing : Qualified nephrologists, qualified and responsible technician staff, nurses, dietitian, HK staff etc are a must.

I am Tripathy, the owner of a newly constructed hospital, but since I am not from the healthcare Q background it is getting difficult for me to run the hospital. Please advise me with a suitable and reasonable solution. A K Tripathy, Latur

First of all recruit a person with MBA in hospital administration, who has an experience on the operations A of the hospital. Otherwise there are many healthcare consultancies who do the operations and marketing of hospitals which shall help you out in the initial years to run the hospital. to know how to do the equipment planning for 75 -bedded multispeciality hospital? Q aI want Dr Ashish Saraiya, Mumbai

Equipment planning is a vital element in the successful completion of a hospital project. First of all recruit a A dedicated biomedical professional who can correctly evaluate, review and configure as per the requirement of the set up. There are different stages in equipment planning, firstly prepare a budget for medical equiment then shortlist the equipment which has to be used, based on different departments and bed size. Then select the vendor, develop specifications and compare the technical specification of two-three vendors, and finally negotiate and procure the equipment.

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

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www.expresshealthcare.in

DECEMBER 2012

H|O|S|P|I|T|A|L|I|N|F|R|A PRE EVENT

Hospital Build & Infrastructure India 2012 It promises to be a power packed three-day technical conference where the stake holders of the hospital infrastructure industry would be sharing their views and opinions with the delegates ospital Build & Infrastructure India 2012 (HBII), a threeday exhibition and conference which will offer a direct access to the latest opportunities in the Indian hospital infrastructure and healthcare market is slated to be held on December 14-16, 2012 at Bombay Exhibition Centre, Mumbai. HBII 2012, this year, is set to be the largest strategic gathering of investors, commissioners, backers and managers of healthcare-related building projects with key players and exhibitors in planning, design, construction, operations, management, supply and refurbishment. The event aims to highlight issues that are essential to hospitals, nursing homes, architects, builders, project managers, consultants and manufacturers to remain compliant, competitive and sustainable. Concurrent platforms have been engineered to reward, demonstrate and educate industry professionals on the latest technological advances. One of the major initiatives for the HBII Conference 2012 is a three- day technical conference for industry professionals to benefit from the experience of renowned global industry leaders. The conference will deliberate on key issues related to hospital design and planning, innovations as well as engineering aspects to look for when building or upgrading small as well as large healthcare units. In addition to the speaker presentations, it will include attractive panel discussions, from internationally acclaimed companies and influential healthcare personalities from India which will serve as an excellent catalyst to the entire conference agenda. Categories of awards ● Leaders in HealthcareWinning Strategy in the new regionalised multinational healthcare market place ● Hospital Build, Design and Upgrade- Designing and building safe, functional, effective architecture & infrastructure ● Quality of Care- Leap over the quality chasm through redesigning healthcare quality model

A glimpse from HII 2011

HBII 2012- An ideal place for networking

HII 2011 attracted many delegants for its conference

Conferences at the HII 2011 had many interesting topics DECEMBER 2012

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Few of the speakers include ●

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Dr Chandrasekhar R, Chief Architect - DGHS, Department of Health, Govt. of India Dr Ramakanta Panda, Vice Chairman & Managing Director, Asian Heart Institute Dr Rana Mehta, Director, Healthcare, PWC India Dr Sujit Chatterjee, LH Hiranandani Hospital Vishal Bali, CEO, Fortis Global, India/Singapore VP Kamath, Chief Operating Officer, Wockhardt Hospitals Dr Rajiv Kumar Jain, Director (Health and Family Welfare), Ministry of Railways, Government of India Raju Narayan,CEO, Parkway Group Dr Mahesh Reddy, CoFounder and Director, Nova Speciality Surgery Ameera Shah, Managing Director and CEO, Metropolis Healthcare Dr Vishal Beri, Chief Operating Officer, Hinduja Healthcare Dr Girdhar J. Gyani, Member, Governing Board, National Accreditation Board for Hospitals & Healthcare Providers Dr Shakti Gupta, Head, Department of Hospital Administration, Academy of Hospital Administration Dr.Sameer Khan, Chief Operating Officer, Nova Medical Centers Dr Anupam Karmakar, General Manager, Operations, Jaslok Hospital Dr. Yash Paul Bhatia, President, Indian Healthcare Quality Forum Gaurav Malhotra, Managing Director & Chief Executive Officer, Patni Healthcare Joy Chakraborty, Director Administration, Hinduja Hospital, Mumbai

Growing stronger and bigger with participation from leading companies Leading companies, products and technology from India and abroad at HBII will provide the necessary thrust to the industry, striving to meet the rising demand for new and better healthcare facilities.

Several leading companies like Tata Motors, Godrej Interio, Sio Vassundhara International, STH Architect, Portalp International, Modular Concepts, Tahpi , Mehta Tubes Limited, Zebra Technologies, Hospaccx India TM, Allarch India, CR Medisysytems, Attune Technologies, Draeger, Alvo, Ram Metal Industries, Knauf RAK FZE, Linet, Hospaccx India Systems, Mindray, Bluestream Manufacturing Services, Agora Climate Control Systems, Aeropure Systems, Light & Magic Automation, Eubiq India, Archetype, American Institute of Architects, Bioni Paints India, Medica Synergie, Helix Corporation, Cosign India, RMG Polvinyl, Tata Consultancy Services, Redsun Communication, Meditek Engineers, Medimek Industries, Pratiba Medinox, HLL Lifecare, Piercing Systems, Studex, CAEM India, Inpro Corporation, Medirail India, The Best Interiors, Airox Technologies and many more are expected to have their presence at HBII 2012 since it will be a major healthcare event to develop and consolidate connections in healthcare infrastructure business within India. HBII will cover the whole spectrum of healthcare infrastructure segment with products ranging from architecture and design, construction, flooring, ceilings, lighting, ambulances, medical equipments, OT medical systems, healthcare IT, lights and pendants, HVAC, hospital curtains, doors etc. for the healthcare industry. Companies and individuals interested in exploring and studying the burgeoning Indian healthcare market now have an established platform to meet and learn from the key stake holders from major healthcare facilities of India. The only trade show of its kind in India, HBII will provide everyone in the hospital supply chain an unmatched opportunity to network, upgrade knowledge, source, sell, share ideas and technology, partner, ALL under one roof. For more information contact Tel: +91 22 4048 1710 hospitalinfra-india.com EXPRESS HEALTHCARE

H|O|S|P|I|T|A|L|I|N|F|R|A HBII 2012

Hospital Build & Infrastructure Awards The awards will recognise leaders in the healthcare industry who have devoted their efforts to building hospitals that help improve healthcare services and raise the bar in providing world-class patient care. ospitals are an integral part of healthcare services and each hospital has its own distinct character, creating an environment that helps the patient to recover. When architects design a hospital, they find inspiration from the vision, mission of the project and from the local environment. As these sectors grow, so does the need to reward industry leaders and innovators in a variety of categories. Therefore, the Hospital Build and Infrastructure India (HBII), an event in its third year has introduced the Hospital Build & Infrastructure Awards this year. These awards will act as a platform to promote the professionals who have worked hard to achieve a hospital environment that enables and promotes a healthy life. The awards will recognise leaders in the healthcare industry who have devoted their efforts to building hospitals that help improve healthcare services and raise the bar in providing world-class patient care. The Hospital Build & Infrastructure Awards is a part of the Hospital Build & Infrastructure Awards International Series which is organised in its other portfolio of events like Hospital Build Middle East. The Awards is open for all and a nomination procedure is made available online by the organisers. The HBII Awards are managed by HOSMAC as their Knowledge Partners. A panel of jury members including top officials from leading players in the hospital infrastructure sector like Department of Health, Govt. of India, Siemens, GE Healthcare and HOSMAC to name a few have been put together to select the winners from all the nominations received. The key sponsors for this are CareFusion and Silver Thomas Hanley Health Architecture. CareFusion is a global corporation serving the healthcare industry with technologies, services and analytics solutions that help measurably improve the safety and cost of healthcare. Their market-leading brands help hospitals improve medication management, lower costs in procedural areas, reduce infections and advance the care of ventilated patients. Silver Thomas Hanley Health Architecture on

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the other hand has over 30 years of experience in hospital infrastructure space and deliver innovative healthcare solutions that represent exceptional value for money for our clients. Health is their core business. They have an extensive and unrivalled healthcare project portfolio of over 2000 projects, incorporating a range of successfully completed healthcare facilities ranging from small, local community projects to large, complex international designs. The HBII awards consists of some very interesting categories such as:

Best Physical Environment Award (Built) Award qualifiers: Designers, architects and healthcare facilities owners of completed hospital projects in India, who are able to demonstrate how the design of the built environment of the hospital/healthcare facility has created an outstanding space and is built to enhance the experience felt by patients, staff and visitors through an innovative and considered approach to the physical environment. Judging criteria: Privacy of patients, accessibility and movement for patients and staff signages, aesthetics for visitors and patients, harmony between colours and functionality.

Best Sustainable Hospital Project Award Award qualifiers: This award will be given to an outstanding hospital project in India that advances sustainable development through design, and is open to both built and planned projects. The entries are open to hospitals who can demonstrate outstanding commitment to sustainability in terms of its design, development and construction. In particular, highlighting the innovative use of new materials, products or construction methods, which will save energy and encourage future efficiency. The project should demonstrate an efficient use of resources, such as energy and water, and use of materials that reduce environmental and health impacts of the facility. Submissions must be able to show qualitative and quantitative data demonstrating suswww.expresshealthcare.in

tainable initiatives on most, if not all, of the following points: Judging criteria : Innovative use of materials, waste management, preparedness to treat public health, efficient use of energy, complies with government norms for green

Best Healing Environment Award Award qualifiers: This award will be given to hospitals who can demonstrate how a considered approach to the all elements, both physical and human, work together to ensure a strong healing environment. This award will focus on how the facility hasmanaged to deliver the best healing environment through a combination of factors. This award is aimed at recognising the best all round management of a healthcare facility in India. Judging criteria: Reduction of patient stay, reduction in infection, staff to patient ratio, well managed patient nutrition programme, good health and safety records

Best Technology Initiative Award Award qualifiers: This award is aimed at recognising the best technology initiative in a new or upgraded healthcare facility. It will focus on how the facility utilises a new technology in a various innovative ways that improve the healthcare outcomes, reduce the time spent to diagnose or treat patients, and make the experience of the patients more friendly and pleasant. This new technology should also open the door for usage of new ways or trends in dealing with patients. Judging criteria: Increase in patient experience, improvement in healthcare outcomes, reduction in time spent on diagnosis and treatment, annual savings, improved business/profits

Architect/Designer of the year for Healthcare: Award qualifiers: Individuals/companies who have designed and commissioned a healthcare project. Judging criteria: Design vs usage, timelines, compliance for patient safety, compliance for norms, client satisfaction. This designer or company support its nomination through blue print of the proj-

ect, drawings of the project, key features of the project, challenges if any involved in the project, brief description of the project.

Builder/Construction company of the year for Healthcare Award qualifiers: Companies who have successfully built a hospital /healthcare project. Judging criteria: Size, adherence to time lines, compliance for patient safety, compliance for norms, client satisfaction. The companies should be able to justify the nominations through blue print, chief engineer/engineers involved, key challenges in the project, time and size of the project and brief description of the project.

The Best Initiative to Improve the Design Standard of Healthcare Facilities Award qualifiers: This award is open to individuals, institutions, or governmental organisations who have integrated evidencebased design, sustainable science, leadership training, and best practice benchmarks for planning and initiating healthcare facilities. The nominee should clearly aim to articulate specific recommendations for public policy, guidelines, and frameworks for lasting collaboration across disciplinary boundaries, in creating a world-class health facility design. The initiative should promote the improvement in the standard of existing and future healthcare facilities and clearly demonstrate connections between design and the delivery of healthcare services. Judging criteria: This multi disciplinary initiative should combine key principles of architecture and interior architecture, healthcare innovation, leadership and management and human health services. It should facilitate the development of outstanding innovative and consistently high quality work in health design and contribute to increased efficiency and management of health systems; policy development, health legislation and ethics, within the framework of primary healthcare.

DECEMBER 2012

H|O|S|P|I|T|A|L|I|N|F|R|A HBII 2012

Business Match Making at HBII 2012 It is a new segment being introduced at HBII 2012 to connect the right business partners, generate business leads and offer a good networking platform he third edition of Hospital Build & Infrastructure India has been receiving an encouraging response from leading Hospital CEOs, CMOs, Directors, Hospital Consultants and top decision makers who are registering their visit at HBII 2012 in large numbers and confirming their presence, to see and purchase from India's largest display of hospital infrastructure products, services and technology, all under one roof. Considering the overwhelming response from the exhibitors and delegates, the organisers have introduced the much in demand ‘Business Match Making Service’ during the three-day

event. This will enable the pre-registered visitors and exhibitors to fix prior appointments during the event and will be able to make the most of their participation. Through the business matching service, the organisers aim to connect the right business partners, buyers and sellers before, during and after the exhibition, thereby generating new business leads and opportunities as well as a platform to discuss business needs in a neutral environment. HBII 2012 has partnered with an experienced vendor, Socialwalk, to bring the Business Matching service for all exhibiting companies

and visitors. The service is one of the many valueadded services at the event which will be offered complimentary to all the participants at the event. All the pre-registered visitors and the exhibitor will be connected through an online portal created by Social walk where the visitors can view exhibitors' products and contact the exhibitors directly, post their sourcing requirements and receive exhibitors' responses and also request and confirm appointments with exhibitors. This practice of Business Matchmaking, being introduced at the event will certainly ensure that the exhibitors receive quality

leads and the visitors get an easy access to all the products, solutions and services on display throughout the three-day exhibition. And ensure that the purpose of the visitors and the exhibitors are met.. HBII 2012 business match making URL is: http://apps.socialwalk.com/e vents/650-hospital-buildand-infrastructure-india for all who are interested to visit and make the most of this opportunity to source their hospital infrastructural needs, either a big or a small healthcare unit. For more information contact Tel: +91 22 4048 1710 hospitalinfra-india.com

HBII 2012

Technology Preview of HBII 2012 Profiling some of the national and international companies participating at HBII 2012 eading national and international companies continue to confirm their participation at Hospital Build & Infrastructure India (HBII) – India’s premier international exhibition and conference on hospital infrastructure, planning, supplies and healthcare development – to be held from December 14 -16, 2012 at Bombay Exhibition Centre, Mumbai. Here are some of the exhibitors who will be showcasing their latest products and technology at HBII 2012.

Aeropure UV Systems Aeropure UV Systems focusses on delivering solutions for air and surface quality, based on utra violet germicidal irradiation (UVGI) technology to the Indian and international markets, with wide ranging applications in indoor air quality, energy conservation of air conditioning systems and for germicidal disinfection of indoor air and surfaces.

Allarch India This company offers solutions from architecture designs to medical grade mobile computing under one roof with understanding of evidence-based healthcare. DECEMBER 2012

Allarch Healthcare Technologies is committed to deliver innovative and enabling technologies to healthcare providers for translating the vision of safer, optimised and healing environment into practice.

Archetype Group, India Archetype Group, a leading multi-disciplinary construction consultancy in Asia, and AIA Associes, specialise in the development of high quality and technical healthcare facilities and will showcase their combined skills and competencies at HBII 2012. AIA Associés is one of Europe's foremost healthcare design firms, offering a full range of combined expertise and outstanding services in architecture, engineering, urban planning and sustainable development.

Bioni Paints India Bioni India will introduce a modern coat of paint that can do a lot more than simply look good. Bioni India, in collaboration with Bioni Germany and Fraunhofer Institute, introduces paints and coatings based on silver nanotechnology that creates new and eco-friendly paintwww.expresshealthcare.in

ing solutions for building interiors and exteriors. Bioni Paints currently comes in three variants: Bioni Hygienic: The perfect interior solution for hospitals, clinics and food processing facilities Bioni Nature: The perfect interior solution for schools, pre-schools, hotels and spas Bioni Perform: Exterior painting solution for residential buildings and hotels

Bluestream Manufacturing Services For over 60 years, GOJO has been a leader in the areas of infection control and skin science, bringing innovative products to market, designed to promote good hand hygiene and skin health. With their leading brands PURELL, America's instant hand sanitiser, and PROVON, Micrell, a leading skincare brand, GOJO will be showcasing innovative products, dispensing platforms and educational tools focused on improving hand hygiene compliance and patient outcomes.

C R Medisystems The hospital infrastructure division of Medisystems manufactures products and

systems for modern hospital infrastructure; comprising, electronic nurse-call systems, bed-head panels, patient bed lamps, OT pendants, OPD patient-Call and OPD queue management systems. These products perform with excellence and reliability in over three hundred installations in India and overseas. The latest models and upgrades of each of these products are on display at the HBII 2012 exposition.

Cosign India Located in Belgium (HQ), Mexico and India with business partners in more than 80 countries, Cosign is one of the world leading suppliers of architectural sign systems, designed for a wide variety of applications and markets, since 1993. Cosign has a comprehensive range of sign systems which offer limitless design variations due to its modular nature. Their products and applications are referenced in a very broad range of market sectors, such as healthcare, public infrastructure, education, hospitality, point of sales, corporate offices, government,their mission is to provide our distribution partners with differentiating, innovative and EXPRESS HEALTHCARE

H|O|S|P|I|T|A|L|I|N|F|R|A competitive sign solutions. Cosign India is a distributor of SloanLED (US) and Optiframes

Draeger Medical India Dräger, the international leader in the fields of medical and safety technology will feature anaesthesia workstations, medical ventilation, patient monitoring as well as neonatal care for premature babies and newborns, ceiling supply units, IT solutions for the OR and gas management systems amongst other products for the entire hospital requirements. Draeger Medical India is a leader in acute point of care (APOC) business.

Eubiq India Eubiq Singapore is the inventor and manufacturer of GSS System - the world’s most flexible power outlet system. GSS System is the infrastructure platform of the future - all your power, data and communication (audio, video and telephone) needs can be neatly integrated onto a single track. Eubiq products based out of Singapore, has a strong presence in the retail industry in Dubai, Singapore and some parts of Europe.

Godrej Interio Godrej Interio has launched a new series of healthcare furniture in recent times. Their products in this space range is indigenously designed to match global safety standards and offer distinct competitive advantages to patients, healthcare providers and all other stake holders alike.

Helix Corporation The company is into distribution and support of biomedical equipments since 16 years with a reputed clientele spread all over India. They will feature products in testing and calibrating equipment, oxygen concentrators for home and hospital applications, spirometry products and medical gas pipeline systems.

Knauf Rak Fze/ Registration Sponsor Knauf, being one of the world’s leading productions and construction material company with over 220 facilities and 22,000 employees, is present in over 60 countries. Knauf recognises that each part of a new hospital holds unique challenges, such as mixtures of acoustic, fire ratings and impact performances. It has solutions for special requirements, such as X- Ray protection (new technologies), interior and exterior design, and access panels options for operation theatres.

Medica Synergie Prominent healthcare consultancy firm, Medica Synergie, will showcase sustainable architecture and complete project solutions. They will provide solutions on transforming new and existing healthcare units, both small and large. Separate divisions catering to both public as well as private healthcare units to cater for their varying requirements.

ments: patient monitoring and life support products, invitro diagnostic products and medical imaging systems. Healthcare facilities equipped with Mindray’s products can be found in over 190 countries and regions. They will showcase high-quality, competitively priced medical devices to make healthcare more accessible and affordable around the world.

Modular Concepts: Modular operating rooms and turnkey medical engineering solutions will be on display from Modular Concepts. One point solution for design and build of modular operating rooms, medical gas systems, pneumatic tube systems, architectural products, hospital fit outs including electro mechanical works etc., will be displayed by international supplier Modular Concepts.

Piercing Systems India Piercing Systems India, (PSI) specialising inimportation, distribution and training of state of the art ear, nose any belly piercing systems, jewellery, studs and supplies will present a one stop shop for all piercing requirements. Studex is the world’s largest ear piercing manufacturer in delivering 100 per cent hypoallergenic ear piercings and earrings for sensitive ear provides ideal opportunity for medical practiosioners, hospital/clinic to start offering extra service.

Medimek Industries

Ram Metal Industries Llc (Profex)

Mindray has three wellestablished business seg-

With IT solutions for life science organisations and

healthcare players and providers, Tata Consultancy Services (TCS) has complete IT expertise in the healthcare industry. Their consultants take complete responsibility for analysis, estimation, design and programming, application testing, problem resolution, acceptance, documentation and status reporting. They draw from experience and capabilities in healthcare delivery, clinical practice, medical informatics, security and privacy, biomedical engineering, and information technology.

Tata Motors With increased awareness and better access to healthcare coupled with increasing congestion in the cities, the demand for advance life support ambulances has to increase. In order to meet the future needs, Tata Motors has developed a wide range of ambulances. Tata Motors will showcase how they provide a complete transport solution to the Healthcare industry.”

Zebra Technologies A global leader respected for innovation and reliability, Zebra offers technologies that give a virtual voice to an organisation’s assets, people and transactions, enabling organisations to unlock greater business value. The company’s extensive portfolio of marking and printing technologies, including RFID and real-time location solutions, illuminates mission-critical information to help customers take smarter business actions.

INTERVIEW

HBII 2012 will bring together hospitals and visitors from Tier II and Tier III cities Guru Prasath K R, GROUP EXHIBITIONS DIRECTOR, HBII

ospital Build & Infrastructure India 2012 (HBII), a power packed three-day technical conference and exhibition is close at hand. According to the organisers and participants, HBII 2013 is geared to be the largest strategic gathering of investors, commissioners, backers and managers of healthcare-related building projects with key players and

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exhibitors in planning, design, construction, operations, management, supply and refurbishment. In a candid interaction with Raelene Kambli, Guru Prasath K R, Group Exhibitions Director shares his views on the hospital infrastructre industry in India, HBII's role in fostering growth for the sector and the highlights of the event

Excerpts.... www.expresshealthcare.in

You have been in the hospital infrastructure sector for quite some time now. What is your outlook on the hospital infrastructure sector in India? The last few years have seen massive investment and expansion in the Indian hospital infrastructure sector with a large number of new healthcare facilities and renovation of existing facilities nation-

wide. Going by the industry reports, the Indian healthcare sector is pacing at a growth rate of 20 per cent and is expected to touch the $100 billion mark by 2015 from the current level of $65 billion. It is undoubtedly on everyone’s radar and is attracting investments from all across the globe. Reports also suggest that India is expected to witness the DECEMBER 2012

H|O|S|P|I|T|A|L|I|N|F|R|A largest number of merger and acquisitions (M&As) in the healthcare sector and with 100 per cent foreign direct investment permitted for health and medical services, there are already activities from major national and international healthcare brands in India. The advancing healthcare facilities in India have also led to a rise in the Indian Medical tourism share. India’s share in the global medical tourism industry is expected to reach around three per cent by the end of 2013. Medical tourism is expected to generate revenue around $3 billion by 2013. The current scenario certainly highlights burgeoning opportunities in the Indian hospital infrastructure sector.

What are the infrastructure challenges faced by hospitals in India? How can the infrastructure sector contribute in overcoming these challenges? Currently India’s one billion plus population is being catered to by about 13000 hospitals and that is woefully inadequate. To further add to this, the hospital bed ratio stands at 0.9 hospital bed for every 1000 people. While India has several centers of excellence in healthcare delivery, a large number of healthcare facilities still are limited in their ability to drive healthcare standards because of poor hospital infrastructure in the vast majority of the country. The challenges the sector faces are substantial, from the need to improve physical infrastructure to the necessity of providing health insurance and ensuring the availability of trained medical personnel. This demand supply mismatch has led to cost of healthcare in India getting increasingly prohibitive. There is a vast scope for healthcare players to bridge this gap. The possible solution to meet the increasing demand and to exploit the existing opportunities certainly includes investments and combined efforts from private and public healthcare players who can further complement each other’s skills, expertise and resources across the states in India. This will lead to the creation and augmentation of hospitals, diagnostics, speciality and telemedicine clinics which can provide access to quality healthcare to both rural and urban masses. Though the costs involved in the complete upgradation of the hospital infrastructure sector are huge, there are enormous pay-offs in longterm investments in this sector. DECEMBER 2012

What role does the HBII play in boosting the Indian hospital infrastructure industry? As mentioned earlier, there are numerous opportunities in the Indian hospital infrastructure sector and to encash upon it; a dedicated platform is needed for discussions and associations. HBII has structured itself to provide the industry with a holistic platform to come together under one roof to showcase, see, discuss and work together on all the aspects involved in hospital build, design and upgrade. We are offering a platform where investors, planners, builders, contractors, architects and designers will meet senior managers and commissioners of PSU and private healthcare facilities in India to work together as a potent business force. An exhaustive range of products, solutions and services across all areas of hospital investment, planning, designing, building, operating, managing and refurbishing will be showcased and highlighted here.We intend to provide a one stop solution for the Indian Hospital infrastructural needs thus offering our exhibitors, visitors and the industry, an optimum business environment for face-to-face business meetings between the providers and the relevant buyers and end-users from India's hospital infrastructure industry. HBII has been receiving a good response from the industry with an increased no. of new exhibitors and sponsors from India and abroad. The phenomenal response, support and participation from the hospital infrastructure industry clearly indicate the trust and value that HBII has generated in a short span of three years.

The first two editions of this event were called HII, and this year there seems to be a re-naming/re-branding to HBII. What is the rationale? HBII is a part of the Hospital Build Series of events on hospital infrastructure which are organised in Middle East, Europe, China, Turkey and Russia by the Informa Exhibitions which also proudly hosts many very strong partnerships that it maintains and constantly builds upon in over 70 countries worldwide, for global mega-events that include few of the leading Medical events, namely the Arab Health - world’s most important and leading event for the Healthcare Industry and ADMC, Africa Health to name a few. From this year onwards we have initiated the process of www.expresshealthcare.in

falling in line with our international portfolio of Hospital Build & Infrastructure events and from next year onwards we will be completely replicating the international programmes and practices to reinforce HBII’s position as the only international event for hospital infrastructure in India.

How have you geared up for the HBII 2012? What preparations have been underway? Most of the organised private infrastructure is confined to the state capitals or Tier I cities. Very few have made inroads in Tier II and Tier III cities. At HBII this year, we have invested major efforts to bring in hospitals and visitors from Tier II and Tier III cities as well and bridge this gap. We are pleased to share that leading Hospital CEOs, CMOs, Directors, Hospital Consultants and top decision makers are registering their visit at HBII 2012 in large numbers and confirming their presence. The marketing reach has been further expanded by contracting 21 national and seven international media partners to effectively promote the event. HOSMAC has been appointed as knowledge partner for the event to efficiently support the Conference and Awards. HBII has received support from various industry associations like the American Institute of Architects (Archetype group), AWESOME, Hiranandani Hospital, Medica Synergie and the Ontario Government support from Canada to name a few. A strong line up of speakers and industry illuminatis have been invited to speak at the forum and share their expertise and discuss the way forward. New initiatives like the Hospital Build Awards and Business match making services have also been introduced in addition to the industry specific conference tracks, product demonstrations, seminars and display of leading hospital infrastructure products, technologies and services.There is much more to witness and explore at this three-day platform this year.

What are the highlights for this year? HBII will introduce the first ‘Hospital Build & Infrastructure Award’ with seven categories to highlight and reward the excellence achieved by the Hospitals, Architects and Builders for their valuable contribution to Indian hospital infrastructure. HBII will also include the

‘HBII 2012 Conference’ for industry professionals to benefit from the experience of the renowned industry leaders from across the world, the highlight of it being the day one session on ‘Leaders in Healthcare’. The business match making centre will also be one of the major attractions this year which will undoubtedly benefit the exhibitors and visitors alike with direct valuable meetings throughout the three day exhibition.

What will be the key topics to be covered under the scientific programme? In the current scenario, there is a need for exchange of technology and education to the doctors and hospital owners on various aspects related to design, telemedicine, infection control, ventilation systems, filtration systems, integrated hospital theatre and use of newer technology to develop the facilities better. The conference programme is designed keeping all this in mind and will deliberate on some key issues related to hospital design and planning, innovations as well as engineering aspects to look for when building or upgrading small as well as large healthcare units. The topics are broadly categorised into three segments, namely the Leaders in Healthcare, Hospital Build, Design and Upgrade and Quality of Care. Like very year, the three day HBII conference will have renowned leaders as speakers at the forum.

Who are the national and international speakers at the event? The conference programme is expected to bring together some of the prominent figureheads from hospital sectors that will include Dr Chandrashekhar R, Chief Architect, Ministry of Health and Family Welfare, Dr Rana Mehta, Healthcare ED, PWC, D. Ramakanta Panda, MD, Asian Heart Institute, Dr Sujit Chatterjee, CEO, L H Hiranandani Hospital, Dr Shakti Gupta, Head, Department of Hospital Administration, AIIMS, Dr Vishal Bali, Group CEO, Fortis Healthcare, VP Kamath, COO, Wockhardt Hospitals, Dr Girdhar Gyani, Member, Governing Board- NABH, Rajiv Kumar Jain, Director (Health and Family Welfare), Ministry of Railways, Dr Yash Paul Bhatia, President, Indian Healthcare Quality Forum, Gaurav Chopra, Managing Director, HKS India and Rajendra Chaudhari, Global Head - Enterprise Solutions, TCS to name a few of our EXPRESS HEALTHCARE

H|O|S|P|I|T|A|L|I|N|F|R|A your expectations?

renowned national speakers. International speakers include Bruce Crook, Director of International Projects, Silver Thomas Hanley Architects, Australia, Marcelle Mcphaden, Accreditation Canada International (ACI), US, Amer Bin Ahmed, Managing Director, Knauf, UAE, Aladin Niazmand, Global Director, Health Facility Planning Specialist, TAHPI, UAE, Emmanuel Smith, Chief Operating Officer, Portalp International, France, Frederic Nantois, Associate Partner International Development in Healthcare sector, France, Cyril Jacob, Managing Director, Archetype Group, France, Sven Knoll, Founder CEO, Bioni, Germany, Remko Rausch, Business Developer, Drager Medical GmBH, Germany.

HBII 2012 has received a very good response from new exhibitors and sponsors. Some of the top brands who will be displaying state of art Hospital infrastructure products at the event are Tata Motors, Godrej Interiors, Draeger, HLL Lifecare, Allarch Healthcare, Eubiq, CR medisystems, Mindray to name a few. There are few new entrants like Knauf, STH Architects, Carefusion, Bowman Rilley amongst others who will further widen the range of products and solutions on display at the event for the healthcare facilities. Healthcare architects and consultants have also joined the exhibitor category and I am sure in the next edition we will have more participation from such categories.

The last HBII 2011 edition attracted some very prominent participants in the exhibition. What is new for this edition and what are

This is the third year that this event will be organised in Mumbai. Are you not considering other cities and states within India?

Certainly yes! Our exhibitors have shown keen interest to explore options of such an event in other cities, especially at New Delhi. We are seriously considering their feedback and have been engaging our talks with our exhibition committee to look into this possibility for next year.

What is your message for the participants, exhibitors and visitors at HBII 2012? If you are planning to upgrade, refurbish your existing hospital facility or looking for solutions for your new facility then HBII is just the right platform for you to visit. We are delighted to invite the entire healthcare fraternity to the 3rd International Hospital Build & Infrastructure India 2012. This yearsâ&#x20AC;&#x2122; event will showcase more than 100 participating companies, and will exhibit products and solutions for wide range of hospital planning, hospital infrastructural products, medical technology and much

moreâ&#x20AC;Ś. The event has been structured to enable you to get the most out of your visit and we warmly invite you to attend all event features relevant to your business.

As healthcare management is being seen as an alternative/parallel career alternative to medicine, a number of medical colleges have started offering courses in this field. Do you plan to have any pull for academia or students at HBII? We have always paid attention to invite a good number of medical colleges for the conference and this year as well we have sent invitations to the deans of colleges across the nation to encourage and send their students to participate at the event and benefit from the unlimited knowledge and exposure imparted through the platform. raelene.kambli@expressindia.com

INTERVIEW

Godrej Interio aims to leverage its business through HBII 2012 A I Buvaneshwar, GM AND BUSINESS HEAD, GODREJ INTERIO, GODREJ & BOYCE

odrej Interio, a leading home furniture and furnishing company has participated in the HBII 2012 as one of the key sponsor for the event. A I Buvaneshwar, GM and Business Head, Godrej Interio, Godrej & Boyce shares his expectations from the event with Raelene Kambli

When did you enter the healthcare infrastructure segment? What are your contributions in this space ? While we have been present in the furnishing segment for close to a decade our entry into critical infrastructure is recent as we needed to study its specific needs. We view the healthcare environment as integral to the healthcare delivery process. Hospital furniture has to satisfy the expectations of patients, doctors, attendants, maintenance staff and other stakeholders which are at times very challenging, covering aspects such as safety to patients, comfort, mobility and ability to withstand long duty

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cycles without failures. The furniture design must make cleaning easy for better infection control and enhanced hygiene. The type of material used must be bacteriostatic resistant , and the environment must be supportive. Medical furniture must help in therapeutic procedures by co-ordinating well with other medical equipment and devices used. Godrej Interio has developed sufficient in-house expertise in designing interiors and execution of work places. We offer entire range of hospital furniture from examination couches, ward beds, patient room furniture, ICU beds and accessories including mattresses. Ergonomic patient beds designed to offer maximum safety to users along with reduced effort levels for operation and maintenance. While the safety to the patient is assured through fulfillment of stringent FDA safety requirements, the reduction in bed operating effort helps reduce fatigue levels of the staff helping them to be www.expresshealthcare.in

more productive and efficient at work place. In the long run it helps staff to remain healthy. Strikingly contemporary and aesthetically appealing healthcare beds from Godrej Interio with intelligent choice of material, besides offering a soothing effect to the already agonised patients as well as stressed out staff and visitors, offer long lasting, differentiated look to the hospital which break the monotony of hospital furniture which remained almost the same for many decades in India. This way, we aim to upgrade the healthcare environment and healthcare delivery infrastructure in India to global standards.

You are one of the key sponsors of the this event. What is your perspective about the HBII event? This is the first year we are participating in HBII and we are eagerly looking forward to have our first experience. We are glad that we are able to be part of the HBII event which helps in showcasing the strengths of various corpo-

rates, both national and multi national who operate in the healthcare and infrastructure segment and know about their achievements, industry specific challenges and concern areas. This event attempts to bring all stakeholders under one roof to understand common issues and challenges and how desired plans can be chalked out unitedly. Recognition of talents and achievements by the industry encourages the achievers and motivates everyone to resolve and aspire to achieve even greater feats in the coming years.

What are your expectations from HBII this year? To be able to understand the global trend in healthcare as well as infrastructure industry and how we as manufacturers could prepare ourselves to be able to leverage the opportunities in future. raelene.kambli@expressindia.com *(Check out the full interview online at www.expresshealthcare.in)

DECEMBER 2012

H|O|S|P|I|T|A|L|I|N|F|R|A INSIGHT

Designs to save Anirban Das, Chief Architect, Medica Synergie elaborates on the various ways in which hospital designs can play a role and help to cut costs and save money esigns for saving! In hospitals? Sounds strange! We believe the domain of economics of a hospital belongs to the hospital administrator. Then how does it relate to the architect’s role? Let's have a close look at the way hospital designs are generally done. Have you asked your architect if he has a comprehensive understanding of the complex functioning of a hospital? Or does he consider it similar to other creative work that he does for other clients who are into various other investments like shopping malls, software technology parks, multiplexes ...... so on and so forth! You, as a doctor or an investor from a different field, may have spelt your requirement to an architect and he designed it. As a specialist doctor you may have checked the intra-departmental planning of the spaces in terms of your comfort and with respect to your way of functioning as a specialist working at micro level. You may be happy with the planning of your own department but have you thought about other specialities and support services and whether they function in an orchestrated way? After the inauguration of your hospital, when the doctors/specialists are on board, you may be hearing from the people who run the show that in many of the places things are not working? You introspect and get convinced that it's really not working and you need changes. You are in the process of modifying the plan to make it conform to your specialists' requirements. Finally you have compromised! You have compromised on the operational efficiency and investment. You made additional investments. You spent on the opportunity cost for the delay in functioning of the hospital. Moreover, business models and SOPs consider a hospital sustainable first and then profitable. The design of the hospital acts as a catalyst to make business models succeed. The integrated design of the hospital helps to follow SOPs and improve efficiency of the workforce along with improved customer satisfaction. In the process you save on your

ANIRBAN DAS

Chief Architect, Medica Synergie

DECEMBER 2012

investments and increase throughput to make it breakeven faster. As a prelude to savings, the design and construction process covers the whole ‘life’ of a project, from recognition of a need to the operation of the finished facility. This approach ensures that all issues are considered from both, a business and a technical point of view. Furthermore, this approach recognises and emphasises the inter-dependency of activities throughout the duration of a project. It also focuses on the ‘front-end’ activities whereby attention is paid to the identification, definition and evaluation of the requirements in order to identify suitable solutions. Factors that contribute to a hospital’s success story in the changing healthcare scenario are varied and myriad. Few basics of hospital design that result in savings are as follows: www.expresshealthcare.in

Market analysis and business modelling A business model based on identification of specialities and facilities coupled with the targeted socio-economic strata of the population that fits with the appetite of the investor is the key. The healthcare seeking behaviour of the target population and their expectation of the built environment leads the thought process of the architect. Involvement of the architect in the discussions on business models, especially on phases of development to achieve breakeven, sparks the idea for approach to design which is most effective in the given circumstances. With the given parameters and guidance from the business model, the approach to design with due consideration to the functional zoning of a hospital marks the beginning point. Efficient hospital designs help to minimise the interweaving of

various activities along with containment of activities in specific zones.

Outpatients' department A major segment of people seeking healthcare in a hospital comprise the OPD patients. And be it relatives or friends, each patient is escorted by three to four persons as attendants, on an average. Hence, the waiting areas should be designed to optimise the space requirements as well as accommodate the crowd. The space allocated for the waiting can be optimised by careful calculation of number of persons waiting in a particular period of time. If the waiting are is small, problems crop up, not immediately but after some time when the patient load picks up. The discomfort of people leads to loss of patients to other hospitals. However, bigger waiting areas may be good to look at but add to the capital investment. Hence, optimiEXPRESS HEALTHCARE

H|O|S|P|I|T|A|L|I|N|F|R|A sation of spaces by understanding patient load helps you save. However, the architect must have the knowledge and experience to understand the methodology to calculate waiting time. Moreover, the fatigue due to waiting for long time in front of the consultation room may be relieved by giving them an extra exposure to natural light and greenery. This improves face value of the first interface of the patients with the hospital.

Diagnostic services The clinical support services in a hospital are shared facilities. Doctors in their domain of super-specialities feel more comfortable to have all clinical support services nearby or within the department. Often it leads to duplication of spaces and equipment. To support those spaces a handsome investment is required to provide services like electrical, airconditioning etc. More often location of these spaces at various places in the hospital leads to complexity of laying services and moreover, it leads to difficulty in servicing the same. This not only increases the capital investment but also increases operational costs since more manpower is engaged to run it. Hence integrated planning of clinical services saves the investment. There are many proximity-related diagnostics services like echo, TMT etc which can be planned in the same cluster so that the staff can do multitasking and the manpower is reduced. An understanding of diagnostic services helps an architect to plan spaces efficiently and save cost.

unless they are attended to frequently. Crowding in front of the emergency is common in majority of Indian hospitals. Such crowd affect the caregivers from performing their duties and even other emergencies at the same time face the brunt of it. Planning of exclusive waiting areas for the crowd in grief and counselling rooms make a lot of difference in managing the crowd. This helps all those who are involved in the emergency situation i.e. the patient, caregivers and the anxious relatives. This intangible portion of the planning principles of ER makes a major difference in functioning of a hospital.

Emergency department A place where within no time every facility in a hospital is required. In here, the caregivers literally run to save a life. A wrongly located emergency department (ER) can ruin a hospital's activities in case of emergencies like accidents, effects of political vengeance etc. Activities in an ER may be perceived in two major parts. One relates to clinical procedures being done and the other is to manage the patients' attendants, friends and relatives in grief. For the former, proximity of the imaging, ICU and operation theatres are essential and the route of travel to these facilities should not criss-cross other circulation patterns of a hospital. However for the later, managing emotions of the crowd becomes extremely difficult

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forced usage of spaces may justify the capital investment on dumb waiters in CSSD. Taking CSSD at a different level sometimes becomes an advantage to control the overall movement of materials including consumables, as the sterile supplies for OT are directly stored in the CSSD complex. In such a scenario, the OT works independently and issual of sterile materials for uses other than in the OT is taken care at a different level, thereby reducing the movement in the OT floor. With judicious planning of such activities a lot of floor space can be saved.

Modular in-patient areas Operation theatres and CSSD As a standard practice, the OT and CSSD are located in close proximity with each other for ease of issuing sterile materials and instruments. During the space planning, many a times it happens that the outline of the floor plates could not be matched with the lower floors in a hospital as various activities in the other floors may not sum up to the total area. For such situations, it becomes effective to bring the CSSD at a different level and connect it with the OT complex through a pair of dumb waiters, thus saving lot of space and filling the empty spaces that may be left due to integrated planning of various departments. Judicious analysis of redundant or www.expresshealthcare.in

Market forces play a big role in the type and number of patient rooms in a hospital. With economic development and increase in spending capacity of the people, the choice in type of inpatient facilities vary. For the change in expectations of people over a period of time, the flexibility to adjust the size of rooms to accommodate specific requirements is the need of the hour. There are many instances where people are not interested to share rooms with other people. On the other hand, multi bed patient rooms are required, especially at the start of a hospital. So, modular approach to accommodate such variations is the answer. Using easily removable walls like gypsum board wall are a better

choice over traditional brick mortar construction as it adds to the flexibility. In spite of a little more capital investment on partition walls, the savings achieved from not disturbing the infrastructure while making the transitions are evident.

Services Design of services play a critical role as it is considered to be the backbone of a hospital. Improper layout of services leads to disruption of activities in departments when there is a blockage in the plumbing and sanitary lines. Planning of a hospital becomes easy when we close our eyes to the planning of services. It is been observed in many places that going by the requirements of the doctors/specialists, proper routing of services are not done and some "jugaad" kind of layout like taking drainage lines along the winding corridors as and when required is carried out, ignoring the serviceability factor completely. There are enough examples where doctors are insistent on their kind of planning and ignore the architect's advice on serviceability. Integration of services with the planning ultimately saves the capital expenses and operating costs. Thus, it is the in depth knowledge of the architect in healthcare planning and designing that makes the difference! DECEMBER 2012

H|O|S|P|I|T|A|L|I|N|F|R|A PRODUCT UPDATE

Elixir: Godrej’s offering for modern day gynaecs Godrej Interio’s Elixir range of gynaecological examination couches and tables, with their avant-garde features, are designed to offer optimum comfort and convenience to both the doctor and the patient

he medical consultation marks the beginning of the healthcare delivery service: an interaction characterised by privacy, comfort and reassurance. At this point, the patient interacts with the physician for the first time, forming the defining impression of the level of care to be received. Gynaecological consultations are interactions requiring a much higher degree of privacy, safety, hygiene and sensitivity toward the patient, during ● Routine checkups in different months of pregnancy, ● Consultations and examination for fertility treatment, ● Examination for urinary problems, ● Examination for hormon-

DECEMBER 2012

al problems, Examination for infections/skin problems, ● Examination for cervical/ovarian/uterine cancer and precancerous conditions, ● and associated problems of the female reproductive system. The Elixir range of gynaecological examination couches and tables is designed to make the gynaecological consultation a reassuring experience. 1. Elegant, compact design, maximizing standing space, and enhancing caregiver access to patient. 2. Zero metal contact to patient, zero sharp edge contact to caregiver. 3. Rexene and foam upholstered surface with round●

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5. 6. 7. 8.

10.

ed corners and edges, for comfort and durability. Unique height of backrest, ergonomically recommended for patient comfort. Backrest adjustable with pull-turn lever with clutch wire. Seat ection with perineal U-cut recessed profile. SS sliding tray on slider arrangement, below the U-cut recess. Adjustable upholstered calf-rests mounted on height-adjustable lithotomy rods, secured with velcro straps. Foot section foldable on hinge brackets, adjustable in horizontal and folddown positions. Sleekly designed BP tray arrangement, folding compactly into storage,

with two lockable drawers with SS handles. 11. Additional shelf provided for open storage. 12. Clear understructure with high ground clearance for ease of access, cleaning and stability. 13. Tissue roll holder provided, for ensuring a fresh surface and hygienic examination for every patient. 14. Levelling screws to ensure stability over uneven flooring 15. Plastic bushes on base ease movement to prevent scratches on flooring. 16. Double footstep available optionally with non-skid rubber mat surface for safe, comfortable mounting and dismounting by patient. EXPRESS HEALTHCARE

H|O|S|P|I|T|A|L|I|N|F|R|A Unique extended height backrest ● ●

rest and seat section ,to tilt backrest at different angles in range from 0 degrees up to 70 degrees.

Unique extended height backrest Existing products have a comparatively short narrow

U-Cut Perineal recessed profile in seat section ●

●

Existing products have the U Cut Perineal recessed profile [with/without upholstery, often with direct metal and sharp edge contact] positioned at edge without foot section existing to support patient. Elixir Gynaec variants have the U-Cut Perineal recessed profile safely covered with upholstery at edges, at junction of Seat section and Foot section, to support patient.

Upholstered calf rests adjustable on height: adjustable lithotomy rods ●

●

Existing products have relatively uncomfortable stirrups on height adjustable lithotomy rods, to support

headrest to support the patient’s back. Elixir Gynaec variants have an extended height of backrest which is comfortable for the patient, and ergonomically recommended.

Handle lever on clutch wire to operate backrest ●

Existing products have backrests adjustable manu-

●

patient’s legs during examination. Elixir Gynaec variants provide ergonomically contoured, upholstered Calf rests secured with velcro straps, to support patient’s legs during examination

Tissue roll holder ● ●

●

Existing products do not have a tissue roll holder/any provision to keep tissues. Elixir Gynaec variants contain a rod behind backrest for mounting tissue roll, such that a fresh sheet of

ally on ratchet/gas lift which is located behind the backrest. Elixir Gynaec variants have a user-friendly handle lever located conveniently at the junction of back-

tissue can be unrolled for each patient, and every patient is ensured a safe, hygienic gynaecological examination. This feature is specially important in a tropical climate where multiple patients leave traces of perspiration on the surface and risk of infection may be high. This way, the Elixir Gynaec Examination Table is uniquely built for a superior degree of patient comfort and hygiene levels. Moreover, its thoughtful features, sleek design and ergonomic contours, enhance patient safety and caregiver ease: the perfect beginning to a reassuring care experience.

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www.expresshealthcare.in

DECEMBER 2012

IT@Healthcare 'It is important to include ICT planning at the design stage of hospital construction' British Telecom (BT) is one of the largest providers of communication across the globe and now, with its Healthcare division, is foraying into the APAC region. Janette Benett, Clinical Director, BT Health, tells us more about the company's plans and offerings in India, in a chat with Shalini Gupta cusses the IT investments made in the healthcare segment and analyses whether it is providing the required ROI

Page 54 MAIN STORY

UID: Collaborative model for better healthcare insurance in India Rahul Phadnis and Mandar Nayak opine that UID, with effective IT implementation, can serve as a much needed information repository for increasing health insurance penetration in India

RAHUL PHADNIS,

ndia’s healthcare industry is now at par with that of other emerging economies on account of its fast paced growth. This can be further enhanced by the Government’s initiative for collaboration between various health insurance companies making way for a consolidated data warehouse or a health information repository. This repository will also help in limiting the prevailing fraudulent practices. The advent of UID has now added benefits to this industry, and tapping into such a knowledge bank can mean the difference between a steep climb or fall in business for health insurance providers. The repository can also provide the Indian Health Ministry with a basis to combat epidemics proactively.

Growing healthcare sector in India Healthcare is one of India’s largest sectors in

terms of revenue and employment, and the sector is expanding rapidly. Currently, the Indian healthcare market is estimated to be around $34.2 billion, and is expected to grow at a rate of around 23 per cent per annum. With government initiatives like National Rural Health Mission (NRHM), the healthcare expenditure is targeted to rise from 0.9 per cent of GDP to two to three per cent of GDP by 2012. With a registered annual growth of 9.3 per cent between 2000 and 2009, India’s healthcare is now comparable to the growth rate in other emerging economies such as China, Brazil and Mexico. One factor propelling the growth of healthcare sector is the country’s booming population, with the current figure at around 1.1 billion and increasing at a two per cent annually. By 2050, the population is projected to reach

Technology Architect, Infosys Technologies

Technology Lead, Infosys Technologies

DECEMBER 2012

What is health insurance? Health insurance is a coverage that is provided by the insurance companies for medical care services to individuals or group of individuals. The individual or groups of individuals need to pay a premium in order to avail a health insurance policy. With a health insurance policy, people reduce their risk of incurring medical expenses in the event of illness that are covered in the policy. Some of the challenges for health insurance providers are:

14 86

MANDAR NAYAK

1.6 billion. The current market for private health insurance schemes, which was initially dominated by the public sector is expanding. Even with the private sector currently holding more than 70 per cent of the healthcare, the increasing number of both public and private healthcare facilities is expected to propel demand for the industry.

Current Market Untapped Market

30 70

Private Public

Sources: 1.Insurance industry: key trends and perspectives, Ernst & Young, 2009 2.Ernst & Young analysis

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Consolidated data store The single most challenging hurdle for health insurance companies in India is to tap into a consolidated data store, having information pertaining patients, hospitals, medical service providers and other related elements such as clinical and operational indicators. With wide spread implications, such a store may end up being a make-it or break-it factor for new health insurance companies. Even with numerous benefits, insurance companies have had limited success with their attempts to build such an information source. For one, identifying individuals uniquely has been a trying job. Further, privacy laws in India are yet to progress to a level which enables easy sharing of patient’s data between insurance companies and hospitals. Hence the problem lies in information not being shared between the insurance companies. Low penetration and untapped market- With more than 800 million of the total population falling in the low income group, a majority of people are either not at all covered or insufficiently covered. Seventy five per cent of expenditure on healthcare in India is still being met by ‘out-of-pocket’ consumers. Over 40 per cent of the low and middle income population borrow money or sell assets to pay for hospitalisation. These numbers deem that health insurance in India is limited only to the high and middle class segments of the population. Fewer health insurance plans are actually targeted for the poor and these cannot match the EXPRESS HEALTHCARE

I|T|@|H|E|A|L|T|H|C|A|R|E needs of all the diverse communities and their priorities. Such a gap between the need and fulfillment means lesser number of the low income groups actually opt for health insurance. Adding to the limitations is the fact that the plans do not cover expensive treatments or impose limits on covered illnesses. High claim ratios - One of the other challenges that health insurance companies in India face is high claims ratio, and one of the reasons for this is bad pricing. The handshake between medical service providers and insurance companies does not happen due to which the medical history is not available with the insurance companies, leading to incorrect premium being levied on the customer.

A health insurance collaborative model

Medical Service Provider

Patient

Health Insurance Company

Third Party Administrator

Unique Identification Number (The Aadhaar Project) - A step ahead Unique identification number is a string/number which identifies an individual in India uniquely. The current population of India is around 1.2 billion and each Indian national will be eligible to have a unique identification number. The Unique Identification Authority of India (UIDAI), lead by Chairman Nandan Nilekani, has been set up to do this job of issuing unique numbers. The UID number will be issued only to those residents who satisfy the verification procedure. This unique identification number will be associated with the name, sex, address, marital status, identification mark and finger biometrics for every person residing in India. UIDAI's job is only to issue a number and this

Key players in the health insurance sector

Medical Service Providers Would include hospitals, medical care centers, doctors, dispensaries, nursing homes, diagnostic centres and pathology labs.

Health insurance Companies A company which provides insurance to an individual against risk due to ill health.

Customer

Third Party Administrators The TPAs provide support services to the policy holder on policy related issues and claim settlements.The insurance provider outsource their administrative tasks like issuing identity cards, processing claims, making payments etc, to third party adninistrators.

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Insurance Regulatory Board The Insurance Regulatory and Development Authority (IRDA) is the statutory body responsible for business in India. They have the authority to grant licenses to private companies.

Health Information Regulatory Board

Health Insurance Company

UID

CIDR

Health Ministry

Reports

Health Information Repository

Reports

Overcoming the challenges in health insurance Challenge

Conquered by

Consolidated Data Store

Collaboration between insurance companies and other stakeholders of the healthcare industry will result into a single intelligent data store.

Low penetration and Untapped market

With UID repository fused into the health information collaborative model, tailor made reports and trend analysis can be obtained and the analysis will help in tapping different segments of the market.

High claim ratio

Reports from Health Information Repository and CIDR can showcase historical trends that can prove to be an important factor in underwriting and actuarial sciences for calculating appropriate premiums.

number will be reflected on a card which will be issued by the registrar. Registrars will be either the state governments or some of the central government agencies. Biometrics system will be used to ensure that a unique number is assigned to the individuals. A colossal repository called Central ID Data Repository (CIDR) will be built from the data collected by the authority. The data collected would have information on the name of the individual, date of birth, sex, and biometric details. Implementation of UID has added advantages for the health insurance system, ranging from tracking individuals to countering unforeseen epidemics. www.expresshealthcare.in

A health insurance collaborative model The health information collaborative model can be built on the lines of CIBIL, an information bureau which helps banks, financial institutions and other financiers to share credit histories of retail and commercial customers. Healthcare data is more sensitive and significant than data from some of the other sectors. A health information repository can be implemented in the form of a data warehouse and would target at providing the insurance provider with a simple view of its historical data. Health information repository will be controlled by a regulatory body like Health Information Regulatory Board (HIRB). Data feeds to

the HIRB will be in an encrypted format to ensure data security. HIRB will solely exist to regulate the sharing of information between healthcare stakeholders. Hence, HIRB may share reports with insurance companies at its own discretion based on the information requested. On a broader level HIRB may capture cumulative data for appropriate ailments from insurance companies and medical service providers. Additionally, HIRB along with the health ministry, may mandate sharing of medical information for critical or high risk illnesses (like cancer, AIDS, swine flu etc.) defined by the board. Insurance companies/medical service providers will need to share all the details DECEMBER 2012

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

for such illnesses at regular intervals with HIRB. Based on its guidelines, HIRB may provide aggregated data and critical illness data to health insurance companies. The health insurance collaborative model illustrates the process of populating the repository from various sources namely; hospitals, insurance companies, third party administrators (TPAs )and providing reports like high value claims, coverage effectiveness, critical illness reports etc. Using on-line analytical processing (OLAP) tools users can swiftly generate various types of reports and track various business parameters from different viewpoints. Depending upon the business requirements and other factors or constraints, one can opt for any of the database technologies such as Teradata, Oracle, and Netezza etc. A typical health insurance model could be as shown above. The major entities in such a model are as follows ● Health insurance firms ● Medical service providers like hospitals, doctors etc. ● Third party administrator (TPA) ● Health Information Regulatory Board (HIRB) ● CIDR or the UID Repository ● Patients

Solution Blueprint The Source Data File Processor will act as an engine for all types of source file formats. Any file data not conforming to any of the predefined input file formats will be loaded to a separate region called the ‘Reject Area’. For the valid file formats, the processor engine will strip off the headers and DECEMBER 2012

move the data to the common staging area. Data profiler will be used to analyse data for completeness and accuracy. Profiling techniques will be used to evaluate missing fields and duplicate records which will be the first step towards improving the data quality. The ETL process is based on the data policies consisting of business rules and data validations. These policies are configurable, thereby rendering more flexibility to the transformation process. A master data repository is capable of providing a consistent and reliable way to access data. Comprehensive audit information for data load can be captured and reported in the system. Using a scheduler the entire system can be automated to run, based on source data file availability or during specific times.

Building a health information warehouse The high level business architecture would consist of the four main components: 1.Sources 2.Transformation Engine 3.Health Information Warehouse 4.Analytics Building such a warehouse would consist of steps like Extraction: The data that needs to be extracted will be from the following sources: ● Heath insurance provider databases – These databases would consist of new memberships and claims. This data can be provided by the insurance companies to the health repository in an encrypted format. ● Hospitals – They need to have a database on the patients undergoing any surgical or medical procedures. This data may flow from the hospitals to the www.expresshealthcare.in

TPAs. The TPAs can then send this data in an encrypted format to the health repository. Both health insurance companies and hospitals will need to share data in some common standard electronic format. Transformation: The data that is extracted from the sources need to be transformed before they can be loaded in the staging areas. This will be required to get the data in a standard format (as per the data model) before consolidation. One can use any of the following approaches for transformations: ● ETL tools ● Operating system scripts and native database coding functionalities. The business transformations which include data cleansing, data quality, and business policies will be based on inputs from HIRB and CIDR boards. Loading: For loading the transformed data into the data warehouse tables, one can use the ETL tools or native database loading utilities. Business intelligence application: This application will be used for analytics and will facilitate the need to generate and access customised reports over the data warehouse. Such an application can generate different types of reports such as: ● High value claims ● Diseases with high number of claims ● Coverage effectiveness ● New business premiums ● Policies sold ● Claims processed ● Average processing time ● Critical illness report for insurance companies ● Health ministry can take

reports, based on HIRB and CIDR, which can enable government to determine steps to proactively promote wellness programmes in under privileged areas and high health risk population. Depending on HIBRs guidelines, health insurance companies can request specific reports from HIBR which can be used for efficient underwriting. Some of the sample reports that can be used by the health ministry may be in the format given in the tables below.

Benefits of a collaborative model for health insurance ●

●

Tracking an individual using UID is now easier as compared to other parameters that were used before. With reports from HIRB showing trends across various parameters such as age, gender, aliment, medical expenses etc; health insurance companies can now accomplish efficient underwriting. Availability of a consolidated data will guarantee access to statistical data which are critical for the DSS operations of a health insurance company. The company can now analyse the past and current trends of age groups, prevalent diseases etc, and create targeted products for specific groups. Creation of a data mart for detecting, investigating and evading health insurance frauds. Efficient tracking of health conditions. e.g. detecting trends of prevalent diseases, raising EXPRESS HEALTHCARE

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

City

Age

Gender

Ailments

April-2010 Pune

55-60

Male

Diabetes

April-2010 Pune

55-60

Female

April-2010 Mumbai

55-60

April-2010 Mumbai

55-60

Number of cases

Month

City

Age

Gender

4012

April-2010

Mumbai

15-35

Male

Diabetes

2378

April-2010

Mumbai

15-35

Female

Male

Diabetes

5249

April-2010

Pune

15-35

Male

Female

Diabetes

2544

April-2010

Pune

15-35

Female

Accidents Total expenses cases 225

13,75,000.00

6,00,000.00

253

19,45,000.00

7,35,000.00

UID

Name

Location

Age

Diagnosis description

Admission/Visit Date (YYYY-MM-DD)

Insurance Status

Claimed amount (in Rs)

INABFEZE9038

Amit Sharma

Pune

AIDS

2010-04-24

Yes

Nil

BSACSEB78292

John D'souza

Panjim

Cancer

2008-06-11

Yes

10,000

UYCBWEDO5290

Irfan Hafiz

Ajmer

Swine Flu

2010-12-20

Yes

4,000

●

Conclusion

alerts in case of epidemics and health reports based on various geographical areas. People in low income groups and below poverty line can now be targeted with tailored programmes and effective coverage.

The significant stake holders of the healthcare sector can be brought together by the Health Information Regulatory Board (HIRB), which is one of the most critical components of the collaborative model. A health insurance

Reporting Peroid (YYYY-MM)

Location

Age group

Ailments

Number of Cases

2010-04

Nashik

1-10

Swine Flu

3562

2010-04

Nanded

21-30

Swine Flu

1035

2010-04

Nagpur

31-45

Swine Flu

2504

Remarks

repository, comprising of data for all patients and policy holders, can be built based on the collaboration between the health insurance companies, medical service providers and third party administrators. This will help overcome some of the hurdles currently prevailing in the Indian health insurance industry. The UID can then keep track of the patients undergoing treatment in medical centers irrespective of whether the person is a policy holder or not. The other advantage of UID is

that it will provide a new set of probable customers, more from rural areas and people below poverty line. These failures can be reduced substantially with the introduction of UID, and through health insurance companies that can create tailor made schemes for these groups. The health insurance repository will also provide an added advantage to proactively tackle the situation in case of epidemics.

References: 1.UID and Public Health, http://uidai.gov.in 2.Healthcare in India, Emerging market report 2007, rice waterhouse Coopers. 3.Health Insurance in India, K. Sujatha Rao, National Commission on Macroeconomics and Health, Govt. of India.

About the authors Rahul Phadnis is a Technology Architect with Infosys Technologies. Mandar Nayak is a Technology Lead with Infosys Technologies.

INTERVIEW

'It is important to include ICT planning at the design stage of hospital construction' Janette Benett CLINICAL DIRECTOR, BT HEALTH,

ritish Telecom (BT) is one of the largest providers of communication across the globe and now, with its Healthcare division, is foraying into the APAC region. Janette Benett, Clinical Director, BT Health, tells us more about the company's plans and offerings in India, in a chat with Shalini Gupta

What was the idea behind setting up the Asia Pacific Health Practice (APAC) division? How does India fit into it? The Asia Pacific Health Practice (APAC) has been set up to co-ordinate and drive our health strategy and capabilities in the region while ensuring that each country evolves and tunes their approach to respond to the local market, managing the delivery of our existing

EXPRESS HEALTHCARE

health contracts, business development activity and growing our existing business in the region. Health is a local business and it’s really important that we have the right capabilities and resources in place to best serve customers in the region. In India, we intend to target the healthcare IT spend of private hospital chains beginning with core BT products such as BT One, Assure, Advise, Compute and Connect. Target customers include private/corporate sector hospital chains, speciality hospitals and greenfield hospital projects. We see great potential for the role of IT in advancing national health programmes to millions of Indians.

How huge is IT healthcare APAC market? By how www.expresshealthcare.in

much is it expected to grow in the next few years? What is the YoY growth? What share of this is British Telecom (BT) aiming at? BT’s strength in health IT infrastructure and services is well positioned to bring value to new hospitals and hospital upgrades and as such will be our first target market. Excluding Japan, the overall health IT market in Asia Pacific is valued at about £7.1 billion in 2011/12. BT estimates that its current addressable market in healthcare in the region is £1.3 billion in 2012/13, growing to £1.6 billion by 2014/15 which is a CAGR of 10 per cent (based on IDC Model 2011 and IDC Public sector market sizing. This includes BT propositions mapped to the physician and hospital segments of the health market.)

What experience can BT draw upon from its work in other regions to deliver healthcare infrastructure solutions in countries like India and other in APAC region? BT is one of the largest providers of communication services across the globe delivering solutions in more than 170 countries. We have been working on a wide range of health IT business across the Asia Pacific region, including complex and large infrastructure contracts for new hospitals, clinical safety management consultancy, and electronic health records work. From my experience, I can say that our world-class management experience of building large scale programmes and our ability to deliver end-to-end services is a great asset and differentiator. These experiDECEMBER 2012

I|T|@|H|E|A|L|T|H|C|A|R|E ences have helped us share some of the best-practices and learnings from one country to the other. For instance, in the UK, we are one of the largest suppliers of IT and communications services to the National Health Service (NHS), helping them provide better, safer and more efficient healthcare. Our experience from implementing such a large scale programme can be leveraged in India as well, considering the large scale population and diversity that the country has to offer. Every country today struggles with the issue of addressing the demand of many and India is no different. This is where our experience of delivering a programme of complex and large scale is an added advantage. Another example that comes to my mind is from Singapore, where we are IT partners for Connexion at The Farrer Park Company. This is Singapore’s first integrated healthcare and hospitality complex, comprising a specialist medical centre, a private tertiary hospital, and a luxury hotel with state-of-the-art conference and wellness facilities. Given the varied range of solutions, BT has the ability to provide the same comprehensive range of programme management and systems integration services in India as well as helping position the country as one of the leading health tourism facilities in the region. Our learning in addressing the need of health markets world over has resulted in continuous evolution in our strategies in the APAC region. In markets like India and China, we are working on delivering a solution which brings together patient information, held in multiple disparate systems, to provide a single source of information for patients’ medical records.

What is BT’s key differentiator in the healthcare space? Our products and services centre around core capabilities in infrastructure management, security, unified communications and mobility, drawing on the expertise of BT Advise, which brings together experts who deliver consulting, systems integration and managed services. The eHospital solution brings together the best in digital networked ICT services to help customers create a DECEMBER 2012

healthcare environment where they can give patients a better experience, boost organisational efficiency and staff productivity and keep costs in control. It’s not about ICT imposing change; it’s a way to support the work-flow changes that clinicians themselves are demanding. BT has a strong track record in Tele-health & Electronic Health Record (EHR) and areas which we believe the Indian administration would like to progress and collaborate on. All the solutions above are not exclusive to the Indian market and are offered to the other markets as well in the APAC region. As the UK and India markets are very different, the portfolios are customised as per the needs of these markets.

et expenditure when seeing a GP. Government policy will be essential in terms of finding ways to encourage and reward GP uptake of IT as well as potentially funding it, so that individual and wider public health improvements can be achieved. Government intentions regarding universal insurance coverage may facilitate this along with newer ways of providing software such as software as a service that can assist in achieving the desired outcomes. The prevailing

Primary doctors and specialists are on an equal footing for healthcare IT adoption in the UK vis-avis India. How important has government policy been in this regard especially with the NHS encouraging the system? What are the lessons to be learnt for India? In the UK, funding of healthcare is through

In markets like India and China, we are working on delivering a solution which brings together patient information, held in multiple disparate systems, to provide a single source of information for patients’ medical records taxation and General Practitioners (GPs) contract with the NHS for the delivery of services. IT is used to process all payments to GPs for those services who in so doing provide a huge amount of information on the patient which is analysed at practice, regional and country wide levels to identify areas in need of improvement or good practice that others could learn from. This includes establishing disease prevalence, interventions and treatment undertaken and outcome. It would be impossible to for individual GPs to provide this level of information without IT automating the data collection and reporting process. In India the funding model is different, with patients bearing out of pockwww.expresshealthcare.in

Public health infrastructure requires an urgent revamp to provide health care access to the non-urban and semi urban with safe and affordable health care.

What are the trends that will shape Healthcare IT of the future? Electric Health Record systems would help health care stakeholders share vital medical reports, data and information. With the increased use of tablets and other mobile devices, EHR data, reference medical material, and a host of valuable data that in the past was only available in the office or hospital can now be accessed on these devices improving patient outcomes. Personal Health Record system is also gaining importance as it helps individuals

and their health care providers to manage basic health requirements. This trend is fast shaping the healthcare sector as it empowers patients to manage their health between visits to the hospitals.

How many people will be recruited as a part of the India centre? What kind of partnerships are you looking at? Although we do not break out numbers as per verticals, we have more than 800 employees In India who are committed to ensuring our success in the Indian market. In India we intend to target the healthcare IT spend of private hospital chains beginning with core BT products such as BTOne, Assure, Advise, Compute, and Connect. While our target customers include private/corporate sector hospital chains, speciality hospitals and Greenfield hospital projects, we would like to work closely with public sector and Brownfield installations as there exists great potential for the role of IT in advancing national health programmes to millions and millions of Indians across the diverse sub-continent.

With the huge costs that it entails to bring technology to the masses and an increasing focus of governments worldwide in reducing healthcare costs, how challenging it is for companies such as yours to provide affordable healthcare at the same not comprising on technology? The prevailing Public health infrastructure requires an urgent revamp to provide health care access to the non-urban and semi urban with safe and affordable health care. Delivering affordable health care to India's large population presents enormous challenges and opportunities for the medical community. Innovative technologies, processes and partnerships forged by the Indian government and private companies have begun bridging the health care gap. In order to achieve the best outcomes for patients and healthcare providers it is important to include ICT planning at the design stage of hospital construction. The country will witness great benefits from modernisation of hospitals and general health services. shalini g@expressindia.com EXPRESS HEALTHCARE

Radiology MAIN STORY

Probing legalities of ultrasound M Neelam Kachhap examines the field of diagnostic ultrasonography, ethical issues connected to this subject and the legal premise under which it is supposed to be practised

edico-legal cases are on the rise in India. Although all fields of medicine attract medico-legal attention, recently, the field of diagnostic sonography has been in the publiceye. The medico-legal limelight is focussed on ultrasonography and sonologists, thanks to the recent media attention and celebrity talk show on female foeticide. Sex determination and subsequent female foeticide is an inhumane as well as illegal act. However, the issue of sex determination is only one of the many legalities associated with ultrasonography since it has vast applications in diagnostic imaging. From soft tissue imaging to treatment of lesions, today ultrasonography is used for a variety of purposes in medicine. Thus a sonologist could face the court, not only for violating The Pre-conception and Pre-natal Diagnostic Techniques (PC/PNDT) Act but also for a lot of reasons like missed diagnosis, invented lesions, misreported lesions, etc.

Ignorance is not bliss India has witnessed rapid developments in healthcare practice, with newer technologies and interventions promising better outcomes for patients. Informed patients are expecting more from doctors, leading to increasing dissatisfaction on the patients' part. In these times, where medico-legal cases against doctors are witnessing a sharp rise, being abreast of the fast changing laws has become even more important. Despite this, there are many sonologists who are not acquainted with the legalities of ultrasonography. "Most sonologists are unaware of the categories of litigation arising out of medico-legal issues in ultrasonography," says Dr Madhavan Unni, Professor and Consultant Radiologist, Kerala Institute of Medical Sciences (KIMS), Kerala. Seconding this, Dr Priya Chudgar, Senior Consultant Radiologist, Kohinoor Hospital, Mumbai avers, "To err is human and radiologists are also human beings. It is not uncommon in radiology practice to miss a diagnosis." Ignorance of law is not a defence. One cannot stand in court and say, 'I was unaware of the law'. It is upto the individual doctors to keep abreast of the rapidly changing laws and indemnify themselves. Like medicine, law also has its own language which needs to be comprehended by the doctors to fully understand the impact.

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R|A|D|I|O|L|O|G|Y Medical negligence The most common complaint registered against a doctor is of medical negligence. But, does it apply to sonologists? Yes, it does! "A mistake committed by the sonologist during the course of his professional duty, could be considered as a 'Tortuous Act',” opines Diljeet Titus, Founder, law firm Titus & Co, New Delhi. The laws governing medical negligence are, by far and large, a section of Law of Tort, in addition to Indian Contract Act. "Tort is a civil wrong, as opposed to a criminal wrong where a defendant breaches a duty to the plaintiff (complainant). Negligence may be defined as the “breach of a duty caused by the omission to do something which a reasonable man, guided by those considerations which ordinarily regulate the conduct of human affairs would do, or doing something which a prudent and reasonable man would not do”. The definition involves three constituents of negligence: a legal duty to exercise the due care; breach of the said duty; consequential damage," explains Sajid Mohamed, Partner, PDS & Associates, Mumbai. He adds that to be successful, the plaintiff must establish that the defendant (sonologist) owed a duty of certain care towards the patient, this duty was breached, and this breach resulted in the immediate proximate damage to the patient directly or indirectly. At times one feels that the plaintiff has a difficult task to prove this, but in reality it is a doctor's own lack of proper documentation and non-observance of standard operating procedures (SOPs), which makes it easier for the plaintiff to establish negligence on the part of the doctor. Duty of care is established as soon as the patient walks into a doctor's clinic and submits him/herself to examination. A doctorpatient relationship thereby comes in to existence. The Supreme Court in Laxman v. Trimbak, held, “The duties which a doctor owes to his patient are clear. A person who holds himself DECEMBER 2012

out ready to give medical advice and treatment impliedly undertakes that he is possessed of skill and knowledge for the purpose. Such a person, when consulted by a patient owes him certain duties viz., a duty of care in deciding whether to undertake the case, a duty of care in deciding what treatment to give or a duty of care in the administration of that treatment. A breach of any of those duties gives a right of action for negligence to the patient. The practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor very low degree of care and competence judged in the light of the particular circumstances of each case is what the law requires.”

Legalities in ultrasonography Other than negligence there are other legalities in ultrasonography such as missed diagnosis, invented lesions, and misreported

A mistake committed by the sonologist during the course of his professional duty, could be considered as a 'Tortuous Act’ Diljeet Titus

The legal relationship of the sonologist to the technician (sonographer) is governed by the law of agency Sajid Mohamed

FOUNDER, TITUS & CO NEW DELHI

PARTNER PDS & ASSOCIATES

on initial interpretation. The perceptual variety accounts for approximately 80 per cent of all radiologic errors. Because radiologic errors are common, and allegations that a diagnostic error has been committed account for 70 per cent of all medical malpractice lawsuits filed against radiologists, it is no wonder that radiologists are being forced into the courtroom as defendants in malpractice actions with discon-

In these times, where medico-legal cases against doctors are witnessing a sharp rise, being abreast of the fast changing laws has become even more important. Despite this, ther are many sonologists who are not acquainted with the legalities of ultrasonography. lesions. "Missed diagnosis in ultrasonography is a disease/lesion which could not be interpreted properly, and reported appropriately by the sonographer, in spite of it being there and is obvious when another sonographer does the ultrasound scan with reasonable skill and care within reasonable time from the first scan," informs Dr Unni. "Radiologic errors are of two types: cognitive, in which an abnormality is seen but its nature is misinterpreted, and perceptual or the ‘miss’, in which a radiologic abnormality is simply not seen by the radiologist www.expresshealthcare.in

certingly high frequency," elaborates Dr Chudgar. "The Supreme Court of India, in Jacob Mathew v. State of Punjab (2005) 6 SCC 1, held that, “A professional may be held liable for negligence on one of the two findings: either he was not possessed of the requisite skill which he professed to have possessed, or, he did not exercise, with reasonable competence in the given case, the skill which he did possess. The standard to be applied for judging, whether the person charged has been negligent or not, would be that of an ordinary competent person

exercising ordinary skill in that profession. It is not possible for every professional to possess the highest level of expertise or skills in that branch which he practices. A highly skilled professional may be possessed of better qualities, but that cannot be made the basis or the yardstick for judging the performance of the professional proceeded against on indictment of negligence. “Accordingly, we believe that ‘missed diagnosis’ could be equivalent to ‘medical negligence’ in the eyes of law if the test described above is proven. Examples of missed diagnosis are instances when an ultrasonologist fails to report an anomaly e.g. a twin pregnancy which is then subsequently picked by a second ultrasonography done by himself or by a peer or something that goes unnoticed and leads to a complicated clinical outcome. In such cases, a ultrasonologist has the right to adopt a defence of "difficult foetal positioning", "scanty liquor", limitations of the machine etc., but the case will be judged on its own merit and an expert's testimony,” says Titus. Invented lesions are instances where findings were reported when none existed. Misreported lesions are cases where the findings were not missed but incorrectly reported or interpreted.

Does consent matter in ultrasonography? The element of consent is a critical issue in medical EXPRESS HEALTHCARE

R|A|D|I|O|L|O|G|Y treatment. In an article 'Consent and medical treatment: The legal paradigm in India', Dr Omprakash V Nandimath, Associate Professor, National Law School of India University, Bangalore, says that the patient has a legal right to autonomy and self determination enshrined within Article 21 of the Indian Constitution. He can refuse treatment except in an emergency situation where consent is not needed. The consent obtained should be legally valid. A doctor who treats without valid consent will be liable under the tort and criminal laws. The law presumes the doctor to be in a dominating position, hence the consent should be obtained after providing all the necessary information. "This may perplex many sonologists who may wonder if they need to take an express consent even for a "routine" ultrasonography. However, they must appreciate that it is likely that a plaintiff will raise the lack of informed consent as a cause for legal action coupled with an action in negligence. The problem would be compounded when there is a gap in the understanding of an implied consent in the mind of doctor and the patient. Thus, it is always useful to have a clearly written consent outlining all terms and exceptions. In emergency procedures, when patients are unable to give consent, a physician may be excused from such discussion or obtaining consent. In case of minors, consent must be obtained from their lawful guardians,” adds Titus.

extremely important that the physician never delegate his or her duties to the sonographer. It is the physician's duty to give the diagnosis. In a group practice, as far as possible, one should report on the procedure that one has performed. If the fiduciary relationship is in the capacity of partners in a group, then the responsibility will be jointly as well as severally." However, Dr Chudgar paints a different picture. "In the current Indian setting of sonography practice, technicians do not play an important role, as most ultrasounds are performed by radiologists. However this may be an issue in group practice. It needs to be clarified beforehand with separate indemnity insurance and thus prime responsibility is on the signing person," she admits.

Legal responsibility in group practice

ty. Therefore, it is very important to maintain proper documentation. "Ultrasound report is a scientific professional opinion. It has to be written, documented and signed with extreme care. It should not be taken as a document for legal purpose, by a layman or person unable to understand its technical limitations," warns Dr Unni. Dr Chudgar agrees, "Documentation and archiving are extremely crucial for every radiology report, so as for sonogra-

Usually sonologists practising in a group or under an employee are also liable to the law. "The legal relationship of the sonologist to the technician (sonographer) is governed by the law of agency," says Mohamed. He adds, "The agent (sonographer) is a person who by a contractual relationship acts for, or under the control of, or by the direction of a principal (sonologist). In a private clinic, the sonographer will be the direct employee of the physician. It is

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Significance of documentation Documentation is the holy grail of medico-legal issues. It is of utmost importance to either incriminate or release the sonologist from any kind of legali-

Most sonologists are unaware of the categories of litigation arising out of edico-legal issues in ultrasonography Dr Madhavan Unni

Documentation and archiving are extremely crucial for every radiology report, so also for sonography Dr Priya Chudgar

PROFESSOR AND CONSULTANT RADIOLOGIST, KIMS

SENIOR CONSULTANT RADIOLOGIST KOHINOOR HOSPITAL

phy. It works as best evidence for medico legal issues. If patient is uncooperative or body habits make it difficult for complete evaluation, it is necessary to mention in reports. Many times some organs are partially obscured by bowel gas or not optimally evaluated due to patient related limitations, note of same can be made in report. In case any doubt, differential diagnosis can be given or clinical/pathological corre-

Documentation is the holy grail of medico-legal issues. It is of utmost importance to either incriminate or release the sonologist from any kind of legality. Therefore, it is very important to maintain proper documentation

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lation can be recommended. It is important to understand that radiological tests are adjunct to clinical diagnosis and not final authority. Every modality has its limitations, for e.g. bowel pathologies are not always detected on ultrasonography. Clinicians need to be aware of such issues. Also radiologists should take complete responsibility of their reports. It is important to check every report and sign it personally. These precautions will surely reduce errors."

Providing the legal aspect Titus says, "The documentation process and sign-posting are of crucial importance in the medical field. With regards to report writing, vague and meaningless reporting must be avoided.” Mohammed adds, “Law holds sonologist responsible for lapses in their own conduct, irrespective of any liability that might be imposed on other physicians. Clinicians often receive reports which are described with wide variation and there is lack of uniformity in the terminologies used.” “National associations of ultrasonologists should formulate a lexicon of terminologies and definitions to provide standardised language in reporting images. A report must describe in its body a complete description of all abnormalities - that is everything seen by the eyes - but in the conclusion should discuss only those findings that are important to arrive at the inference. When rendering radiology reports, radiologists should refrain from hedging, defined as the making of calculatedly noncommittal or ambiguous statements,” he advises. Every sonologist should understand the sources of error in sonography and the elements of negligence that form the basis of litigation. Errors happen; what is important is to learn to accept them with honest, humble and communicative approach and to be alert. Frequent errors need to be uncovered and highlighted, in order to prevent repetition of the same mistakes. mneelam.kachhap@expressindia.com

DECEMBER 2012

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Breakthrough in Digital Tourniquets The T-Ring provides a bloodless operating field for emergent and elective medical procedures involving the digits and lower extremities and hence is the safest tourniquet in wound care for digit injuries

CUBE introduces TRing, a digital tourniquet, designed to give healthcare providers a safer and more effective option to current digital tourniquet methods. T-Ring is FDA approved and manufactured by Precision Medical Devices, US. While current digital tourniquet methods are effective, they all have the risk of complications associated with their use such as excess pressure and necrosis due to prolonged application. The T-Ring is the only digital tourniquet that automatically adjusts to the size of the digit, resulting in a safe, reliable pressure with each use. In fact, the T-Ring has been shown to effectively provide haemostasis while applying less pressure than any other tourniquet method! This makes T-Ring the safest, most efficient and effective digital tourniquet in use today.

Breakthrough design It instantly exsanguinates as it is slid onto the digit, providing immediate haemostasis and ideal wound visualisation. The device comprises a brightlycoloured outer plastic ring within which is a flexible disc which itself contains a hole. This is supplied in a sterile packet and can be

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pushed over the lacerated digit to exsanguinate it and provide haemostasis. The ring has two â&#x20AC;&#x153;cutawayâ&#x20AC;? sections on it, which allow its two halves to be separated, pulled apart and gently moved over a larger laceration if appropriate. Similarly, the device can either be gently slid off the finger or the plastic outer ring can be broken and the inner flexible portion cut. There are a number of

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other methods to stop bleeding. A study has shown that this device provides sufficient pressure to provide haemostasis but at a pressure which is lower than that of a Penrose drain or surgical glove tourniquet and which therefore is less likely to cause tissue injury. Numerous articles advise not to use the mentioned methods due to the risk of neurovascular injury resulting from excessive

pressure, and the risk of necrosis of a digit due to a forgotten tourniquet. These methods have continued to be used, despite the warnings, because of lack of a better method. In an effort to minimise these complications, experts recommend using the least amount of pressure necessary to achieve haemostasis. The difficulty with this recommendation is twofold: â&#x2014;? Unlike pneumatic tourni-

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quets used in limb surgery, there is currently no clinically useful method to measure the pressure applied by a digital tourniquet. ● Excessive pressures can easily be reached with all other methods. The pressure applied by the tourniquet will depend on the size of the digit, the type and size of the tourniquet, and the manner in which the tourniquet is applied. The T-Ring was specifically designed to eliminate the risks associated with these methods.

Indications The T-Ring has been

developed to provide a bloodless operating field for emergent and elective medical procedures involving the digits of the upper and lower extremities. In the evaluation and management of acute problems, its uses include: ● Wound exploration for foreign bodies, or underlying tendon, bone or joint injuries ● Wound repair of lacerations, avulsions, and tip amputations ● Management of nail and nail bed injuries ● Achievement of complete haemostasis to allow closure of smaller wounds with adhesive strips; eliminating the need for painful injections and

costly, time consuming suturing ● Drainage of paronychia, and finger and toe abscesses The T-Ring is also indicated for the management of the following elective procedures: ● Elective tendon, bone or joint surgery ● Excision of tumours, warts and other deformities ● Wound or scar revisions ● Biopsies

The T-Ring advantage! The T-Ring has numerous advantages when compared to current digital tourniquet methods: ● Automatically adjusts to any size digit ● Safe pressure - every time

DIGITAL TOURNIQUET DEVICES - COMPARISON

DIGITAL TOURNIQUET DECVICES - COMPARISON PENROSE DRAIN

SAFE, RELIABLE PRESSURE EVERY TIME (AUTOMATICALLY ADJUSTS TO ANY

GLOVE

GLOVE &

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PNEUMATIC

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YES

FASTEST AND EASIEST TO APPLY

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WORKS WELL ON FINGERS AND TOES

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SIZE DIGIT!)

FREE FROM OPERATOR ERROR (CANNOT OVERTIGHTEN, FORGET ON DIGIT OR USE INCORRECT SIZE)

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●

Unlike other methods, it cannot be over tightened ● Immediate haemostasis provides ideal wound visualisation ● Highly visible, will not be forgotten on the digit ● Slides over lacerations, avulsions and traumatic skin flaps ● Faster and easier to use than any other method ● A breakthrough in digital tourniquet safety! The T-Ring may also be used in the pre-hospital arena for the immediate, temporary control of bleeding associated with traumatic injuries. Professionals that use the T-Ring include fireman, paramedics, and military personnel. It is also found in first aid kits on construction sites, restaurants and other facilities with a high frequency of injury to the fingers. 3 Cube brings the T-Ring to India for the first time. Made in California, US this product is US FDA approved, does not require special precaution for storing and has a shelf life of 4 years. It is extensively used in most trauma centres within the US and globally as well as US Military.

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

Interventional Radiology An insight on radiofrequency ablation, its working and its benefits from Modi Medicare

DECEMBER 2012

Radio Frequency blation â&#x20AC;&#x201C; How Does it Work? Radiofrequency is a type of electrical energy that has been used in medical procedures for decades. At the most basic level, this electrical energy is used to create heat. The heat is created in a specific location, at a specific temperature, for a specific period of time, and ultimately results in the death of unwanted tissue. During a radiofrequency procedure, an ablation probe is placed directly into the target tissue. An array of several small, curved electrodes are deployed from the end of the probe into the tissue. The generator is turned on and target temperatures are input. The radiofrequency energy flows through the electrodes, causing ionic agitation, and therefore friction, in the nearby tissue. This friction creates heat, and once sufficient temperatures have been reached, the heat kills the target tissue within a few minutes. Thermocouples (tiny thermometers) incorporated into the tips of the electrodes allow continuous monitoring of tissue temperatures, and power is automatically adjusted so that the target temperatures remain constant. CT guidance/Ultrasound is typically used to monitor the treatment process. Heat is a very effective means of killing tissue. As tissue temperature rises above 113Â° F (50Â° C), protein is permanently damaged and cell membranes fuse. The process is rapid, typically requiring less than 10-15 minutes exposure time for a 5cm ablation. Depending on the power applied and the resistance of

the tissues, heat decreases rapidly at a specific distance from the electrode tip, limiting the ablation size. The size of the ablated area is determined largely by the size of the probe, the temperature of the tissue, and the duration of time the energy is applied. There is a sharp boundary between dead tissue and unaffected surrounding tissue. Thus unwanted tissue can be ablated without much sacrifice of surrounding normal tissue.

What is an RF procedure like? One option is a percutaneous approach, in which the electrode is inserted through the skin to the desired location. The radiologist usually uses ultrasound or CT guidance to guide the needle to the right location. This is the least invasive way that RF is performed. General anesthesia is usually not necessary, but typically the patient is sedated. If general anesthesia is not used, some discomfort or pain maybe felt while the area is being ablated. Patients may experience a slight fever for two or three days after the procedure. Physicians often allow the fever to resolve without intervention. RF ablation procedures have a relatively low rate of complications. Most of the complications are considered minor. The following are the complications associated with this procedure: infection (abscess), bleeding, pnuemothorax, abnormal heart rhythms, and skin burn. For further details please contact : modimedicare@gmail.com

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Schiller India launches enhanced software for Neonatal Ventilator - Sophie The new software feature will improve Sophie’s already proven ability to handle critical neonatal patients

chiller India, a leading Swiss joint venture company in the field of medical diagnostics, is proud to announce a new software version for their neonatal ventilator “Sophie”. This has been launched by Stephan GmbH, a company world renowned for its advances in neonatal ventilation. The new software feature will improve Sophie’s already proven ability to handle critical neonatal patients. “External Respiration Sensor”, a newly developed system of Fritz Stephan GmbH, detects the abdominal movement of patients by means of an external respiration sensor. This is then converted into a stable, fast-reacting (<30ms) trigger signal, thus allowing SNIPPV which can further improve the efficiency of ventilation. Due to its innovative control system, Sophie allows swift changes between invasive and non-invasive ventilation thus allowing the optimal support of the so-called INSURE method (INtubationSURfactant-Extubation). According to Hormazd Cooper, Vice President, Sales, “Sophie when coupled with the option of High Frequency Oscillator, offers a significant price to performance ratio benefit. The External Respiration Sensor upgrade, optimises the NIV application, with synchronisation – sNIPPV mode. This new option allows the synchronisation of mandatory ventilation, with external respiration sensor instead of flow or,

significantly reduces the incidence of reintubation. Sophie offers the application of nCPAP or SNIPPV, both.

Features of Sophie ● ● ● ● ● ●

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pressure sensor using the spontaneous breathing of the patient, induced by patient’s abdominal movement.” The application of NIV permits lungprotective ventilation strategies thus helping reduce the occurrence of air leak syndromes and BPD. The use of NIPPV reduces the danger of ventilation failure after extubation and therefore

10.4” colour TFT monitor with waveforms and loops Easy to use panel with single rotatory knob and direct function keys Integrated humidification system Three level graded and colour coded alarms Modes: CMV, Assist / Control, SIMV, CPAP Combination modes: SIMV +PSV, Assist / Control + PSV, HFOV+ IMV Flow or pressure trigger Freeze and measure with calipers Upgradeable to HFOV (optional) Upgradeable to external respiratory (abdominal sensor) (optional)

For details contact: Atul Jabde , Product Manager Schiller Healthcare India Advance House, 2nd Floor, Makwana Road, Off Andheri-Kurla Road, Andheri East, Mumbai - 400 059 Phone: 022 61523333 / 29209141; Toll Free:1800 2098998 Fax: 022 29209142 Email:sales@schillerindia.com / support@schillerindia.com/– atul@schillerindia.com Website: www.schillerindia.com

Inbody from Biospace W Inbody from Biospace and market by Contel Medicare is the world's first body composition analysis device that measures basic health conditions in over 20,000 hospitals and sports centers in Korea

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ith ‘InBody’ which is operated by our exclusive technology, Biospace is a total-healthcare enterprise that ranks first in Korean body composition analyser market and second in body composition analyser market for experts. As a main product of Biospace, InBody is a medical device that analyses body composition by measuring bio impedance that is created when passing minute currents in human body. InBody measures Muscle Mass, Body Fat Mass, Total Body Water, Protein and Mineral with a basic principle that currents tend to go through muscles well and not fat (due to the different amount of body water). Body composition analysers have existed for many years, but

Biospace developed ‘Direct Segmental Measuring Method’, first in the world, improving accuracy and reproducibility. With its accuracy, high reproducibility rate and fast simple measurement method, InBody is being used to measure basic health conditions in over 20,000 hospitals and sports centers in Korea. Moreover, with strong brand www.expresshealthcare.in

awareness in Korea, people call body composition test an ‘InBody Test’. Over the success in Korea, InBody is developing fast in the world market with a global network including local subsidiaries in Japan, US, China and 40 agencies all around the world. In 2008, Biospace was awarded as 'Top export of 5,000,000 dollars’ and its overseas sales is

increasing 15~20 per cent annually. InBody is the world's first body composition analysis device that uses the 8-point tactile electrode method. Having received FDA approval in the United States and approval of other countries' authorities, such as in Japan, this product's high quality and accuracy has been validated. Biospace is also developing extra services such as providing a nutrition and exercise guide software ‘Lookin’Body’, health-enhancement system ‘u-town’ and others. In particular, the company is striving to achieve superior competitiveness that will facilitate success in advanced markets around the world, such as those in the US, Japan, and Europe. DECEMBER 2012

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DIVA LC Clean, sliding door with controlled leakage flow IVA LC Clean is dedicated to sites where air permeability must be controlled. It is used in hospitals, research laboratories, clean rooms and recovery rooms. It proposes specific technical solutions, and provides an enormous usage comfort.

open during maintenance operations. Frame tightness is also essential. The frame is equipped with a specific jamb profile that perfectly covers the stainless steel wall frame. The design is particularly neat with white belt and inside seals, smooth, round shaped covers and adequate floor guide without drilling. An appropriate detection and contactless switch pack is also proposed for hospital applications.

HDS Clean, Hermetic sliding door

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People transporting sensitive materials or pushing a carriage appreciate a wide automatic opening. ● Doors opening without contact or handle manipulations allow respecting stringent hygienic rules. ● Adjusting leaves opening and closing speeds limits contamination exchanges between two areas Special rubber seals have been designed to ensure the leakage flow control in rooms with a pressurised atmosphere. The meticulous leaf adjustment allows the air flow to be regulated. The operator is equipped with ergonomic and tight covers against dust and eventual other residues or liquids. They also hold

As real sanitary defence barrier, the HDS Clean door ensures a reinforced tightness against air and dust. It is designed to comply with health and safety requirements, while providing high daily utilisation comfort. 100 per cent hermetic up to 25 Pa and with a leak flow of 0,10 m³/h/m² to 50 Pa, the HDS CLEAN exceptional performances of airtightness, certified by laboratory tests, make this

door a reliable and reassuring equipment. HDS CLEAN door is dedicated to operating theatres, disinfecting rooms, sterile chambers, clean rooms or other environmentally controlled rooms. It combines a powerful operator and a tight door panel adapted to the sanitary sector. The operator lifts and moves the door panel in a secured smooth fluid movement. The opening of the door is a fully automatic operation controlled by various systems specific for each utilisation (remote control, foot or elbow pushbutton, contactless switch, detection radar, etc.). Leaves are made of a rigid core coated with high density stratified panels. They are available in a large colour range. Other materials or coatings are also available to meet all specific requirements (sound insulation, transparency, damp environment). Many control devices can also be easily programmed (contactless switch, elbow control device, pushbutton, contact carpet).

ISO H, Swing door operator combined with hermetic leaf ISO is one of the most powerful and compact swing door operators on the market, combining both comfort and design. Designed for intensive use, ISO is the ideal solution to transform easily and with discretion a manual door into an Automatic door without requiring big works for its installation. It is particularly dedicat-

ed to hospitals, consulting rooms, and more generally to areas where manual operating doors are not recommended for hygiene reasons. ISO is equipped with special functions (Self learning, Push and Go, Antiwind, Master-slave function to combine two operators) to meet various requirements. It also exists as emergency break-out version to handle the leaf in both directions in case of an emergency. Flexible and functional it

adapts on any type of door, whether in new or existing buildings. It Hermetic leaves can be combined with an ISO H pushing operator, to meet hygiene and health requirements in hospital specific areas such as disinfection, sterile and clean rooms. It provides a hermetic closure where hygiene rules have to be observed. Also Portalp provides specific hermetic leaves with a wide choice of filling finishes (laminated or stainless steel coated leaf, sound insulation, anti-bacterial glazing). use today.

Changing scenario of medical equipment market Anil Srivastava, National Sales Manager - Medical Equipment, gives an insight on the changing demands of the growing Indian medical technology industry and Nihon Kohden's offerings to meet this demands

ANIL SRIVASTAVA, National Sales Manager Medical Equipment

DECEMBER 2012

ith the changing technology landscape, demand of improved healthcare delivery and changing patient profile, the Indian medical technology industry is on fast track growth and is creating exciting scope to improve the way care is given to the patients. Patient monitoring is one of most occupants without which trauma and emergency, critical care and intensive care units of a healthcare delivery establishment cannot function. More dependency on accuracy of parameters coupled with data storages including the full disclosure of waveforms, which include beat by beat waveform storage and review. It means clinician doesn’t need to go back to the central monitor to check the beat by beat wave-

form, clinicians can check the detailed information next to the patient. This all review data is time linked, helps in reducing the time spent operating the monitor. This facility helps clinician to spend more time on the patients and helps in faster clinical decisions at bed side. Emphasis is growing on non invasive techniques to measure important parameters like continuous cardiac output. Nihon Kohden recently launched the esCCO, a novel technology to noninvasively measure continuous cardiac output from ECG and SpO2. esCCO is a new technology to determine the cardiac output using Pulse Wave Transit Time (PWTT) which is obtained by the pulse oximetry and ECG-signals from each cycle of the ECG and peripheral pulse www.expresshealthcare.in

wave. esCCO provides realtime, continuous and noninvasive cardiac output measurement. Ease of operating and ease of access to the technology will be the key in future. Wireless telemetry in patient’s care is newer technologies that are being getting in fast. In clinical study Vanderbilt University Medical Center, Nashville TN, US has completed a 1,270 patient two year controlled study evaluating continuous vital sign monitoring of post-surgical hospital patients. A preliminary analysis of the study data has shown an 85 per cent reduction of unplanned ICU transfers and a 69 per cent reduction of unplanned step down unit transfers for the patients on the study versus nonstudy patients on the same

floors during the same time period (p<0.001). Had all patients on the study floor been placed on the study during the study period, over 10 million dollars in hospital charges could have been avoided.. Keeping customer support on top priority, Nihon Kohden has a large customer support network of 45 engineers located at more than 40 locations pan India. Contact Anil Srivastava National Sales Manager Medical Equipment Nihon Kohden India 308, Spaze Tower-A, Spazedge, Sector-47, Sohna Road, Gurgaon -122002. India Mob: +91-98106-99223 Tel No: +91-124-493-1007 Toll free No.: 1800 103 8182 EXPRESS HEALTHCARE

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A leader in laminated flooring Hygienic’ Pergo floors are specially designed for improving the hygiene of sensitive environments

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hirty years ago Pergo started a revolution when it introduced laminate floors to the world. Ever since then, Pergo have been setting new standards for themselves and the laminate flooring industry at large, thus Pergo has transformed floors forever.The health of any individual is truly dependent on the health of the floor that he lives and works on. Hygiene with regards to floors is the key concern of the day. No one can afford lapses in the cleanliness and hygiene of floors. Pergo the global leaders and manufacturers of high quality laminate flooring have yet another reason to be acclaimed as the best international flooring company. Pergo has launched a new and simple way to enhance the cleanliness of floors in sensitive environments such as health care, old age homes, hotels and restaurants. Improved hygiene is achieved without the use of chemicals. Tiny traces of aluminium-oxide present in the floor surface prevent bacteria from multiplying and they die out. Pergo’s Public Extreme collection is graded as class 34, a grade which only reconfirms the durability and quality of the laminate flooring. Public Extreme has also used technologies like anti-static, hygiene, perfectfold and a few more that makes this collection the perfect choice for heavy traffic public areas like hotels, restaurants, clubs, offices, malls, stores, etc .In today’s modern world of interiors style, look, feel and durability which is of utmost priority and thus the Pergo’s

Original Excellence Collection of laminate flooring does just that. Pergo’s Total Design series of eight artistic floors with motifs such as giant fingerprints in bronze and silver, black and white barcodes, stylewood,Facette black, leather mocca and clouds are available through class 33 and class 32 range. These floors have been launched as a part of Pergo’s broadened assortment for 2012 providing and designed look of laminated floors. Also Pergo Living Expression collection which is graded as class 23/32, a grade which only reconfirms the durability and quality of the laminate flooring from Pergo. A perfect choice when it comes to domestic areas, the Domestic Extra range of laminate floorings comes in a wide range of decors and designs giving you an opportunity to experiment with various ideas for your floors. The 20 year residential guarantee that comes with this range of Domestic Extra reinstates the durability that

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Pergo is much known for and take away your worries of flooring in years to come. These Pergo floors is made out of Pergo’s trademark TitanX™ Advanced technology that makes the flooring more durable as aluminium oxide is sprinkled over it, which is the second hardest material after diamonds. Dust and dirt is a regular problem that surrounds us today. This causes a high level of infestation of harmful organisms like bacteria fungi and other’s that in turn become the cause of sickness and diseases to spread in our homes. But with the Hygiene technology used in this new collection these harmful organisms are neutralized. These collections has been given Fire Class Bfl-s1 which means that the planks don’t easily contribute to fire, making your space a safer haven to work and live in .The 20 year residential guarantee that comes with this range of Domestic Extra reinstates the durability that Pergo is much known for and take away your worries of flooring in years to come. Pergo Domestic Extra Range is priced at Rs. 175 Per sq ft,Living Expression is priced at 210 Per sq ft, Public Extreme is priced at 330 Per sq ft,Original excellence is priced at 270 Per sq ft, Total Design is priced at Rs 285 Per sq-ft for class 33 and 235 Per sq-ft for class-32 category decors. ”A lot of time and commitment goes into floor care. It is wise to do everything possible to make floor maintenance easier, healthier and

efficient. The first step towards attaining this goal is selecting an easy maintenance and safe floor for which laminate is best option,” said Naresh Maheshwari, CEO, Pergo India. ”. ’Hygienic’ Pergo floors are specially designed for improving the hygiene of sensitive environments. It is difficult to think of a simpler and safer way of removing bacteria. This is yet another innovation from Pergo that makes the company’s floor out of the ordinary,” adds Maheshwari. He further goes on the say,“Pergo is a Sweden based laminate flooring brand with prominent positions in North American and European markets and as well in India with growing market. The company develops, manufactures and markets flooring of high quality with distinctive designs and unique properties for both homes and commercial areas. Since the time when the company invented laminate floors in 1977 and created a new type of flooring material, Pergo has become one of the world’s best known and trusted flooring brands. Pergo’s inventions are protected throughout the world by nearly 500 granted patents and pending patents”. For Details contact: Pergo India Pvt. Ltd., M-13, 1st Floor, Greater Kailash-II (Market), New Delhi – 110048 Telephone:+91 11 41435741/42 Fax:+91 11 41435740 Website:www.pergo.com DECEMBER 2012

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