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VOL 7. NO 2, FEBRUARY, 2013
Chairman of the Board Viveck Goenka Editor Viveka Roychowdhury* Assistant Editor Neelam M Kachhap (Bangalore) Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das Delhi Shalini Gupta
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The Great Indian Healthcare Factories – II: Aravind Eye Care System-In service for sight ............................................34
PRODUCTION General Manager B R Tipnis Production Manager Bhadresh Valia Asst. Manager - Scheduling & Coordination Arvind Mane Photo Editor Sandeep Patil
Knowledge
DESIGN Asst Art Director Surajit Patro Chief Designer Pravin Temble Senior Graphic Designer Rushikesh Konka Layout Vivek Chitrakar
Stem cell tracking using nanoparticles......................................41
CIRCULATION Circulation Team Mohan Varadkar
Life
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Bio-absorable stents implanted for first time in Eastern India at BM Birla Heart ..................................................................................................17
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FEBRUARY 2013
Third annual GAPIO conference held in Kerala ..............................................18 Columbia Asia Hospital, Mysore receives coveted NABH accreditation............19 UK Health Minister visits India ....................................................................20
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Dr Raghuvanshi: Active leader ............51
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Editorial
BOT: Panacea or Pandora's box?
W In this issue we analyse the pros and cons of the BOT model. Its application to healthcare is still being debated and some argue that its old-wine-in-a-newbottle
ith India dubbed as the diabetes capital, and growing evidence of the link between high insulin levels and certain types of cancer, the impact of a growing community of cancer survivors will be immense. An industry contact at one of the overseas missions was sharing the news that they would soon be having a conference on cancer. In passing, I mentioned that this was one disease that was sure to leave its touch on most families and she responded that she had already lost one sibling to cancer and the another was a stage three survivor. What struck me was that the latter, even though now battling obesity from the after effects of chemotherapy, still volunteers at the children’s wing of the local cancer institute. The petty problems we face in life are nothing compared to what people go through with this dreaded disease, especially children, commented my friend. The good news is that many people have outflanked the big C and are now learning to live with cancer. The bad news is that we as a society still fear cancer and a cancer survivor often finds himself/herself fighting two battles: one is physiological but the more insidious struggle is psychological. As our story in the Strategy section, 'Life after cancer: Issues of cancer survivorship' points out, we are looking at a steep increase in the number of cancer survivors but we as a society are clueless about our role. Barring a few shining examples, the medical fraternity also needs to develop more organised ways of supporting this community. Our other major story in this issue is in the same spirit as our Anniversary issue in January where we featured 13 people who we felt could be game changers in India's evolving healthcare industry. Moving from individuals to potentially game changing business models, in this issue we analyse the pros and cons of the Build-Operate-Transfer (BOT) model. Its application to healthcare is still being debated and some argue that its old-wine-in-a-new-bottle: just another hybrid variation of PPPs. Will BOT be able to eliminate the ills bogging down the sector? As GP-led practice gives way to or grows into neighbourhood clinics, then nursing homes, and later on into larger (70-100 bedded) facilities and finally into franchisees of national multi-speciality corporate chain hospitals, doctorentrepreneurs who want to leapfrog to the next level during their life time rather than leaving it to the next generation, need to find the right model to suit their vision. Maybe BOT could be the answer to these entrepreneurs. In the same vein, a hospital architect at the HBII 2012 commented on the potential of Tier III and IV cities in India's hinterland as future healthcare hubs. There are doctors from the hinterland who have inherited huge tracts of ancestral land which they'd like to transform into a healthcare facility which bears their name, she said. They could find some answers in the BOT route. Will BOT be the panacea or just another Pandora's box?
Viveka Roychowdhury viveka.r@expressindia.com
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FEBRUARY 2013
Letters QUOTE UNQUOTE
Well written articles i, I came across the article on eclinics/online consultation. (Market cover story, September 2011, Express Healthcare: ‘Online Consultation: E-clinic Clicks’) on your website. It was well written.
H
Saroj Soren (IIT M graduate) saroj70@gmail.com
A good concept he concept of highlighting 13 Game changers for the year 2013 was brilliant. It really feels great to know about our counterparts from the industry who are doing such good work. Dr Akash Rajpal CEO, Ekohealth
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was at the IRIA conference in Indore and saw the print version of the issue/article (Spotlight, December 2012, In Imaging: ‘Accidental Pioneer: Dr Arjun Kalyanpur’). Thank you very much! It is very nicely written and I greatly appreciate it. Dr Arjun Kalyanpur CEO, Teleradiology Solutions (TRS)
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“India has about 900 million mobile phone users who pay about Rs 150 per month. By making it mandatory for them to pay Rs 20 more, the generated funds could be turned into a kind of unique health insurance policy. We are taking forward the idea to the Central government in coordination with the National Innovative Council” Dr Devi Shetty Chairman, Narayana Hrudayalaya (NH) (Announcing NH’s adoption of cloud applications by ICT Health)
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FEBRUARY 2013
UPFRONT Indian CVD experts to lead the World Heart Federation
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wo of India’s leading experts in cardiovascular disease (CVD) prevention and control has been elected to the helm of the World Heart Federation. Professor Srinath K Reddy, took over as the President and Professor Salim Yusuf, as President Elect, effective as of January 1, 2013. Professor Reddy is regarded as a global leader in preventive cardiology and a thought leader in global public health and is currently the President of the Public Health Foundation in India (PHFI). Professor Yusuf is Professor of Medicine and Executive Director of the Population Health Research Institute at McMaster University and Hamilton Health Sciences, where he has established an international programme of research in CVD and prevention involving 85 countries. Immediate Past President, Prof. Sidney C Smith Jr, MD said, “Professors Reddy and Yusuf’s thought leadership and pioneering approaches to CVD science and its direct application to health policies will strongly position and enable the World Heart Federation to combat the world’s number one killer – CVD – which causes 17.3 million deaths each year.Their expertise will lead to new strategies, not simply follow existing approaches.” Commenting on his goals and strategies for reducing CVDs as the head of World Heart Federation, Professor Reddy said, “I will particularly prioritise action on high blood pressure and tobacco which are the foremost risk factors for global disease and disability, and especially focus health promotion and disease prevention among young persons and women.” Professor Yusuf said, “I am committed to working together with the World Heart Federation board, its member organizations, partners, staff and supporters and with a new generation of emerging leaders worldwide to realizing the vision that within two decades we can reduce CVD burden by over 50 per cent”. Proessor Salim Yusuf’s presidential term will start in January 2015. EH News Bureau FEBRUARY 2013
Market 'At Orthofit, all evaluation is free' Chaitanya Shah, Founder, Orthofit
‘The market for powder free gloves in India is driven by JK Ansell’ Ranjukumar Mohan, Director & Business Head, JK Ansell
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M|A|R|K|E|T n our January issue, Express Healthcare presented 13 interesting business models and strategies introduced by dynamic professionals from the healthcare sector with a view to find feasible solutions to some of India’s pressing problems - limited access to healthcare facilities and mounting healthcare costs. On the same lines, we continue our quest to find more sustainable ideas to improve accessibility and affordability of healthcare in India. Our findings tell us that the industry, inclusive of both private and public sectors, have been rolling out various plans to bridge this gap. However, the fact that still remains is that India needs scores of new hospitals to serve its healthcare requirements and these can be made available by way of partnerships between various stakeholders of the healthcare sector either in the form of public private partnerships (PPP) or other joint venture models. PPP is the most commonly used form of partnerships applied in Indian healthcare sector. Shobha Mishra Ghosh, Senior Director, FICCI lists down some of the partnership models tried and tested so far in the Indian context which are as follows: Service Contract Model: The public hospitals in the sector outsource the non clinical support services to the private sector. Examples● DOTS programme on anti-tubercular therapy ● Non-clinical hospital services, e.g. laundry, catering, waste management etc ● Clinical hospital services e.g. radiology, pathology ● Chiranjeevi scheme of Gujarat Government Management Contract Model: Public hospitals are built and financed by the Government and handed over to the private partners for management to increase efficiency, improve quality and transfer operational risks, e.g. private management of primary health centres in Tamil Nadu. There is a large presence of corporate houses in management of such projects. Joint Venture Model: For setting up new hospitals, the Government participates through equity which is limited to providing land. The facility is expected to offer free care to a certain percentage of OPD and IPD patients. E.g. - Land subsidy to private healthcare providers by Delhi Government for 25 per cent
mally, with well established clinical and operational protocols. It can then be handed back to the owner or promoter group for continued management, with limited supervision from the hospital group. Alternately, the management of the hospital could be outsourced on a long terms basis.”
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One has to do a on-the-ground study on the viability and the pros and cons of the arrangements worked out in the existing BOT projects in India Shobha Mishra Ghosh SENIOR DIRECTOR FICCI
free IPD and OPD treatment. Well, all of these partnership models have their own set of loopholes. Some of these common models used in India to set up hospitals and healthcare centres have been under constant debate. Reason being that the existing partnership engagements by the Central and State Governments along with the private sector have been made in a makeshift manner with no clear cut framework while scaling up at a national level. To overcome these constraints, the industry is now seeking new avenues to build viable healthcare set-ups that will not only increase the number of hospitals but will also be sustainable in the long run. One such option that the industry is currently evaluating is the Build Operate and Transfer (BOT) model. The model comprises outsourcing the early stages of a hospital project’s execution to the specialists and once the project starts running smoothly it is taken over and run by someone like the government or a corporate entity. Elaborating on the legal framework of the concept, Ayanabh DebGupta, CEO Projects & Consultancy, Medica Synergie updates, “A BOT framework is established through a contractual agreement between any two private/public entities. In lieu of this agreement, the
In the public sector a PPP can be structured in various permutations and combinations of BOT models, due to availability of land with the government Ayanabh Debgupta CEO - PROJECTS & CONSULTANCYMEDICA SYNERGIE
skills and assets of each sector (public and private) are shared in delivering a service or facility for the use of the general public. ” Dr Vivek Sama, MD, American Hospital Management Company, India has been involved in many private sector BOT projects in healthcare. He explains, “The BOT model involves a collaboration between the promoter group and the hospital development and management group. The relationship can be structured as a partnership, or as a service provided by the hospital group to the promoter group. As a partnership, it can be very similar to a PPP model. The hospital group will invest in the hospital and operate it for a number of years (usually >15 years) before handing it back to the promoter group. The hospital group generates financial returns during the years it is operating the hospital. Further, the promoter group retains the real estate and gets a fully functional hospital at the end of the BOT term. In the service model the hospital group charges a fee for the planning, development, and operations of the hospital on behalf of the promoter group. This is usually a consulting fee during planning and development and a share of revenue during the operations phase. The hospital group manages the hospital until it is functioning opti-
In India, BOT is practiced in both private and public sectors but functions differently in both arenas www.expresshealthcare.in
How does BOT work in India? Across the globe, BOT finds extensive application in infrastructure projects such as the energy sector (power plants, refineries), transportation (toll roads), water and wastewater plants, landfills and healthcare projects. In India, the concept is quite prevalent in the roadways and the energy sector. Healthcare being traditionally an asset heavy investment arena, BOT is still in its infant stage. The model is practiced in private and public sectors but functions differently in both arenas. Describing the BOT applications in the private sector, Debgupta, says, “There are few private sector healthcare enterprises who have adopted innovative BOT models that make healthcare business viable and scalable”. He further elucidates the scenarios in which it is applied. Scenario 1: Here the builder is the owner as well as the financer of the project. Builder will purchase the land, develop the required infrastructure and lease it to the operator. The operator will pay the lease rent to the builder. There may or may not be some percentage of revenue sharing between the builder and the operator. In this model, the builder and operator do not share common expertise. Scenario 2: In this case, venture capitalist is the source of finance capital. The ownership remains with the operator who is also the builder. There is no revenue sharing model in this framework. The financer holds shares in the healthcare organisation in proportion of the money invested and benefits from the return on capital is only through sale of shares or IPO. Scenario 3: This is a coownership model wherein the builder and the operator establishes partnership by sharing equity. The builder will invest in land and building while the operator will invest in equipment and manpower. Scenario 4: Real Estate Investment Trust (REIT) Model which assists healthFEBRUARY 2013
M|A|R|K|E|T care infrastructure growth plans through acquisition, development, joint ventures and monetisation. ● Acquisition REIT acquires running facilities and leases them to operators under longterm lease agreement. Operator benefits from REIT’s due diligence and under writing capabilities. ● Development - REIT, through its lease arrangements, is able to fund the development of state-ofthe-art facilities for operators as a custom built hospital facility. ● Joint ventures - REIT participates selectively in joint venture structures that align its interests with those of its clients while providing an opportunity for shared growth in the investment. ● Monetisation - REIT offers alternatives to owning real estate assets by purchasing facilities from clients, who continue to operate the properties under long-term leases. However, in the public sector, this model is treated more like a PPP which is a long time partnership between the public and the private entity rather than a technical BOT which is a contractual agreement meant for the initial stages of development and establishment of a healthcare set-up. Giving a clearer picture on this, Debgupta says, “In the public sector a PPP can be structured in various permutations and combinations of BOT models, due to availability of land with the government. In these kinds of partnerships, the role of the developer is played by the Government and operator’s role can be played by the private player, while financing the project can be shared equally between building and equipment by either party”.
Comparison of traditional funding and BOT hybrid model Traditional model
Future model
Cost per bed in lakhs
Key factors driving today’s costs
Cost per bed in lakhs
Land
10
Right out purchase
1
Civil, Interiors & Services
35
Medical Equipment
15
Pre-operative Expenses
5
Cost per bed
65
Built up space–1000 sq ft/Bed building cost Rs 1200 / sq. ft Minimal utilisation, unplanned procurement Market competition Higher loans, Delayed project
3.5 10 5 19.5
An edge over other concepts BOT as a model has some interesting advantages to offer if implemented in an effective manner. The concept allows stakeholders involved in the project to leverage their respective strengths i.e. land/finance as well as hospital management expertise. Explains, Dr Sama, “The benefits are numerous. A BOT process if handled by a competent hospital development firm can and should deliver meticulous feasibility and business plan developFEBRUARY 2013
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M|A|R|K|E|T ment so that all stakeholders have realistic and consistent expectations. The business plan, developed by a credible hospital group, provides comfort to financial institutions. Additionally, the hospital group is able to leverage its experience and network to the benefit of the promoter group. For instance, during the development phase the model will result in extensive savings in cost and time through project management, equipment planning and procurement, and vendor negotiations. During the operations phase, the professional hospital group is able to achieve better physician recruitment, better patient flow, and better contracts with payers and vendors. The result is the development of a profitable, efficient, and well reputed hospital in a shorter period of time.” “A BOT model prevents an aspiring entrepreneur in healthcare from getting diluted in the effort to raise equity or corresponding debt,” points out Debgupta. In a table below, Debgupta clearly portrays the difference in the kind of investment required for a traditional model and a BOT model.
BOT can extend to public health and can be explored with experts in their domain for the right strategy of implementation, evaluation and modifications of even a national health policy agenda Meeta.Ruparel DIRECTOR, AUM MEDITEC
A BOT process, if handled by a competent hospital development firm, can and should deliver meticulous feasibility and business plan development so that all stakeholders have realistic and consistent expectations Dr Vivek Sama MD, AMERICAN HOSPITAL MANAGEMENT COMPANY
Finance – Operate – Transfer (DBFOT) projects provided by FICCI areHowever, Ghosh questions the viability of these projects. “One has to do a on-the-ground study on the viability and the pros and cons of the arrangements worked out in the above projects to get a clear idea of the extent of success in such initiatives,” he replies.
Well, it’s still the learning period for the industry and contentions like these is sure to occur at this stage. However, the BOT contracts between the promoter group and the professional agency must be clearly written and complied with in order to ensure success for both parties. What could derail the development of such projects is a breakdown of trust between the involved stakeholders. Moving forward, the industry will need to take that extra effort in understanding the implementing the right BOT model to attain sustainable healthcare setups. Ruparel suggests that the BOT approach or methodology should not be restricted to turnkey projects only. It can be applied in areas to employ IT support within hospitals, for Six Sigma deployment, brand building and development of marketing strategies for hospitals. She further goes on to say that BOT in healthcare service can also extend to public health and can be explored with experts in their domain for the right strategy of implementation, evaluation and modifications of even a national health policy agenda or for that matter even e-health network, etc. She feels if the right kind of BOT methodology is applied in healthcare it will lead to a lot of cost savings. As said earlier, BOT in healthcare is still in its infancy and only time can tell whether this new concept will act as the catalyst for change or not. Having its own set of pros and cons, we can only hope that with the passage of time the industry will make the best use of this concept – applying it in areas that are pertinent.
Apart from the questions raised on the viability of the BOT projects backed by the government, there seems some kind of delusion surrounding the concept. While there are many who feel that concept will make a difference, there are few who rebut it as well. In fact there are some experts who feel that concept is quite misunderstood in India, especially when it comes to BOT in the government sector. Ruparel points out that the industry is not clear of the actual definition of the concept. What they do is applying some frameworks of the PPP model to BOT. Abhishek Pratap Singh, Senior Consultant, PWC also feels that concept is not wellperceived in India. He says the industry still needs to learn more before they set the trend. Gaurav Chopra,
Project
Status in January 2011
Cost (Rs in Cr.)
Type
Greenfield Super Specialty Hospital at Bathinda
Construction
99
Design – Build – Finance – Operate – Transfer (DBFOT)
Greenfield Super Specialty Hospital at Mohali
Construction
118
DBFOT
Construction
225
Concession BOT
Bidding
275
Build Own Operate and Transfer (BOOT)
Vivek Shukla, AGM Business Development and Corporate Relations, DM Healthcare opines that the model is practiced more in the private sector rather than the public domain and is adopted mainly by corporates who are not from the healthcare sector to establish hospitals in India. He further informs that corporates such as Hero Honda and Jindal Steel and Power Group have set up hospitals using the BOT model in the NCR for their employees. Similarly, well-known healthcare institutes such as Cleveland University, MIO and the American Hospital Management Company are also setting up hospitals in India using the BOT model. Meeta Ruparel, Director, AUM MEDITEC also feels
Punjab Institute of Medical Sciences Indira Gandhi Government Medical College (IGGMC) Complex (Maharashtra) EXPRESS HEALTHCARE
Making better BOTs
that quite a lot of projects coming in the private sector will be established applying the BOT concept. She also points out that these projects are customised to suit the demand of the stakeholders involved in such contracts. Dr Sama also informs that the American Hospital Management Company are working on two BOT projects in the NCR, and are in discussions for several more. Where the public sector is concerned, there some few projects underway. Suresh Shetty, Health MinisterMaharashtra in an earlier interaction had informed us of one such project which the Maharashtra government will soon commence wherein the state government will provide the land and the private sector partner will be building the premise, operate it for a fixed term period and will then transfer the hospital to the State Government. When asked in which area of Maharashtra this hospital will be established, the minister informed that the project sanctioning is in its initial stage and will be made public as soon as the contract is signed. Ghosh also lists down some other BOT projects in the government sector that are on the cards. Some examples of BOT/Design – Build –
Projects on the cards
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MD, HKS India on the other hand challenges all possibilities of the development of such concept in India. He asserts that BOT does not work in healthcare and certainly not in India.
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The debate
raelene.kambli@expressindia.com
FEBRUARY 2013
M|A|R|K|E|T MEDICAL TECHNOLOGY
Bio-absorable stents implanted for first time in Eastern India at BM Birla Heart The new bio-absorbable stent provides the mechanical support to the artery when it is required and then slowly dissolves away over a period of two years or the first time in Eastern India, a revolutionary new genre of bioabsorbable stents were recently implanted in a patient in Kolkata’s BM Birla Heart Research Centre. BM Birla Heart Research Centre is a super speciality hospital dedicated exclusively to the diagnosis, treatment and research related to cardiothoracic and vascular diseases. Angioplasty till date are done in a fashion where traditional stents when implanted in coronary arteries do their job of providing mechanical scaffold to the dilated coronary artery during an angioplasty, when it is needed in early months. However, it continues to
F
were recently implanted during angioplasty of significant blockages in coronary arteries, at the Centre by Dr Anil Mishra, Medical Director, and
Dr Dhiman Kahali, Consultant Cardiologist. “This is next major leap into advancement for treatment of coronary artery
blockages, which has come more than a decade after drug eluting stents came into clinical practice and is likely to revolutionise and become
treatment of choice for coronary artery blockages,” said Dr Mishra. EH News Bureau
The new bioabsorbable stent provides the mechanical support to the artery when it is required and then slowly dissolves away over a period of two years remains in the coronary artery there after forever, even when it is not required. This leaves a metal jacket in the dilated portion of the artery making it difficult to deal with, if another blockage develops in the same area, leaving no space at times to implant a bypass graft if surgery is contemplated nor space to put another metal stent inside previously placed stent. The new bio-absorbable stent provides the mechanical support to the artery when it is required and then slowly dissolves away over a period of two years leaving native coronary artery with all its functionality. This keeps the native coronary artery open for any possible treatment option like repeat stenting or bypass surgery in case blockages develop again at the same site. Five such stents called ABSORB biovascular Scaffold (BVS) FEBRUARY 2013
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Hospi News
Fortis Healthcare’s Heart Command Centre in Agra ortis Healthcare recently inaugurated Fortis Escorts Hospital Agra (FEHA), a unit of Fortis Escorts Heart Institute, New Delhi. Dr Ashok Seth, Chairman, Cardiac Sciences, Fortis Escorts inaugurated the facility in the presence of Dr RS Parekh, a known social worker. Dr Seth said, “Equipped with cuttingedge technology and a team of super-specialists in cardiology, Fortis Escorts at Agra is a onestop destination for all heart related ailments for local patients and of the adjoining areas. The expertise and delivery of those advanced techniques of angioplasty and heart surgeries will be personally overseen by me. Advanced techniques like dissolvable stents in place of metallic stents and renal denervation therapy for hypertensive would also soon be made available to the people of Agra.” Dr Raajiv Singhal, Zonal Director, Fortis Escorts, New Delhi added, “Through Heart Command Centres of Fortis Escorts, we aim to bridge the divide between the quality of cardiac care services in metro and nonmetro cities. Fortis Escorts Hospital, Agra is a part of this initiative. Now with the setting up of Fortis Escorts, people of Agra will have access to superspecialised cardiac care services without the hassle of travelling to Delhi which automatically results in cost saving for the patients and family.” The hospital is equipped with diagnostic services like angiography to detect heart disorders. The treatment options at Fortis Escorts Agra include primary PTCA or angioplasty, artificial pacemaker, coronary artery bypass, valve replacement and periphery bypass surgery.
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M|A|R|K|E|T INDUSTRY UPDATE
Third annual GAPIO conference held in Kerala Delegates across the globe will launch screening programmes in non-communicable diseases which is set to achieve representation from 30 countries hysicians of Indian origin from across the globe recently congregated at the third annual conference of Global Association of Physicians of Indian Origin (GAPIO) in Kochi, Kerala. GAPIO was launched in January 2011 to bring together 1.2 million physicians of Indian origin in the world on one professional platform. This substantial workforce of physicians is a valuable resource, which can help to mobilise significant developments in the healthcare globally. GAPIO already has representation from 15 countries in the President’s Council.
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Speaking on the occasion of 3rd annual conference at Kochi, Dr Prathap C Reddy, President, GAPIO said, “Establishing itself as an association of the Indian medical diaspora, GAPIO is marching ahead to impact global healthcare. The moment has arrived for the Indian doctor to take a lead in shaping the contours of global health scenario.” GAPIO will launch a comprehensive screening programme for non-communicable diseases in Chittoor district of Andhra Pradesh as a pilot project which will then be replicated in other parts
of the country, according to Dr Reddy. GAPIO would like to work closely with the Government of India and different state governments in screening programmes, highlighted Dr Reddy. According to Dr Ramesh Mehta, Secretary General, GAPIO, an exchange programme to facilitate senior faculty exchange across institutions in India and other countries will also be launched this year. “The President Council of GAPIO has resolved to draw a large number of members from the fields of research and academics this
year to help achieve its objectives. GAPIO will also focus on encouraging young physicians to participate in exchange programmes across the globe,” said Dr Anupam Sibal, Joint Secretary, GAPIO. Having held conferences in Delhi, Birmingham, Hyderabad, New Jersey and Kochi, GAPIO will hold its 3rd midyear conference at Los Angeles in June 2013 to carry forward the agenda of the organisation. By the end of 2013, GAPIO will have representatives from more than 30 countries. EH News Bureau
HOSPI NEWS
Apollo Hospitals to establish the first proton therapy centre for cancer treatment Signs contract with IBA worth approx Rs 400 crores pollo Hospitals plans to establish a Proton Therapy Centre in India, reportedly the first of its kind across South East Asia, Africa and Australia. This launch is worth approximately Rs 400 crores, which covers the equipment and services supplied by Ion Beam Applications SA (IBA) to help establish the Apollo Proton Therapy Centre including the long-term operation and maintenance contract. IBA will equip the Apollo Proton Therapy Centre with its Proteus PLUS multi-room
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configuration which will include three treatment rooms with Uniform Scanning and Pencil Beam Scanning capabilities. IBA will also provide all dosimetry equipment to ensure the safest and fastest commissioning of the centre so that patients can benefit from this technology starting 2016. In addition to this, the Apollo Proton Therapy Centre will have a significant portion of the facility dedicated to research and development which will apparently strive to foster innovation so as to make modern healthcare
accessible and available for the nation. Speaking on this new initiative, Dr Prathap C Reddy, Chairman, Apollo Hospitals Group said, “This new proton therapy facility will give patients access to the most advanced radiation therapy technology. Moreover, the centre will become an International Proton Therapy Centre of Reference in Asia, allowing us to further enhance our ability to provide superior cancer care and promote the benefits of proton therapy technology across the sub-continent.”
Olivier Legrain, CEO, IBA, commented, “We are excited to be making proton therapy available for the first time in India. The Indian healthcare market is growing rapidly and there is a significant need for innovative approaches to cancer therapy. Apollo Hospitals is one of Asia’s leading healthcare providers and through our collaboration, IBA further strengthens its world leading position in proton therapy and will be at the forefront of delivering the latest in innovative cancer therapy to the Asia region.” EH News Bureau
INDUSTRY WATCH
DMAI joins the Partnership for Maternal, Newborn & Child Health DMAI will set up a small team of volunteers to focus on maternal and child health post this development isease Management Association of India (DMAI) has been admitted to the Partnership for Maternal, Newborn & Child Health (PMNCH) hosted by the World Health Organisation (WHO). As per a DMAI release, it is the first organisation from India to become a member of PMNCH. DMAI will set up a small team of volunteers to focus
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on maternal and child health post this development. Expressing thanks to PMNCH and its host WHO, for taking DMAI on board, Rajendra Pratap Gupta , President , DMAI promised to make a difference in Women & Child health policies and programmes of this country. The Partnership is an alliance of approximately 450 organwww.expresshealthcare.in
isations that partners to accelerate progress towards the Health Millennium Development Goals (MDGs) and particularly MDGs 4 and 5. PMNCH intends to work with DMAI to achieve objectives within the scope of their common responsibilities. These responsibilities include advocating for the life of every woman, newborn and child, supporting
the concept of continuum of care and supporting the implementation of The Partnership Strategic Framework and contribute, through direct or indirect work to 2012-2015 Strategic Framework and the workplan. DMAI is looking forward to collaborating with PMNCH to address the challenges of women’s and children’s health. EH News Bureau FEBRUARY 2013
M|A|R|K|E|T HOSPI NEWS
Columbia Asia Hospital, Mysore receives coveted NABH accreditation The accreditation is valid for three years but requires a reassessment in the middle of this period olumbia Asia Hospital, Mysore has received the National Accreditation Board for Hospitals and Healthcare Providers (NABH) accreditation, the highest national recognition for quality patient care and safety. The hospital achieved this in a little over three years after inauguration. “We have met all the standards set by NABH and the accreditation is a testimony to our commitment to provide the best quality of healthcare to the people of Mysore,” said Dr Viju Rajan, General Manager, Columbia Asia Hospital- Mysore. The NABH accreditation process covers all aspects of hospital management like fire safety, disaster handling, infection control practices, equipment maintenance, customer feedback, credential checking of the staff and doctors, employee satisfaction etc which ensures that the hospital quality is achieved and maintained. The accreditation once granted is valid for three years but
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pital has been a major contributor to our growth process. The hospital that started operations three years back has already become well recognised and sought after. We have always
focused on technology and international standards of clinical care combined with the highest levels of quality.” Congratulating the team, he further added, “This accreditation further
strengthens our commitment to patient safety and International quality healthcare.” The NABH certificate is an added feather in the hospitals’ endeavour to provide quality healthcare and
spread awareness on healthy living among the people of Mysore. The hospital has been working on various healthcare awareness drives for the people of Mysore. EH News Bureau
The hospital that started operations three years back has already become well recognised and sought after requires a reassessment in the middle of this period. The NABH is part of the Quality Council of India (QCI) set up by the government of India as an autonomous body to establish and operate accreditation programme for healthcare organisations. The board is structured to cater to much desired needs of the consumers and to set benchmarks for progress of the healthcare industry. Speaking on NABH accreditation, Dr Nandakumar Jairam, Group Medical Director and Chairman, Columbia Asia Hospitals said, “We have grown extensively in the past few years and are now recognised for the quality of our service and the Mysore hosFEBRUARY 2013
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Expansion
M|A|R|K|E|T INDUSTRY MEET
UK Health Minister visits India Urgent Care Centre opens facility at Kalkaji in Delhi rgent Care Centre, a pioneering model of pre-hospital care medical centres in India launched its second centre in Delhi, a month after coming up with its first centre at Vikas Marg. The centre is located in Kalkaji/Nehru Enclave region of the capital and plans to provide critical and immediate attention to all medical urgencies. Urgent Care Centres will be accessible 24x7. Each Urgent Care Centre is equipped to reach out to the needy in the first 60 minutes after a medical emergency has occurred .“There could be an 8-12 hour waiting in a public hospital, while the visit to an emergency in a private hospital can be very expensive. We are bridging the gap by providing walk in on the spot emergency care at a very reasonable cost,” said Dr Pervez Ahmed Chairman and MD, Aapka Urgicare. The Urgent Care Centres are wellequipped to cater to the primary healthcare needs of the local communities (treatment for common injuries and conditions like cuts, burns, flu and out patient department clinical services including preventative screening, basic diagnostics and vaccinations) as well as capabilities and experience to treat most episodic healthcare needs, including cardiac arrest, stroke symptoms, breathing problems and most trauma incidents. The centres also aim to provide high-quality care at the time of medical exigencies that require immediate attention to bring relief to the patients and their families. Some common problems, including chest pains, fractures, accidental injuries, allergies, anxiety, abdominal pain, headaches and infections, can be tackled at urgent care clinics.
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Expects healthcare partnerships to strengthen between the countries ollowing a week-long programme in India, the UK Health Minister Anna Soubry said that she expects the health partnership with India to “further develop and focus, among other themes, on primary healthcare, research and new technologies, education and training and regulatory issues.” Soubry’s visit included New Delhi, Thiruvananthapuram, Bangalore and Chennai. Speaking at the Indo-UK Diabetes Summit in Chennai, Soubry hoped that the large UK delegation would share “what we have been doing to help drive improvements in outcomes and reduce the significant variation in care that people currently receive across the UK. We are all also keen to learn from the extensive work you are doing to improve diabetes care across India.” She commented that just as the UK delegation was keen to learn from India’s record at delivering quality healthcare at low-cost, they are also keen to learn from India’s volume and complexity of cases, and its vast base of clinical data. Earlier in New Delhi, Soubry called on the Union Health Minister Ghulam Nabi Azad and senior officials in India’s Health Ministry. She met the Drug Controller General of India, Dr GN
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Singh. She visited the All India Institute of Medical Sciences and the Public Health Foundation of India and a range of Indian and UK businesses with an interest in healthcare. Soubry’s discussion ranged from primary and public healthcare delivery and human resource development to innovative, low-cost IT solutions and customised delivery. In Thiruvananthapuram, Soubry called on the Kerala Chief Minister Oommen
Chandy and launched a Kerala Health Department booklet ‘Quality standard for post-partum haemorrhage and hypertensive disorders of pregnancy’ which brings together the work and plans of the Kerala Health Department and the Kerala Association of Obstetricians and Gynaecologists and of NICE International, UK. She visited a primary healthcare centre (PHC), the Kerala Institute of Medical Sciences and Sree Chitra Tirunal
Institute of Medical Sciences and Technology. She then visited the Ziqitza Ambulance Control and Dispatch Centre (CDC) to support the London Ambulance Service’s partnership with emergency services in India. In Bangalore, Soubry visited Narayana Hrudayalaya Hospital and Biocon. She also called on the Karnataka Health Minister Aravind Limbavali. In Chennai, Soubry visited Apollo Hospitals and Dr Mohan’s Diabetes Specialities Centre. She called on the Tamil Nadu Health Minister Dr VS Vijay. She also attended a business event hosted by the CII and UK Trade & Investment to encourage commercial links between medical equipment and devices companies from the UK and the private sector in India. EH News Bureau
COMPANY WATCH
Analog Devices on the list of world’s 100 most innovative companies The company makes it to the list for the 2nd year in a row nalog Devices was named one of the world’s most innovative companies in the Thomson Reuters 2012 Top 100 Global Innovator SM programme. The programme analyses patent data and related metrics using a proprietary methodology to identify organisations that lead the world in innovation activity. This is the second straight year that Analog Devices is on this list, said a release. The Thomson Reuters report announcing the 2012 listing stated, “Being recognised as a Top 100 Global Innovator is a prestigious dis-
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tinction. It confirms an organisation’s commitment to progressing innovation globally, to the protection of ideas and to the commercialisation of inventions. The Thomson Reuters 2012 Top 100 Global Innovators are the world leaders in innovation.” Commenting on this announcement Somshubro (Som) Pal Choudhury, MD, Analog Devices India said, “We are delighted at being included in this prestigious list for a second straight year. This recognition is a testament to Analog Devices’ continued focus on building a culture of innovation and www.expresshealthcare.in
excellence to deliver high performance electronic equipment to our customers across the globe. Engineers at our India Product Development Center in Bangalore are closely involved in research and innovation to develop some of the most challenging designs today, including MEMS, high performance DSPs, and Analog and Mixed Signal products that are revolutionising the electronics industry across key sectors like defence and aerospace, industrial, healthcare, automobiles and consumer electronics. We have also rolled out University Programme in
India which is a demonstration of our ongoing commitment to develop an innovation driven ecosystem in the country.” To compile the 2012 list, Thomson Reuters analysed patent data, including the volume of patents filed, with all organisations having filed 100 or more innovative patents during the past three years. The report also considered how successful companies were in securing patents, the influence of patents in subsequent inventions and whether the patents were globally protected. EH News Bureau FEBRUARY 2013
M|A|R|K|E|T MEDICAL TECHNOLOGY
TAKE Solutions implements mobile-based patient diary system PaDiSys first implementation is at a biopharma company AKE Solutions has implemented its first mobile patient reported outcomes tool ‘PaDiSys’ for a biopharma company focused on the development of small molecule drugs to treat male and female reproductive disorders. TAKE is the exclusive reseller worldwide of PaDiSys through a strategic partnership with NowPos, a company that specialises in developing mobile-based solutions for life sciences. The PaDiSys solution reportedly helps sponsors to improve patients’ treatment adherence and compliance towards the protocol and patient reported outcomes. PaDiSys also allows sponsors to walk away from a paper based approach to filling out questionnaires and assessments during clinical trials, thereby enabling the clinical staff to closely monitor patient compliance and safety. Clinicians and site staff are equipped with easy-to-use
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to clinical research studies across therapeutic areas. Flexible configuration allows the product to be used in different types of research, ranging from drug efficacy, behav-
ioural, observational, adherence, quality of life, or lifestyle based studies in various therapeutic areas. He further added, “PaDiSys was developed from the ground up by
embracing key aspects of mobile technology and the need for a low cost turnkey solution. Our strategic partnership with TAKE, along with their vast network of
clients, is helping us reach out to the core pharma community needing to improve their PRO and study compliance by many folds.” EH News Bureau
The PaDiSys solution helps sponsors to improve patients’ treatment adherence and compliance analytical dashboards that monitor patient data in real time, and can intervene when necessary to ensure compliance. With quick deployment, implementation and simple use for both subjects and clinicians, there is a much higher adherence to a study regimen, thus improving trial compliance, claims the company. Ram Yeleswarapu, President and CEO said, “TAKE has been providing solutions and services to life sciences customers for 12 years, and safety is one of our core areas of expertise. In partnership with NowPos, we can provide biopharma companies with cutting edge mobile technology and quality, while reducing costs and accelerating trial execution.” Vikram Marla, CEO, NowPos M-Solutions said, “The PaDiSys platform caters FEBRUARY 2013
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Fund Raising
SG Eye Hospitals A raises Rs 50 crores from Sequoia Capital
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SG Eye Hospitals has recently raised Rs 50 crores from Sequoia Capital. ASG Eye Hospitals is currently present in six cities across Rajasthan and plans to expand to Jharkhand, Madhya Pradesh, Uttar Pradesh, Chhattisgarh and Bihar. The funding will be used to support expansion of the hospital group in central and north India. “ASG Eye Hospitals offers expert ophthalmic care for a wide range of ocular sub-specialties. We provide comprehensive diagnosis, treatment and surgical services through our cutting edge technology,” say Dr Arun Singhvi and Dr Shashank Gang, Founders, ASG Eye Hospitals. “Ophthalmic care requires highly skilled and trained professionals and
The group plans to expand to Jharkhand, Madhya Pradesh, Uttar Pradesh, Chhattisgarh and Bihar ASG provides world-class surgeons having vast surgical experience and expertise.The Founders as well as many specialists at ASG are trained at AIIMS, India’s foremost medical institution,” they add. Adding to this, Abhay Pandey, MD, Sequoia Capital India Advisors said, “ASG Eye Hospitals brings the best technology in healthcare to Tier-II and Tier-III markets and offers advanced and competent eye care services in the region. The team led by Dr Singhvi and Dr Gang are highly committed towards building an accomplished healthcare institution focused on patient-centered care.” EH News Bureau
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M|A|R|K|E|T MEDICAL TECHNIQUE
Apollo Hospitals recommends robotic surgery to treat cancer Launches the OncoRobotic surgery initiative pollo Hospitals have launched a unique OncoRobotic Surgery week-long initiative which would commence on World Cancer Day, February 04, 2013. It aims at creating awareness about the advantages of robotic surgery as a better modality of surgical treatment for cancer, as it is more precise, minimal evasive, heals faster and has better clinical outcomes for treatment of cancer. The hospital also informed that renowned proctors from Korea and California, Dr Krishnansu S Tewari, Professor & Director of Research, University of California, Irvine Medical Center, Dr Byung Soh Min, Department of Surgery, Yonsei University College of Medicine and Dr Woong Youn Chung, Chief, Endocrine Surgery Division, Department of Surgery, Yonsei University School of medicine will be in Delhi from January 31 to February 13, 2013. In addition to sharing knowledge with their
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Indian peers, they will conduct workshops, where they will perform OncoRobotic surgeries on 20 selected patients in Delhi between February 6-9 in gynaecology; February 9-12 in urology and February 9-12 in colorectal surgery. Speaking on this initiative, Dr Arun Prasad, Sr Consultant, General Surgery, Apollo Hospitals, New Delhi said, “The computerenhanced technology and robotic precision ensure a level of surgical precision never before possible. The use of robotics is changing medicine dramatically. As the technology continues to advance, patients experience the benefits of robotic surgery and the demand for robotic procedures continues to increase. Apollo Hospitals is taking a major step to bring the benefits of this technology to cancer patients in India.” He further added, “Compared with traditional open surgery and standard laparoscopic surgery,
patients treated with robotic cancer surgery benefit from more precise and accurate surgery of the concerned region in addition to decreased blood loss. This leads to less pain, fewer complications, shorter hospital stay and faster recovery. As with other minimally-invasive procedures, robotic cancer surgery requires only small incisions, which minimises trauma to tissues. Unlike standard laparoscopic techniques, robotic cancer surgery uses customised instruments that are held by a robotic arm and controlled by a trained surgeon at a nearby console. The robotic arm allows for a greater range of motion than a human wrist, offering the surgeon improved dexterity and control, while high-definition images enhance visualisation of the surgical field. The greater precision and manoeuvrability allow the surgeon to perform complex robotic cancer surgery procedures in areas that may be
beyond the reach of traditional or standard laparoscopic surgery.” Apollo Hospitals have conducted over 200 robotic surgeries in different specialities and for various disease conditions. The four armed surgical robotic system is a breakthrough in surgical capabilities especially in the areas of urooncology, gynae-oncology, gastro-oncology and head and neck – oncology where precision matters most, claims the hospital. Indraprastha Apollo Hospitals now possesses the state-of-the-art da Vinci Si Surgical System – an effective, least invasive surgical treatment. Indraprastha Apollo Hospitals has successfully conducted numerous robot-assisted surgeries, which include thymectomy, fundoplication, weight loss surgery, thoracoscopic surgery, hysterectomy, myomectomy, and radical prostatectomy, among others. EH News Bureau
INITIATIVE
Wockhardt Foundation and Rashtriya Chemicals and Fertilizers launch Mobile 1000 in Mumbai The initiative aims to provide free primary healthcare to the doorsteps of the poor, weak and needy people in India through mobile medical vans ockhardt Foundation, a not-for-profit organisation launched a mobile medical van under its flagship programme called “Mobile 1000” in association with RCF. The van will operate in Chembur, Mumbai. Dr Huzaifa Khorakiwala, Trustee and CEO, Wockhardt
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Foundation said on the occasion, “We are pleased to launch a Mobile 1000 van in association with RCF. Mobile 1000 is implemented through a unique model of awareness, diagnosis and cure. Each van is equipped with a doctor, driver and a coordinator and provides free consultations
along with free medicines. Our manpower comprises a diligent selection, training, deployment and monitoring process based on our ISO 9001:2008 approved model. A GPS tracking system ensures tight control and monitoring of our operations." The van launched in
Chembur will provide free, primary healthcare to 22,500 patients a year at their doorstep. Basic ailments like cough, cold, fever, diarrhoea, malaria, dengue, dysentry, infections, gastro-entiritis, etc will be treated. EH News Bureau
HOSPI NEWS
Rockland launches multispeciality hospital in Manesar The new hospital is expected to help leverage the entire Rockland Medical Corridor he Rockland Hospitals Group has launched a 505-bed multispeciality hospital in Manesar as a model centre for starting an integrated health care delivery through a health network. The Rockland Health Network is expected to reach out to patients through a network of trained
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health volunteers, quality certified doctors, nursing homes and small hospitals. “The Rockland Health Network creation will begin with the launch of Rockland Manesar. It will connect with 400 clinics and 40 nursing homes and small hospitals in the first phase. The network partners would include www.expresshealthcare.in
private players as well as the government through a public private partnership model,” said Rajesh Srivastava, Chairman, Rockland Hospitals Group. This model will be replicated in phases to cover the entire North India, North East India, SAARC countries, Middle East Africa and
several other countries. With the launch of Rockland Manesar the group would be able to leverage the entire Rockland Medical Corridor which will now have three multispeciality hospitals in Manesar, Dwarka and South Delhi with a total beds capacity of over 800. EH News Bureau FEBRUARY 2013
M|A|R|K|E|T MEDICAL EDUCATION
Maharashtra University of Health Sciences starts a Post-Doctoral fellowship programme The new fellowship programme is in colorectal surgery a h a r a s h t r a University of Health Sciences (MUHS), the apex body which governs medical colleges in Maharashtra has introduced a Post-Doctoral Fellowship programme with four seats to start with. Earlier similar fellowship programmes for this speciality were available in most developed countries and one had to travel there to undergo this specialised training as no such courses were available so far in India. Senior Specialist, Educator and internationally recognised colorectal surgeon Dr Parvez Sheikh of the Nova Specialty Surgery, Tardeo, Mumbai who is also on the board of MUHS for this programme says, “The Association of Colon & Rectal Surgeons of India (ACRSI) was started in 1977 by the Dr RK Menda, one of the pioneers in India. This society has been instrumental in creating awareness about this specialty in the country and training young interested surgeons by conducting instructional courses, live workshops and conferences.” Dr Sheikh further said, “However, this move by the Maharashtra University of Health Sciences is welcome as it will now be able to conduct a residency programme to train a young surgeon in the field of colorectal surgery and award a University recognised fellowship.” Adds Dr MG Bhat, Medical Director, Nova Specialty Surgery, “We welcome this move, as we have seen a huge demand for this kind of surgery among youngsters. Dr Sheikh’s credentials in the sector are par excellence, even on an international platform. Most of the reported problems pertain to common anal problems like piles, fissures and fistulas. However, increasingly patients are coming to us for complex cases such as obstetric injuries, complex and recurrent fistulas and complications after anal surgery. Medical tourism in this is also high not only because of high medico-legal barri-
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FEBRUARY 2013
ers on this subject in western countries, but also because of better treatment for these problems being available in our country.” Says Arun Jamkar, Vice
chancellor, Maharashtra University of Health Sciences, “We recognise that this is an important discipline of medicine and are happy to be the first state in India to provide this
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post-doctoral fellowship programme.” Jamkar added, “In general surgery practice almost 40 per cent surgeries belong to colorectal discipline. 10 per cent of these 40 per cent
are complex surgeries and can be handled only by specialists. With this initiative we aim to build this expertise.” EH News Bureau
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M|A|R|K|E|T IN FOCUS
'At Orthofit, all evaluation is free' Chaitanya Shah FOUNDER, ORTHOFIT
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conducted home exercise programme. We ensure ongoing periodic evaluation to monitor the strength, stability and performance. The physiotherapists treat the cause and not just symptoms. Proper alignment of biomechanical issues is the crux to good posture, energetic and healthy living and enhancing physical performance in any sports. Target Population: ● Young age growing kids ● Active age adults
ith a growing awareness of orthotics and its advantages, the field is slowly but gradually gaining importance in the healthcare scenario. Orthofit is one the leading players in this segment. Chaitanya Shah, Founder, Orthofit and a practicing podiatrist as well as mobility consultant takes about his company, its offerings, the market for orthotics and more, in conversation with Lakshmipriya Nair
What is your share in India's orthotics products market? India is a market where orthotics are practically inaccessible except to high end performers in sports or to the rich and famous. A lot of this neglect can also be attributed to the non-existence of podiatry (medical branch that centres around the treatment and study of ailments regarding the foot and leg and treatment thereof) in India. Patients come to us when they have any pain relating to mobility. Depending on the specific problem, we dispense the following products post detailed bio-mechanical evaluation a. Braces and supports b. Diabetic Footwear c. Diabetic Accessories d. Orthotics e.Thermal Products f. Accessories g. Custom made footwear
How do you plan to augment growth in 2013? In March 2012, we started our first ‘Biomechanics and
How is it effective in comparison with other models?
Exercise Studio’, in addition to our dispensing centre. We hope to start two more in Mumbai this year. At the studio, we focus on: a. Evaluation of lower limb biomechanics to develop a correct posture and gait for promoting energetic life style. b. Sports specific exercise training. c. Enhancing performance in physical and athletic activities. We hope to double our dispensing units this year across
all categories. The physiotherapists in the studio help patients to help themselves by designing appropriate exercise programmes in a graduated manner so it not only helps them to return to their previous activity level but also to enhance their performance. This studio is well equipped to fulfill the need of lower limb rehabilitation programme with respect to improving strength, flexibility, proprioception and agility and also to prevent recurrences.
What is the revenue model for your business? The key concept at Orthofit is to evaluate the mobility related problem and recommend orthotics. We do not charge for the consultation but we have a revenue share for the orthotics that are procured via tie ups with Dr Comfort, Vasyli Medical, McDavid etc; the worlds finest performance orthotics companies. We charge for the in-clinic therapy, focus on providing solution in the least number of exercise sessions and concentrate more on self-
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Evaluation is key. You can buy expensive footwear off the shelf, but will not be able to know if its right. At Orthofit, all evaluation is free, whether you choose to go in for the therapy or product is immaterial. Over the last 16 years, Orthofit has been evaluating the specific problems, going into the details of patient history before prescribing footwear and orthotics. Indians have absolutely no love affair with their feet- the human foot which consists of 26 bones, 33 joints and more than 100 muscles, tendons and ligaments is an engineering masterpiece! Over time, orthopaedic surgeons and physiotherapists have realised this and seen how we treat people. 100 per cent of our clientele is through word of mouth and referrals.
What is the USP of your business? Number one is the free evaluation. Over time, people are realising that an early visit to a podiatrist can save lakhs of money in later stages where the pain takes serious form. We do a detailed foot evaluation at Orthofit. We look for leg length discrepancy, pressure points below the feet, at the sole, the ankle and the toes. We go to the root of the problem, provide physiotherapy, orthotics and even custommade footwear if needed, especially for diabetics, amputees and people who’ve undergone some kind of orthopaedic surgery. lakshmipriya.nair@expressindia.com
FEBRUARY 2013
M|A|R|K|E|T
“Acquisition and expansion will be our priority for the year 2013” Shravan Talwar, CEO, MOOLCHAND HEALTHCARE
commence construction of our new 300-bed hospital at our Medcity campus.
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ecently, Moolchand Healthcare, announced the acquisition of Pankaj Apollo Hospital, Agra. Pankaj Apollo Hospital is the largest private tertiary care hospital in Agra with a capacity of 200 beds. This acquisition is in line with Moolchand Healthcare’s Rs 500 crore expansion plan announced earlier this year and enables Moolchand to expand its footprint to cover Western Uttar Pradesh. The company is aggressively seeking additional acquisition opportunities as they intend to assemble a portfolio of 5-10 hospitals over the next few years. M Neelam Kachhap talks to Shravan Talwar, CEO of Moolchand Healthcare about the recent acquisition and business plans
Are you looking at expanding beyond NorthIndia? Which other locations are on your radar?
We are looking at expanding into markets where we feel we can make additional and subsequent acquisitions. We are aiming at those markets in multiple places where we feel we can gain reasonable market share.
Would you be venturing into any other healthcare segment besides hospitals? Yes, Moolchand has committed Rs 100 crore for acquisitions in the pathology and diagnostic segment.
What new verticals are you interested in? Diagnostics and IVF services are the other sectors that we will be interested in. mneelam.kachhap@expressindia.com
Moolchand has been on a rapid expansion mode. What is the reason for this? The unveiling of the Rs 500 crore expansion plan and the acquisition of Pankaj Apollo Hospitals has set Moolchand on a rapid expansion mode.With this, Moolchand intends to grow as a leading player in the hospital services industry with additional acquisitions and expansions.
CLOUD ENABLED iPAD/ ANDROID READY CUSTOMIZABLE EMR ELECTRONIC CLAIMS
What capital is earmarked for these expansions? Who are the investors? We have earmarked Rs 500 crore for these expansions. This is through means of equity, debt and internal accruals. The only external investor is Sequoia Capital who helped us raise Rs 100 crore.
Please share your expansion plans for 2013? Acquisition and expansion will be our priority for the year 2013. We will aggressively venture out for the same in multiple locations across India. We will also FEBRUARY 2013
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M|A|R|K|E|T 30 MINUTE INTERVIEW
‘The market for powder free gloves in India is primarily driven by JK Ansell’ Ranjukumar Mohan, DIRECTOR & BUSINESS HEAD, JK ANSELL
What is the market scenario for latex powder free medical gloves in the global as well as Indian healthcare market?
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ith a view to eliminate the hazards caused by polymer coated surgical gloves, JK Ansell- a company that provides barrier protection devices to healthcare professionals has introduced the concept of powder free surgical gloves in India. Raelene Kambli finds out more about the product and the market for such products in Indian healthcare sector, in a conversation with Ranjukumar Mohan, Director & Business Head, JK Ansell
What is the market for powder free gloves in India? How does it fare vis-a-vis the global market?What are the growth opportunities for India in this segment? The Indian market for medical gloves is still evolving. While the global market is growing at a compound annual growth rate (CAGR) of two per cent, the Indian market is at seven per cent growth. Every day there is a new hospital or nursing home popping up in India, so the demand for medical gloves is expected to increase.Thus India is indeed an integral part of the global medical gloves industry growth, if not in value terms, but definitely in volumes. This could be attributed to increasing awareness on barrier protection and medico-legal compliance encouraging institutions to go for better barrier protection. Medical tourism is also driving growth of this product category in our country. The market size therefore for surgical gloves in India is Rs 300 crore and this financial year this figure is slated for a growth of 45 per cent, contributing to six per cent of Ansell’s EMEA medical sales. The market for powder free gloves in India is not more than 15 per cent of total market size and this is primarily developed, dominated and driven by JK Ansell.
What is powder-free glove? What are the benefits? Can powder free gloves help in reducing infections within hospitals? How are they better from existing surgical gloves? Traditionally powder is used
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Medical tourism is driving the growth of this product category in India. The market size for surgical gloves in the country is Rs 300 crore and this financial year this figure is slated for a growth of 45 per cent, contributing to six per cent of Ansell’s EMEA medical sales as a donning agent in medical gloves, but it brings with it a range of health hazards. Therefore, a new technology was invented to tide over this menace through polymer coated glove, which requires no powder for donning comfort. Powder free gloves offer a whole host of benefits, primarily they prevent multiple direct and indirect compromises to quality and safe healthcare. GAMMEX PF is a latex powder free gamma sterilised surgical glove unlike ethylene oxide sterilisation of other Indian surgical glove brands. It provides excellent donning and comfort through the use of a unique water-based polyurethane coating allowing for both wet and dry donning. This feature facilitates comfortable double donning and intra operative glove changes. It especially reduces thumb ball effect, and combined with Ansell’s soft latex formulation it ensures extended comfort and
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less hand fatigue. GAMMEX PF has a textured finger and palm, yet a smooth back providing excellent grip and easy double donning. GAMMEX PF has set international benchmarks in the protection device domain with its design and latex formulation being unique to this product. These gloves are thinner at the palm and fingers as compared to other surgical gloves thus enhancing sensitivity for the user. The gloves are also skinfriendly as they have reduced chemical residues free of thiurams and MBT (mercaptobenzothiazoles). PV100 accelerator is completely consumed during the processing stages, leaving no detectable chemical accelerator residue – thereby reducing the risk of contact dermatitis. The mild textured finish of the gloves allow secure handling of instruments in wet and dry conditions.
The total world market for latex medical gloves - powdered vs powder-free is expected to grow to $1.96 billion by 2016. The powdered gloves market is expected to decline by a CAGR of 3.6 per cent and powder free gloves are expected to grow by CAGR of 3.1 per cent by 2016. The respective growth and decline rates shall be steeper in the Indian context as we’re predominantly a latex powdered glove market. In the global context, especially developed markets, powder free gloves represent around 82 per cent of the market whereas it’s retrograde in India where powdered gloves represent more than 85 per cent of the market.
Tell us about JK Ansell’s contributions in this segment? In 2000, the company commenced selling and distributing a wide range of high-end medical gloves. These medical gloves not only protect the healthcare worker from potentially infectious substances but also protect patients from cross contamination. With a 75 per cent market share in the premium powdered gloves segment and a significant presence in other segments, the company is the first to promote the powder free concept. The gloves are sold to major hospitals and nursing homes as well as glove retailing chemist outlets.
What are the company’s plan for India? Are there any major investment plans in the pipeline? We have a rich pipeline of latex free surgical gloves followed by first of its kind anti microbial surgical gloves. The plan is to expand by introducing new product categories and expanding our distribution network to Tier-II and III cities. We’ve new product segments like safety devices and active infection prevention equipment which also hold promising potential in India. raelene.kambli@expressindia.com
FEBRUARY 2013
M|A|R|K|E|T PRE EVENT
ISPO 2013 World Congress to be held in Hyderabad The event which will be held from February 4-7, 2013 at the HICC in Mumbai is expected to bring global prosthetic and orthotic innovations to Hyderabad he ISPO 2013 World Congress will be held from February 4 to 7, 2013 at the Hyderabad International Convention Centre (HICC), India. The 14th edition of the World Congress is being organised by the International Society for Prosthetics and Orthotics (ISPO), will be the first-ever prosthetics and orthotics (P&O) conference and exhibition in India and the South Asian region. ISPO is an advisory body in the field of rehabilitation and P&O to WHO, UN Agencies and the International Committee of Red Cross. This international event is expected to showcase the
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latest equipment, facilities, technology and solutions in the P&O segment. Over 1,000 delegates from 84 countries are expected to participate in the event which would reportedly have more than 100 exhibitors from across the world. Several free paper sessions would also be presented in the event. So far 474 abstracts from 48 countries have been accepted by ISPO. The event is expected to create awareness regarding the latest changes in the field of rehabilitation education and present global networking opportunities in the fields of rehabilitation and
ISPO 2013 is intended to be an ideal forum to learn, interact and find synergies in healthcare technology segment allied health sectors, as well as enhanced scope for innovation and development of appropriate designs indigenously leading to affordable products and components for our people. ISPO 2013 is
intended to be an ideal forum to learn, interact and find synergies in healthcare technology segment. While Dr Carson Harte will deliver the Knud Jansen Lecture there will be three keynote addresses by Dr Ashok Johari, Dr Edward Lemaire and Surinder Mehta at the event. The Congress features oral presentations, instructional courses and symposia, exhibitor workshops, poster presentations and free paper sessions. There are 420 oral and 107 poster presentations. The last edition of the Congress was held in Leipzig, Germany which saw more than 3,000 delegates.
POST EVENT
Metropolis conducts CME on genetic testing and its avenues The event which focussed on the advances in genetic diagnostics and addressed questions like 'Where we are and where are we heading?' received a good response from the delegates y means of genetics, diagnostics has witnessed transcendental developments. However, despite developments and the many promises genetics has made, its developments are yet to percolate to the larger population. A promising research and an expounding clinically viable diagnostic area, ‘from bench to beside’, was the theme for the recent CMEs conducted by Metropolis Healthcare in Mumbai and Bangalore. The idea of the CME was to disseminate knowledge on genetic testing and avenues it promises to deliver. The CME was addressed by Dr Aparna Rajadhyaksha and Dr Anurita Pais on chromosomal microarray and FISH, respectively. Dr Rajadhyaksha currently works in Miami Children’s Hospital in the Genetics Department and is also the co-director of the molecular genetics, cytogenetics and biochemical genetics labs. Dr Pais is the chief geneticist at the Worli lab of Metropolis.
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The idea of the CME was to disseminate knowledge on genetic testing and avenues it promises to deliver Shedding light on the chromosomal microarray, Dr Rajadhyaksha took note of the path genetics has traversed from the discovery of cell to the break-through of polymerase chain reaction (PCR) testing. Following which she discussed the applications of newer technologies like chromosomal SNP-array, exome sequencing, whole genome sequencing and oligonucleotide arrays profiling for gene expression. The role of each of these tests was then explored by giving case based examples and how the application of these technologies helped in arriving at diagnostics and augmenting treatment outcomes. Rolling back from the future avenues to the existing technology at Metropolis lab, Dr Pais elaborated on fluorescence in situ hybridisation (FISH), a technology available www.expresshealthcare.in
with only a handful of laboratories in India, Metropolis – Worli lab being amongst the few. FISH helps understand the biology of the disease, which in turn enables precise disease management and targetted therapies. The power lies in its potential to identify specific genetic aberrations. This ability has propelled this technique to the forefront of diagnostic procedures for prenatal, clinical genetics and cancers. Not only are the applications of FISH wide, but it also ensures a high sensitivity and specificity with a rapid turnaround of testing. FISH has found significant application in diagnosis and prognosis of haematological malignancies and solid tumours. Summing up the role of cytogenetics and molecular testing in cancers, focus was drawn towards the testing
algorithms that ensures a fast comprehensive diagnosis and prognosis; with the identification of molecular markers for minimal residual disease identification and precise disease management in cancers. The Metropolis CME fetched a highly positive reaction from the attendees which included some prominent names from the medical fraternity. The highest response was reportedly from the specialities of gynaecology, paediatrics followed by oncologists. Reacting to the event, Dr Kishori Kadam, a prominent gynaecologist practising in Mumbai said, “We are extremely glad that genetics in India is actually moving from bench to bedside, and Indian diagnostics is making headway. Although there are concerns like cost and ethical issues related to these genetic tests, nonetheless it has a wide application. In gynaecology such tests have a definitive role in diagnosing and managing preventive genetic disorders.” FEBRUARY 2013
M|A|R|K|E|T POST EVENT
Pradanya-2012: A well organised event The theme for the 17th annual National Conference was Healthcare Market 2020 nstitute of Health Management Research (IHMR), Jaipur conducted its annual signature conference, Pradanya-2012 on December 21-22, 2012. In line with the current healthcare scenario, the theme for the 17th National Conference revolved around ‘Health Care Market by 2020’. The conference was preceded by two pre-conference workshops on ‘Performance Excellence’ and ‘Project Management’ which were conducted by Dr Suresh Lulla, Director Qimpro Consulting and Healthcare Planning and Dr Vivek Desai, Hosmac India, on December 20, 2012. Pradanya-2012 was attended by more than 300 delegates from all over the country. The event was inaugurated by Chief Guest Dr Ajay Bakshi, CE0, Max
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Healthcare. The theme of the conference was introduced by Dr SD Gupta, Corporate Director, IHMR, engulfing the pertinent segments of the healthcare market. In his address, Dr Bakshi said that investment in healthcare in the present scenario is nearing $70 billion and it is going to increase up to $350 million by year 2020, leading to a substantial rise in the demand for healthcare professionals and managers. Dr Bakshi also opined that what a manager cannot measure he cannot manage. The event also comprised technical sessions on Healthcare Market 2020, Entrepreneurship in Healthcare, Quality and Patient Safety, Revenue Cycle Management, Cloud Computing and Web Applications, Managing
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Workforce Governance and Challenges of Millennium Development Goals. Pradanya-2012 also consisted of speeches from highly-qualified and veteran speakers from various seg-
ments of the industry. Eminent speakers who delivered lectures at the conference included Dr Ram Narain, Executive Director, Kokilaben Hospital; Dr T Sundararaman, Executive Director, NHSRC; Dr Babu Khan, CEO, Healthcare Sector Skill Council; Dr Suneeta Sharma, Country Director, Futures Group and Dr Siddharth Agarwal, Executive Director, UHRC. Yatin Patil, Head IT Advisor, KPMG; Dr Parag Rindani, CEO, Wockhardt Hospitals; Dr. Barun Kanjilal, Professor, IIHMR, Jaipur. Other speakers represented companies like Philips Health Care; EquNev Capital Bangalore; Octavo Solutions; Wockhardt Hospitals; Medica Synergie, Kolkata; Rajshree Hospitals, Indore; ehealth Enablers, Bangalore and Truworth InfoTech, Bangalore The future realities of healthcare market and addressing the challenges of making the market work for the poor were reiterated. Speakers advocated joining six sigma and the theory of lean management to obtain a new concept on lean six sigma for improving quality. Different perspectives on the revenue cycle and what a hospital should do to save losses by improving the processes and design were elaborated. Emphasis was also laid on various types of clouds; considerations for using cloud and the health applications of cloud computing. Moreover, the dearth of human resources and adequate infrastructure hindering the attainment of Millennium Development Goals to which India is a signatory was deliberated to be quintessential. Pradanya 2012 also had the entire landscape of IHMR, Jaipur canvassed with over 30 poster presentations. Six papers, selected from 50 abstracts received from all over the country, were also read during the event. The valedictory session had an inspiring speech by Prateem Tamboli, CEO, Fortis-Escorts, Jaipur. Thus Pradanya 2012, ended on a high note, with a promise to elevate this platform of knowledge sharing with newer vistas and more dimensions. EXPRESS HEALTHCARE
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EVENTS UPDATE Green lean six sigma certification training for healthcare Date: February, 6-8, 2013 (Yellow belt training) 11 – 16, 2013 (Upgradation to green belt training) Venue: Bangalore
(panchal@medicall.in) Mob: +91 9360727424
The Annual Conference of the Indian Society of Interventional Radiology Date: February 14-17, 2013
Last date to register: January 18, 2013; Friday 5:00pm Upgradation to Black Belt: follows tentatively in June Date: March, 1-17, 2013 (Fridays, Saturdays and Sundays only) Last date to register: February 6, 2013; Wednesday 5:00 pm Upgradation to Black Belt: follows tentatively in July Venue: Delhi 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 uniqueness of this programme is in its module that 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 at the same time 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, meetaruparel@hotmail.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 healthcare industry, purchase managers Contact details: Medexpert Business Consultants Pvt Ltd C-3, Shree Vidya Apartments,14 Balakrishna Street, West Mambalam, Chennai - 600 033 Tamilnadu, India Phone: 91 44- 24718987 Contact: Yogita R Panchal
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Venue: Kovai Medical Centre and Hospital, Coimbatore Organiser: The Society of Interventional Radiology (US) Topic: The Society of Interventional Radiology (US) will be co-partnering this meeting and a full delegation will be representing the American Society to help postgraduates in india connect to centres in US for fellowships and training. there will be hands-on training exclusively for post graduates students which will be co-attested by both SIR and ISVIR Contact: Dr Mathew Cherian Email: isvir2013@gmail.com Website: http://isvir13.com/
Demystifying performance excellence in Healthcare
Organiser: SMi Group Topic: The event will focus primarily on oncology imaging modalities and applications in pre-clinical case studies, clinical imaging applications and innovations in imaging technology Speakers: Experts like Bert Windhorst, Head - Radiopharmaceutical Chemistry, VU University Medical Centre; Francois Lassailly, In-vivo Imaging Specialist, Cancer Research UK; Peter EggletonMedical Director, Merck; Prash Krishna, Director - Oncology, Clinical Development, Eisai and Werner Scheuer, Research Leader Preclinical Imaging, Pharma Research and Early Development, Roche Diagnostics Contact: UK Office, Opening hours: 9.00 - 17.30 (local time) Tel: +44 (0) 20 7827 6000 Website: http://www.smi-online.co.uk Email: events@smi-online.co.uk
AIIMS-MAMC-PGI imaging course on "Recent Advances and Applied Physics in Imaging" Date: March 29-30, 2012 Venue: AIIMS
Date: February 14-17, 2013 Time: 10 am to 1pm
Organiser: Department of Radiodiagnosis, AIIMS
Venue: Indian Merchants Chamber, Church gate, Mumbai
Topic: Recent advances and applied physics
Organiser: Indian Merchants Chamber RBNQ trust
Speakers: Eminent speakers from AIIMS, MAMC, PGI
Topic: A half day seminar with briefings and short exercises to demystify the various dimensions of the IMC RBNQ performance excellence model. The briefing will be value to all clinical and non-clinical members of a healthcare organisation.
Contact: Dr. Sanjay Sharma, Dr. Ashu Seith Bhalla, Organising Secretary, Department of Radiodiagnosis, AIIMS, Ansari nagar, New delhi-29 Tel: 011-26594889, 011-26594925 Email: aiimsmamcpgi2013@gmail.com
Entry: Free (Prior Registration Must) Faculty: Dr Geeta Bhardwaj, Lead Trainer IMC RBNQA Trust Speakers: Suresh Lulla, Chairman IMC RBNQA Awards Committee, Founder and MD, Qimpro Consultants, Anil Kamath, Chairman, Esemcee Strategic Advisors Shallanay Mallashaw Camatx Associates Management and Healthcare Strategists. Contact Maya Desai Tel: 022- 2204 6633, 2202 5438
Imaging in Cancer Drug Development
iPHEX 2013 Date: April 24-26, 2013 Venue: Mumbai Organiser: The Pharmaceuticals Export Promotion Council of India (Pharmexcil) Topic: iPHEX 2013 is expected to be an industry exposition in India showcasing diverse range of products and will include formulations, APIs, AYUSH, nutraceuticals, health services, biotechnology and biotechnology products, R&D Services
Date: March 13-14, 2013 Website: www.pharmexcil.com Venue: The Copthorne Tara Hotel, London, UK
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FEBRUARY 2013
The journey so far Medicall has grown from strength to strength since its inception in 2006. With Medicall 2013 in Gujarat fast approaching, Express Healthcare recalls the journey traced by the premier event which is attended by crème le crème of the medical fraternity
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edicall—an event which gets top of the mind recall when it comes to naming successful events which bear a tremendous influence on the industry they represent. It is hailed as India’s premier medical equipment expo and the first real “supermarket” for hospital equipment and supplies. Thus, it has undoubtedly traced a success story, yet every story has a beginning.
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The beginning Twelve years back, a young man out of medical college and his friends dreamt of starting their own hospital. The dream became a reality and a 30-bed hospital was built, which later went on to become a 400bedded hospital in South India. The ambitious young man who dreamt of establishing his own hospital and managed to do it against all odds was none other that Dr S Manivannan and his hospital is known as Kavery Medical Center and Hospital. However, this path to this achievement was not easy and was strewn with lots of trials and travails. Dr Manivannan and his friends faced many hurdles in the course of their growth and these very hardships and challenges were the seeds from which Medicall emerged. It was born with the idea to share their expertise with the fellow medical fraternity. They realised that many of their problems were a result of limited knowledge about the medical industry and thus, thought of sharing their own experiences and learning with the young and aspiring healthcare professionals of the present day so that their paths to success
would be less strenuous and more accessible. In his own words, Dr Manivannan states, "I am the Promoter-Director of the 400bed hospital group KMC hospital, Trichy, Tamil Nadu. I have undergone the pains of bringing up a hospital in a small Indian town where we rarely get an opportunity to know about latest developments in medical equipment industry. Big companies do not concentrate in such cities due lack of adequate sales force and feel that it is a small market. I wanted to share my experience which I gained over a period of a decade with my fellow colleagues and that prompted me to start Medicall expo."
Medicall – the rise over the years 2006: The first Medicall exhibition was introduced as a small medical equipment expo and was hosted at Chennai. It was very well received by the industry and there were more than 100 exhibitors and 3000 visitors. 2007: Medicall 2007 was bigger and better than its first edition. There were more exhibitors and visitors at the event. 2008: The third edition of Medicall attracted 5,400 visitors from across the country. Apart from hospital owners, hospital administrators, and people from other segments like dealers, architects, hospital consultancy, nurses, and biomedical engineers, exhibitors dealing with hospital flooring, lighting, energy saving equipment, storage solutions, ambulance fabricators, etc., also participated for the first time in this show. 2009: With more than 5700 visitors attending
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Medicall team: Yogita Panchal and Sundarajan
Medicall 2009, the expo bridged the gap between the buyers and users and managed to bring them together on one single platform. In this three-day expo, more than 250 exhibitors from all over India and China displayed their latest equipment. Medicall became a pan-India event than just a regional expo in Chennai. 2010: Availability of unique products, many exhibitors for the same product, international exhibitors were the USPs of Medicall 2010. It was bigger and more incisive in terms of content and participation. International participation increased and over 400 exhibitors from China, Germany, Taiwan, England and India displayed their latest medical equipment. It grew to become India's largest and Asia's third largest medical equipment expo. 2011: Around 7500 visitors from India and other countries like Sri Lanka, Nigeria, Nepal, and Taiwan visited the three day show. The Healthcare Innovation Awards, instituted for first time in this edition of
Medicall, attracted several applications from across the country. More than 430 exhibitors from India, Germany, China, Taiwan, Korea, Japan and Iran participated in the show and displayed A-Z requirement of hospitals. 2012: Medicall 2012 Chennai was yet another remarkable event. It had huge participation from healthcare industry experts and professionals as well as several new and innovative segments like fashion show on hospital garments and “Hospital Property Mela” was also introduced. Over 500 companies exhibited their products. Representatives from Germany, China, Taiwan, South Korea, Pakistan, Malaysia and more participated in Medical last year.
The future path With its constant evolution and growth, it is to be expected that Medicall 2013 will continue to provide a big fillip to healthcare sector in general and the medical equipment industry in particular.
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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 edicall 2013 is being touted as the concrete prescription for accelerating your business success. The organisers assure that they are committed and passionate to be preferred healthcare partner towards crystallising remedies in healthcare products and services. Medicall 2013, the 10th edition of the event, slated to be held at Gujarat University Exhibition Hall from February 8-10, 2013 in Ahmedabad promises to be a definitely ‘must-attend’ and memorable event in 2013. It is expected to be an ideal B2B platform for manufacturers, buyers, traders, distributors, as well as government dignitaries and offer a golden chance to meet the market leaders. Medicall 2013 will be attended by industry leaders like Philips, Godrej, Sai Infosystems, Mahindra and Mahindra Ambulances, Vissco India etc. The event at Ahmedabad will offer myriad deliberations by industry doyens and networking sessions with pre scheduled opportunities between key stakeholders, buyers and sellers. It intends to be a perfect business setting for the healthcare fraternity.
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Medicall organisers invite you to flaunt your products and services at the event. The profile of exhibiting equipment/services are varied and include ambulances, consumables, energy saving equipment, healthcare consultants, laboratory equipment, dental equipments, OT and ICU equipment, patient monitoring systems, physiotherapy and orthopaedics, refurbished equipment, surgical instruments, telemedicine, wound care products, life support systems, laundry equipments, implants, housekeeping solutions, healthcare IT solutions etc. The Indian healthcare industry is poised to reach $79 billion in 2012 and $280
billion by 2020, and create increasing demand for specialised and quality healthcare facilities. Further, the hospital services market, which represents one of the most important segments of the Indian healthcare industry, is expected to be worth $ 81.2 billion by 2015. The 10th edition of Medicall is expected to give a boost to the growth in the healthcare sector. MEDICALL as a brand continues to draw a high percentage of decision makers, hospital owners, doctors, medical directors and purchase heads in addition to being a proven and highly successful platform for attracting affluent producers,
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dealers and suppliers. The fact that its previous hosting attracted over 430 exhibitors and over 8250 quality visitors mostly from the its core target group, adds to its allure. To facilitate the continued growth of the healthcare industry, Medicall is also organising conferences on ‘Good to Great’ which transform your family owned good hospital into a great healthcare institution. Other value added conferences are on ‘Hospital Material Management’ and ‘Internal Audit’. For three days, Medicall in Ahmedabad will serve as the nerve centre of the healthcare business in India, and is expected to surpass
the 10,000 footfalls from last year. The steady growth in participation at Medicall every year, in terms of numbers already achieved, is an indication of the benchmark it is about to set in terms of business volumes and visitations, claim the organisers. The steering team for this show is piloted by Dr S Manivannan, CEO Medicall, K Sundararajan Project Director and YogitaPanchal, Manager – Corporate Marketing. Medexpert, organisers of Medicall are also conducting the Medicall conference in Sri Lanka from March 15-17 2013 at Colombo. For more details: www.medicall.in
FEBRUARY 2013
Ziqitza Health Care: Saving lives Ziqitza Health Care has been contributing to Indian healthcare and its progress through its well-developed emergency medical response services and patient transport services iqitza Health Care has been contributing to Indian healthcare and its progress through its welldeveloped emergency medical response services and patient transport services Ziqitza Health Care Limited (ZHL) has been a pioneer in the emergency medical response services and patient transport services in India since 2005. ZHL was set up by a group of young professionals who, after their education/training in the US and professional employment/entrepreneurial projects in India, realised the acute need for organised and networked ambulance service in India for saving lives. ZHL’s vision is to assist in saving human lives by providing a leading network of fully equipped advanced and basic life support ambulances across the developing world.
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Its vision is to meet international standards for quality in emergency medical services and be accessible to everyone regardless of their income bracket. They claims that their value lies in being ethical, being transparent and fostering teamwork. ZHL operates the emergency medical response (ambulance) services under two models: Dial ‘1298’ for Ambulance – Fee for Service model with cross subsidy, where the rich and affordable pays higher and the poor pays less, and for very poor/accidents/emergencies the service is free of cost. Currently this service is operational in the city of Mumbai, Odisha, Punjab, Bihar and Kerala. Dial ‘108’ in Emergency–This
model is usually in Public Private Partnership with State Governments, this could be either free to patient or on a user fee, as per the contract with State Governments. The service is provided to emergency victims. This model is operational in Bihar, Trivandrum, Punjab and Rajasthan. ZHL also understands the ever changing needs of the health sector and have realised that today hospitals and organisations are focusing on their core competency and are outsourcing other aspects of operations. ZHL provides
fully equipped ambulances with trained drivers and paramedics to the hospitals/organisations to cater to their outsourcing requirements. They are currently operating more than 860 ambulances across six states and have served more than 1.9 million people till date. ZHL is part of EMSC – reportedly the world's largest ambulance company. They claim with pride that every minute they are serving more than two lives! Their strategic partners are London Ambulance Services, Life Supporters Institute of Health Science and New York – Presbyterian Emergency Medical Service (NYP-EMS). Contact Ruchika Beri Website: www.zhl.org.in Email: ruchika.beri@zhl.in
Ambulance outsourcing: A boon for hospitals Ruchika Beri, Assistant Manager- Marketing, Ziqitza Health Care Ltd (ZHL) explores the trend of getting outsourcing their ambulance services and the benefits accrued by doing so ith the global healthcare business growing at exponential rates, hospitals in India are feeling the pressure to prioritise on their core competency – managing their patients and providing excellent treatments. Most leading hospitals and nursing homes in India are now focused on improving their core competence and have shifted focus on outsourcing other aspects of hospital management like catering, housekeeping or pharmacy. One of the key management issues faced by hospitals is managing their ambulance fleet. To cater to the acute need of well equipped and maintained fleet of ambulances in hospitals, emergency medical services are being outsourced to state-ofthe-art companies leaving the end consumer hale and hearty. The benefits of the same are immense, and include: ● Customisation fitting hospital needs – Companies
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are now venturing into management and operations support service for operating advanced lifesupport ambulances of hospitals and other institutions. ZHL provides hospitals with custom-designed ambulances and trained manpower and this helps hospitals concentrate on its core competency of medical care activities. 24/7 services – Emergency doesn’t come with a warning. To keep a step ahead of them, com-
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panies like ZHL keep a live track of the ambulances 24/7 and provide the hospitals with a comprehensive report on every aspect of the ambulances, right down to its speed, its travelling on any specified day or time etc. This also ensures 365 days uptime for the ambulances for the hospitals. Improved technology and design – Nowadays amublances are designed, modelled and operated on international lines and
About Ziqitza Health Care ZHL is currently operating 860 ambulances across Mumbai, Bihar, Kerala, Punjab, Odisha and Rajasthan. ZHL has been the pioneer in introducing ‘ambulance outsourcing’ in India in 2011and is currently managing and operating ambulances for leading hospitals. ZHL has reputed investors like Acumen Fund, GMR/AMR (US' largest Ambulance Company), HDFC, IDFC and India Value Fund on board. ZHL’s Strategic Partners include London Ambulance Services, Life Supporters Institute of Health Science and New York Presbyterian Emergency Medical Service (NYP-EMS). Since inception, ZHL has served more than 19 00,000 people across India. www.expresshealthcare.in
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comprise modern medical equipment like defibrillator ventilator, pulse oxy-meter, cardiac monitor, ECG, suction machine, resuscitation kit, syringe pump etc. In addition, it also consists of patient transfer facilities like collapsible stretcher, scoop stretcher, spine board, canvas stretcher, stair chair cum wheel chair etc. Trained manpower: It is very crucial that the ambulance crew is trained and able to provide adequate care during an emergency or transfer. ZHL ensures trained emergency medical technicians and drivers who are provided the training by LIHS, the International Training Centre of the American Heart Association (AHA), enabling them to stabilise patients and transfer with medical support. EXPRESS HEALTHCARE
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Strategy Life after cancer: issues of cancer survivorship The number of cancer survivors is increasing worldwide, every year. Yet there is very little information on physical, social, financial, mental aspects of life after cancer. M Neelam Kachhap, looks at cancer survivorship in a new light to find new models of service and care. Page 36 MAIN STORY
The Great Indian Healthcare Factories – II: Aravind Eye Care System-In service for sight In the second of a series of articles on ‘The Great Indian Healthcare Factories’, featuring stories in healthcare that are exemplary and worth emulating, Gp Capt (Dr) Sanjeev Sood chooses Aravind Eye Care System and traces the reasons that contributed to its success
Aravind Eye Care System (AECS)An overview GP CAPT (DR) SANJEEV SOOD Hospital Administrator and NABH empanelled Assessor
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It was in the year 1976 that Late Dr G Venkataswamy established an 11bedded Aravind Eye Hospital in a small rented house in Madurai. His mission was simple yet his vision was grand- to eliminate needless blindness by providing compassionate and high quality eye care. Today, Aravind’s operations include a chain of seven eye hospitals with a combined strength of more than 4000 beds, a network of outreach centres in the state of Tamil Nadu and a complete integration of its processes and resources. In the year ending March 2012, over 2.8 million outpatients were treated and over 350,000 surgeries were performed, making Aravind the single largest enterprise
providing eye care in the world. Adjudged among the world’s top 100 NGOs by The Global Journal, ACES has been a subject of many international case studies, including Harvard Business School, in social entrepreneurship, public health, corporate business and academic excellence. The Conrad N Hilton Foundation awarded the $1.5 million Humanitarian Prize for the year 2010 to ACES for doing extraordinary work to alleviate human suffering. Aravind’s mission and vision statements don’t just remain on paper; they come alive in each of the organisation’s activities. Even now, 37 years after its inception, Aravind continues to be a beacon of innovative healthcare worldwide. What makes this organisation so unique, realise its mission and vision,
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and reach milestones that others can only envy? To answer this question, one has to examine the Aravind Eye Care System’s visionary leadership, strategic management, organisational culture, unique business model and other key attributes.
The leadership Late Dr Govindappa Venkataswamy or 'Dr V' as he was affectionately called was the founder chairman of ACES. At one point of time, he was affected by rheumatoid arthritis, but through his hard work and determination he overcame his disability and earned his masters in Ophthalmology from Madurai Medical College. He joined as a faculty in the same College, where he was appointed head of the Department of Ophthalmology and later Vice-Dean of FEBRUARY 2013
S|T|R|A|T|E|G|Y the College. During this period, he launched many successful programmes to reach out to the visually impaired and their rehabilitation. He has also performed over one hundred thousand successful eye surgeries. Dr V blended his spiritual life to his daily work remarkably well. As a young man, he was highly inspired by Sri Aurobindo’s philosophy. Aravind was founded on this principle of service and continues to be guided by it. In recognition of his remarkable work in the fight against blindness, Dr. V was honoured with the Padmashree award in 1973 and invited to deliver an address at the Harvard Divinity School on the theme of living a spiritual life in the contemporary age in 1991. The results of putting his philosophy into action are evident in the remarkable career of Dr. V and the growth of ACES into an internationally renowned institution since its inception in 1976. ACES will remember the day, July 7, 2006 when it lost its founder, the great visionary Dr. G. Venkataswamy. Today, the conglomerate AECS is run by a team of eminent professionals like RD Ravindran, P Namperumalsamy and RD Thulasiraj.
The strategy There are several key attributes that define AECS’ unique strategy. A sense of compassion and commitment of employees, all activities aligned with organisational mission and values, focus on core professional competencies with no frills attached, factory like efficiency and process optimisation, practice of lean management, achieving economies of scale, complete forward and backward integration of all processes and resources are the hallmark of Aravind’s service, operations and its scintillating performance.
Exploiting economies of scale In the year ending March 12, Aravind attended to 2.8 million eye cases in OPD, performed 350,000 surgeries, comprising 40 per cent of eye care in Tamil Nadu. Aravind Eye Banks have collected 2,800 corneas, of which 1,800 were transplanted. An average surgeon does about 25-40 procedures per day or 2600 surgeries per year in Aravind Eye Hospitals. Since 1976, Aravind has given sight to more than one million people in India. Aravind generates volumes through its outreach programmes and tele-ophthalmology enabled satellite centres, which penetrate the remotest of villages. It organised 2600 camps in the last one year to reach out to every individual needing eye care.
intra-ocular lenses constituted a major component of the total surgical costs, Aravind obtained a transfer of technology through the US-based Seva Foundation, and Combat Blindness Foundation, to permit it to manufacture these lenses and other surgical consumables at a fraction of the cost. Aurolab is one of the few device manufacturing companies that is both ISO 9001, CE and USFDA certified. The manufacturing activity has scaled up to nearly 600,000 lenses. Today, Aurolab has grown into an organisation with six product divisions (intraocular lenses, pharmaceuticals, sutures, instruments, spectacles, and hearing aids) and more than 200 employees. The affordably priced intra-ocular lenses are exported to some 120 countries around the world, providing another source of revenue for Aravind. LAICO, established in 1992 with the support of the Lions Club International SightFirst Programme and Seva Sight Programme, is Asia's first international training facility for blindness prevention workers from India and other parts of the world. It contributes to improving the quality of eye care services through teaching, training, research and consultancy. Aurosiksha – is another venture of AECS to enhance the reach and quality of education drawn from the rich knowledge base that the organisation has harvested since 1976. Its four essential attributes - digitisation, immediacy, virtualisation, and globalisation – drive knowledge sharing.
Aravind delivers an entire range of eye care services from primary eye care to tertiary eye care Aravind has trained several thousands of eye care professionals across the world over the last three decades.
Care delivered through echelon of eye centres Aravind delivers an entire range of eye care services from primary eye care to tertiary eye care. Its vision centres provide comprehensive primary eye care including triage, referral services and also create adequate awareness in the community. This network structure, allows Aravind to reach a large rural population at their doorstep in South India.
Unique HRM Policies Complete integration of supplies and human resources Aravind Eye Care System includes a spectrum of diverse activities. ACES is centrally governed by a Board of Directors. The Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Lions Aravind Institute of Community Ophthalmology (LAICO) and Dr G Venkataswamy Eye Research Institute are governed by the GOVEL Trust and Aurolab by the Aurolab Trust. Recognising that the imported FEBRUARY 2013
The organisation follows unique HR practices by optimal use of skilled man power .It imparts in house training to mid-level ophthalmic personnel, mostly rural women, in a two-year course. These personnel never had the chance to go to college, now they get the opportunity to enter the work stream as mid-tier technicians. AECS recruits without commercial advertisements. Currently, 350 medical officers and consultants, 1,500 mid-level ophthalmic personnel and 500 administra-
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tive staff are on AECS’s rolls. Not only the attrition rates are minimal there is also a sizeable waiting list of applicants.
Practicing lean management With efficient processes,stream lined work-flows and well designed assembly line, Aravind is able to handle high patient volumes with minimum waiting time. With less than one per cent of the country's ophthalmic manpower, Aravind accounts for five per cent of the eye surgeries performed nationwide.
Reaching out to bottom of pyramid Through its pioneering approach of using social science research to understand who is in need of eye care and what is needed for them to receive it, Aravind provides free transportation to bring patients to its hospitals and addresses the issue of gender inequity to provide eye care at the grass root level. Rather than thinking of poor at the bottom of pyramid as victims of fortune, Aravind looks up to them as value demanding care recipients.
Harnessing dual pricing and cross subsidisation Almost half of the patients seen and surgeries performed at Aravind are free of cost. Aravind takes no donations or charity and yet makes a profit that is enough to fund a new hospital every three years. The organisation remains financially viable from the nominal charges collected from paying patients. The average cost of each surgery is approximately Rs 2000/- only, which is 1/10th the average cost at a private Indian hospital and 1/300th the cost in US hospital.
Achieving best outcomes Equipped with sophisticated technology, Aravind performs the latest state of the art procedures like DSEK and PC IOL for corneal services, selective laser trabeculoplasty for glaucoma, implantable contact lens, Zeiss YAG II plus laser and LASIK for cataract service, minimal invasive strabismuss surgery for squint, and prefilled syringes of Avastin for diabetic retinopathy. Aravind’s morbidity rates are benchmarked against and consistently exceed those of the Royal College of Ophthalmologists in the UK. Aravind Hospitals are now going in for NABH Accreditation.
Conclusion Thus, by embracing best practices and business principles in lean management, rationalising manpower utilisation, adopting innovation, factory-like system efficiency and process optimisation, the scale of Ford Motors, the efficiency of McDonald and Toyota; professional excellence, Sri Aurobindo’s compassion, congruence of vision and values, committed leadership of Dr Venkataswamy and the current management, Aravind has woven a great success story that is truly Indian as well as worth emulating and replicating in any setting. The author is a Hospital Administrator and NABH empanelled assessor based in Chandigarh.
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Life after cancer: Issues of cancer survivorship The number of cancer survivors is increasing worldwide, every year. Yet there is very little information on physical, social, financial, mental aspects of life after cancer. M Neelam Kachhap, looks at cancer survivorship in a new light to find new models of service and care
ancer survivorship landscape is shifting. The number of people winning the battle against cancer is increasing. It is estimated that approximately 25 million people are living as cancer survivors worldwide. Having come through the maze of detection, treatment and management of cancer, these patients continue to face problems. It is also estimated that a large number of these patients require both medical and non-medical care and our healthcare system at present does not have adequate approaches to deal with these issues.
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Cancer survivors The cancer survivors are those individuals who live beyond cancer diagnosis and its therapy. They could be living a disease-free life or a cancer-free life. According to the National Coalition for Cancer Survivorship, US, “An individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life. Family members, friends, and caregivers are also
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impacted by the survivorship experience and are therefore included in this definition.” Agreeing Dr AK Dewan, Medical Director and Chief of Head & Neck Surgery, Rajiv Gandhi Cancer Institute says, “Cancer survivor is someone who is living with or beyond cancer.”
The Indian survivors There are many survivors in India. “The number of people conquering cancer is rising,” says Dr V Shanta, Chairman, Cancer Institute (WIA) Chennai. “It might surprise many to know that more than 4,000 patients, young and old, treated at the Cancer Institute (WIA), Chennai, for different cancers, have lived a normal life for more than 20 years after treatment,” she adds. However, not everybody is as optimistic as Dr Shanta. Giving a different picture Dr BS Ajaikumar, Chairman, Healthcare Global (HCG), Bangalore says, “In our own study, we have found that 84 per cent of breast cancer patients treated at HCG, on average live up to six years www.expresshealthcare.in
and significant high number of patients live for long time.” “Survivors are increasing, leading good quality of life and cancer today is more of a chronic disease,” he adds.
Common cancers in India Experts agree that lung, head and neck, cervix and breast are the common cancers seen in Indian population. “The common cancers in men are head and neck, lung, colorectal, prostate, and GI cancers and in women cervix, breast and GI cancers,” informs Dr Ajaikumar. “Cancer of the cervix has good survival rate and early stage diagnosis of breast cancer has good survival rate. There are good survival rates for head and neck cancers also. Poor survival is seen in lung cancers and advanced colorectal cancer cases,” he informs. Concurring to his thoughts Dr PK Das, Senior Consultant, Oncology Indraprastha Apollo Hospitals says, “Among females, common cancers are cervix and uterus cancer
(common in rural) and breast cancer (common in cities); in males, lung cancer, head and neck cancer.” “Better survival rate is seen in lymphoma, gencell tumour, chronic leukaemia, paediatric cancers, and early stage breast cancer,” he adds.
Early detection is the key to survival Cancer survival depends on early detection and therefore awareness plays a major role in survival. “Cancer is curable if detected early and treated early. Earlier the stage, better is the survival. Better survival is seen in some of childhood cancers (ALL, lymphoma, germ cell tumours) and few of adult cancers (CML, testicular cancer, breast cancer),” says Dr Dewan. “Seventy per cent of cancer patients report late and majority of the time focus of treatment is palliation. But with modern methods of treatment, the cure rates have improved. About 40 per cent of all cancer patients may live beyond five years,” FEBRUARY 2013
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Each cancer has different survival rates and that is also based on the stage at which it is diagnosed Dr Anil Heroor
Of the total diagnosed patients 25-30 per cent patients live a disease free life Dr PK Das
Chances of recurrence depend on stage of cancer, site and type of cancer Dr A K Dewan
The social stigma around the disease (cancer) should be eradicated for the benefit the society Dr Ajaikumar
ONCOSURGEON, FORTIS HOSPITAL MULUND
SENIOR CONSULTANT, ONCOLOGY INDRAPRASTHA APOLLO HOSPITALS
MEDICAL DIRECTOR AND CHIEF OF HEAD & NECK SURGERY, RAJIV GANDHI CANCER INSTITUTE
CHAIRMAN, HEALTHCARE GLOBAL (HCG), BANGALORE
he adds.
Disease-free life There is no set data on the number of patient living a disease-free life, but experts say a fraction of patients’ live disease-free life. However, it varies from individual-to-individual and the type of cancer. “Of the total diagnosed patients 2530 per cent patients live a disease free life,” opines Dr Das. On a different front, Dr Anil Heroor, Oncosurgeon, Fortis Hospital Mulund says, “Cancer is a group of diseases. Each cancer has different survival rates and that is also based on the stage at which it is diagnosed. If we go by rule of thumb then early stage cancers have a survival of 80-90 per cent and late stage cancers have a survival of 0-20 per cent.” Enumerating yet another figure, Dr Ajaikumar says, “64 per cent of the patients diagnosed early and if treated properly can be disease free. In advanced stages it depends on the site of the cancer. 60 to 70 per cent of breast cancer patients live a disease free life and 30 to 40 per cent in lung cancer.”
The fear of recurrence While living through cancer is a traumatic experience many patients fear recurrence. The period following treatment in which the risk of cancer recurring is relatively high is also very traumatic for patients. “In early stage cancers, there are only 15 to 20 per cent chances of recurrence. In advanced stages it depends on organ specific and recurrence rate is 40 to 60 per cent. In most of the cases everything depends on the organ site and advanced stage of the disease,” informs Dr Ajaikumar. Agreeing Dr Dewan FEBRUARY 2013
informs, “Chances of recurrence depend on stage of cancer, site and type of cancer. For most solid tumours chances of recurrence are about 10 per cent - 20 per cent for stage I cancer and 90 per cent for stage IV disease. Some cancers are highly curable with newer chemotherapy drugs and targeted therapy. ALL, testicular tumours, Hodgkin’s disease and childhood cancers have high cure rates.”
Issues of cancer survivors As soon as the topic of cancer survivors is broached one gets a feeling that they only have psychological problems. However, for some it’s a life defining experience and therefore they need 360 degree interventions. Experts believe that within the existing health care system, the cancer care models are largely focused on diagnostic methods, treatment aspects, cure, and disease failure and survival rates. There is very little research and intervention approaches for the aftereffects of cancer diagnosis and treatments for an individual cancer patient. Cancer survivors are at increased risk of developing various physical and psychosocial conditions, which require to be identified and attended within the cancer care system. “Cancer survivors often have medical
Cancer survival depends on early detection and therefore awareness plays a major role in survival www.expresshealthcare.in
and psychological problems and needs. These needs vary from person to person and change over time,” informs Dr Dewan. “Cancer survivors feel fatigue related to disease and treatment. Survivors may have various disabilities related to organs which have been removed like jaw or stomach, rectum or bladder removal. Chemotherapy, radiotherapy may affect cognitive function and growth of children. Survivors of childhood cancer have life expectancy 28 per cent shorter than general population,” he adds. He further explains that some survivors even when cured struggle with the emotional trauma of having experienced a life–threatening disease. About 10 per cent of survivors develop major depressive disorders and others experience adjustment disorders. Many survivors are anxious about any minor symptom unrelated to cancer. Many of the survivors suffer from post traumatic stress disorder. They may face adjustment problems with spouse, other family members, as well as at working place.” Cancer survivorship has been looked through the glass of psychosocial anomalies giving rise to the field of psychosocial oncology. “At HCG, we have psycho oncology department, which counsels the patients, motivates them and takes out the fear. We give a lot of importance to good counselling,” says Dr Ajaikumar. Most of the hospitals in India have support groups. For example, Tata Memorial Hospital (TMH), Parel has After Completion of Therapy (ACT) clinic for childhood cancer survivors. However, increasing number of patients are living full-lives and therefore we need to
look beyond the old concepts of adaptation or adjustment. As survivors are living longer productive lives, there is a need for new concepts, measures and interventions to maximise this outcome. Innovative models of cancer survivorship and care need to be advanced. Acknowledging this Dr Dewan says, “A cancer survivor is a cancer fighter. He/she is a fighter after the diagnosis is established. Delhi must have a “survivorship centre” for working to help improve health outcome for cancer survivors. It may assist in development of services, as well as promoting research and education. It may address issues of employment, insurance, medical benefits to cancer survivors.” The social stigma related to cancer can be fought if proper survivorship approaches are in place. “It’s a myth to call cancer a killer disease. It’s curable if diagnosed and treated at the right time and right way,” emphasises Dr Das. Cancer can also be treated and people should not fear the disease. “Cancer should be now considered as a chronic, lifestyle disease. With advancements in technology and knowledge, we are able to deliver better medical outcomes and control the disease. The social stigma around the disease should be eradicated, which will benefit the society at large,” reiterates Dr Ajaikumar. Today, there are advanced diagnostic and therapeutic options available for the management of cancer in our healthcare system, however very few approaches are available to deal with issues related to cancer survivorship. mneelam.kachhap@expressindia.com
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S|T|R|A|T|E|G|Y 30 MINUTE INTERVIEW
‘JCI accreditation is mainly to make our hospital a better and safer place for our patients’ Rekha Dubey COO, ADITYA BIRLA MEMORIAL HOSPITAL
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ditya Birla Memorial Hospital recently became the first multispeciality care hospital in Pune to achieve a certification for quality standards from the Joint Commission International (JCI) in the US. Rekha Dubey, COO, Aditya Birla Memorial Hospital shares more details on this achievement and elaborates on the procedures of the JCI accreditation to Raelene Kambli
Congratulations on this most recent achievement. Could you give us details on the procedure and scope of the survey conducted by JCI prior to awarding the accreditation to the hospital? Also, what exactly did the survey involve, on a daily basis?
It is a momentous occasion for all the employees of Aditya Birla Memorial Hospital (ABMH) to be the first JCIaccredited hospital in Pune. Applying for JCI accreditation was an ABMH initiative, to respond to the growing demand around the world for standardbased evaluation in healthcare. The main purpose of going for JCI accreditation is to meet our hospital mission and vision - 'Compassionate quality healthcare and excellence first aid always' Scope of survey: Three surveyors: a physician, nurse, and an administrator evaluated all the clinical and non-clinical departments’ performance, including the management of ABMH.
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Surveyors covered the entire hospital (capacity 500 beds) in three days. Their main emphasis was on patient care and patient safety. They intensively reviewed the nurse and doctor’s documentation in providing patient care. They tapped each and every corner of the hospital, e.g. hospital facility tour, patient care, infection control, medication management system, improvement in quality and patient safety system, closed patient record review staff qualification and education. The main focus was on medical staff and leadership interview. Procedure: Every day, morning survey started at 7:30 am and stopped at 5 pm. JCI survey procedure started with documentation review. Surveyor
tested and verified the hospital performance through tracers to evaluate the actual care that a patient receives. During the stages mentioned above, they reviewed documentation, and role of various stakeholders (i.e. nurses, doctors, dietician, physiotherapists, patients and their family members) and systems (i.e. medication management, medical records, CSSD, F&B, house keeping, air conditioning system, patient counselling and education system) in providing patient care. Entire survey focused on the integration and coordination of patient care processes. Every day they had a meeting with the management www.expresshealthcare.in
to discuss their findings, based on interviews, observations and document reviews. On a daily basis, the survey involved day briefing, tracer activity as we mentioned above and hospital facility tours. Hospital staff and patients were interviewed during tracer and facility tours to know about their performance and the care given to patients.
When did the hospital apply for accreditation? How long did it take to achieve it? The hospital applied for the accreditation in first week of September 2012 and it took approximately six months to achieve it. The hospital submitted an application for survey to JCI in August 2012 and the scheduled survey dates
were December 10-14, 2012.
How much investment was made in order to achieve these quality standards for JCI accreditation? Actual investment was nil as Aditya Birla Memorial Hospital is a multispecialty facility with state-of art infrastructure like advanced technology and international equipment. We only had to pay the accreditation fee which was approximately Rs 50 lakhs.
How will this achievement help the hospital to provide better care to its patients? Will this move help in
achieving economies of scale for the hospital group? Quality healthcare, patient’s safety and well-being has always been our priority. Implementation of the international patient safety goals has been one of the ‘top changes’ that has helped cultivate a culture of enhanced patient safety and quality of care. JCI accreditation is mainly to make our hospital a better and safer place for our patients. JCI has ‘a long-term international experience in quality and safety control as well as the highest standards of hospital processes.’ So it definitely helps in improving our hospital economies.
How do you plan to sustain the quality standards within the hospital? Will JCI keep a close watch on the quality standards separately? To sustain the quality standards, we have adopted a philosophy of management that stimulates continuous quality improvement through the establishment of uniform quality measures, daily quality rounds, implementation of a quality assurance programme that includes both internal audits and training of personnel, creation of annual quality improvement goals, and the identification as well as use of clinical ‘best practices’ in an effort to achieve appropriate patient outcomes. And above all we have high-tech and dedicated staff to respond to the most demanding requirements of our patients. Yes, JCI mentioned that they will visit the hospital at any point of time after accreditation to check hospital performance in implementing the quality standards.
What is your next move after achieving JCI accreditation? Our next move will be to retain the JCI accreditation and Aditya Birla Memorial Hospital’s name and fame by focusing on continuous monitoring of organisational structure process and outcome and retain better managed leadership to increase our customer satisfaction. raelene.kambli@expressindia.com
FEBRUARY 2013
IT@Healthcare MAIN STORY
ROI in Healthcare IT investments Sridharan Mani, Director and CEO, American Megatrends India, in this white paper, discusses the IT investments made in the healthcare segment and analyses whether they provide the desired results in terms of ROI
SRIDHARAN MANI Director and CEO American Megatrends India
ndia is one of the world’s most lucrative healthcare markets and is expanding rapidly, according to latest findings of a report titled ‘Indian Healthcare – New Avenues for Growth’. NHRM funding has been increased by $4.14 billion in the budget 2012-2013 for the current financial year. According to Fitch, the current size of Indian healthcare industry is $65 billion and is expected to reach to $100 billion by 2015. India has the fastest growing healthcare IT market in Asia, with an expected growth rate of 22 per cent, followed closely by China and Vietnam (Source: Springboard research). Indian IT market is poised to be $250 million by 2012. Combined study by industry body and Ernst & Young suggests that India will need as many as 1.75 million additional beds by the end of 2025. Further, an investment of $86 billion is required to achieve one doctor, two beds and 2.3 nurses per 1000 population by 2025. The above facts clearly indicate that the healthcare industry in India is growing at rapid phase and also the investments being made in IT is also increasing year on year.
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IT in healthcare IT has positively impacted every industry, and healthcare is no exception. The latest generation medical equipment with sophisticated system has supported physicians to diagnose and cure patients from critical and life threatening diseases. Technological advancements in telemedicine, picture archiving and communication systems (PACS) and healthcare information systems (HIS) have made significant inroads in providing better system for patient care.
Return on Investment (ROI) The basic mantra would be that if the income from the investment were more than the expenses made to it, it is considered as positive ROI. Many healthcare institutions are happy when the equipment purchased or IT system implemented returns positive ROI. This outlook promotes FEBRUARY 2013
competition with other healthcare institutions and makes them invest in new equipment and technologies that provide them with better brand image in order to keep the competition away. Since the cost of investment is rapid increasing, the ROI is also affected. It can be easily argued that investments made in IT healthcare are more related to improving the branding and imaging in the market place. However, the real revenue for any healthcare institution comes from providing efficient patient care. ROI =
ሺீ ூ௩௦௧௧ି௦௧ ூ௩௦௧௧ሻ ௦௧ ூ௩௦௧௧
The big question is that has investments in IT improved the efficiency in providing better patient care and thereby increasing the ROI? It could be fairly said that the healthcare institutions across the globe have made significant investments in IT and medical equipment. However, the return on investment from this is always objective and is highly questionable. The reason being that many of such investments have become merely an expense, as it did not provide the desirable returns.
Why IT investments have turned into an expense? Manual processing: Several investments made in healthcare IT are related to collecting, storing and maintaining patient health related details. However, these systems are not used efficiently. Some of the reasons are: ● The clinicians record patient information, diagnosis and treatments on paper, in a free style manner known as the “Case Sheet”. This still remains the record for physicians to do the analysis. ● Even though some of the super-speciality hospitals have started using IT systems and equipment for medical information, the patient information is merely collected in electronic form and the hard copy of the medical record www.expresshealthcare.in
is attached to the “Case Sheet”. ● The file folders with full slips of paper and massive file rooms are still the norm in most of the public and private hospitals in India. ● If a patient has to visit more than one department in the same hospital, then separate records are created in each department with the same duplicate information. It is often seen that same information that as name, age, gender, height, weight, etc., gets repeated often in multiple places without the need for it. This ends up in duplicating the efforts and leads to more paper filing. Collating all these documents and forwarding to physicians are always delayed and it keeps the physician away from providing timely care to patients. ● More often than not these paper-based records are misplaced or lost, which in turn causes unnecessary delays or leads to repeating the procedure all over again. ● Due to high volume of paper-based records, the storage space requirement increases and also escalates overall maintenance and support costs. Moreover, retrieving information is time consuming and many a times, the physicians provide consultation to the patients without any patient health records. ● These paper-based systems increase the cost of service and compromises on overall efficiency. The quality of service delivery in many cases is affected. Fragmented systems: Healthcare institutions make high-cost investments to bring in advanced technological equipment for diagnosing and treating patient illness. However, these systems tend to be standalone and never get integrated with the hospital information system. The health vitals and other information collected from these systems never get digitally stored. These records are not
made available to physicians for comparative analysis until paper-based records from these systems are stored in a file. In many cases, the systems tend to be very expensive and to break-even the cost by itself is a challenge. New technology disruptions: When a healthcare institution implements a new system/equipment, the old system becomes obsolete. The patient history/health information in many cases is not imported to the new system (due to incompatibilities) and hence get lost. The healthcare institution would be forced to run both systems in parallel, as they are not compatible. This increases the overall operational cost and support and in turn reduces ROI. Poor utilisation of assets: In many cases, the systems and assets purchased for improving the efficiency in providing quality healthcare is not efficiently utilised. Hence, the assets lie dormant and do not provide the required returns. Some of the reasons are: ● Asset found missing from its location and needs to be tracked. It becomes more critical during emergency times ● System is so complex that only an expert can work with it ● System requires more manual inputs and it is too time consuming ● User needs good amount of training to handle the system. With increase in attrition rate, the trained users are not available to work with the system/asset. Hence, less efficient and paper-based systems are used
How to increase ROI? In today’s scenario, the ‘IT has barely touched the patient care’1 and it needs to change. Healthcare institutions should focus on improving operational efficiency to increase customer satisfaction. The goal of any healthcare institution is to provide better patient care to improve customer retention and increase the rate of returns. In order to achieve better returns, it is important to EXPRESS HEALTHCARE
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I|T|@|H|E|A|L|T|H|C|A|R|E realign the organisational practices and implement measures to improve customer satisfaction. The following measures could be used in any healthcare institution to leverage better returns from their existing investments. Data collection to decision support: The IT systems should not be merely used as data terminals for entering patient information and printing records for filing. All healthcare institutions have some form of HIS. The data terminals should become part of the HIS ecosystem and all the information collected from this data collection terminals should be automatically loaded into HIS without any manual data entry. This would help save time and costs as well as reduce paperwork. Since the information is stored electronically, the physicians and clinicians can access patient information and history from anywhere to provide better patient care. Standalone to integrated: Medical equipment that are standalone should also be integrated with HIS. The output from MRI, CT SCAN, PACS and others should automatically be uploaded to patient records in HIS. Having multiple systems maintaining
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the same information is a cause for confusion. The medical equipment come with advanced communication mechanism to support easy integration with HIS. Hence, steps should be taken to integrate these equipment/systems with HIS using glue code/logic. Improve asset utilisation: Implementing systems to track asset location and monitoring utilisation can help to improve the returns derived from the assets. Misused or assets with low utilisation incurs more expense than returns. Also, the assets need to be in place and available at the right time for clinicians to do their tasks efficiently. Proper tracking of assets and preventive maintenance will help to increase the life value of the asset and its returns. Investments in new technologies/equipment: Healthcare is a rapidly growing field and investments in the new technologies are always welcome. However, enough care should be taken to ensure that these technologies can co-exist and integrate with the existing set-up that is being used in the healthcare institutions. If this does not happen, then the years of accumulated data on patient
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care, diseases and diagnosis would become unusable. The information gained on decision-making would be lost. Hence, while selecting a new technology, it is better to evaluate whether the system is downward compatible. If not, alternatives should be identified to have the system integrated with existing systems using glue code/logic. Also, it is important that the new systems implemented are user friendly and easy to use. Complex technologies and systems will keep the users at bay. Implementing new technologies/equipment with detailed planning and integrating with existing set-up can help achieve higher ROI. Workflow: Email-based tracking and manual tracking are less efficient and time consuming. By implementing AIMS, ITIL V4 based service delivery and support system, the issues can be tracked and escalated, based on the service level agreement (SLA). Automating the work-flow helps to speed things and ensures that the right task is assigned to the right person in the right queue. With automated ticketing and workflow, the tracking of issues gets centralised and
easy and the senior management can have a complete control over the issues that affect the growth and returns.
Conclusion Investments made in information technology are no longer considered as costs and they should provide tangible returns. A solution driven approach should be considered while implementing systems. Discreet systems increase manual work, costs, maintenance and affects productivity. All systems should co-exist and integrate with HIS platform to provide desired returns. New system implementation and equipment purchases should be integrated with the existing setup to provide better returns. IT investments should be made to improve patient care and increase customer satisfaction. Any IT investment made should be backed by the core business objective of achieving higher ROI.
References 1. Institute of Medicine report: Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.:National Academy Press, 2001, p.176.
FEBRUARY 2013
Knowledge Fertility preservation in cancer patients
The Nuss Procedure
Dr SK Das, Sr Consultant, Action Cancer Hospital, talks on infertility caused due to cancer and its treatment
Dr L M Darlong, Consultant,Thoracic Surgery & Thoracic Surgical Oncology, Fortis Hospital Noida elaborates on the Nuss procedure and its advantages
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MAIN STORY
Stem cell tracking using nanoparticles N Dr Aparna Khanna, Dean, School of Science, NMIMS, Mumbai opines that non-invasive and sensitive imaging techniques can prove valuable for optimising cell therapy
Fig 1
anoparticles are promising tools for various applications in biomedical research due to their small size and ability to penetrate cells. Stem cell research is a rapidly evolving area, despite being fraught with innumerable challenges and hurdles that are yet to be overcome to realise its ultimate potential. There has been a recent spate of activities with respect to the clinical application of foetal, cord and adult stem cells. Though the appears promising, there are severe limitations to stem cell based therapies. One major obstacle has been monitoring the bio-distribution and homing of implanted or injected stem cells in the human body. Hence, an urgent need exists to develop non-invasive and sensitive imaging techniques, which
DR APARNA KHANNA Dean, School of Science, NMIMS Mumbai
FEBRUARY 2013
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will prove valuable for optimising cell therapy. The article outlines the therapeutic potential of stem cells, several hurdles faced by clinicians for optimising cell therapy and how some of the challenges can be overcome by using sensitive non-invasive imaging technology.
Stem cells: Sources, types and clinical application Stem cells have two specialised properties that make them unique and unlike any other cell of the human body. First is their indefinite proliferative ability; which simply means that you can have an unlimited and inexhaustible supply of these cells. The second feature of these highly prolific cells, is their inherent capacity to differentiate upon receiving appropriate stimuli, into various cell types of the
human body. The most versatile of the stem cells reported are the human embryonic stem cells (hESC). The source of the hESC are surplus embryos (five-day blastocyst), which can be obtained from in vitro fertilisation clinics, with proper informed consent and following national necessary ethical standards. Subsequently, a hESC line is established from the surplus embryos, brought to the laboratory and warrants a procedure that requires skilled technical expertise and takes about 810 months. So, from a five day blastocyst, a hESC line is established, which is said to be virtually immortal and at your disposal, possessing the potential to differentiate into neurons, oligodendrocytes, cardiac cells, pancreatic islet cells, hepatocytes; theoretically, to almost all the 210 cell types found in the human body. Such is the tremendous potential of stem cells and its use in regenerative medicine, that damaged or diseases cells can be replaced with the cell types derived from stem cells. The first hESC line established in the world was in 1998, by Dr James Thomson and co-workers at the University of Wisconsin1. The other commonly reported sources of stem cells are bone marrow, umbilical cord blood, umbilical cord and adipose tissue/lipoaspirates. These sources are termed as “multipotent”, unlike the hESC which are termed as “pluripotent”, because of the restricted differentiation potential associated with adult stem cells. Adult stem cells are not as versatile as embryonic stem cells. More recently, another source of stem cells were discovered through a breakthrough research. These are the induced pluripotent stem cells (iPSC)2. Here, normal skin cells can be transformed EXPRESS HEALTHCARE
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have to be registered at the Clinical Registry-India, a site maintained by the Indian Council of Medical Research (ICMR). According to the registry, currently there are 29 ongoing studies registered using stem cells. The details are given at www.ctri.nic.in. Despite, the promising clinical data, a number of unanswered questions with respect to the bio-distribution of stem cells in the human body, homing or movement of the injected stem cells into desired organs and their long term effects need to be addressed. These issues can be overcome by developing sensitive non-invasive imaging modalities, which will prove valuable in optimising cell based therapies. The treating physician should be able to address questions with respect to number of cells to be injected, viability of cells after injection and the migration pattern to the targeted organ.
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leukaemia, myelodysplasias, bone marrow failure syndromes, haemoglobinopathies and immune deficiencies. Since the first cord blood transplant was performed in 1988, stem cells derived from umbilical blood have been used in more than 30,000 transplants worldwide to treat a wide range of blood diseases, genetic and metabolic disorders (US Cord Blood Banking Industry Report, 2012). Cell transplantation has emerged as a potential therapy for Parkinson’s disease and has been under rigorous experimentation, both in animal models and human patients. In two well-defined
dependent variation, scarcity of foetal tissue, number of cells required and ethical concerns. Additionally, a fraction of patients suffered from dyskinesia (jerky movements) after transplantation, either due to the stem cells or the procedure (sterotactic surgery). Further, in a recent report foetal stem cells were injected into a patient’s brain, who suffered from a rare genetic disorder, ataxia telangiectasia, and it triggered tumours5. Hence, a word of caution is to be aware of the adverse reaction and associated problems. Adult stem cells, the mesenchymal stem/stromal cells (MSC) are another population of stem cells found in bone marrow and in a number of other tissues, and have used for stem cell therapy. The plethora of diseases that can be cured using MSCs are graft versus host disease (GVHD), Crohn’s disease multiple sclerosis (MS), motor neuron disease (MND) and ALS, Parkinson’s disease (PD), diabetes mellitus (DM), chronic obstructive pulmonary disorder (COPD), acute myocardial Infarction (MI), dilated cardiomyopathy (DCM), osteogenesis imperfecta, osteodysplasia and liver failure to mention a few.
individual to another (allogenic). One of the earliest examples of stem cell transplantation has been bone marrow transplantation, following which was the cord blood stem cell transplantation. Here, the haematopoietic stem cells (HSC) from an HLA matched individual is injected intravenously, and is widely used in haematological disorders or malignancies like acute and chronic myeloid and lymphoid
double blind trials, carried out in the US, in the 1990s, the possibility of using stem cells from aborted foetuses (foetal embryonic transplantation) was investigated3,4 and provided a cell therapy paradigm for neuronal repair in the human brain. This was one of the first published reports and the concept that stem cells could help in neuronal repair emerged. However, some of the limitations included; donor
The details of the ongoing/completed clinical trials can be obtained from www.clinicaltrial.gov, a registry of the US National Institute of Health (NIH). ClinicalTrials.gov currently lists 4196 ongoing clinical trials using stem cells, with approximately 90 per cent of the studies using adult stem cells. Similarly, in India all clinical trials being carried out using human participants
blood vessels, can be administered either intravenously, oral route or inhalation. They can also be targeted to reach specific organs or tissues in the human body. For biomedical applications, it becomes essential to ensure that the nanoparticles synthesised possess characteristics such as biocompatiblilty, indicating safety and nontoxicity; otherwise they will be rejected by the body. Further, they have to be
(reprogrammed) into pluripotent stem cells using genetic manipulation. This implies that if this concept works in a clinical setting, the need for embryos would be eventually removed, and patient-specific stem cells could be made, thus enabling customised therapy. For their pioneering research on reprogramming, this year, the 2012 Noble prize in Physiology and Medicine was fittingly won by Sir John Gurdon, University of Oxford and Dr Shinya Yamanka, Kyoto University, Japan. The goal of stem cell research is to obtain functional cells which can replace damaged cells in a variety of degenerative or debilitating disorders like Parkinson’s disease, type I diabetes, spinal cord injuries, liver diseases, to name a few. Fig 1 depicts a schematic representation of the use of stem cells in regenerative medicine.
Stem cell therapies: Where are we? The therapeutic potential of stem cells is immense. Two modes of stem cell transplantation exists- patient specific (autologous), and not patient specific, i.e. from one
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Stem cells derived from umbilical blood have been used in more than 30,000 transplants worldwide to treat a wide range of blood, genetic and metabolic disorders
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Nanotechnology and biomedical applications Nanoparticles, as the word suggests, are particles with size in the “nanó” range that is 1-100 nm. The advantages of these very small sized particles are that they can traverse through
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retained in vivo for reasonable long periods. Various methods have been employed to synthesise nanoparticles, which involves basic and inorganic chemistry. With the advancements in synthetic chemistry, nanomaterials can be modified to required size, shapes and properties. Due to their small size and high surface energy, the bare nanoparticles tend to aggregate. Hence, they need to be coated with suitable agents so as to increase their stability and solubility. A number of approaches are used to functionalise nanoparticles, involving the use of materials such as proteins, polysaccharides and synthetic polymers. Once the nanoparticles are synthesised, detailed characterisation should be performed to understand whether the properties of the nanoparticles with respect to its size, coating are retained. Detailed characterisation entails sophisticated instrumentation like UV-vis spectroscopy, fourier-transformed infra red spectroscopy (FTIR), X-Ray diffraction (XRD), transmission electron microscopy (TEM), etc. The ultimate challenge is to design multiplex systems for drug delivery, imaging and therapeutics, using nanotechnology. Fig 2 shows a schematic structure of a functionalised super paramagnetic iron oxide nanoparticle (SPIO) with a tagged fluorophore to allow in vivo imaging.
In vivo imaging technology for tracking stem cells Various imaging modalities available for cell tracking are computed tomography (CT), positron emission tomography (PET), magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT) and optical imaging. Each of these methods have their pros and cons. Some of the major hurdles are insensitive contrast agents, short half life, dilution of signal because of cell division, and genetic modification of stem cells, posing regulatory concerns for human stem cell clinical trials. Hence, it is recommended that a multimodality approach that would ensure sensitivity and reproducibility should be used for in vivo tracking. Such dual optical/MRI have been described using visiblewavelength fluorophores and Gd3+ chelators conjugated to high-molecular-weight FEBRUARY 2013
the School of Science, NMIMS, in collaboration with IIT, Mumbai, where we are in the process of designing novel nanoparticles (SPIO) to be used for long term stem cell tracking. We have been able to synthesise homogenous magnetic iron oxide particles, sized 7-9 nm (see inset) and have performed in-depth characterisation of the generated SPIOs. Further, the detailed cytotoxicity and stem cell-nanoparticle interaction, in vitro are in progress. The ultimate aim of the research is to select the most promising magnetic nanoparticles generated during the in vitro studies, for preclinical studies, to enable tracking of the stem cells in vivo. scaffolds such as dextran. Magnetic iron oxide nanoparticles are primarily used in medical resonance imaging (MRI), serving as excellent contrast agents. Magnetic nanoparticles can be classified into a few groups like superparamagnetic iron oxide particles (SPIO) or ultrasmall SPIOs (USPIO) and function by creating local field inhomogeneities that cause decreased signal on T2- and T2*-weighted images in a MRI scanner. Besides, they help to distinguish between soft tissues; the iron content is biodegradable and biocompatible and excess iron will be recycled by the cells using biochemical pathways for iron metabolism. Moreover, as the magnetic properties of the cells are retained after coating, these properties can be exploited to deliver the cells at appropriate sites in the human body. Several clinical studies utilising magnetic nanoparticles to label cells have been conducted. Some of the clinically approved iron oxide particles are Feridex/Endorem (dextran
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coated SPIO), Resovist (SPIO particles that are coated with carboxydextran).The first report involving magnetically labeled stem cells was from a patient with brain trauma who received an autologous transplant of Feridex-labeled neural stem cells (NSCs) into the damaged temporal lobe6. NSCs were isolated from exposed neural tissue (brain injury region) from the patient. Cells were cultured to select for neural progenitor cells and labeled with Feridex prior to stereotactical transplantation. The patient was then imaged with a 3.0-T MR scanner weekly for 10 weeks after transplantation. Hypointense signals at the injection sites were only observed after transplantation and the signal persisted for seven weeks. Although there are a few encouraging results on stem cell tracking, some of the commercially available magnetic iron oxide particles have certain limitations, and the search is on for an ideal biocompatible nanoparticles for use in stem cell tracking in humans. Research is underway at
References: 1. Thomson, JA; ItskovitzEldor, J; Shapiro, SS; Waknitz, MA; Swiergiel, JJ; Marshall, VS; Jones, JM. Embryonic stem cell lines derived from human blastocysts. Science 1998, 282 (5391), 1145–1147. 2. Takahashi, K; Tanabe, K; Ohnuki, M; Narita, M; Ichisaka, T; Tomoda, K; Yamanaka, S. Induction of pluripotent stem cells from adult human fibroblasts by defined factors. Cell, 2007 131(5), 861-72. 3. Freed, CR; Greene, PE; Breeze, RE; Tsai, WY; DuMouchel, W; Kao, R; Dillon, S; Winfield, H; Culver, S; Trojanowski, JQ; Eidelberg, D; Fahn, S. Transplantation of embryonic dopamine neurons for severe Parkinson’s disease. N Engl J Med. 2001, 344, 710-19. 4. Olanow, CW; Goetz, CG; Kordower, JH; Stoessl, AJ; Sossi, V; Brin, MF; Shannon, KM; Nauert, GM; Perl, DP; Godbold, J; Freeman, TB. A doubleblind controlled trial of bilateral fetal nigral transplantation in Parkinson’s disease. Ann.Neuro. 2003, 54, 403414. 5. Amariglio, N; Hirshberg, A; Scheithauer, BW; Cohen, Y; Loewenthal, R; Trakhtenbrot, L; Paz, N; Koren-Michowitz, M; Waldman, D; Leider-Trejo, L; Toren, A; Constantini, S; Rechavi, G. Donor-derived brain tumor following neural stem cell transplantation in an ataxia telangiectasia patient. PLoS Med. 2009 Feb 17;6 (2):e1000029. 6. Zhu J, Zhou L, XingWu F. Tracking neural stem cells in patients with brain trauma. N Engl JMed 2006, 355:2376–2378. EXPRESS HEALTHCARE
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Fertility preservation in cancer patients C Dr SK Das, Senior Consultant, Gynae-Oncology, Action Cancer Hospital, expounds on infertility caused due to cancer and its treatment and highlights the various methods that are coming to the fore to preserve fertility in cancer patients
DR SK DAS Senior Consultant, Gynae-Oncology, Action Cancer Hospital
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ancer since long has been considered a deadly disease. The incidence of cancer cases particularly in younger population has seen an alarming rise in the recent years. Overall statistics show that 810 per cent of cancer patients are below 40 years and one per cent below 20 years of age. In the light of such increasing number of cancer patients falling in the reproductive age group, fertility preservation has become a growing concern among doctors and patients alike. Every woman dreams of going through the phase of pregnancy when her mind and body prepares itself for the joys and responsibilities of motherhood. It brings with itself a positive feeling that life is purposeful and complete. The feeling of being able to bring a new life into the world is overwhelming. However, when this dream is not fulfilled and realisation dawns that one will not be able to bear children, it leaves a sense of incompleteness in the woman’s life. More so, when infertility is not natural but occurs due to the side effects of the treatment of a fatal disease like cancer. The dual agony of suffering from cancer and not being able to conceive has become a serious issue among the medical fraternity. To counter this, there have been constant endeavours of doctors all over to come up with fertility preservation techniques for female cancer patients. With better management of various cancers, there are a host of ways in which it is now possible to preserve a cancer patient’s fertility. Cancer and its treatments — including surgery, chemotherapy and radiation therapy — can hamper a patient’s ability to conceive. In surgical procedures, generally the reproductive organs are removed when cancer is diagnosed in any part of the reproductive tract, thus, reducing fertility. However, in recent years the focus has been more on the conservative techniques of treatment especially when the patient is young and the disease has been detected in early stage. For young cervical cancer patients who have a desire to conceive later, conisation or radical trachelectomy are the surgeries performed. Conisation means removing the lesion on the cervix in the form of a cone
Radical Trachelectomy and the margins are tested to confirm that the patient is free of disease. In radical tracheolectomy, the parametria (tissue adjacent to the cervix) and vaginal cuff (the end of the vagina close to the cervix) are also excised along with the cervix as part of the operation. This surgical procedure is generally accompanied with laparoscopic pelvic lymphadenectomy. As the uterus is preserved along with the ovaries, this technique is considered conservative in nature and has yielded good results as far as pregnancies and deliveries are concerned. In a bid to conserve the fertility of young endometrial cancer patients, a high dose of hormone is administered instead of radical hysterectomy where the uterus is fully removed. This treatment makes use of hormones that cause the endometrial cancer to regress. For ovarian cancer patients, conservative treatment is advised when border line malignancy or patient has germ cell tumours. For earlier ovarian malignancy, unilateral salpingo-oopherectomy (removal of one fallopian tube and one ovary which preserves the uterus and the ovary and fallopian tube of the other side) along with omentectomy (removal of the abdominal lining) is performed. These procedures require a close follow-up. www.expresshealthcare.in
One of my young patients suffering from ovarian cancer was devastated when she came to know that due to the treatment that she has to undergo for the disease, her fertility could be at stake. But the good thing was that since she was in the early stage of cancer, it was possible for us to preserve her future fertility with the use of conservative treatments (unilateral salpingo-oopherectomy and omentectomy). The patient’s cancer is now in control and she is the proud mother of a healthy baby girl. Chemotherapy has adverse effects on a woman’s fertility due to their toxic effect on oocyte (germ cell involved in reproduction). The extent of damage depends on the dose, the type of drugs used and the age of the patient. One way of reducing toxicity in the oocyte is by suppressing ovarian function with drugs like gonadotropin-releasing hormone (GnRH) agonists or oral contraceptives. Another emerging treatment that has proved to preserve fertility is the use of apoptotic inhibitors (Sphingosine-1-phsphate) which protects oocytes from CT (cholera toxin) induced apoptosis (process of programmed cell death). The risk of infertility from radiation therapy depends on the dose of radiation and the area of the body that is exposed to radiation.
Radiotherapy causes reduced blood supply to the uterus causing atrophy of endometrial resulting in difficulty in implantation of fertilised embryo. Radiotherapy also causes damage to ovarian follicles, thus causing premature ovarian failure. To reduce the effect of radio therapy, two methods can be employed. ● By shielding the ovaries with lead shields, thus, avoiding effect of radiation on ovaries. ● While doing surgery, ovaries can be transplanted in paracolic gutter on both the sides saving its blood supply. Other methods of fertility preservation of cancer patients include Ovarian Tissue Cryo Preservation where cortical strips from the ovary are removed laparoscopically and cryo preserved. This tissue is then implanted in the pelvis or grafted to the subcutaneous tissue as and when pregnancy is required. Ovarian cryo preservation has the advantage that wedges of ovarian tissue can be collected by laparoscopy from each ovary at any stage of the menstrual cycle without compromising a woman’s health. The ovarian tissue can also be cultured which results in achieving either primordial follicle or isolated immature oocyte in vitro maturation. Embryo and oocyte cryo preservation are two technologies that have yielded satisfactory results for women cancer patients with partners. The process involves the thawing and freezing of the egg and the embryo. Both the treatments make use of the in vitro fertilisation (IVF) procedure. The fertilised embryo is stored and transferred to the uterus as and when the patient is ready to conceive. Although they have proved to be one of the most successful treatments for fertility preservation, care should be taken that the embryo is devoid of cancer cells before it is transferred to the uterus. Despite the progress that has been made, the preservation of fertility in cancer patients is an emerging discipline; more awareness is required among oncologists, immunologists and endocrinologists regarding the issue. Patients should be counselled about the option of fertility preservation at the onset of the treatment. FEBRUARY 2013
K|N|O|W|L|E|D|G|E 30 MINUTE INTERVIEW
‘The number of craniofacial anomalies including cleft lip and palate is a little higher in India’
P DR KRISHNA SHAMA RAO
rof Dr Krishna Shama Rao has been actively practicing craniofacial surgery since 1991, establishing the first dedicated cleft and craniofacial centre in Mangalore and later on through Maaya Foundation setting up 11 centres across India, where free surgery is provided to the patients involving both cranial and facial deformities. Since 1991, he has completed over 16,500 such surgeries, both in India and abroad. In an interaction with Lakshmipriya Nair, he explains further about craniofacial deformities, the reasons they are caused and how craniofacial surgery is beneficial and more Tell us more about craniofacial surgery and the problems that it addresses? Craniofacial surgery is a very niche superspeciality which deals especially with deformities involving the cranium (skull) and the face. In some instances, either only the skull is deformed or only the face is deformed in isolation, whereas, in a larger number of patients, the entire skull and face (craniofacial region) is affected simultaneously. When present at birth, such deformities are called congenital craniofacial anomalies, and almost 50,000 such children are born every year in India with cranial and facial deformities. As special training, skills and qualifications are required for the surgeon to address the problem, not only from the medical and surgical point of view, but also with a very strong grounding in the fields of dentistry, especially maxillofacial surgery.There are less than 10 active full time craniofacial surgeons across Asia and less than a 100 across the globe. How has it evolved with time? Pioneered by stalwarts, like Dr Paul Tessier and Dr Hugo Obwegesser, amongst others around 1968, the techniques of surgery have become both easier in terms of planning as well as execution, due to tremendous advances in imaging like CT, MRI, 3D reconstructions and also making external steriolithographic models of the skull and the face to the exact millimeter in order to simulate the surgery prior to the actual procedure.The use of endoscopes, resorbable plating systems, 3D planning software and of course high-end opera-
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The biggest challenge is the absence of awareness amongst the public as well as a lot of health professionals that such surgeries can be performed safely with excellent outcomes in India in a dedicated craniofacial centre tion theatres and ICU's have made the surgery very safe and most such patients are usually operated upon at the age of six to eight months itself. In fact some deformities where one needs to lengthen the bone using specialised distraction devices, surgery can be performed the day the baby is born in order to help save its life at the earliest What are the challenges that you deal with in your chosen line? The biggest challenge is the absence of awareness amongst the public as well as a lot of health professionals that such surgeries can be performed safely with excellent outcomes in India in a dedicated craniofacial centre. The surgeries are expensive as they take several hours and lots of materials and even a free surgery funded by Maaya Foundation would cost up to Rs 75,000, at a no profit, no loss basis. The second challenge is the absence of enough trained surgeons and dedicated centres. With this in mind, Maaya Foundation hopes to initiate a separate training programme in craniofacial surgery by April 2013. Clefts are congenital defects, so are there any factors which are responsible for it? Is it hereditary? All congenital defects are not necessarily inherited. Cleft lip and palate has at least five genes implicated as one of the causative reasons, but, due to www.expresshealthcare.in
the low penetration of the gene, at present, one cannot label cleft lip and palate as a specific genetic defect. Hence, it is called multi factorial. However, some of the more serious craniofacial malformations like Crouzon’s, Apert’s Syndromes, have specific genes which have already been identified as mutated. It is possible in the future, that in those cases, where a specific gene is identified, gene therapy might prevent the disease completely.This is yet to happen. How do Indians fare as far as these anomalies are concerned? Are we more susceptible to them? If yes, why? The number of craniofacial anomalies including cleft lip and palate is a little higher in India (one in 700) as compared to the western countries where it is one in 1,000 live births. Due to the large population of India, the number of such patients is obviously high. What are the problems caused by these deformities? Common conditions like cleft lip and palate lead to obvious social stigma, poor self esteem, speech defects, hearing defects, etc. The more complicated craniofacial anomalies might also compress the brain leading to lower intelligence and scholastic performance, as well as compression of the eye ball leading to partial or complete blindness. In some conditions, like hemifacial micresomia, not only is the external ear missing, but the
entire hearing system may be abnormal leading to deafness on one side. What are the measures that need to be taken to avoid the occurrence of these deformities? Currently, there are no guaranteed standard measures that can be taken to avoid such deformities. However, being in good health, and avoiding drugs and medication, during the first eight weeks of pregnancy, as well as avoiding exposure to radiation, would certainly help in reducing the chances of such a deformity. Consanguineous marriages also increase the risk of a malformed baby. Tell us about the work done by Maaya Foundation. Maaya foundation was started in 2006 as the first all Indian NGO dedicated purely to free treatment of children born not only with simple cleft lip and palate anomalies, but, also with the most complex craniofacial deformities. Spread over 11 centres across India, over 6500 free surgeries have been conducted since 2007. It is the vision of Maaya Foundation that each state have a comprehensive centre, which not only treats the children free of cost, but eventually, it is also self sustaining to remain active serving the society for generations to come. lakshmipriya.nair@expressindia.com
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The Nuss Procedure Dr L M Darlong, Consultant,Thoracic Surgery & Thoracic Surgical Oncology, Fortis Hospital Noida elaborates on the Nuss procedure and its advantages
DR L M DARLONG Consultant, Thoracic Surgery & Thoracic Surgical Oncology, Fortis Hospital Noida
he Nuss procedure is a surgical technique for correction of pectus exacavatum, a congenital chest wall deformity caused due to abnormal development of ribs, cartilage or breast bone. In pectus excavatum or funnel chest, the breast bone is depressed leading to sunken or caved chest appearance. It is one of the most common congenital deformities of the anterior wall of the chest. It can either be present at birth or develops during puberty. What causes this condition is not known, though 40 per cent cases have hereditary association. It is more common in males. While we don’t have Indian figures on the occurrence of pectus excavatum, the Western incidence is 1 in 500 to 1000 live
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births. Besides pectus excavatum other deformity which are less common are pectus carinatum/pigeon chest in which the chest protrudes out and defects in which both defects exist. In the Indian context, pectus excavatum is considered a cosmetic problem, which is not true. Even serious cases of pectus excavatum may not threaten life, but it affects heart and lung functioning as there is not enough room for these organs to develop due to the sunken chest. This can be physically disabling for the patient and may manifest in heart problems indicated in the symptoms like shortness of breath, low tolerance for exercise and chest pain. Mild breathing difficulties and frequent, long-lasting colds may
result from less severe forms. Nuss procedure is a minimally invasive procedure that aims to force the sternum forward and hold it there with the help of a steel bar. It is based on the principle of bone and muscle remodelling along the rigid framework provided by the steel bars which lifts the breast bone to overcome the defect. In this procedure, small incisions of 2.5 cm are placed on each side of the chest, under each arm. Long-handled tools and a narrow fibre-optic camera are inserted through the incisions. A curved metal bar is threaded under the depressed breastbone, to raise it into a more normal position. In some cases, more than one bar is used based on the extent of deformity and age of the patient. The bars are
Nuss procedure at Fortis Noida Fortis Noida performs advanced Nuss procedure using technique of pectoscopy and crane lift. It has the “chest wall deformity clinic” specifically for such cases and deals with both domestic and international patients. The clinic deals with pectus excavatum, pectus carinatum combine deformities and chest wall deformities arising from trauma/tumours. The clinic deals with pectus deformity in all age group from children, teenagers and adults. Chest wall deformity clinic provides 1. Advanced Nuss procedure for pectus excavatum/ funnel chest 2. Reverse Nuss for pectus carinatum or pigeon chest. 3. Sandwich technique for complex excavatum/ carinatum 4. Press mold technique for complex chest wall deformity The centre employs the following technique for safety and result
1. Pectoscopy - It is endoscopic creation of the space where bars are to be placed. 2. Crane lift – To lift the breast bone away from heart before bar placement 3. Pectus tunneloscopy – Endoscopic inspection of the area created above heart and bar placement under vision. 4. Thoracoscopy – Endoscopic view of the chest cavity The “chest wall deformity clinic” has an online query site at http//www.pectusindia.com through which outstation domestic and international patients are screened to confirm their diagnosis. Online review of pectus questionnaires, clinical images and radiological images help us in planning the management of such patients Such cases are planned keeping in view their schedule like school vacation for children, college holidays for teenagers.
removed after two to three years. Bar removal procedure is done through the original small incisions of previous surgery on either side of the chest. The surgery corrects the cosmetic deformity boosting the patient’s selfconfidence and improving heart and lung physiology. The dictum for the time of surgery is “the earlier the better”. The ideal age for pectus excavatum surgery is three years using the Nuss procedure. At this age the bones are soft and can be easily remodelled with less pain. Moreover by the time, the child is five years of age and ready to go to school, the bar is ready to be removed and avoids psychosocial implication from peer group in their class. The early correction of sunken chest avoids physiological effect on heart and lung functioning and psychosocial implications of the defect. The chest wall remodelling effects of the bar allows it to grow as a normal chest. In India there is absence of dedicated clinics for repair of sunken chest. The medical community also has less awareness on the management of sunken chest. It is usually perceived as a cosmetic deformity. As a result, parents seeking advice of the correction of this condition in their children are often asked to live with it. This results in the loss of precious time because correcting sunken chest is more advantageous in kids with Nuss procedure.
Case study: Fortis Noida operated on a three-year old child in July 2012. She is doing well, her brother no longer teases her as the dent on her chest is gone, the parents say her posture has improved and she is more social now and goes for swimming too. Her bar will be removed by the age of five years, and with her deformity corrected she will attend school free of psychological and physiological implication which would not have been the case if it was left untreated. Similarly, the hospital has operated on teenagers who were left untreated during childhood and continued suffering psychological trauma with physiological limitation due to the deformity. With the help of internet such young,
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1. Pectus excavatum showing depressed breast bone compressing the underlying heart and lung. aware, educated net-savvy individuals were able to locate the hospital and get their pectus deformity corrected. In adults too people in their 30’s have had their pectus deformity corrected mainly due to its psychosocial impact. Cost to patients Cost of treatment varies
2. Crane lift device attached to deformity.
3. Crane lifting of the deformity
4. Pectoscopy creation of space for bar placement
5. Pectus tunneloscopy bar placement
6. Nuss bar before fixation
7. Nuss bar after fixation and correcting defect
from Rs 2 to 3 lakhs depending on the number of Nuss www.expresshealthcare.in
bars used and the age of the patient. The younger the
patient the lesser the cost due to less hospital stay. FEBRUARY 2013
Radiology MAIN STORY
Evolution of radioactive therapy in cancer treatment Dr Manish Chandra, Senior Radiation Oncologist, Jupiter Hospital gives a run-down on the history of radiation therapy in cancer and the various happenings which contributed to its progress -ray and radioactivity were discovered in last decade of 19th century in Europe. Not only do they resemble in many physical characteristics, they were also discovered very close to each other in 1895 and 1898 respectively. Medical use of both X-ray and radioactivity soon after. X-ray was used for preliminary diagnostic imaging and radioactivity was used to treat superficial skin cancer. With further technological advancement, higher energies of X-ray could be generated. This led to the use of X-ray in treating deep-seated tumours. However, early 20th century proved that these techniques can cure cancer but may cause cancer as well. This led to further refine-
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DR MANISH CHANDRA Senior Radiation Oncologist Jupiter Hospital
ment in the techniques and equipment delivering radiation for treatment. It has steadily improved since then and today, radiation is delivered precisely to destroy cancer cells while saving the normal tissues around them. Radium discovered in 1898 was the main radiationdelivering isotope used in the treatment of cancer till mid1900s. But with radium kept getting costlier, difficult to procure and people become aware of the health hazards to the health workers. So, cobalt was then developed as an alternative and the first Cobalt 60 unit was installed in 1951 at the University Hospital in Saskatoon, Canada. This machine treated 6728 patients before it was decommissioned in 1972. Parallel to this, there
was a major revolution in the field of linear accelerators which had grown from low voltage to very high voltage beams. The first mega voltage linear accelerator was installed at the Stanford University in 1956. The iconic photograph of a two-year-old child suffering from Retinoblastoma (tumour of the eye) receiving treatment is still kept by the Radiation Oncologist (Fig 1). During the same time there was a renewed interest in internal radiation therapy known as brachytherapy (radiation therapy started with brachytherapy but later shifted its focus to external beam radiation therapy). In 1940s there was considerable development in the field of brachytherapy, mainly for gynaecological cancers,
A 2-year-old boy - the f irst patient to receive radiation from the original medical linear accelerator at Stanford FEBRUARY 2013
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prostate cancers and superficial skin cancers. The primary advantage of Linear Accelerator over Cobalt unit was short treatment time as well as uniform and higher dose rate. The limitation of the accelerators in the early years was its fixed gantry, but by 1960s, this problem was also resolved. Linear accelerators became the preferred mode of treatment along with electron beams. Its use was limited because of higher cost and frequent breakdown. Till 1980s linear accelerators and Cobalt units were fighting for their superiority in terms of treatment delivery, stability and cost effectiveness. In late 1970s, computer started infiltrating medical equipment and linear accel-
Hand with Rings: print of Wilhelm Rรถntgen's first "medical" X-ray, of his wife's hand, taken on December 22, 1895 and presented to Ludwig Zehnder of the Physik Institut,University of Freiburg, on January 1, 1896 EXPRESS HEALTHCARE
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Radiation unit at Jupiter Hospital erator took the full advantage of it. In early 1980s, cobalt unit were replaced by linear accelerator in Western countries. After a decade, cobalt units were limited to only third world countries. There is no denying that computers changed our life and it had an impact on radiation therapy as well. After adopting the computer with open arms, it changed completely in over a decade (mid 1980s to mid-1990s). With better linear accelerators it was possible to deliver a uniform dose to the designated site and could shape the beam with lead blocks. However, the preparation of these blocks was a very labour-intensive and difficult task. Then, Multi-leaf collimator came into picture in mid-1980s, though it was conceived way back in 1965. It changed the complete dynamics of linear accelerators. 3-D conformal treatment became the basic treatment and then graduated to intensity modulated radiation therapy (IMRT). Imaging in radiation therapy was not far behind and it too was simultaneously
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improving over the years. It evolved from film-based imaging to digital imaging and then to cone-beam computed tomography. Then, when some thought there is nothing else in radiation therapy to be explored, cone beam computed tomography with low voltage radiation emerged, offering diagnostic quality of images. It is a pleasure to work in this golden era of radiation oncology where an oncologist can offer treatment that can be delivered to the patient with minimal adverse reactions. Popular to the contrary belief, radiation therapy in this era is completely safe to the health worker and the dosimetry analysis has shown that radiation oncologist health workers receive the least amount of occupational radiation as compared to other health workers (cardiology, operation theatre, orthopaedics and radiology)
Techniques that can be used with current medical linacs: With the current trend using linear accelerator a variety of treatment techniques www.expresshealthcare.in
are possible. Some of the techniques as follows 1.3D Conformal Radiotherapy: Through the advancement of imaging technology, enhanced images of the body allow for programming of treatment beams to conform better to the shape of a tumour. Hence treatment is more effective and side effects are reduced. By treating with large numbers of beams, each shaped with a multileaf collimator (MLC) or cerrobend block, radiation dose is delivered uniformly and conformally to the tumour. 2. Intensity Modulated Radio therapy (IMRT): IMRT is one of the latest advancements in radiation therapy. This new approach to treatment allows for dose sculpting and even distribution of delivery to avoid critical structures while delivering precise uniform treatment. In this technique, the multileaf collimator (MLC) moves and modulates the radiation as the linac treats the patient 3. Stereotactic Radiotherapy & Radiosurgery (SRT): SRT is a three-dimensional navi-
gational technique to target the tumour volume with very low to minimal dose to the surrounding normal tissues. 4.Dynamic Adoptive Radiotherapy (DART): Imaging, in the field of radiation therapy, has improved a lot and this led to evaluation of the tumour dynamically during the treatment and adapt as per the regression and change in the tumour size. 5. Image Guided Radiotherapy (IGRT): As the name suggests, it is the technique where we use image guidance to deliver radiation therapy. I am really privileged to have my wish list of the latest and complete radiation therapy unit at Jupiter Hospital in Thane, to treat the patient in the best way possible. The field of radiation oncology is going to see many more new changes in the years to come and future of radiation therapy appears to be image-guided and adaptive. In the next decade, the only mode of treatment delivery in radiation therapy would be image-guided. FEBRUARY 2013
Hospital Infra ‘Usage of a waterless scrub reduces the potential harm caused by microorganisms through infections’ Indian hospitals are constantly faced with the problem of contaminated water supply. 3M India has introduced an innovation solution to this problem
Page 50 MAIN STORY
The copper protection Dr Anu Kant Mital, Spokesperson, Antimicrobial Copper – International Copper Promotion Council (India) speaks on the anti microbial properties of copper alloys and how infections in hospitals can be reduced by using infrastructure made of copper alloys
DR ANU KANT MITAL Spokesperson International Copper Promotion Council (India)
FEBRUARY 2013
hen a patient is admitted to a hospital, he is immediately exposed to various infections already present in the hospital in other patients who also are admitted. They may end up exposing themselves to various bacteria, viruses and such innocuous infections or to more severe diseases like tuberculosis, HIV, Hepatitis C, and infectious agents like the methicillinresistant staphylococcus aureus (MRSA). According to the centres for disease control and prevention, hospital-acquired infections (HAI) constitute the fourth-greatest cause of death in the United States — following only cancer, heart disease and stroke. More Americans die every year from HAIs than from breast cancer, HIV and automobile accidents combined. One out of every 20 patients in a hospital will become even more ill than when he or she arrived during the time spent at the hospital because these patients contract and suffer the horrors of a deadly infection leading to an increased morbidity. Hospitals have become cesspools of deadly bacteria, viruses and toxic mould. Approximately 2.5 million individuals in the US become infected this way each year, and more than 100,000 of them die. To put this in perspective, the American Hospital Association (AHA) says there were 33.4 million inpatient hospital admissions in 2006. These statistics are frightening, and are especially disheartening, because these infections are preventable. A majority of these infections are transmitted by coming in contact with surfaces that are infected, like bedrails, IV poles, dressing trol-
W
leys etc. These objects are coming in contact with infected patients and their relatives who come to visit or attend to them, as well as medical and paramedical health workers. Although a standard protocol of sterile practice like routine hand washing and disinfectant use remain as the first line of defence, it has been shown that pathogens can survive in the most microscopic of all scratches and crevices on these surfaces. Studies around the globe have shown that various pathogens survive on these inanimate objects in the hospital for long periods of time and may even thrive on them. According to the Association for Professionals in Infection Control and Epidemiology, MRSA can stay virulent on hard surfaces for as long as 56 days while the study done by the state of New Jersey shows that MRSA can stay virulent on hard sur-
by microbiologists of repute have tested and proven that one such material exists. In fact it has been around for centuries and has been used by humans for its anti microbial properties in many ancient civilisations till the current age. This miracle material is copper. Studies have been recorded using the pure as well as alloys of copper which contain at least 60 per cent copper. They have proven that this material is able to kill all bacteria including the superbugs and also the now common viruses like H1N1 etc. Recently studies in ICUs of super speciality hospitals like the Memorial Sloane Kettering Hospital, as well as two other hospitals, in the US, over a period of 42 months, found that in the wards that had these touch surfaces made of copper alloys with 60 per cent copper, almost all (99.9 per cent)
In many countries newer ICUs are being made with this anti-microbial copper touch surfaces or are being retrofitted faces for as many as 90 days. Now, if these surfaces of the inanimate objects could be rendered totally sterile then of course there would be no pathogen to transmit. Thus the need for the third line of defence- a novel approach- i.e. to have all these commonly touched surfaces made of a surface that sterilises itself. Also this unique surface material would have all the other physical and mechanical qualities that the conventionally used materials possess. Studies across the globe www.expresshealthcare.in
of all bacteria died on coming in contact with these inanimate objects like the IV stands, the bed rails and the side and over bed tables. These results have been consistent across hospitals in the UK, South Africa, Chile, Japan, Korea and other European countries. The studies further examined the infection rates in these wards and found that infection rates were reduced by 40-70 per cent (depending on how many touch surfaces were made of copper) as compared to identical ICU
wards in the same hospital where no touch surface was made of copper. Due to these studies, infection control officials in various healthcare settings are taking notice and in many countries newer ICUs are being made with this antimicrobial copper touch surfaces or are being retrofitted. The hospital equipment makers are in the process of starting new product lines with the anti-microbial copper touch surfaces incorporated. Even in India the sensitisation of the healthcare industry has started and many infection control specialists are working towards getting anti microbial copper touch surfaces in their hospitals. To account for our environment a study has been approved and is currently underway at the Tata Memorial Cancer Hospital. The new ICU in the hospital has a set of four beds in one ward which has been altered to have the equipment like the bed-rails, foot rails, IV poles, the side and overbed tables as well as the dressing trolleys modified to cover the touch surfaces with anti microbial copper alloys. The opposite ward with four beds is being used as control. Regular swabs are being taken off the touch surfaces to measure the bio burden and compare the load of colony forming units on both wards. The future healthcare setups will use more of this anti microbial copper alloy touch surfaces to reduce the burden of hospital acquired infection is a foregone conclusion. This is evident from the fact that many major greenfield projects are already specifying the anti microbial copper alloy products in their tenders and the medical equipment manufacturers have introduced products using this material EXPRESS HEALTHCARE
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H|O|S|P|I|T|A|L|I|N|F|R|A 30 MINUTE INTERVIEW
‘Usage of a waterless scrub reduces the potential harm caused by microorganisms through infections’ Gautam Khanna, EXECUTIVE DIRECTOR, HEALTHCARE BUSINESS, 3M INDIA
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ndian hospitals are constantly faced with the problem of contaminated water supply. 3M India has introduced an innovation solution to this problem. Gautam Khanna - Executive Director, Healthcare Business, 3M India tells Raelene Kambli that clinical areas wihtin the hospital need to go waterless to resolve this issue
What are the challenges faced by hospitals in India concerning water quality? How does water quality in Indian hospitals impact infection control? Availability of abundant clean water is no more a given situation, and is becoming difficult and expensive to procure. According to the Ministry of Health and Family Welfare, a 100-bedded hospital should have at least 10,000 litres of potable water per day. Additionally, the average use of water per bed ranges from 400 to 450 litres per day. Most facilities today cannot provide so much water to a single patient due to the problem of
ranges from Rs 0.8-1.5 per litre) Summarising the problems: ● Absence of strong guidelines and monitoring tools for hand hygiene. ● Acute shortage and/or poor quality of water leading to increasing ineffective hand hygiene ● High costs associated with purifying water for surgical settings ● Lack of appropriate hand antiseptic solutions in the Indian market to tackle these problems
Tell us about your study ‘Random Analysis of water quality in Indian hospitals and its impact’? What are its findings? 3M conducted an internal study to find out the levels of contamination in water in hospitals. For this, water samples were collected from six hospitals across cities, and a microbial analysis was conducted of the water being used. The results showed that a majority of the samples had a high level of contamination. Details of the results are as below:
Results
Sample Total aerobic count
E. coli
S.aureus
Pathogens P.aeroginosa Salmonella sp
1 2
Greater than 300 CFU Greater than 300 CFU
Present Absent
Present Present
Absent Absent
Present Absent
3*
Greater than 300 CFU
NT
NT
NT
NT
4*
Greater than 300 CFU
NT
NT
NT
NT
5
Less than 10CFU
Absent
Absent
Absent
Absent
6
Less than 10CFU
Absent
Absent
Absent
Absent
7
Greater than 300 CFU
Present
Absent
Present
Absent
*Not tested for pathogens due to limited available of sample water scarcity.The limited water used may be highly contaminated due to lack of proper treatment. In critical environments of a hospital like the operation theatre, water is used in large quantities. While shortage of water may prevent surgeries from taking place, the poor quality of water may also lead to higher infections, considering the fact that all the surgical hand preparations done today need water. Additionally, the cost involved in purifying water in large quantities is quite high. (Average cost of RO water
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You say that there is a need to go waterless in hospitals. What do you mean by this? Why is it so? From the results of the study conducted, it was clear that there are issues in the availability of the right quality of water for critical areas of the hospital and costs of ensuring quality water seem to be underestimated. In such a situation, in a country where natural resources are depleting and becoming a scarcity, it is smart to ‘Go waterless’ sooner than later.
How does this help keep infections at bay? www.expresshealthcare.in
Surgical site infections (SSI) have been one of the key reasons for increasing cost, morbidity and mortality related to surgical operations and continues to be a major problem. While various reports claim that SSI rate in Indian hospitals ranges from nine per cent to 20 per cent, the costs of such high SSI is yet to be quantified. Increased hospital stay, higher morbidity and mortality, and higher consumption of antibiotics are some of the direct costs associated with increasing SSI- all leading to a significant cost of maintaining the healthcare infrastructure. Usage of a waterless scrub reduces the potential harm caused by microorganisms through infections.
Tell us about 3M Healthcare’s new innovation - Avagard? What are its advantages? One of the biggest innovations by 3M in handhygiene for healthcare practitioners is Avagard Waterless Surgical Hand Antiseptic- the only FDA-NDA approved waterless surgical hand antiseptic in the world today. 3M Avagard, developed on a patented liquid-crystal technology can help counter most of the problems related to hand-hygiene. Some of the unique benefits of the product include: ● Fast, highly effective and much better persistent antimicrobial protection when compared to conventional water-based PVP or CHG scrubs ● Significantly reduces or eliminates the use of water for surgical hand preparation ● Considerably reduces the amount of antimicrobial solution consumed for hand preparation ● Reduces material waste of sterile towels, scrub brushes and hand-rub, used in traditional methods of surgical hand preparation ● Cuts down the overall time spent in surgical scrubbing (from average five minutes to one minute), thereby increasing the OT productivity ● Reduces overall costs for the
hospital
Is it possible for any hospital to go completely waterless? And how? We cannot eliminate water from a hospital. But we can drastically reduce the amount of water consumed with Avagard.
Will this add to the operating costs within hospitals? This will actually reduce operating costs, not increase it. Since this waterless scrub leads to lesser material waste of sterile towels, scrub brushes and hand-rub which is a part of the traditional surgical hand preparation, the overall cost of going in for a waterless scrub is lesser by atleast Rs 12 per hand wash before surgeries.
How do you plan to market your product in India? Avagard has a benefit for everyone in the ecosystem – it reduces chances of infection for patients, easier preoperative preparation for surgeons and other healthcare providers, lower operating costs for the hospital management. So, with the right educational programmes and spreading the right message to each stakeholder, we can successfully launch this product. The educational programmes will be focused on the benefits of moving away from traditional practices. Sampling of the product is also a key technique for commercialisation. Further, conducting more studies on water quality in hospitals in India to further clinically validate our claims will help us tie up with surgeon societies in India eventually. Even hospitals are conducting studies to evaluate the efficacy of using Avagard.
Any set targets for this year? Since the product is a disruptive innovation, commercialising the product will take time.We plan to create awareness in almost all hospitals with more than 50 beds across the country. Our focus will be on concept selling and changing the practice of healthcare professionals by creating awareness. raelene.kambli@expressindia.com
FEBRUARY 2013
TIMEOUT
Dr Raghuvanshi: Active leader He is the loyal senapati, confidante, friend and an active leader. Meet the Vice-Chairman of the Narayana Hrudayalaya (NH) group, Dr Ashutosh Raghuvanshi. He reflects on his journey and association with NH Chairman Dr Devi Shetty, in a conversation with M Neelam Kachhap
here aren't many people inside or outside Narayana Hrudralaya (NH) who understand it better than Dr Ashutosh Raghuvanshi. Having shaped it and seen NH grow, Dr Raghuvanshi feels proud that the company is trying to dissociate healthcare from affluence. The MD, VC and Group CEO of the NH group Dr Raghuvanshi, has worked with Dr Devi Shetty, Chairman of NH since his Manipal days. Dr Raghuvanshi was born and brought up in the hills of Dehradun and lived and worked at most places in India. He has finally settled in Bangalore after an illustrious decade at Rabindranath Tagore International Institute
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FEBRUARY 2013
of Cardiac Sciences, Kolkata, where he started the department of cardiac surgery. Youngest of three siblings, Dr Raghuvanshi lived a 'swachhand' childhood. A self-confessed prankster, as a child he was quite naughty and dragged himself through school. "I was a very mediocre student. Till my 11th standard, I was not serious about studies at all," shares Dr Raghuvanshi. The choice of medicine came to him accidentally. "My elder sister wanted to be a doctor, but she could not study MBBS. I am very close to her and she started to encourage and motivate me to do medicine," he remembers. At that time he was in his 11th standard. He had not done www.expresshealthcare.in
very well in the 10th standard and wanted to prove himself. He did well in 12th and subsequently went on to do his MBBS from the prestigious Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra. Spending time at Sevagram, Wardha was part of the curriculum and Dr Raghuvanshi found his bearings there. The rebellious and carefree Dr Raghuvanshi transformed into a focussed and humble surgeon. He finished his MBBS with distinction and continued his internship at ESI, Hospital Delhi. It was during this time that a chance visit to a friend at a different hospital in Delhi brought Dr Raghuvanshi in close contact with cardiac sur-
gery. He was mesmerised by the high-end technology and array of fascinating equipment used for the surgery. He lost his heart to cardiac surgery that day and decided to pursue it till his dying day. Many noted cardio-thoracic surgeons like Dr Sharad Pandey chiseled his art and Dr Raghuvanshi completed his MCh cardio-thoracic surgery from Bombay Hospital, Mumbai. After spending four years at Bombay Hospital, Dr Raghuvanshi joined Apollo Hospital, Chennai and later moved to Vijaya Heart Foundation, Chennai. However, he was not very happy with his career at that point as he was looking for bigger challenges. It was at EXPRESS HEALTHCARE
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L|I|F|E this time that Dr Raghuvanshi met Dr Shetty who was going to start the Manipal Heart Foundation, at Bangalore. He joined Dr Shetty's team and continued to work with him, later joining Rabindranath Tagore International Institute of Cardiac Sciences (RTIICS), Kolkata as Clinical Director & Consultant Cardiac Surgeon. He recently gave up surgery to take up administrative roles in the company. “I wanted to
concentrate on operations and management, but the thought of cardiac surgery still thrills me,” he shares. He wishes to mentor and coach the younger generation of workers at NH to cultivate the NH way of thinking and work ethics. Mahatma Gandhi and his teachings have been Dr Raghuvanshi's greatest inspiration and continue to guide him even today.
He has had an illustrious career and an impressive resume. However, there are some things about people that resumes can't capture, personal qualities that go a long way toward explaining their success. In Dr Raghuvanshi's case, the quality that stands out is the respect that he shows for his patients and fellow employees. Most of them hold him in high regard. Although he never mar-
Mixed Bag Your best prize in life so far: My smile Your first day in school: I don't particularly remember that day, but I do recollect that my father mistakenly walked me up to the second standard division wherein I was trying hard to search for batch mates who were of my age. I was around four years old at that time. Your first ambition: To be an architect. I remember my father was building our house when I was a kid and I used to play with the building material sand, bricks etc. And thus, I thought when I grow up I would build my own buildings and planned for them playfully.
Your first day at school: I don't remember it. What I do remember is my third standard class teacher. She was an Anglo-Indian and used to favour me and give me candies. Your first day at work: It was quite expected as an intern at ESI hospital, in Delhi I was very scared though. The first time you fired somebody: I felt worse than the person I fired.
a very happy childhood. Your happiest moment: When my niece was born Three things that you cannot do without: My Blackberry (mobile), cup of tea and internet One trait that you would like to change about yourself: I get angry very fast. I would like to control my emotions in a better way.
The toughest decision you have taken: To give-up surgery.
Your first vehicle: It was a car, Maruthi - 800 which I bought in 1989.
The best memory of your childhood: In Dehradun, all the greenery and flowers I had
One parental advice that you remember: My father used to say "Exercise to remain fit."
ried, and had no children of his own, he has been a favourite uncle to his nieces and nephews. He lives along with his mother and his 'babies' two adorable black Labradors. He has a sweet tooth and likes to unwind with the movies. Discussing about movies, he says, "I like almost all kinds of English movies." Catching up a movie at home is his favorite time-pass. "I love watching the Oceans series and recently saw all the three movies back-to-back," he says. As far as music goes, he likes the popular Hindi music. "I don't particularly follow any song. I hear music on the go," he shares. Dr Raghuvanshi likes to read. His favorite subjects are science, history and business. "Unfortunately, I don't really get time to read books. I read a lot of magazines and newspapers. I regularly read 'The Economist' as I feel it has very good articles," he says. Although he likes to travel he does not get too much time away from work. “I keep on traveling for professional purposes and as faculty for conferences. My favourite travel destination is Bali, Indonesia" he says. mneelam.kachhap@expresindia.com
CONTRIBUTOR’S CHECKLIST Express Healthcare accepts editorial material for the regular columns and from pre-approved contributors/ columnists. ● Express Healthcare has a strict non-tolerance policy towards plagiarism and will blacklist all authors found to have used/referred to previously published material in any form, without giving due credit in the industry-accepted format. As per our organisation’s guidelines, we need to keep on record a signed and dated declaration from the author that the article is authored by him/her/them, that it is his/her/their original work, and that all references have been quoted in full where necessary or due acknowledgement has been given. The declaration also needs to state that the article has not been published before and there exist no impediment to our publication. Without this declaration we cannot proceed. If the article/column is not an original piece of work, the author/s will bear the onus of taking permission for re-publishing in Express Healthcare. The final decision to carry such republished articles rests with the Editor. ●
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Express Healthcare’s prime audience is senior management and professionals in the hospital industry. Editorial material addressing this audience would be given preference. ● The articles should cover technology and policy trends and business related discussions. ● Articles by columnists should talk about concepts or trends without being too company or product specific. ● Article length for regular columns: Between 1300 - 1500 words. These should be accompanied by diagrams, illustrations, tables and photographs, wherever relevant. ● We welcome information on new products and services introduced by your organisation for our Products sections. Related photographs and brochures must accompany the information. ● Besides the regular columns, each issue will have a special focus on a specific topic of relevance to the Indian market. You may write to the Editor for more details of the schedule. ● In e-mail communications, avoid large document attachments (above 1MB) as far www.expresshealthcare.in
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as possible. Articles may be edited for brevity, style, relevance. Do specify name, designation, company name, department and e-mail address for feedback, in the article. We encourage authors to send a short profile of professional achievements and a recent photograph, preferably in colour, high resolution with a good contrast.
Email your contribution to: viveka.r@expressindia.com Editor, Express Healthcare FEBRUARY 2013
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People Dr K M Cherian gets the “Best Manager of the Year” award The accolade was given by the Europe Business Assembly
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ounder and CEO of Frontier Lifeline Hospital, Dr K M Cherian has been recognised as the “Best Manager of the Year” from India by the Europe Business Assembly, UK. Frontier Lifeline Hospital has also been recognied as the “Best Enterprise” by the prestigious European award in the science
and medical sphere by this international award. Both international prizes are a famous statue made by renowned London jeweller Alfred Winiecki. It is shaped as a hand symbolising hard work. The Europe Business Assembly conducted this award ceremony as part of the
Social Ceremonial Reception which took place in the famous Hofburg palace (Vienna, Austria). Dr KM Cherian, Founder and CEO of Frontier Lifeline Hospital quoted, “I am extremely honoured to have been recognised as “Best Manager of the Year” and for Frontier Lifeline to have won
“Best Enterprise”. This award has further motivated my team of doctors and me to work harder to ensure best medical care for our patients. We will continue to discover breakthroughs in the field of cardiology that will benefit not just our patients but every patient in the world affected with heart diseases.”
Fortis appoints four distinguished doctors to its team The new appointments are in the field of gastroenterology, anaesthesia and obstetrics and gynaecology
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ortis Memorial Research Institute (FMRI) has recently appointed three renowned doctors to provide latest and cutting edge solution to complex medical problems. Announcing the appointments, Dr Ashok V Chordiya, Zonal Director, Fortis Memorial Research Institute said, “I am delighted to welcome Dr Avnish Seth, Dr Hari Hara Dash, Dr Urvashi P Jha and Dr Suneeta Mittal at Fortis. I am confident that their enormous expertise in their respective speciality areas will be a huge asset for our patients, at our state-ofthe-art flagship facility." Dr Avnish Seth is the
Director and HOD, Gastroenterology & Hepatobiliary Sciences and Director of Fortis Organ Retrieval & Transplantation (FORT). An alumnus of Armed Forces Medical College, Pune, Dr Seth completed his MD (Medicine) from Pune University in 1990 and DM (Gastroenterology) from PGIMER Chandigarh in 1995. He then worked as a consultant to the Armed Forces in Gastroenterology and Hepatobiliary Sciences with special interest in advance GI Endoscopic procedures and treatment of liver disorders. Dr Hari Hara Dash is the
Director, Anesthesia. He had done his MBBS in 1973 and MD in Anesthesiology in 1977. He had achieved Honors and Gold Medal in Anatomy, Gold Medal in Surgery, and also received the best Review Article award in 2006. Dr Urvashi P Jha has over 30 years experience in treating women with gynaecological problems, using best clinical practices and protocols. She has extensive surgical expertise in advanced gynaecological procedures. Her specialisation lies in the use of laparoscopy, hysteroscopy (key hole surgery), and natural access route (vaginal) sur-
gery. In addition, she has been recognised by her peers for exceptional endoscopic work treating complex infertility, cancer, endometriosis, fibroids, ovarian cysts and tumours and genital birth defects. She has also pioneered and supported the development of menopausal medicine. A strong voice for women health issues in India. She has engaged with stakeholders within her specialisation, medical fraternity and with the general public to raise the quality of care. Dr Suneeta Mittal was the Head of the department of obstetrics and gynaecology in All India Institute of Medical
Sciences (AIIMS) and has joined Fortis as a Director & HOD in Obstetrics & Gynecology. Dr Mittal has carried out significant research with WHO and contributed to several WHO monograms including Medical Eligibility Criteria for Contraceptive use. She has over 240 publications in International and National journals, books and book chapters and has received several awards, orations and fellowships including prestigious `Fellowship of National Academy of Medical Sciences' and 'Fellowship ad eundum of Royal College of Obstetrics & Gynaecology.”
Dr SKS Marya, Vice Chairman, Max Healthcare appointed President, Indian Orthopaedic Association His vision is to ensure young orthopaedic surgeons have easy access to best practices in education and training in orthopaedics
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r SKS Marya, Vice Chairman, Max Healthcare and Chairman - Max Institute of Orthopaedics and Joint Replacement Surgery, Max Healthcare has been appointed as the President of Indian Orthopaedic Association (IOA). Dr Marya is a renowned joint replacement surgeon in Asia and has been in the field of medicine and orthopaedic surgery for almost 30 years. He took charge of Indian Orthopaedic Association's (IOA) as President to initiate plans to further the cause of education in India and South Asian Association for Regional Cooperation (SAARC) countries. His vision FEBRUARY 2013
is to ensure that young orthopaedic surgeons have easy access to national and global best practices in education and training in the field of orthopaedics. Dr Marya said, "This is an incredible achievement. I am looking forward to helping IOA to achieve even greater success. Having comprehended the challenges and opportunities of the industry, I will be thriving to provide strategic direction to the long-term growth of orthopedics in India. I attain my role at IOA with an aim to make education in the field of orthopaedics easily accessible to the young learners and the
future surgeons of India. I am confident that the association would result in further strengthening of IOA." Dr Marya specialises in joint replacement surgery for the joints of upper and lower limbs (primary and revision) and trauma management based on IAO Principles. He has to his credit over 12000 knee, hip, shoulder, finger and toe surgeries, reportedly. He is credited with pioneering various complexes and advanced techniques to treat bone and joint related problems and shared his knowledge with multiple surgeons across India, Asia and Europe. In recognition of his www.expresshealthcare.in
service and expertise, Dr Marya has been conferred a number of awards and recognitions including the 'Praman Patra' from the Chief Minister of Punjab, 'Haryana Vigyan Ratna' from the Chief Minister of Haryana, 'Distinguished Service Award' from the Indian Medical Association (IMA) Delhi and 'Bharat Jyoti Award' from the Governor of Tamil Nadu. Dr Marya is also the author of seven text books on Orthopaedics. He has conducted live surgery demonstrations in India and countries abroad like Zimbabwe, Philippines, Malaysia, Poland to name a few. He has also
deliver lectures on orthopaedics in more than 20 countries. Dr Marya has been the President of various national orthopaedic associations like the Indian Society of Hip and Knee Surgeons (ISHKS), Indian Arthroplasty Association (IAA) and Delhi Orthopaedic Association (DOA). He is on the board of directors of Asia-Pacific Arthroplasty Society (APAS), education director of Societe Internationale de Chirurgie Orthopedique et de Traumatologie (SICOT) and president-elect of Arthroplasty Society in Asia (ASIA ). EXPRESS HEALTHCARE
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L|I|F|E BOOKSHELF
Guides on nursing
esearch funded by Agency for Healthcare Research and Quality (AHRQ) has demonstrated that an inadequate nursing staff directly correlates with adverse patient outcomes. And, several studies (L Quine, JS Murray, others) have revealed that bullying of and by nurses is a serious problem and that studentnurse bullying of faculty is increasing. Two books being released by the Honor Society of Nursing, Sigma Theta Tau International (STTI), offer guidance on how to improve nurses’ working, teaching.
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and learning conditions. The books are:
Creating and Sustaining Civility in Nursing Education Problems related to rudeness, insolence, discourteousness and disrespect can significantly disrupt a nurse’s work environment and interfere with a patient’s quality of care. Creating and Sustaining Civility in Nursing Education is written by an author and lecturer known for her work in academic civility. Cynthia Clark reportedly shares stories, exemplars, and tools to
About the authors
C
ynthia “Cindy” Clark , the author of Creating and Sustaining Civility in Nursing Education, is a fellow in the American Academy of Nursing and in the National League for Nursing (NLN) Academy of Nursing Education. She is the recipient of numerous teaching, service, and research awards, including the 2012 'Most Inspirational Professor Award' and the 2011 'NLN Excellence in Educational Research Award'.
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ennifer Mensik, the author of The Nurse Manager’s Guide to Innovative Staffing is on the American Nurses Association’s Board of Directors. Mensik is a former Executive Director of Quality and Patient Safety for the UCLA Health System and has worked at Banner Health in various roles, including the system director of Clinical Practice and Research. She has also served as the president of the Arizona Nurses Association.
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www.expresshealthcare.in
keep the problem of incivility in nursing education from spiraling into aggression and jeopardising the learning and practice environment. “Clark helps us realise how each of us is potentially part of the problem and all of us are part of the solution,” says Donna Hedges, Associate Director at the Baptist Health System School of Health Professions in San Antonio. “These are timely and truly constructive ways to manage these challenges.”
Title: Creating and Sustaining Civility in Nursing Education Author: Cynthia Clark Lecturer Publisher: Sigma Theta Tau International Pages: 244
The Nurse Manager's Guide to Innovative Staffing For busy nurse managers, effectively analysing workforce, patient population, and organisation to determine proper staffing is daunting. Research traditionally has not gone much beyond calculating hours
per patient day with bedside nurses. The Nurse Manager’s Guide to Innovative Staffing provides easy-to-apply models, examples, and stories on how to obtain quality outcomes, staff satisfaction, and patient satisfaction and safety. The book’s author, Jennifer Mensik is the administrator for nursing and patient care at St Luke’s Health System in Idaho, US. “The linkage of the achievement of optimal outcomes for patients, nurses and the organisation is masterfully done. Setting the stage based on nursing principles and scope of practice provides an evidence-driven approach to this work,” says Kathy Malloch, Clinical Consultant to API Healthcare Inc in Hartford, Wisconsin, US. Both books are available for purchase at www.nursingknowledge.org. Title: The Nurse Manager's Guide to Innovative Staffing Author: Jennifer Mensik Publisher: Sigma Theta Tau International Pages: 280
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MODULE MACHINE & REMOTE OT TABLE
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Ask for free trial sample Lonza is one of the world’s leading suppliers to the pharmaceutical, healthcare and life science industries. Its products and services span its customers’ needs from research to final product manufacture. As a leader in preservative technology, Lonza offers a variety of products for the personal care industry. Anchored by dimethyl, dimethyl hydantoin (DMDM Hydantoin) and Iodopropynyl Butylcarbammate (IPBC) chemistries, the Lonza line includes patented, unique blends as well as globally accepted versions. These potent preservatives offer excellent protection against spoilage from microbial degradation. A New Generation of Disinfectants (US EPA Registered) Lonza is also a global market-leading supplier of antimicrobials, preservatives and public health related chemical technologies. Lonza offers one of the broadest portfolio of biocidal quaternary ammonium based disinfectant and sanitizer formulations for use in the environmental service, healthcare, food service, food processing and institutional-commercial markets. For more information, visit our website www.biocidl.com/biocidl/en.html Lonzagard™ – NAHS (Non-Alcoholic Hand Sanitizer) – HD-2 (Alcohol-40% with 4th generation quats, hand disinfectant)
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v EO Cartridge Puncturing inside the chamber in vacuum conditions (Negative Cycle)
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Trade & Trends Sonosite: Turning the tide in ultrasound technology Pavan Behl, Director & General Manager, SonoSite India
3 Cube introduces the safest tourniquet in wound care for digit injuries
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Biozeal's eclectic offerings Biozeal is a leading medical equipment dealer. It provides products for medical treatments and services like cardiology, patient monitoring, critical care, imaging, gynaecology, oxygenerator, consumables and accessories
Disposa-View*
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Prone Position Head Cushion with Mirror
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No calibrations to conduct Simple set up and operation Place the cartridge in-line Prime the IV line Insert the cartridge in the warmer and close the covers The system warms fluids rapidly and automatically to a target temperature of 40 °C
Pulse Oximeter 1)Tuffsat
Laryngoscope Systems Greenlight II ●
ISO Green Standard
2)Trusat
●
● ●
Gain clear view and access to face, eyes, and endotracheal tube through slotted mirror design Control infections and eliminate reprocessing with single-use Comfort and support patient‘s head and neck in the contoured face cradle
enFlow IV Fluid/Blood WarmerNo bulky cassettes or tubing jacket ●
No controls to adjust
●
● ●
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Laryngoscope handle and blades The Greenlight II provides a wide range of features and benefits for laryngoscopy which may enhance clinical application, patient care, and materials management. Both handles are backed by a five year warranty and are compatible with the Safe Sac laryngoscope handle cover, which helps to prevent soiling and cross-contamination
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TruSignal Enhanced SpO delivers improved performance during clinical motion and low perfusion ● The same proven durability as in our popular OhmedaTuffSat handheld oximeter ● Ohmeda TruSat is backed by a full, one-year warranty Contact: Jimmy Makhija C- 23, Santmira Co-op. Hsg. Society Kanya Nagar, Kopari Colony Thane - 400603 Maharashtra, India Mob: 9768156266 Email: info@biozeal.in / biozeal@yahoo.in EXPRESS HEALTHCARE
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Does India really need healthcare reform !!! Association for Healthcare Reform (AHR) is a platform to share knowledge, intellect, experience and skills for the overall development of the healthcare community
Defining 'Healthcare Reform' “Sustained purposeful change to improve the efficiency, equity and effectiveness of the health sector” – Peter Berman (1995) “Defining priorities, refining policies and reforming the institutions through which those policies are implemented” – Cassels (1997) From above definitions it is very clear that the word was coined years back. For every nation to be economically strong they need to build a strong healthcare system which is affordable and accessible to every individual.
Association for Healthcare Reform The Association for Healthcare Reform (AHR) was formed in 2005. AHR is a platform formed by healthcare professionals and executives from the global healthcare industry to share knowledge, intellect, experience and skills for the overall development of the healthcare community and to bring all the stakeholders on one platform. It is an intellectual organisation spread out at a national level. It has more than 50 Chapters across India and is growing further with a strong presence of professional base across the country. They had been instrumental in conducting various healthcare activities, programmes and projects for the benefit of the society across the length and breadth of the country. It is a non-sectarian organisation which is politically not affiliated to any organisation and endeavours to promote social welfare, community spirit and knowledge in society. AHR aims to come forward and make a visible difference in the lives of people and subsequently the whole nation. They are a platform where individual scattered efforts can transform into a collective and effective force for the renovation of whole of the healthcare community. It is the largest and the only not-for-profit organisa-
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tion focused to transform the healthcare sector in India through its healthcare development networks. They seek involvement of the healthcare professionals, to volunteer in their mission of making the present healthcare scenario a dynamic one. Their intend to make the country's healthcare system responsive to the fast changes taking place dynamically and demographically to further shape the community into a conscientious and responsible part of nation, so that they are able to rise and walk shoulder-to-shoulder with their brethren to form a robust society and work together for the progress and development of a great nation. Their prime focus is on “Universal Healthcare for All”. Other focus areas include cognisance/ recognition, economic awareness, social responsibilities etc. related to healthcare. They have leveraged the benefits of technology and has a functional website alongwith a very active presence on the social media to supplement their growth and coordinate their activities. They also advocate peoplecentered policies for dynamic health planning and programme management in India. They have pitched major reforms in healthcare which received overwhelming response from the policy makers and the industry alike. It will continue to address the ‘need gaps’ in policy making through its recommendations from time to time as healthcare reform has to become an integral part of the Indian healthcare system. They believe that building a knowledge pool would contribute and convert ‘ideas’ into ‘reality’ for the healthcare sector in India. Tie ups with many healthcare organisation, NGO’s, corporate and volunteers to support their vision and mission. Currently, they are working on issues like advocacy, policy programmes throughout India. In future, they will expand www.expresshealthcare.in
the scope to lead its goal and successful in establishing to become an enabler in building a robust healthcare system in India. AHR is a registered society under Societies Registration Act 1860, Maharashtra, Mumbai (Reg. No. G. B. B. S. D 2005)
ble private sector with accountability and quality service. Mere economic development doesn’t lead to the progress of a nation. The more healthy a nation is, the more conducive it will be to all-round progress. AHR will perpetually strive to promote health and peace, in the society.
Vision and Mission Their ideology is delineated to be a model healthcare community which is : ● Advanced in healthcare education and reform ● Socially progressive ● Culturally vibrant ● Economically dynamic To strive and achieve for affordable, accessible, quality, comprehensive, preventive, promotive, curative, rehabilitative standards of healthcare which empower healthcare professionals to transform the sector, for the benefit of the society in general and nation as a whole.
Objectives of AHR Their primary object is to make healthcare a reality for the people of India by promoting community health, social justice and human rights related to the provision and distribution of health services in India. They are trying to achieve these goals through campaigns, policy research, advocacy, need based training, media and parliament interventions, publications and audio visuals, dissemination of information and running of health and development projects in difficult areas. Works for people centred policies and their effective implementation. It sensitises the general public on important health and development issues for evolving a sustainable health movement in the country with due emphasis on its rich health and cultural heritage. AHR strives to build up a strong health movement in the country for a cost-effective, preventive, promotive and rehabilitative health care system. We work towards a responsive public health sector and responsi-
What they do They are a multi-disciplinary team who have expertise in: ◗ Reorganisation and restructuring of the existing healthcare system by involving the community in health service delivery ◗ Health policy research and policy interventions for a cost-effective promotive and preventive health care system ◗ Advocacy and lobbying with policy makers ◗ Supporting voluntary efforts through formation and strengthening of similar developmental initiatives ◗ Initiating sustainable health and development programmes at grassroots ◗ Developing communication strategies aimed at promoting campaigns and health education ◗ Dissemination of information to wide range of audience ◗ Research on government policies, effective networking with government, UN and voluntary organisations ◗ Responding to disasters and calamities ◗ Research on current issues which affects Indian healthcare system ◗ Health management information system ◗ Quality of care. Contact Registered Office : 103, Old Post Building, Sewree Cross Road, Sewree. Mumbai -400015 M a h a r a s h t r a , IndiaTel: +22 24119786 Mob: +91 9821629786 Email: info@ahr.org.in Website: www.ahr.org.in FEBRUARY 2013
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Sonosite: Turning the tide in ultrasound technology Pavan Behl, Director & General Manager, SonoSite India talks about the advancements in ultrasound technology and the various offerings from Sonosite for this segment
PAVAN BEHL Director & General Manager, SonoSite India
FEBRUARY 2013
ltrasonography has been used by physicians for many years, but in the past twenty years the technology has improved significantly – it is now more compact, portable, can create higher-quality images and is less expensive. Point-of-care (POC) ultrasound is a safe and effective form of mobile imaging defined as “ultrasonography brought to the patient and performed by the provider in real time”. It is used at the bedside or point-of-care for immediate diagnosis or procedure guidance purposes. POC ultrasound has many proven advantages. Technological advancements in ultrasound systems are providing great benefits in point-of-care delivery. POC ultrasound has become an extension of the clinical examination and the evidence for benefits from use of POC ultrasound is significantly expanding. It is not only accurate, rapid, non-expensive, noninvasive and radiation free, but can be used in both stable and unstable patients. Point-of-care ultrasound may also be performed parallel to physical examination, revival and stabilisation. Knowledge, training, technical proficiency, critical decision making, and imagination are gradually making it another stethoscope. Advantages include improved diagnosis and treatment based on clinician-obtained real-time images, reduced risk of iatrogenic complications when used for procedure guidance, and decreased length of stay and cost of care as a result. Conventionally earlier ultrasound machines were used only in the field of obstetrics and gynaecology but with technological advancements, pointof-care ultrasound systems have found wide applications in emergency, critical care, anaesthesiology, sports medicine, pain management, rheumatology, paediatric, dermatology, surgery, oncology, cardiology, and trauma etc. In remote locations where access to the larger ultrasound machines is limited, healthcare providers can carry portable systems that deliver the same diagnostic capabilities as their larger counterparts. Being lightweight, handcarried ultrasound systems can be carried directly to the patients, enabling one to perform safe, efficient and more informed diagnostic decisions. Modern hand-carried ultrasound systems are easy to understand, boot up very quickly and have excellent image quality with good battery backup. These are the desired key features that a healthcare practitioner always seeks in a system. In critical cases like accident, trauma where patients are mostly immobile, point-of-care technology can reach
U
patients where they are, be it along the roadside. The immediate results obtained through onsite ultrasound help speed up diagnosis, which, in turn, can lead to more appropriate interventions. SonoSite, the world leader in mountable and point-of-care ultrasound offers solutions that meet the imaging needs of the medical community. Designed to help meet the new standards of patient care, SonoSite systems are perfect diagnostic ultrasound tool for clinical assessment and procedural guidance at the hospital bedside and in the physician’s office. Learning a new ultrasound technique or procedure can be challenging. The accuracy of the ultrasound technique and results also rely on one’s skills, experience, education and training. SonoSite recognises the importance of training and education to support the learning needs of the physicians. The company has teamed up with some of the leading specialists in the medical industry to design a series of courses focusing on POC ultrasound. Courses are designed to teach those who have little or no experience in the use of ultrasound in their daily practice. Our various products available in the market are dedicated to bring high quality ultrasound to patients.
EDGE ULTRASOUND MACHINE The Edge ultrasound system’s enhanced image quality aids your diagnostic confidence. A solid aluminium core helps to protect your investment for the long term. And a splash-resistant silicone keyboard makes cleaning and disinfection that much easier. With the Edge ultrasound system, you have access to a new generation of POC ultrasound visualisation.
M-TURBO ULTRASOUND MACHINE The M-Turbo ultrasound system offers striking image quality. Our most versatile system for abdominal, nerve, vascular, cardiac, venous access, pelvic, and superficial imaging. The M-Turbo ultrasound system gives you striking image quality with sharp contrast resolution and clear tissue delineation. This ultrasound equipment lets you visualise detail, improving your ability to differentiate structures, vessels and pathology.
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S SERIES ULTRASOUND SYSTEMS S Series ultrasound machines are the industry’s first mountable ultrasound. They offer a zero footprint and can be mounted on a wall, the ceiling, or a stand. Our mountable ultrasound systems have a simplified control that let you focus in on your target areas in a matter of seconds. High-resolution images help you see exactly where to perform procedures and allow for accurate diagnoses when treating patients. The S Series ultrasound machines are built to meet US military standards for durability. They boot up quickly, are lightweight, and are built with intuitive designs for ease of use.
NANOMAXX ULTRASOUND MACHINE T h e NanoMaxx ultrasound system combines best-inclass performance with affordability and simplicity. With its uniquely simple control, high-quality diagnostic imaging, colour power Doppler and colour-flow velocity, the NanoMaxx ultrasound system helps physicians make clinical decisions or guide interventional procedures. Not only is the NanoMaxx a portable ultrasound machine, it uses proprietary technology so you can optimise many system settings at the touch of one dial.
MICROMAXX ULTRASOUND MACHINE The MicroMaxx ultrasound system offers impressive image quality with minimal keystrokes, wireless data transfer, fluid-resistance for easy cleaning and disinfection, and extreme durability. Designed to make your job easier, faster and more accurate, the MicroMaxx ultrasound system makes point-of-care ultrasound an affordable reality. From busy offices and big-city hospitals to critical-care situations where seconds count, the MicroMaxx ultrasound equipment boots up within 15 seconds. The system software is hard-wired and purpose-built for faster boot-up times, faster digital image processing, and the ability to run for a long time. Power is efficiently used, extending battery life for use wherever needed. EXPRESS HEALTHCARE
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3 Cube introduces the safest tourniquet in wound care for digit injuries The T-Ring, a US FDA approved toruniquet, provides a bloodless operating field for emergent and elective medical procedures involving the digits and lower extremities -Ring is designed to give health care providers a safer and more effective option to current digital tourniquet methods. 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 TRing 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 the “T-Ring” the safest, most efficient and effective digital tourniquet in use today. It instantly exsanguinates as it is slid onto the digit, providing immediate haemostasis and ideal wound visualization. The device comprises a brightlycolored outer plastic ring within which is a flexible disc which itself contains a hole. This is supplied in a sterile packet and can be pushed over the lacerated digit to exsanguinate it and provide haemostasis. The ring has two “cutaway” sections on it, which allow its two halves to be separated, pulled apart and gently moved over a larger lacera-
T
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tion if appropriate. Similarly, the device can either be gently slid off the finger or the
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plastic outer ring can be broken and the inner flexible portion cut.
Numerous articles advise not to use the mentioned methods due to the
FEBRUARY 2013
T|R|A|D|E & T|R|E|N|D|S 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 is Excessive pressures can easily be reached with all
Indications
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. The T-Ring may also be used in the ER and pre-hospital arena for the immediate, temporary control of bleeding associated with traumatic injuries.
WEGACHECK – A holistic approach to diagnosis reliable, future-oriented instrument for evidencebased medical investigation was created for contemporary and effective use in practices.
A
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oxidative stress Fitness and muscle analysis Acid-alkali balance Environmental impact
Medical evaluation
Recording method
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The two fundamental concepts supporting the WEGACHECK technique are Functional Medicine and Pischinger’s basal System.
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Researching the causes of illnesses Regulatory ability of the organism Functional disorders
The T-RING Advantage!
The T-Ring is used in elective medical procedures involvThe T-Ring has numerous ing the digits of the upper and lower extremities. In the eval- advantages when compared to current uation and management of acute problems, its uses include: digital tourniquet methods: ● ● ● ●
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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 hemostasis 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 and biopsies
● ● ● ● ● ● ● ●
Automatically adjusts to any size digit Safe pressure - every time 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 digita tourniquet safety!
WEGACHECK utilises bioimpedance mechanism during the measurement. It applies an electrical stimulus with pulsed measurement organs. In a measurement, WEGACHECK points out all the reaction organs that have something to do with the disease. The WEGACHECK recording is thus a snapshot, directing one’s attention to the organs that currently need attention. WEGACHECK can play a vital role in Indian healthcare market as a frontline diagnostic tool for Doctors and a device for monitoring chronic illnesses and a quick scan as a preventive care tool. All in just eight minutes! WEGACHECK is CE0494 certified as a diagnostic device for complimentary medicine and ISO 13485 : 2003 certified diagnostic medical device manufactured by Wegamed, Germany. Contact 3 Cube Bio Med Services 305 Maker Chamber V Nariman Point Mumbai –21 Phone: +91 22 66576031 Mobile: +91 9820655730 E-Mail: jsheth@3cubeservices.com Web: www.3cubeservices.com FEBRUARY 2013
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Allengers: A name to reckon with The company has recently come up with a wide range of specialised products in varied categories llengers, an Indian multinational company based at Chandigarh since its inception in 1987 has been an innovative force not only in the field of radiology but also has a wide range of medical equipment in the field of cardiology, orthopaedic, urology, neurology, gastroenterology, etc. The company’s product range includes: X-Ray machines (HF/LF),CArms(HF/LF),Cathlabs (Mobile/Fixed), Lithotripter, Mammography, DSA Systems, DR Systems, Remote controlled RF table, OPG, TMT, ECG, Monitors, EEG, EMG, and PSG. It also expands to hospital softwares such as HMS and PACS. Till date, Allengers has exceeded their installation base to more than 21,000 and are exporting their products to 70 countries. With around 25 years experience in the industry the company takes pride on its professional services, quality installations and customer satisfaction. Having installations at premier institutes/corporate hospitals like Wellspring, Fortis, Mallya, Apollo, PGI, Vatsalya, Narayan Hrudayalaya, Yashodha, Rockland, GNRC, Down Town, Aditya, BL Kapur, AIIMS, Mahajan Imaging,etc., itself proves that the company stand for ‘Quality and Commitment.’ As such Allengers an independent and highly specialised medical device manufacturer is not only focused on developing need of the hour medical equipment but also focused on providing value for money equipment. As a think tank the company processes technical knowledge into new medical products and solutions for users and patients. Celebrating their silver jubilee by virtue of their quality and services the company has grown to be a major Indian MNC and has added another feather to its cap by being honoured with the prestigious National AwardMSME in recognition of ‘Outstanding Performance In Entrepreneurship’ engaged in manufacturing. This award was conferred by the President of India and Minister for MSME in Vigyan Bhawan, New Delhi on September 2, 2011. Allengers’ dedication to deliver better than the best has also been rewarded in the form of prestigious ‘Century International Quality Era Award’ in the realm of customer satisfaction, leadership, strategic planning and benchmarking as established in QC 100 TQM Systems in the Gold Category at Geneva, Switzerland. The company has recently been bestowed with the Engineering Export Promotion Council (EEPC) award. This award was conferred for their export
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Allengers’ C- arm
Allengers’ Full field digital Mammography
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performance for two consecutive years 2009-10 and 2010-11 under category: “Star Performers in Product Group for 2009-10 and 2010-11 (Silver Shield), Medical and Surgical equipment and orthopaedic appliances, Medium Enterprises”. The award function was presided over the Deputy Chief Minister of Punjab and Minister of Revenue and Rehabilitation, Punjab on September 28, 2012.
Allengers’ DR systems Allengers’ Digital Radiography systems, based upon its technology allows for a streamlining of work flow and greater flexibility. Allengers had launched Digital Radiography system, namely the digital mobile radiography system ( MobilX DR) which has proven to be very instrumental in streamlining of work flow. This machine is loaded with unique features that can be easily moved through compact elevators due to its compact design and weight. Allengers MobilX DR which is battery operated has a storage capacity of 50,000 images. Telescopic Radiogenic tube has vertical movement along its stand and as well has horizontal movement in all directions which helps in positioning of tube head near bedside for X-rays. Besides this it has 1” movement switch for fine controlling which further helps positioning of the machine. Due to its wireless (Wi-Fi) digital radiography function it has wide applications in trauma, ICU, general wards, paediatrics and neonatal departments. Allengers has installed seven of these unique machines at Advanced Trauma Centre and Advanced Pediatric Centre in PGIMER- Chandigarh. The machine not only saves time, but also helps in managing heavy work flow and has ability to be synchronised with their existing hospital network. As per the specialists at PGIMER these stand-alone imaging solutions are bringing digital xray imaging directly at the patients bed side- where it’s most needed. The special advantages linked to the MobilX DR being: ● 50 to 85 per cent reduction in patient exposure. ● Increased patient throughput. ● Flexibility in image manipulation. ● Accurate and superior image capture. ● Solving throughput by fast action. ● Faster and better medical evaluation. ● Faster treatment time during trauma, paediatric and neonatal cases. ● Faster treatment evaluation even at patients bed-side. As the technology continues developing, Allengers will be eager to adopt
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and pass on technological benefits to its customers. Although DR’s growth today is slow but would eventually pick up in the coming years. This would be due to its advantages of reduced radiation dose, improved image quality and productivity. Quick capture of high resolution images and the procedure to view them immediately is critical and of utmost importance to patient care. The use of digital technology in diagnostic medical imaging is rapidly expanding. All medical facilities which aim to streamline work flow should only aim towards having a DR, in order to encounter the increased challenges in the future as images through a DR would be increasingly and quickly managed through PACS. Also, DR definitely has an advantage over the CR due to its reliability to handle larger patient load by greater ease of use and elimination of cassettes. Another imaging modality of Allengers is mammography which has gained immense awareness. Having installed mammography machines at different medical facilities at the national and international levels has prompted Allengers to develop digital mammography. Its uniqueness being that it provides for a better breast image especially when it comes to dense breasts. International statistics have shown a significant reduction in mortality (between 19 and 32 per cent ) in screened women compared with women who were not mammographically screened. This technology also facilitates easy transmission of the images to another specialist for viewing and that too in few minutes. Allengers state-of-the-art full field digital mammography system uses a big format (24cmx30cm) amorphous selenium direct conversion detector for high resolution images. The high frequency generator enables minimum soft radiation. The fully isocentric gantry provides effortless motorised movements having a lower gantry position for wheel chair patients. This technology converts X-rays to electronic images of the breast which can be viewed, optimised and stored on a computer. This technology also produces incredibly sharp digital images. The latest being Allengers Digital Mammography FairyDR, also called Full-Field Digital Mammography (FFDM), is a mammography system in which the X-ray film is replaced by solid-state detectors that convertsX-rays into electrical signals. The electrical signals are used to produce images of the breast that can be seen on a computer screen or printed on special film. The software in the Allengers FairyDR makes FEBRUARY 2013
T|R|A|D|E & T|R|E|N|D|S it possible to mark suspicious findings in the breast and receive a more precise image. The digital development enables better penetration and consequently, improved diagnosis. The largest motivator for healthcare facilities to adopt Allengers FairyDR is its potential to reduce costs associated with processing, managing and storing films. Just like mammography, X-ray of the breast tissue is also an effective way to detect breast cancer in its earliest stage. This technology can detect breast changes long before they can be felt, giving one more choice in treatment option and a greater chance of survival. Digital radiography is ready to emerge from its development phase and Allengers is always on the path to develop user friendly innovative medical equipment at unmatched prices and services thereby giving ‘Total Value for Money’ and ‘Satisfaction’. And with more requirement (demand vs supply) equations, access to such improved imaging modalities will improve. Also Allengers’ objective is to be recognised as a premier Indian medical equipment manufacturing company at world level for its quality and commitment. With the launch of RollX DR, a fully integrated cost effective Mobile DR, Allengers has added another feather to its cap. This unique model was launched during IRIA 2013 at Indore where it received good feedback especially due to its light weight and sleek design. This mobile wonder also operates on a standard wall socket (15 Amps / 230 Volt) and has an option with either wired or wireless flat panel detector. Through this model the user can now further have access to procure a state-of-the-art Mobile DR system at lower cost but with the facilities which truly would assist him now and in the future. HF as it is called is High Frequency, which has revolutionised radiography has become the industry standard. This HF X-ray system has an advanced X-ray generator, more efficient than the previous 2 pulse (Line Frequency) Conventional Xray generators. This HF modality of Allengers medical equipment are MARS series of HF X-ray machines which are specialised models for general radiography and
fluoroscopy applications. The major HF advantages are: ● Lower radiation doses ● Diagnostic precision ● High quality images ● Reduced exposure time ● Longer X-ray tube life and greater efficiency ● Because of the increased consistency of the Xray beam there is less scatter, as such the image quality is improved These HF X-ray systems are the latest next generation X-ray systems and are an ideal substitute to the conventional X-ray systems especially in high throughput areas. Technology is the single most important consideration when investing in a new X-ray system. So, technologically the high energy output efficiency drives the X-ray tube to produce greater mR per mAs resulting in: ● Upto 50-60 per cent shorter exposure time ● Lower patient dose and beneficial for technician too ● Consistent imaging quality The outcome is a higher quality image with greater detail and greater contrast is achieved as compared to a conventional X-ray system. To demonstrate its commitment towards mankind for providing word class technology medical diagnostics products at affordable prices. Allengers also ventured into cardiac, monitoring, neuro and critical care segments by establishing state-of-the-art R&D house. Within a short span of time Allengers has introduced Single Channel, 3-Channel, PC-ECG, TMT, EEG, EMG, POLYSOMNOGRAPH and vital sign multipara monitors. The Allengers Libra-Plus series of Multipara monitors are powered with ‘ALLOXY’, an indigenously developed algorithm for Pulse oximetery, highly accurate NIBP measurement through “Suntech” technology, ECG/ Respiration/temperature and IBP measurements through indigenous technologies. Speaking of current technologies the “ALLOXY” has been developed and refined to provide accurate “SpO2” measurements in ICU, O.T. conditions as per specifications of International ●
Standard ISO 80601-2-61:2011 The ‘Libra-Plus’ has undergone stringent clinical trials for more than one year under different conditions, environments and demographics and tested on various types of populations before it is launched in market. The ‘Libra-Plus’ is modular in design with separate modules for SpO2, NIBP, ECG/ Respiration/ Temperature, IBP and side stream/ low flow/ mainstream EtCO2. Such a kind of technology is always user friendly and after sale cost is much lower than single board technology. As such these monitors have become an in-dispensable tool in all medical facilities in order to measure a patients vital signs and to display the data so obtained. Allengers has also come up with a new series of cathlabs, namely the : NEW ‘F’ & ‘M’ SERIES Allengers is the only company giving contemporary Flat panel technology in mobile cathlabs. This all new mobile cathlab series comes along with Super ‘C’ for the better and faster access of all the angles and above all Super ‘C’ allows the head side entry of the patient. Allengers' new 'Fixed' & 'Mobile' series is also equipped with the latest synergy software for enhanced image quality. This new series is also having better aesthetics with new foot end controller for software interface, radiation free preview collimation, for radiation free collimator application and non contact proximal sensors for patient safety even in mobile cathlabs. The other series of Allengers C-arms which are witnessing great demand are its HF Series and recently a trolley less C-arm has also been developed with an integrated trolley concept. Another model of Allengers C-Arm with LDHD technology is using the 50 KHz Frequency for better safety. Allengers has always been in the forefront in exploring newer options and creating specimens of great work and application. The company is committed to improving health through excellence in image based patient- care by providing the medical equipment at an affordable price to various medical facilities in India and abroad. It encourages you to visit their website www.allengers.com to learn more about our products and services.
Schiller India ties up with Paramed Medical Systems, Italy for Standing MRI The tie-up will enable Schiller to offer the only ‘Standing-MRI’ in the world - the MrOpen Superconducting MRI chiller India, a leading Swiss joint venture company in the field of medical diagnostics has tied up with Paramed Medical
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Systems, Italy which deals in medical imaging equipment. According to Sudip Bagchi, Associate Vice President – Radiology, Schiller India, this tie-up will enable the company to offer the only “Standing-MRI“ in the world - the MrOpen Superconducting MRI. “The UShaped Magnet Design,eliminates claustrophobia while the horizontal magnetic field design presents the best combination of coil geometry and field direction www.expresshealthcare.in
leading to superior image quality for neuro spine, mukoskeletal imaging, interventional imaging and kinematic studies,” he informs. Schiller is committed to providing state-of-the-art medical diagnostic equipment and services, and Paramed Medical Systems’ new hybrid cryogen-free technology enhances Schiller’s offerings for radiology. Paramed Medical Systems develops, manufactures and markets medical imaging equipment for healthcare facilities and private practices worldwide. The company uses a recently discovered material (the magnesium diboride) in its systems,
therefore positioning its products at a technological leading edge. For details contact: Sudip Bagchi – sudipbagchi@schillerindia.com Associate Vice President Schiller India, Advance House, 2nd Floor, Makwana Road, Off Andheri-Kurla Road, Andheri East, Mumbai - 400 059 Phone: 022 61523333 / 29209141 Fax: 022 29209142 Email:sales@schillerindia.co m/support@schillerindia.com Toll Free:1800 2098998 Website: www.schillerindia.com EXPRESS HEALTHCARE
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'We can learn a lot from doing business with India' Dr Jochen Kopitzke, CEO and owner of Philipp Kirsch GmbH tells Lakshmipriya Nair about his company, its offerings to the healthcare market, his experiences at the helm of 150-year old organisation and his plans for progress in the coming years You have been at the helm of Philipp Kirsch GmbH for a year now. So, how has the year been? The year has been outstanding. We achieved a new sales record and have stepped forward with our products and production technologies. Thanks to constant innovations, we have a solid base for further growth in the future.
DR JOCHEN KOPITZKE CEO and Owner of Philipp Kirsch GmbH
What are the major changes that you bought in after taking over the reins? For a company that exists for almost 150 years, the major change is the change itself. Changes began in 2010 when I entered the company to became the successor of Mr Kirsch in 2012. In this two-year transition period I developed the long term strategy and made the corresponding investments in product development and new production technologies. Today, we practice change every day by constantly improving our products and processes.
Tell us about the products and its applications offered by Philipp Kirsch GmbH? We are a German manufacturer of highly reliable refrigerators and freezers for medical purposes such as the storage of blood, pharmaceuticals or laboratory samples. Those delicate goods are expensive and need a constant storage temperature. Our products feature warning devices for the case of critical temperature deviations and a state-of-the-art temperature documentation for quality assurance.
What makes the products in your portfolio different from its counterparts in the market? Thanks to the experience we gained during our long history, our products are leading in technology and quality. Quality leads to reliability. The latter is a key factor for our clients. Our long lasting business relationships and product certifications made by the independent TĂœVInstitute demonstrate that we
fulfill this prerequisite. When I entered the company, I was impressed by the amount of product features our refrigerators and freezers have and how they facilitate the customers every day use. These are the reasons why we are market leaders in German hospitals with a market share of approximately 90 per cent.
How is the market for these products at the moment? What are the challenges and opportunities? The market in Germany shows a solid growth. As in India, the healthcare sector is getting more and more important in many countries. Higher standards of storing sensitive goods go hand-inhand with the growing healthcare industry. So I see good opportunities for our high quality products made in Germany. Our challenge is to guarantee highest product quality for a reasonable price. So we have to constantly improve.
What are your plans for the
Indian healthcare market in 2013? This year, we launched our new “ESSENTIAL Line�. It is designed for the Indian market, because it combines all the key features like quality and reliability for a reasonable price. I expect a positive response from our Indian customers so that this product line will play an important role in our portfolio.
How vital is the Indian market to you and how is it different vis-a-vis the global markets? The Indian market has played an important role in our strategy to increase export activities. The market is very diverse. For some customers, the product price is very important, for others it is the state-of-the-art technology and quality. Together with our strong sales partner in India we will continue to develop the market by supplying products for different groups of buyers. We can learn a lot from doing business with India.
BigSun Technologies launch software prog in healthcare sector Software based on the practical needs of a medical practitioner in both private and government sectors igSun Technologies has launched a software programme which facilitates management of healthcare delivery at individual level as well as institutional/hospital level in all specialities. The product has been designed based on inputs received from different countries such as the UK, the US and Asian countries. The software is based on the practical needs of a medical practitioner in both private and government sectors and compliments the technical expertise of the medical consultants to ensure quality inputs in management of patient care. The software amplifies the managerial skills of a doctor which is rel
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T|R|A|D|E & T|R|E|N|D|S evant in today's globally competitive environment. The business benefits that can be realised from implementation of the product includes streamlining OPD appointments, single unique identity for customers across OPD, IPD, pharmacy managing more patients effectively, improved time management using patient calling, improvised PACS, improved service with increase in volumes, integrated services minimising billing errors, provide appointments and reports online through secure password access, improved ward management based on alerts, manage OT availability better, provide real time transparent surgery estimates, provide service help desk to improve operations, record management for easy retrieval and transparent in patient billing with Package (PPN) tracking for TPAs and
insurance providers. The software can be used in the following departments in the healthcare sector:
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GRN & Supplier Information Billing, Refund & Scroll
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Intra-ward Transfers Vitals Recording Doctor Visit Recording Discharge Intimation
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Patient Appointments Diagnosis /Prescription Investigation/Treatment History Daily/Weekly Schedule Summary Billing, Refund & Scroll
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Admission Transfer & Discharge Details Drug Request,Doctor Notes Discharge Summary Cost Estimation Billing, Refund & Scroll
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Surgery Booking Details of Equipment Used Drug & Laboratory Orders Entering Anesthesia / OT Records
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Receivables Tracking Quick Claim Processing Increased Efficiency Excellent Claim Management
Dietitian/F&B
Pharmacy Pharmacy Drug Configuration Drug Issue to Patients & Billing Maintenance of Drug Inventory
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Images linked to Patient Data Reports Accessible to Doctors Ensures Correct Diagnosis Effortless Expense Management
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Diet Module as per Patient Variety of Diet Plans Tracking of Feeds & Menu Cost Management
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Data Stored in Organized Manner Instant Retrieval of Patient History Medical Records Easily Accessible Faster Diagnostics in Emergency
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Medicine Prescription General Medical Records Previous Consultation History Investigation Reports
hosconnn.com: online healthcare consultancy HOSCONN.com, seeks to simplify complications of healthcare by leveraging the benefits of the digital space orld’s one of the most beautiful and technically perfect buildings, Tajmahal’s architecture was “outsourced” and was” executed” in India. Had there been an Internet, the things would have been better & faster Hosconnn.com –online healthcare consultancy portal aims to use Internet techknow-logy ● To simplify the inherent complications ● To provide value based decision-making, and ● To provide expert advice available and accessible to the medical fraternity throughout the nation HOSCONNNN is a team of experienced healthcare industry professionals having rich experience and strong commitments and are dedicated to a mission to optimise the resources and minimise the wastage through online “consultancy route”
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Perceptual distortion and correction: healthcare vs other industries Healthcare is completely different from other industries. Other industries' markets and customers can be creFEBRUARY 2013
ated, however in healthcare patients cannot be created, hence it (healthcare) requires a different approach for sustained growth. Hence, HOSCONNN founders also strongly feel that “hospitals should be built not only as per market potential but also as per clients competency, capability, adaptability and resource mix”. Last but not the least, there should not only be entry plan but also an exit plan.
Online consultancy approach HOSCONNN provides consultancy services on specific issues through case study based approach (Consultants of the projects would be cross examined to enhance the quality of recommendations/solutions). Through the online route they would also offer advisory consultancy and solutions to the clients, and provide guidance to the team implementing and executing the project on behalf of the client. The motive is that the clients should have more comfort levels, ease and leverage vis-a-vis their resource mix. HOSCONNN's key responsibilwww.expresshealthcare.in
ity would be to advise client to manage/optimise project cost.
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Perceptual balancing Over the years kneejerk/adhoc responses to issues, challenges and even opportunities have been quite common across various strata of healthcare. Through expert and experienced knowledge pool of HOSCONNN.com, the company would strive to “analyse and grade” the operational and opportunity issues and “calibrate” the responses/strategies.
Speed is the need HOSCONNN's online status would help to have more time and sharper focus resulting into quality deliverables in two to four weeks irrespective of issues/locations
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Consultancy service portfolio We provide comprehensive consultancy services for: ● H o s p i t a l Construction/Project Consultancy (Sans PMC) ● Hospital Administration ● Hospital Operations ● Hospital Quality Benchmarks like ISO, NABH etc, ● Hospital IT Infrastructure ● Hospital HR Solutions
Value system and beliefs ●
Why online? On-line “case studies driven” healthcare consultancy is “relevant” in changed perspectives (competitiveness, quality, commercials, cost, and technology etc) because it would: ● Would bring in fresh perspectives to the issues to be undertaken and prevent intellectual and creative inertia
Would prevent CCP (cut, copy and paste) Mitigate the lack of experienced consultancy professionals across nation On-line consultancy is beyond Infrastructural Limitations
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Market is eternal and hence there are no short cuts Market is primarily driven by professional values and character
Contact: M Rastogi Bangalore Tel: 9845208778 Email: info@hosconnn.com Website:www.hosconnn.com EXPRESS HEALTHCARE
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The Leading Solution For Oncology Follow-Up he unique solution for multimodality oncology followup Myrian® XL-Onco is the culmination of eight years of development of the Myrian platform. Dedicated to oncology follow-up, it manages the sequencing of tasks essential for the management of the cancer patients with elevated efficiency and in strict complaince with the international RECIST rules, consensually established by European, Canadian and American authorities. The Cheson protocol whose parameters can be set by the
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Original Technologies Automated retrieval of prior exams, dedicated clinical workflow obeying RECIST rules, automatic 3D registrations of examinations in elastic mode, automated production of reports and graphs.
Applications It is used to follow the course of a patient's cancer by comparing the latest examination to prior results. This follow-up involves key steps managed by the software that considerably simplifies the radiologist's work
First Rate partners The best specialised cancer teams contributed to the development of this module: ● Curie Institute (Paris, France) ● Pitié-Salpêtrière (AP-HP - Paris Public Hospitals Authority) (Paris, France) ● Hôpital Européen Georges Pompidou (AP-HP - Paris Public Hospitals Authority) (Paris, France) ● Civil Hospices of Lyon (HCL)(Lyons, France) ● Montpellier University Hospital (Montpellier France) Contact: Jigish B Modi Tel: 2506 5664, 98670 01110, email: modimedicare@gmail.com Skype: modi.medicare XL-ONCO
ONCO3
user are also available. Myrian XL-Onco was developed and validated jointly with leading French experts and makes Intrasense a world leader in oncology follow-up software applied to medical imaging. It is intended for routine clinical practices of hospital treating cancer patiens as well as pharmaceutical companies and CROs in the framework of phase I, II and III clinical trials to evaluate anit-cancer therapies.
XL-ONCO1
XL-ONCO2
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REGD. WITH RNI NO.MAHENG/2007/22045. REGD.NO.MH/MR/SOUTH-252/2013-15, PUBLISHED ON 8th EVERY MONTH & POSTED ON 9, 10 & 11 EVERY MONTH, AT IND.EXP.PSO.
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