Express Healthcare October, 2014

VOL.8 NO.10 PAGES 88

Cover story Gen Next Strategy Emerging technologies: Robotic vs patient specific implants IT@healthcare Mobile device convergence in healthcare

www.expresshealthcare.com OCTOBER 2014, `50

CONTENTS MARKET Vol 8. No 10, OCTOBER 2014

Chairman of the Board Viveck Goenka Editor Viveka Roychowdhury* Chief of Product Harit Mohanty BUREAUS Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das Bangalore Assistant Editor Neelam M Kachhap Delhi Shalini Gupta DESIGN National Art Director Bivash Barua

ROLE OFIMAGING IN

ORTHOPAEDIC SURGICAL INNOVATIONS Dr Murali Poduval, Additional Professor, Orthopaedic Surgery, JIPMER, Puducherry elaborates on how advances in imaging have led to innovations in orthopaedics | P30

Deputy Art Director Surajit Patro Chief Designer Pravin Temble Senior Graphic Designer Rushikesh Konka Artist Vivek Chitrakar

IN IMAGING

STRATEGY

Photo Editor Sandeep Patil MARKETING Regional Heads Prabhas Jha - North Dr Raghu Pillai - South Sanghamitra Kumar - East Harit Mohanty - West Marketing Team Kunal Gaurav G.M. Khaja Ali Ambuj Kumar E.Mujahid Yuvaraj Murali Ajanta Sengupta PRODUCTION General Manager B R Tipnis Manager Bhadresh Valia Scheduling & Coordination Rohan Thakkar CIRCULATION Circulation Team Mohan Varadkar

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DIGITAL IMAGING FOR HIGH-END ORAL DENTISTRY TREATMENT

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DOSE VIEW 3D: AN INTUITIVE PATH TO OMMISSIONING QA

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PUNE TO HOST CT FEST 2014

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ALLENGERS ROLLSCAN: REVOLUTIONISING ORTHOPAEDIC IMAGING

71

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FORTIS HOSPITAL SHALIMAR BAGH WINS THREE AWARDS

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INTERNATIONAL INITIATIVE FOR NEURODEVELOPMENTAL DISORDERS LAUNCHED

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COLUMBIA ASIA ANNOUNCES $150 MILLION EXPANSION

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APOLLO HOSPITALS AND ALIVECOR ANNOUNCE EXCLUSIVE COLLABORATION

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NEPAL INTRODUCES IPV WITH SUPPORT FROM GAVI, THE VACCINE ALLIANCE

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KDAH LAUNCHES PERSONAL GENOMICS CLINIC

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FORTIS TO DIVEST STAKE IN RADLINKASIA FOR SGD137,000,000

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COGNIZANT TO ACQUIRE TRIZETTO

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IDFC RELEASES 12TH INDIA INFRASTRUCTURE REPORT

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MEDICALL 2014: A GREAT SUCCESS

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APOLLO HOSTS CONFERENCES ON PATIENT SAFETY AND HEALTHCARE IT IN KOLKATA

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CII HOSTS 9TH HEALTHCARE EAST

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4TH INNOVATIONS IN CARDIOLOGY SUMMIT HELD IN GURGAON

LIFE

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DR HS CHHABRA TO TAKE OVER AS THE 15TH PRESIDENT OF ISCOS

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GAGANDEEP SINGH TAKES CHARGE AS FORTIS CFO

EMERGING TECHNOLOGIES: ROBOTIC VS PATIENT SPECIFIC IMPLANTS

P42:INTERVIEW: MANOJ KUMAR Executive VP & CEO, Ricoh India

P43:INTERVIEW: RAJEEV SHARMA Head-Corporate Services and Strategic Planning, Mitsubishi Electric

P44:INTERVIEW: DR ASHOK SHYAM Chief Researcher and Head - IORG

Express Healthcare Reg. No. MH/MR/SOUTH-252/2013-15 RNI Regn. No.MAHENG/2007/22045. Printed for the proprietors, The Indian Express Limited by Ms. Vaidehi Thakar at The Indian Express Press, Plot No. EL-208, TTC Industrial Area, Mahape, Navi Mumbai - 400710 and Published from Express Towers, 2nd Floor, Nariman Point, Mumbai - 400021. (Editorial & Administrative Offices: Express Towers, 1st Floor, Nariman Point, Mumbai - 400021) *Responsible for selection of newsunder the PRB Act.Copyright @ 2011 The Indian Express Ltd. All rights reserved throughout the world. Reproduction in any manner, electronic or otherwise, in whole or in part, without prior written permission is prohibited.

EDITOR’S NOTE

Yes, Prime Minister Modi

T

hanking Prime Minister Narendra Modi for his interaction with the Council on Foreign Relations, Richard Haass, President of the CFR humourously remarked that PM Modi has demonstrated how not to answer a question!

And that aptly sums up PM Modi's skills as a politician: staying firmly on course, replying to questions with his trademark humour and earthy examples, which everyone across borders can relate to. If the New York leg of his US trip was about selling the idea of a 'dream India' to the NRI diaspora, the Washington leg seems to be about positioning India as a partner, an open market to the US industry.

Here's my two bits on why PM Modi needs to tweak his message a bit. A Hollywood film costs more than the amount of money we spent to reach Mars, he said in his address to the CFR. At another venue he commented that the cost per km to Mars was less (Rs 7) than the cost per km in an auto rickshaw back in Aamaru Amdavad.

Putting a price to innovation (or manufacturing for that matter) could backfire, because price is a fleeting USP, lost in no time to the next low-cost nation. And the perception is that low cost is low quality. We need to make value and impact of our innovations our real USP. What is the value of our indigenous-developed medical devices in terms of improvement of quality of life or lives saved? I am sure the price of lives saved will outweigh the dollars saved.

Will PM Modi be able to walk the talk back home?

Take for instance, his call to 'Make in India: zero defect, zero impact'. Launched just before he left for the US, he shortlisted 25 sectors for this plan, saying he wants to take our economy ahead on the three pillars of agriculture, manufacturing and services. Pharmaceutical, biotech and medical devices can benefit greatly from this thrust, especially as the initiative also aims to identify select domestic companies showing leadership in innova-

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We need to make value and impact of our innovations our real USP. What is the value of our indigenous-developed medical devices in terms of improvement of qualityof life or lives saved? I am sure the price of lives saved will outweigh the dollars saved

tion and new technology and for turning them into global champions. Many small and medium scale manufacturers, for instance in the medical devices space, could benefit from the 'red-carpet treatment' that the PM's website promises. (http://www.narendramodi.in/prime-minister-to-launch-make-in-indiainitiative/) Beyond the rhetoric, observers are waiting for more details to emerge on how exactly he plans to deliver on his promises. On some of them, he will need nothing short of a deluge of miracles. And will he be able to make his message percolate down the bureaucracy, cut the red tape and roll out the red carpet, as he himself has promised? Especially when you consider the battle he has on his hands from the non-BJP Chief Ministers.

On this issue PM Modi could take some cues from the classic 'Yes, Minister' and 'Yes, Prime Minister' series: “The Opposition aren't really the opposition. They are only the Government in exile. The Civil Service are the opposition in residence."

But it is worse when opposition is cloaked in approval. Another 'Yes, Minister' dialogue predicts how an unhappy bureaucracy could unhinge his plans: "If you are not happy with Minister's decision there is no need to argue him out of it. Accept it warmly, and then suggest he leaves it to you to work out the details." If PM Modi delegates the roll out of his plans down the line, then most of them could lose momentum.

After the first year in office, PM Modi could well find himself in this situation: "A Politician's dilemma.

He must obviously follow his conscience, but he must also know where he's going. So he can't follow his conscience, because it may not be going the same way that he is."

Maybe then he will throw the media some crumbs: "Solved problems aren't news. Tell the press a story in two halves - the problem first and the solution later. Then they get a disaster story one day and triumph story the next."

VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

QUOTE UNQUOTE QUOTE UNQUOTE “Heart disease and strokes are becoming more common in our society than before. I see younger and younger people falling victim to this killer. There is widespread ignorance of the simple fact that it is preventable. The government has already launched an offensive against smoking by taxing tobacco products. The next target is fast foods in school and office canteens which leave citizens with no option but gulp fatty and unhealthy foods. The ill effects of alcohol consumption would also be highlighted.” ‘‘Given the scary global disease burden scenario, it is necessary to give health a permanent place in the format of international diplomacy. Countries need to both externalise and internalise health paradigms as, in the globalised world, there is no room for complacency.”

SEPTEMBER 2014

“No country, however rich and powerful, has the capability to marshal all the intellectual and physical resources that are necessary to fight the rising burden of communicable as well as non-communicable diseases. They want to reach out to give as well as receive cooperation. It is time to institutionalise this in the rubric of international diplomacy.”

Dr Harsh Vardhan Union Health Minister

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MARKET NEWS

Fortis Hospital Shalimar Bagh wins three awards Wins two FICCI HEAL 2014 recognitions; receives government honour for energy efficiency FORTIS HOSPITAL, Shalimar Bagh, a multi-speciality tertiary care hospital has recently been honoured with awards by FICCI and Bureau of Energy Efficiency. The hospital has received 3 Star rating for its building by the Bureau of Energy Efficiency, Government of India, under the Ministry of Power, making it the only hospital from Delhi to receive such recognition. It also received two awards from FICCI- the FICCI HEAL 2014 Award for Excellence in Branding, Marketing & Image building and was adjudged First Runner-up in the FICCI HEAL 2014 Poster Presentation.

As part of the ‘100 Days’ action plan for power sector initiatives of the Government of India, the Bureau of Energy Efficiency is ranking hospitals and multi-storey residential buildings for being energy effi-

As part of the ‘100 Days’ action plan for power sector initiatives of GoI, the Bureau of Energy Efficiency is ranking hospitals for being energy efficient with star ratings cient with star ratings. Fortis Hospital, Shalimar Bagh is the only hospital in Delhi to receive such recognition. In the past, the hospital has won a 3 Star TERI GRIHA rating.

Jasdeep Singh, Zonal Director, Fortis Healthcare said, “It is a moment of gratification to be awarded with three prestigious titles. These recognitions underscore Fortis Hospital, Shalimar Bagh’s continued commitment towards sustainability and the environment. At Fortis, it is

our endeavour to continuously improve upon our own benchmarks of patient satisfaction, service quality, clinical outcomes and efficiency.

We will continue to build on our services and enhance the experience for patient care.”

Fortis Hospital was also declared the first runners up in the poster presentation among 25 finalists. It was recognised for its marketing and branding efforts for the Golden Age Club, an initiative directed at senior citizens.

The Golden Age Club provides the elderly a platform to share and interact with others, and honours them for their contribution to the society.

Fortis runs a strong anti-microbial programme across all its facilities.

The theme of the poster competition was ‘Innovation for Better Healthcare.’ The hospital’s abstract on “The Humble Cell Phone - A platform for innovation, an unprecedented opportunity” was shortlisted from among 75 entries. The hospital also showcased the mobile application on the Antimicrobial Stewardship Programme, titled “Battling the Bugs: A SMART Approach.” Considering the innovation, relevance and scalability of the application, Fortis Shalimar Bagh was declared the first runners up in the competition.

EH News Bureau

International initiative for neurodevelopmental disorders launched An initiative by Ministry of Health and Family Welfare, Bangladesh, supported by WHO WHO AND partners stressed the need for a comprehensive and coordinated response to address the challenges of Autism Spectrum Disorders (ASD) in WHO’s South- East Asia Region. This was deliberated at an initiative launched by the Ministry of Health and Family Welfare, Government of Bangladesh, supported by the

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World Health Organization.

The initiative was launched at a side event held during the ongoing 67th session of the WHO Regional Committee for South-East Asia. “We must empower families and communities with information and services to create a more inclusive world for children who suffer from ASD,” said Dr Poonam

Khetrapal Singh, WHO Regional Director for South-East Asia. “There is an urgent need to develop innovative ways and embed appropriate interventions into health systems to reach the affected.”

The side event aimed to move forward an international partnership of Member States, non-governmental organisa-

tions, international organisations and institutions, towards a Global initiative on ASD and other neurodevelopmental disorders. The partnership would work towards a more inclusive and integrated global community through enhanced services and programmes for persons suffering from ASD. EH News Bureau

Columbia Asia announces $150 million expansion To expand its Southeast Asia and India hospital network COLUMBIA ASIA plans to invest another $150 million to expand its network to 34 hospitals and one clinic by 2018.

Columbia Asia opened four new hospitals in the last few months – in the Indonesian capital of Jakarta, in the Indonesian city of Semarang and in Bangalore and Ahmedabad, India.

In the next four years, the company has plans open eight more hospitals: three in Malaysia, three in India and two in Indonesia. Columbia Asia’s strategy is to create clusters of hospitals in large urban areas. This allows the group to achieve operational and brand leverage across the market in each large city. Around the Malaysian capital of Kuala Lumpur, for example, the company currently has five hospitals, a sixth to open in 2016 and a seventh to open in 2017.

To manage the growth of Columbia Asia, John Northen was recently hired to serve as the CEO of the four-country hospital network. “Since opening our first hospital in 1994, Columbia Asia has grown to become one of the most trusted names in healthcare across Asia,” said Northen, CEO, Columbia Asia Group of Companies. “No other healthcare provider in Asia has hospitals in as many countries operating under a single brand. Our goal is to continue to ensure all patients leave our hospitals cared for medically as well as feeling satisfied, respected and comforted.”

EH News Bureau

Apollo Hospitals and Alivecor announce exclusive collaboration To offer FDA-Cleared Mobile ECG Device in India APOLLO HOSPITALS and AliveCor are joining forces to launch a mobile device to improve access to cardiac screening tools for patients across India. Through an exclusive agreement in India and of South Asia, Apollo Hospitals will introduce the smartphone enabled, medical grade, FDA-cleared AliveCor Heart Monitor as part of its arrhythmia screening and stroke prevention programme providing patients access to this device.

The AliveCor Heart Monitor is compatible with iOS and Android mobile devices to wirelessly record, display, store and transfer heart rate and single-channel electrocardiogram (ECG), the electrical activity of the heart.

“We are excited to collaborate with Apollo Hospitals on their mission to improve consumer access to healthcare,” said Euan Thomson, President and CEO, AliveCor. “Together we can empower patients and their doctors throughout India with a simple, affordable mobile device to help change the way heart conditions are identified and managed.”

“We recognise the pioneering work that has been done by AliveCor in the US and also, the great value that this technology can bring to patients as we work to address the problems of arrhythmias in India.

It’s extremely important for us to provide access to medical devices that are both clinically proven and cost-effective to help our patients manage their cardiac health. This agreement is another step in extending the reach of our Apollo health services to members of our community, our cardiac patients and caregivers,” said Dr Prathap C Reddy, Chairman, Apollo Hospitals.

EH News Bureau

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MARKET

Nepal introduces IPV with support from GAVI, The Vaccine Alliance Afghanistan and Pakistan also planning to introduce IPV by end of next year NEPAL HAS introduced Inactivated Polio Vaccine (IPV) with support from Gavi, the Vaccine Alliance, as part of a plan to ensure that IPV be made available to millions of children in Gavi-supported countries through the introduction of the vaccine into routine immunisation systems.

Children in Afghanistan and Pakistan, two of the final three countries where polio remains endemic, are also set to begin receiving IPV by the end of next year as part of the planned ‘endgame’ for eradicating the crippling disease. Nigeria, the third country where polio remains endemic, has also ap-

Afghanistan, Nepal and Pakistan are among 25 countries who have received approval to begin using IPV with support from Gavi, while gradually phasing out the oral polio vaccine (OPV) which is currently used in most developing countries plied to introduce IPV, with approval expected shortly.

Afghanistan, Nepal and Pakistan are among 25 countries who have received approval to begin using IPV with support from Gavi, while gradually phasing out the oral polio vaccine

(OPV) which is currently used in most developing countries.

Adding IPV to routine immunisation programmes will improve immunity and help prevent new vaccine-associated outbreaks from emerging. In May 2013, the World Health As-

sembly endorsed the Polio Eradication & Endgame Strategic Plan 2013-2018, calling on countries to strengthen routine immunisation programmes and introduce at least one dose of IPV as a lead up to the phased removal of oral polio vaccines.

“Nepal’s introduction of IPV with Gavi support marks an important moment in the global effort to secure a polio-free future,” said Dr Seth Berkley, CEO, Gavi, the Vaccine Alliance. “Gavi is working with partners to ensure that millions of children in the world’s poorest countries are protected with IPV through routine immunisation as an important step towards achieving global polio eradication.”

Countries approved for IPV introductions can also receive a one-time grant to support a share of the additional costs related to the vaccine’s introduction.

EH News Bureau

KDAH launches personal genomics clinic It will offer a comprehensive, one-time test that can help healthy individuals identify their health risks, with a coverage of over 1000 diseases KOKILABEN DHIRUBHAI Ambani Hospital (KDAH), in association with Positive Bioscience, launched a Personal Genomics Clinic that will offer personal genome testing.

They offer a comprehensive, one-time test that can help healthy individuals identify their health risks, with a coverage of over 1,000 diseases including cancer, heart disease, neurological conditions, diabetes etc.

KDAH joins the elite group of hospitals in the world including Mayo Clinic, Cleveland Clinic and Stanford, that incorporate personal genomics into medical practice.

Personal Genome Test reports will be made available during a face-to-face, client-

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centered genetic counseling appointment at KDAH that will last between 30 to 60 minutes with an aim to facilitate in-depth understanding of the report and its implications towards developing an individualised preventive plan for ‘atrisk’ diseases. This is being spearheaded by a genetic counsellor trained at Johns Hopkins University, USA, with expertise in both medical genetics and psychological counseling.

Speaking on this launch, Tina Ambani, Chairperson, Kokilaben Dhirubhai Ambani Hospital said, “We feel proud to launch this cutting-edge technology for Personal Genomics at our hospital as an initiative of preventive health-

Personal Genome Test reports will be made available during a face-to-face, client-centered genetic counseling appointment at KDAH that will last between 30 to 60 minutes care. I am looking forward to map my own personal genomics and use it as roadmap to monitor my future health needs.”

Dr Santosh Shetty, Executive Director and COO, added, “India lags behind the western world when it comes to disease prevention. One of the impor-

tant criterions in the launch of this clinic is to bridge this existing gap. It is now well established that Kokilaben Hospital has always ensured bridging gaps in the area of healthcare in Mumbai, be it in technology or clinical services.”

Samarth Jain, CEO, Positive Bioscience says, “Advance-

ments in Genomics are making it possible to shift the focus of medicine from treatment to prevention by personalised strategies. I am excited with this one-stop Genomics Test Clinic at KDAH where Mumbai residents can now have access to advanced scientific technology, world class facilities and leading doctors all under one roof, and be proactive partners in their own heathcare.”

Dr Shetty and Jain feel positive that this collaboration will help increase life expectancy, provide risk assessment for disease, and will revolutionise healthcare by launching personalised medicine tailored to every individual’s unique DNA. EH News Bureau

MARKET

Fortis to divest stake in RadLink-Asia for SGD137,000,000 Medi-Rad Associates has bought 100 per cent shareholding in the company from Fortis FORTIS HEALTHCARE Singapore, a subsidiary of Fortis Healthcare International, has announced its decision to divest 100 per cent shareholding in RadLink-Asia and its subsidiaries, ‘RadLink’, Singapore, to Medi-Rad Associates (MediRad), an indirect whollyowned subsidiary of IHH Healthcare Berhad, for SGD 137,000,000. RadLink is engaged in the provision of healthcare services including the provision of outpatient diagnostic and molecular imaging services in Singapore.

The deal will be successfully closed following the necessary statutory and regulatory approvals as per local requirements.

Malvinder Singh, Executive Chairman, and Shivinder Singh, Executive Vice Chairman, Fortis Healthcare, said, “This is in line with our strategic decision to intensify our focus on our core hospital and diagnostics business in India. Our international healthcare businesses have all done well. The significant value that we have created, is now being unlocked and will be ploughed back to strengthen our growth in India. Singapore will always remain strategic and integral to our business plans for the future. We are committed to grow the relationships and partnerships that we have established here, the most prominent being our association with the Economic Development Board of Singapore (EDB) and the SGX listed Religare Healthcare Trust.”

JP Morgan and Religare Capital Markets acted as financial advisors to Fortis for this transaction.

EH News Bureau

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MARKET

Cognizant to acquire TriZetto Combined, they will serve nearly 245,000 healthcare providers COGNIZANT, A leader in information technology, consulting and business process services, has entered into a definitive agreement to acquire TriZetto Corporation for $2.7 billion in cash, subject to customary adjustments. Based in Englewood, CO, privately-held TriZetto is a provider of healthcare IT software and solutions.

“Healthcare is undergoing structural shifts due to reform, cost pressure and shifting responsibilities between payers and providers. This creates a significant growth opportunity, which TriZetto will help us capture,” said Francisco D’ Souza, CEO, Cognizant. "We are excited that the integrated portfolio of capabilities across tech-

nology and operations will uniquely position us to help clients drive higher levels of operational efficiency, while reimagining care for the future.

We look forward to welcoming the TriZetto team into the Cognizant family and creating a truly differentiated and sustainable foundation for healthcare.”

Cognizant expects this acquisition will significantly accelerate its market position and strategy of delivering innovative healthcare software and solutions to a wide range of healthcare clients. TriZetto brings to Cognizant significant and complementary new market opportunities, expertise and intellectual property, including: ◗ Multiple industry-leading

Cognizant expects this acquisition will significantly accelerate its market position and strategy of delivering innovative healthcare software

IDFC releases 12th India Infrastructure Report Titled ‘The Road to Universal Health Coverage’ it brings insights of academics, researchers and practitioners to improve healthcare practices IDFC’S ANNUAL publication, the India Infrastructure Report 2013|14: The Road to Universal Health Coverage was released

by Dr Rajiv Lall, Executive Chairman, IDFC in New Delhi.

This report aims to provide a forum for free, frank and open exchange of views necessary to arrive at innovative and workable solutions across various infrastructure sectors that would find acceptance among various stakeholders. Twelfth in the series, since 2001, the India Infrastructure Report 2013-14 brings together a range of insightful perceptions of academics, researchers and practitioners committed to improving healthcare practices.

India Infrastructure Report 2013|14 looks at the challenges for ensuring availability, acces-

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The report brings together a range of insightful perceptions of academics, researchers & practitioners sibility, affordability and quality of comprehensive healthcare to all, and explores strategies to overcome the impediments along the road to UHC. In this process, it also dis-

cusses whether initiatives taken to reduce the burden of people’s health expenditure has yielded desirable results, how to leverage the strengths of the private sector in healthcare delivery, role played by the nonstate entities in rural healthcare, imperatives of engaging with the community and the high impact of preventive care at low cost. The report draws the readers’ attention to some of the emerging issues in the health sector such as rising burden of non-communicable diseases and mental health, human resource crisis in health sector and health concerns of informal sector workers, and steps required to attend to them within the UHC framework.

EH News Bureau

software platforms used by payers and providers. ◗ Enhanced competitiveness in integrated engagement opportunities. ◗ Approximately $1.5 billion of potential revenue synergies cumulatively over the next five years. ◗ Attractive, non-linear software revenue.

TriZetto and its 3,700 employees will be a part of Cognizant’s existing healthcare business which represents approximately 26 per cent of Cognizant’s revenue.

“The transaction is expected to be immediately accretive to Cognizant’s non-GAAP EPS, excluding one-time transaction costs and adjustments,” said

Karen McLoughlin, CFO, Cognizant. “That earnings benefit is expected to increase over time as we realize significant revenue synergy potential from the combination of these businesses.”

Cognizant intends to finance the transaction through a combination of cash on hand and debt, and has secured $1 billion of committed financing in support of the transaction. The transaction is expected to close in the fourth quarter of 2014.

The purchase agreement provides for customary closing conditions and purchase price adjustments including, without limitation, adjustments for items such as cash, indebtedness and working capital.

EH News Bureau

Randox India receives ISO accreditation It covers the filing, packaging, labelling and distribution of in vitro diagnostic test kits, reagents and analysers GLOBAL MEDICAL diagnostics firm Randox’s operations in India have recently achieved registration to both ISO 13485: 2003 and EN ISO 13485:2012 for the manufacture of medical devices. The registrations were awarded by BSI Group India and covers the filing, packaging, labelling and distribution of in vitro diagnostic test kits, reagents and analysers.

Brian Walsh, Head, Randox India said, “Our achievement of these registrations is evidence that Indian confidence and loyalty in the Randox brand continues to grow. We are excited for our future here, and for how

we can contribute to healthcare in India.”

“We are therefore delighted to have been recognised for our standards in India. Manufacturing to quality management standards such as ISO 13485: 2003 and EN ISO 13485:2012 also reinforces the confidence that our customers across India have in Randox and our products. As one of the world’s major growth economies, the scale of the market means there is always room for new business opportunities and we hope that these opportunities continue to grow,” he added.

EH News Bureau

MARKET EVENT POST EVENTS

Medicall 2014: A great success After the successful show last August, Medicall has grown considerably to maintain its position as one of the leading medical shows in India IN THE 12th edition of Medicall held in August 2014, approximately 630 companies from across the globe participated in the exhibition utilising the entire two halls of the Chennai Trade Centre alongwith more stalls in a hanger outside as Hall 3. Most of the exhibitors substantially increased the size of their stall and showcased more products during the third day exhibition. It was a true bazaar for hospital equipment and supplies, ranging from surgical gloves to the most sophisticated medical equipment used world-wide. The

show attracted local, regional and international visitors which summed up to almost

10500 people.

Compared to the Medicall which was held last August 2013,

there was a significant increase of 30 per cent in the number of visitors this year.

Other shows and seminars also took place alongside the exhibition, which acted as attractive highlights of the event.

Medicall offered a great platform to its visitors to: ◗ Buy equipment for the hospital ◗ Get dealership from international companies ◗ Gain knowledge of the best and latest in healthcare industry ◗ Get updates on medical information ◗ Meet collaborating partners

MARKET

Apollo hosts conferences on patient safety and healthcare IT in Kolkata The two-day event took place on September 5-6, 2014 APOLLO HOSPITALS, in association with ISQua, JCI, NABH and many other institutions recently hosted the 4th International Congress on Patient Safety along with the 5th edition of International Conference on Transforming Healthcare with IT 2014 in Kolkata.

International Congress on Patient Safety It served as a platform where the global healthcare leaders shared their experiences and exchanged knowledge and expertise on patient safety which in turn could help in implementing best practices at all levels. This Congress also aimed at improving communication between caregivers and enterprise risk management and patient safety.

The topics on the first day of the conference included: Improving Communication in Patient Safety, Patient Satisfaction vs. Patient Safety, Patient Safety 2020, Technology and Patient Safety, Economics of Patient Safety, and Professional Medical Associations and Road to Patient Safety.

The speakers on the first day included: Dr Prabhu Vinayagam, Asia Pacific MD, JCI; Dr Paul Chang, VP, Accreditation, Standards and Measurement, JCI, US; Dr Sandhya Majumdar, Deputy Director and Senior Specialist, Quality and Accreditation- Medical Affairs, Department and Clinical Governance, National University Hospital, Singapore; Dr Alexander Chiu, Chief Manager, Hong Kong Hospital Authority; S Chandra, HR, Dr Reddy’s Labs; Professor Cliff Hughes, President, Elect ISQua, Australia; Egbert Schillings, CEO, World Innovation Summit for Health, Qatar; Professor Arpan Guha, Director of Education Innovation, Liverpool Health Partners; Capt. Usha Banerjee, Group Nursing Direc-

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tor, Apollo Hospitals; Dr Rahul Kashayp, Assistant Professor of Anaesthesiology, Mayo Clinic, US; Ven Manda, VP, Science, Technology & New Therapies, Medtronic India; Richard Guest, CEO, Siemens Technology, India; Fredrick Radencrantz, Business Development Director, Asia Pacific, Middle East & Africa, ArjoHuntleigh Getinge Group, Germany; A Krishna Kumar, MD and CEO, Philips Electronics, India; Dr Maurice Mars, Professor of EHealth, Nelson R Mandel School of Medicine, South Africa; Deborah K Gardener, International Scientific Affairs and Educational Manager for the Infection Prevention Division, 3M, US; Dr Anita Jain, India Editor, BMJ; Dr BK Rana, Deputy Director, NABH; Dr YP Bhatia, MD, Astron Hospitals and Healthcare Consultants; Dr Jitendra B Patel, President, Indian Medial Association; Dr Jean Marty, French Society of Critical Care, France; Dr Anjan Datta, Past President, Indian Society of Anaesthesiologist; Dr Shivakumar Iyer, President, Indian Society of Critical Care Medicine; Dr SS Kamath, President, Elect Indian Academy of Paediatrics;

Dr KK Kalra, CEO, NABH; and Dr Alokendu Chatterjee, Past President, FOGSI, President, SAFOG. The Asian Patients Safety Awards 2014 to recognise the best practices within Asia were also held on the first day of the conference. These awards recognised the major contribution of individuals and organisations promoting patient safety and quality healthcare by consistently upholding principles of healthy patients, safe and affordable care. Innovation in Safe Communication, Medication Safety, Anaesthesia & Surgical Safety, Infection Prevention and Practice, Innovation in Staff Education were some of the categories in which awards were presented.

The second day of the International Patient Safety Congress focussed on topics such as Enterprise Risk Management and Patient Safety, Safety Lessons from other Industries, Role of Accreditation in Patient Safety, Patient Safety- the Global Perspective, Patient Safety and Innovation, Infection Control and Medication Safety.

The speakers on the second

day of the conference were: Professor Kwong Ming Fock, Chief Risk Officer, SingHealth, Singapore; Karen Timmons, Global Healthcare Business Director, DNV Healthcare, US; Paula Wilson, CEO, JCI, US; Dr Jean Marty, President, French Federation of Private Hospitals, France; David Grayson, Clinical Lead, 20,000 Days Campaign, Ko Awatea, New Zealand; Dato’ Dr Jacob Thomas, Association of Private Hospitals of Malaysia; Tim Galekop, Consultant, Sterilisation and Infection Prevention, Belgium; Anjan Bose, Secretary General, NatHealth; Hans Ossebard, GetUpGetBetter, Netherlands; Dr Elly Nyiam Opat, President, Kenya Medical Association; Priyanka Aggarwal, Partner and Director, Boston Consulting Group, India; Dr Sanjiv Navangul, MD, JnJ Medical, India; Rohit Kumar, MD, South Asia, Elsiever Health Science Division; Varun Khanna, MD, BD; Dr Shubnam Singh, Dean-Education (MIHER), Max Hospitals; Dr Mahendra Bhandari, Senior Advisor, Robotic Surgery, Henry Ford Hospital; Dr TS Jain, President, Hospital Infection Society, India; and Dr Paul Van

L-R: Prof Cliff Hughes, President Elect ISQua Australia; Arjun Ghatani, Minister, Health and Family Welfare, Govt of Sikkim; Chandrima Bhattacharya, Minister of State Dept of Health and Family Welfare and Law, Govt. of West Bengal; Swami Suhitananda Ji Maharaj, General Secretary Ram Krishna Mission and Math; and Preetha Reddy, Executive Vice Chairman, Apollo Hospitals Group

Ostenberg, JCI, US.

International Conference on Transforming Healthcare through IT It witnessed an exciting confluence of minds from the field of healthcare and information technology (IT) who discussed and disseminated the latest happenings in the field of Healthcare IT. This edition of India’s international conference on the Impact of Information Technology in Healthcare reportedly brought together nearly 40 speakers from across the world addressing over 500 delegates about the latest happenings in the field of Healthcare IT in their respective countries.

Developments in HCIT, Deployment of HCIT in Clinical Care, eHealth Around the World were some of the topics discussed at the conference.

Suptendra Nath Sarbadhikari, Director of National Health portal on the Indian government’s initiatives; Khsitij Marwah, Head and Curator of MIT Media Labs; Veera Ragahavan, DELL Services, Executive Director and Head-Global Healthcare Practice, Jitsuzo Katsumata, Deputy General Administration Officer, Koma Tsukai Hospital, Japan; Prof.

Ronald C Merrell, Telemedicine Consultant to NASA; Maurice Mars, Pofessor of Telehealth, Nelson R Mandela School of Medicine; Zakiuddin Ahmed, CEO, e-Health Services, Karachi, Pakistan; and Lt. General PP Varma, Deputy Chief Med, HQ of Integrated Ministry of Defence, India were some of the speakers at the conference.

A panel discussion on issues and potential solutions for transforming healthcare with IT. Kiran Bajwa, MD, Microsoft India, Sandeep Mathur, MD, Oracle India, and John H Daniels VP, HiMSS US, were part of the panel discussion.

MARKET

CII hosts 9 Healthcare East th

In their commitment to provide affordable, accessible and improved services to patients across societies a mix of medical fraternity, technology wiz kids, architects, entrepreneurs and policy makers came together at the event THE 9TH HEALTHCARE East was organised by the CII Eastern Region in Kolkata recently, wherein the way ahead was sought through a day long deliberation to look for “a step towards better care through better infrastructure.” Highlighting the importance accorded to healthcare by the Government of West Bengal, Chandrima Bhattacharya, Minister of State for Health & Family Welfare, Government of West Bengal said that a medical college will be set up at Kurseong near Darjeeling.

Informing that the medical college will be set up through a PPP model, she also mentioned that the district hospitals at Purulia, Cooch Behar, Raiganj, Rampurhat and Diamond Harbour will be converted into full-fledged medical colleges.

This, she felt would be achieved over the next two years. She also said that the government has decided to set up 51 high-end diagnostic centres through the PPP mode and, in a bid to set up more hospitals, as many as 34 hospitals are under construction while six more are to be built.

“High-end diagnostic centres with facilities for dialysis, MRI, CT scan, physiotherapy, and 24x7 healthcare help-lines will be set up across the state,” she informed. She urged the implementation of the PPP model to further enhance healthcare facilities in the state while assuring full cooperation and support for facilitating investment proposals to provide the necessary infrastructural support and ensure timely statutory clearances.

She also launched a CII-Grant Thornton Knowledge Paper titled 'The Eastern Highway – Progressing Towards Smarter Health for All'.

Later, speaking at the conference, Malay Kumar De, State Principal Secretary, Health & Family Welfare said that the tendering process for the medical college has already begun

and informed that the “51 diagnostic centres will start functioning by December this year.”

He also said that the state is contemplating the launch of a ‘Paramedical Council’ in lines of the Indian Medical Council with the objective to “produce quality manpower required to serve the vast untapped healthcare sector.” “With the primary objective of producing good doctors and high-quality support staff, the state government has laid its focus on attracting investments from the private sector for medical education and training. The industry needs atleast 40,000-50,000 medical personnel. The state government has already set up a steering committee to attract private sector investments,” he said.

He appealed to investors “to look beyond Kolkata” and invest in tier-II and III cities in the state. He further stated that business breakeven might be slow but in terms of volume of business, there will be reasons to be “more than happy”.

According to Suyash Borar, Chairman, Healthcare subcommittee, CII - Eastern Region & CEO CMRI Hospital, running hospitals entail a range of challenges and “controlling costs and generating revenues is a

daunting task”. The major challenge lay in reducing operating costs but at the same time maintaining high quality and efficiency. He felt that there was a need for technology-driven facilities with “IT increasingly playing a core role in every aspect of healthcare value chain to ensure faster adaptability of advanced technologies, reduction of service costs and provision of quality healthcare at affordable prices.”

Plenary – I Smart hospitals Designing to offer quality service to an ever increasing number of patients is a great challenge. Kunal Bhattacharya, Principal Architect, RJB Associates, posed several questions such as, “What is smart? Is it to define cleverly? Should hospital facilities be so that it does not drive a patient broke?” The answers perhaps lie in designing smart hospitals that are cost effective, functional, aesthetic and also fit for Indian conditions and not a mere copy of the West.

Giving the promoter’s perspective in planning and designing a smart and sustainable hospital, Ayanabh Debgupta Co-Founder, Medica Synergie said that effective treatment is

possible through a smartly designed hospital that is supported by a good team. He stressed on “effective usage of archived data and learning from the past.”

Vinay Kothari, MD, Hospi Health spoke on how smart design solutions for sustainable healthcare in India can save costs that can be passed on to patients. A good research team can help reduce costs that can ultimately be passed on to patients. Biswarup Ghosh, Healthcare Head, Linde India gave insights on medical gas lay-out in the new generation hospitals.

Dr Rana Mukherjee, MD, Care Continuum stressed on the need for a comprehensive and coherent medical planning where requirements of all stakeholders are addressed. Smart, in his opinion, is a facility that allows re-engineering at all levels in the most cost effective manner.

Prabir Bose, Director-incharge, Woodland Multispeciality Hospital stressed on the aspect of retrofitting new facilities – a challenge for ageold structures.

Plenary 2 Integrating sustainable technology

As the world gets closer with the use of effective technology, healthcare is also leveraging it for progress? We have it all, from futuristic apps to machines dispensing prescriptions and tele-medication. Apple has come up with a hand-held device that records all data of a patient, supports medical intervention with a back-up database and allows discussion facility for all and at every level of service in a hospital environment.

Ahanaa Bhattacharya of Macintel Solutions explained about the application that promises to do away with the heaps of papers and possible human errors in data input Jitin Chandna, Founder and Managing Partner of MedVend Enterprises, found that railway stations in India have everything except a medicine shop.

So he came up with a chain of health kiosks to dispense medicines, measure blood sugar and perform the basic jobs of paramedics. According to Chandna, the kiosks serves as a bridge between the doctor and the patient by enabling the two to talk despite being away. The kiosks will find application in large offices, apartment buildings and in all areas where people gather.

Talking of yet another future

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MARKET application, Nitin Kashyap, Head of Telemedicine, Prognosys Medical Systems said being net-based it allows remote area accessibility. There are specific times slotted for various specialists that are declared well in time for patients to log in. Thus there are cardiac doctors, ophthalmologists and general physicians on call at specified times. It has gained popularity in Maharashtra and has an immense usage potentiality in the North East.

Ratul Mazumder, Assistant VP, Godrej Interio spoke on the new designs available in hospital furniture while Amit Choudhury, Founder CEO, Nick IT Solutions explained in detail the cloud and tap-based digital solutions available for all patients’ information. Ashish Chhawchharia, Practice Head, Eastern Region, Grant Thornton India presented an overview of the report.

The event saw discussions on several vital topics such as healthcare access, leveraging technology to enhance healthcare delivery, and standardising quality of care in the country through accreditation The session was moderated

by Sanjay Prasad, Executive Director & CEO, Mission of Mercy Hospital and Research Centre.

Plenary -III Accreditation to help improve facilities The last plenary session of the conference discussed on how accreditation can improve quality of healthcare facilities in hospitals. Quality of service leads to patients’ dependence and acceptance of services that eventually leads to financials improving for the hospitals.

Speaking from his personal

experience as a practising cardiac surgeon, Dr Kunal Sarkar, Sr Vice-Chairman, Medica Superspeciality Hospitals said that the quality of service following accreditation and standardisation has gone though a sea of welcome change. However as quality is a practice that may vary in perception, there has to be uniformity in its understanding and perception. It is after all a philosophy and not just a requirement.

According to Dr SP Singh, CEO Healthcare, CK Birla Group, healthcare delivery in

private and public hospitals is diverse and quality is not defined. So, accreditation helps set standards and is an influencer to service by setting benchmarks. “Quality comes from accreditation stating what needs to be different,” he said.

According to Richa Deb Gupta, Zonal Director, Fortis Healthcare, there ought to be a platform to share experiences to help set standards. She pointed out that practising hospitals do not share data but it is primary to set accreditation standards.

Dr Singh pointed out that

80 per cent of the healthcare service providers are from the unorganised sector, leaving a huge gap in standardising their services. Dr Sujoy Ranjan Deb, Head of Quality, Narayana Hrudayalaya Hospitals urged on the necessity of setting one’s own benchmark.

Dr Pramod Kumar Sharma, Chairman, Pratiksha Group highlighted the hurdles faced in accreditation as it becomes difficult to ascertain and standardise the performances of various machinery used in hospitals, particularly the ones procured from abroad. He was of the opinion that certification has to be in totality, encompassing man and machine.

Dr KK Kalra, CEO, NABH told the house that accreditation eventually leads to patients’ safety. It cannot be for privately owned hospitals in isolation and government hospitals have to come forward too.

4th Innovations in Cardiology Summit held in Gurgaon Renowned experts including Dr Naresh Trehan, Dr Rajneesh Kapoor, Dr KK Aggarwal and Dr Yogesh Varma discuss latest trends and innovations in the treatment of heart disease Medanta Medicity, and its Senior Director of Interventional Cardiology, Dr Rajneesh Kapoor organised the 4th Innovations in Cardiology Summit at the Oberoi Hotel in Gurgaon recently. Reportedly, over 500 leading cardiologists and physicians attended the summit from across the globe. The key discussions at the summit included the latest techniques and procedures in interventional cardiology including echocardiography, electrophysiology and clinical cardiology.

The educational content, renowned national and international faculty participation and academic integration of regional thought leaders was one of the key highlights of the meeting this year.

In his inaugural address, Dr Naresh Trehan, Chairman

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and MD of Medanta Medicity, Gurgaon said, “In the past decade, the Indian healthcare sector has witnessed a complete transformation. We are now a hub of technological innovations, advanced research projects and world-class medical services.”

Dr Rajneesh Kapoor, Organizing Secretary of the IIC Summit 2014 and Senior Director, Interventional Cardiology, Medanta Medicity said, “In today’s day and age, an increasing number of people are suffering from heart disease due to common lifestyle factors such as stress, unhealthy eating habits and the dependence on substances like alcohol and cigarettes. Given this scenario, there exists an urgent need not only raise awareness about preventive factors, but also to find so-

Over 500 cardiologists and physicians attended the summit from across the globe

lutions to revolutionise treatment. Towards this endeavour, we came up with the concept of the Innovations in Cardiology Summit in 2011, to provide key influencers a platform to discuss, debate and share the major advancements and issues in the field of cardiac care”.

Some of the new developments in cardiology in the recent past have included the development of low cost Indian made stents, CT imaging for aortic aneurysm and the availability of newer cardiac biomarkers.

The IIC conference also featured a special session on medico-legal aspects conducted by the President of Heart Care Foundation of India and the Senior National VP of the Indian Medical Association Dr KK Aggarwal. He spoke about how cases of medical malpractice in cardiology have been increasing in India due to the lack of proper communication.

While guiding doctors on ways to safeguard themselves he said, “Whatever you advise your patients, execute it, document it and preserve it for transparency

and honest conduct is key”.

Dr Yogesh Varma, Head of Cardiology, GMC, Bhopal said, “The Innovations in Cardiology Summit is a great opportunity for doctors who belong to smaller cities in India to interact with leading national and international experts and present their views on new developments in the field. Cardiac treatment in India has evolved such a great deal over the years and has great potential in the future.

I look forward to getting many more such collaborative opportunities in the future”.

Other sessions were conducted by known names like included renowned names such as Dr KK Aggarwal, Dr Miroslaw Ferenc, Dr Khalilullah, Dr TS Kler, Dr RR Mantri, Dr VK Chopra, Dr B Kalra and Dr Rajiv Parakh.

EVENT BRIEF OCT-NOV-2014 30

8th Asia Pacific Association for Medical Informatics 2014 Conference (APAMI 2014)

8TH ASIA PACIFIC ASSOCIATION FOR MEDICAL INFORMATICS 2014 CONFERENCE (APAMI 2014) Date: October 30 – November 2, 2014 Venue: India Habitat Centre, New Delhi Summary: The conference aims to encourage researchers, surgeons, practitioners, young scientists, healthcare workers and suppliers from across the world to cooperate and share knowledge and experience

about how to use information technology to improve the healthcare status of the people. The conference theme is 'Health IT Solutions for Improving Patient Care Contact Website: www.apami2014.com Tel: +91 (0)124 4974180

MEDICA 2014, COMPAMED 2014 Date: November 12-15, 2014 Venue: Düsseldorf Trade Show Complex, Düsseldorf, Germany Summary: More than 4,500 exhibitors from around 65 nations are expected at MEDICA 2014 to present the entire spectrum of new products, services and procedures to raise efficiency and quality in outpatient and in-patient care. The MEDICA trade show’s focus would be on electromedicine medical

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MEDICA 2014, COMPAMED 2014

technology, laboratory technology/ diagnostics, physiotherapy/orthopaedic technology, commodities and consumables, information and communication technology, medical furniture and specialist furnishings, and building technology for hospitals and doctors’ offices.

COMPAMED 2014 is an international platform for suppliers. Around 700 exhibitors would present their technological and service solutions for use within

the medical technological industry – from new materials, components, primary products, packaging and services.

Contact Messe Duesseldorf India Centre Point Building, 7th floor Santacruz West Mumbai 400 054 Phone: +91 (0)22 6678 9933 Fax: +91 (0)22 6678 9911 E-mail: messeduesseldorf@mdindia.com Website: www.md-india.com

cover ) The Reddy sisters: (clockwise from right): Suneeta Reddy, Shobana Kamineni, Sangita Reddy and Preetha Reddy

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next After three decades of pioneering work, Dr Prathap Reddy may have handed over key leadership roles to his four daughters but remains at the heart and helm of India's first integrated corporate hospital chain

BY VIVEKA ROYCHOWDHURY

S

eated in his spacious Jubilee Hills office, atop the Apollo Health City premises, Padma Vibhushan Dr Prathap Reddy, the patriarch of Apollo Hospitals Enterprise Limited (AHEL), exudes an enthusiasm that belies his 80 plus years.

Maintaining a ramrod straight posture, he shows no signs of slowing down even though he anointed his eldest daughter, Dr Preetha Reddy as his successor in July.

He is still driven by his dream, of providing world class healthcare in India to every section of society. A dream that led him to set up a hospital named

for the Greek god of learning, staffed by world class doctors and run meticulously to the best operating standards.

And that is Dr Reddy. A deeply religious man, with the focal point of almost every room on the top floor of the corporate office, devoted to artistic representations of a pantheon of deities. And a doctor to the core, a man driven “not by numbers (of patients) but by outcomes,� as he puts it himself.

There is no doubt that the gods must definitely be smiling on Dr Reddy over the past three decades and he must be fervently hoping that they will continue their benevolence. But he is leaving nothing to chance.

The July reorganisation is a major milestone but not the culmination of a process that started

a long way back.

The evolving vision Leaving behind a flourishing practice in Boston, uprooting his young family, Dr Reddy came back to India in 1971 because his father asked him to. It was almost a decade later, in 1983, that he set up his first hospital in Chennai, inaugurated by the then President of India, Giani Zail Singh. This was the first step in building the foundation of what was to become India's first integrated corporate hospital chain. This was at a time when healthcare delivery was, by default, either a governmentrun or trust-run facility. Almost single-handedly, he nursed and nurtured both AHEL as well as the fledgling healthcare industry, coaxing and cajoling the

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cover ) politicos in Delhi and later financiers, to become part of his vision and invest in his blueprint.

Dr Reddy takes pride in saying that in the 80s, most patients had to travel abroad for complex surgeries. Today, every procedure can be done within the country and at a much lower cost. Be it heart surgeries or liver transplants, Dr Reddy points out that all these can be done in our country at sometimes one-tenth of the cost. Building teams of qualified doctors and staff and having them work to strict SOPs was the mantra; this too at lower costs with no compromise on the outcomes.

As SOPs improved, outcomes improved and consequently, so did costs. He points out how today, a heart patient can leave hospital five days after surgery whereas previously he had to stay for nine days. He predicts that a constant drive to improve clinical applications will continue to drive down costs and improve outcomes.

The next phase of this mission, is to increase access to these services, or as Dr Reddy puts it, to make healthcare more inclusive. He is disappointed that we, as a country, have a long way to go on this parameter. To ensure this happens, he lists three factors that

will play a big role in this phase: technology, media and the four Ps: partnerships between the public and private sectors as well as patients.

He is very forthright in his messages to these stakeholders. Individuals have to be made aware that they first need to take care of their own health and for that media must play a big role in creating this awareness. For the government, he believes that they need to relook our current healthcare system but rather than looking for lessons from systems like US’ ObamaCare or UK’s NHS, we need to have a bottom-up approach and involve people and society in these decisions. He also underlines the need for holistic healthcare. Ironically, we turned away from our traditional systems of health, and now find that we have to revive our ancient traditional ways of Ayurveda, medication, etc to cope with 20th century ills like non-communicable diseases (NCDs).

Dr Reddy is happy to see the focus of current policy makers like Prime Minister Modi and Health Minister

Harshvardhan, to bring 'health for all' through the distribution of free medicines. He is also pleased that health, along with education is one of the national priority areas on PM Modi's agenda. But he points out that the Finance Ministry has done nothing much for the sector.

The sector's long standing demand to be given priority infrastructure status has been ignored, and he feels that agreeing to this, would not cost the Finance Ministry much in terms of tax outgo but would encourage promoters like himself to tap long term funds, and thus make better investments and ultimately grow faster. He concedes that the REIT scheme is going to make a huge difference but here too there are many hitches which need clarifications.

Dr Reddy's penchant for pushing policy makers for change is once again evident when he says that he has told the PM that his patients would get India a seat on the US Security Council! All thanks to tremendous good will that international medical tourists take back with them when they return to their own countries.

Which is why he hopes that the current regime will slowly bring in more rational medical tourist visa rules, especially since these tourists end up spending a lot more than the usual tourist. He reasons that it’s a win-win for all: affordable health for the international tourist, more foreign exchange for the country and more revenues for healthcare players which in turn will see more investments in hospitals and thus

more jobs for doctors and nurses right here in India.

Handing over but still at the heart Dr Reddy decided this July that it was time for the next phase of growth and for that, AHEL needed to redefine its focus.

And with this, came a rejig in the responsibilities of his four daughters, previously designated as Executive Directors, in line with expanded roles. Each has carved a niche for themselves in the areas where they have proven to have a special talent.

It is most definitely this clear delineation of roles and responsibilities, with just the right amount of overlap and divergence between the father and sisters team, that has ensured the smooth growth of AHEL. Many founder-driven enterprises are plagued by in-fighting which finally leads to a division of assets and erosion of the brand. In most cases, these fissures become more evident as organisations transition to the next generation. AHEL has managed to steer clear of this and it is clearly due to Dr Reddy's vision and planning.

Speaking about his four daughters, Dr Reddy says, “They are what they are today first and foremost because each of them had their own passion. We gave them a clear direction on how they should get involved and evolve as healthcare players but their passion is their biggest strength. All of them gave a great level of commitment so I have no way of saying that one

I cannot give each one marks.

Can I give Preetha 51 and the others 49? No. All get 50. But yes, you need a team leader and that is a role Preetha has already played. She is well accepted by her sisters Prathap Chandra Reddy, Founder Chairman, Apollo Hospitals

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is better than the other.”

Demonstrating the firm balance between a father's fondness and a savvy business leader, he says firmly, “I cannot give each one marks.

Can I give Preetha 51 and the others 49? No. All get 50. But yes, you need a team leader and that is a role Preetha has already played. She is well accepted by her sisters.” The leadership will pass on to each daughter, after a Boardapproved term (of probably three to five years) so that there will be continuity of vision as well as infusion of fresh ideas and management style at regular intervals.

Dr Preetha Reddy: Focus on clinical excellence In line with her role of taking the lead, Dr Preetha Reddy assumed an expanded role and was redesignated as Executive Vice-Chairperson, AHEL. She is entrusted with Apollo’s core strength, of maintaining a leadership in clinical outcomes. In line with this, she will work closely with AHEL's 8000 clinicians to review global medical advancements and introduce contemporary protocols to further enhance clinical outcomes.

As she says, putting in place and maintaining quality standards was the portfolio she was given when she first joined the AHEL and she would like this to be her contribution to the legacy of the Group. “Our business model depends on clinician-consultant engagement and that is why we reorganised ourselves in such a way that we can be more focused on this goal.” To her, the challenge of the future is to deliver quicker, faster, affordable, smarter, more efficient and more cutting edge.

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million

6724

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11 per cent growth over FY13

3,168

`

million

PATin FY14

OPERATING EBITDAIN FY14

4 per cent growth over FY13

cover ) “People come to us sometimes after trying out other options, because they trust us, and to live up to this trust, we need to focus more and more on clinical outcomes.

We innovated in the way healthcare was delivered; whether is cutting the time between a person needing an intervention to the time it’s given or taking the point of care closer to the patient,” explains Preetha Reddy.

She will also spearhead AHEL's ambitions in the international space, to make the company a global healthcare destination. “We were the first to predict that people would come to India for quality medical care. No one believed us but today, it’s an accepted business model.”

In addition to catering to international medical patients, they also do a lot of consulting for overseas hospitals and governments, some of them even from developed nations.

She sees this revenue stream growing as such clients are increasingly looking to India to provide answers to their problems. On the possibility of AHEL setting up more overseas facilities, to add to the ones in Dhaka, Bangladesh and Mauritius, she says though they are looking at this opportunity, there is still so much to be done within the country so they feel that the focus should be India rather than the overseas market. She indicates that the capital allocation will be for the domestic market, at least for the next couple of years.

Beyond AHEL, her role also sees her engaging with industry bodies and state and central governments on policy matters concerning healthcare issues. Here, she follows the example set by her father, who has consistently worked closely with policy makers, be it on the transplant and cadaver laws which came into being or more recently, making the case for the healthcare industry to be given infrastructure priority status. In the same vein, she makes the point that there needs to be a rationalisation

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admission to medical school, but bowing to the conservative social mores of the time, their father decided against putting them through the rigorous routine of medical school. But she is quick to add that today, all four of them work 24x7 for healthcare, and on a much larger canvas. (And there is always hope that at least a few of the next generation will be medics but more on that later)

Suneeta Reddy: Balancing inflows and outgo

We innovated in the way healthcare was delivered; whether it’s cutting the time between a person needing an intervention to the time it’s given or taking the point of care closer to the patient Dr Preetha Reddy, Executive Vice-Chairperson, AHEL

in healthcare costs which is skewed in many ways. To meet the government’s diktat for free care, providers may cut corners and compromise quality or inflate costs in other areas. A solution needs to be found; for instance, how much of a role can health insurance play in addressing this prob-

lem, she muses.

But echoing her father, besides cost and access, she feels the larger problem is the looming NCD epidemic and the fact that there is a tremendous lack of awareness, from both patients and government, about the impact. So also, the lack of healthcare education

facilities, in terms of medical and nursing colleges worries her, because this is the root cause of the lack of trained manpower.

When quizzed why none of the four siblings became doctors, she fondly recalls that she and her youngest sister, Sangita Reddy, did secure

INITIATIVES: SACHI (SAVE A CHILD’S HEART INITIATIVE), SAHI (SOCIETY TO AID THE HEARING IMPAIRED), CURE FOUNDATION (CANCER SCREENING, CURE AND REHABILITATION), ASSOCIATED WITH YUVRAJ SINGH'S YOUWECAN

Commenting on the July announcement and the fact that each daughter will get a chance at the helm, Suneeta Reddy, Dr Reddy's second daughter, says, “For the past 30 years, it's always been the four of us and dad as the Chairman. It’s never been one single person. I think this structure will keep the energies of all of us committed to Apollo Hospital. In terms of leadership, I think it’s a good idea to get new ideas and perspective at least every three years. So it's an opportunity for the whole organisation to invigorate itself. Each of us might share a common DNA, passion and commitment for the organisation, but each of us have different perspectives, different strengths. The one thing that we are cohesive about is that we must grow in the healthcare space. For patients, this means delivering best clinical outcomes and for people working for the Group, ensure sustainability and prosperous growth.”

Suneeta Reddy's forte has always been the fine balancing act between funding and spending and she is credited with AHEL's strong financial framework. Now as MD, she will lead the corporate strategy, corporate finance, funding and investments as well as leverage M&As to achieve the accelerated pace of growth and optimise profitability. She will be in direct control of the hospital vertical, overseeing its consolidated in Tier-I markets following the cluster model as well as into the Tier-II and III markets.

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of her father’s achievements?

“No, it was never a burden; rather it was foundation which we built upon,” she says. And as some members of the next generation make their entry into AHEL, she indicates that they will be active in exploring and adding new verticals to the Group. Commenting on the fact that there have been no acrimonious disputes between the four sisters, Suneeta Reddy feels that it’s because they take care of each other, and also being in the business of healthcare, which is all about nurturing, this has carried on into their relationships.

Shobana Kamineni: Exploring new projects

We might share a common DNA, passion and commitment for the organisation, but each of us have different perspectives, different strengths.

The one thing that we are cohesive about is that we must grow in the healthcare space Suneeta Reddy, Managing Director, AHEL

On the branding and marketing side, she indicates that this will evolve as the market demands.

In September, AHEL announced the acquisition of the retail assets of Hetero Med Solutions Ltd (HMSL) Rs 146 crores. Currently in due diligence phase, if the deal goes through, AHEL's existing network will reportedly expand by 320 stores across Telengana, Andhra Pradesh and Tamil Nadu. Explaining the rationale and strategy behind this deal, Suneeta Reddy says, “We were committed to expand in the health retail space. The pharmacy business already has a considerable network and we wanted to consolidate the performance. By acquiring this chain, not only do we add more stores – a physical presence is important in retail – but the

second part is the ability to drive margins. This acquisition is of larger format stores, where we can sell private labels (where the margins are much higher) and therefore after five to six months, we can exploit the synergies of location.” She predicts that margin improvement in the pharmacy space (due to this deal) will be seen in about a year’s time.

In the pure play hospital space, she says the focus is on consolidating AHEL’s presence, using the cluster strategy in the cities where they are the strongest. They have also created around 12 Tier-II models, which as they roll out, will be improving efficiencies so that they can break even much faster. A new initiative is to look at the preventive and wellness space, see what AHEL can do to keep people

healthy rather than falling sick.

AHEL’s play in the wellness space too has different formats like clinics, etc.

She indicates that they are looking at models like wellness centres, gauging what activities can be offered out of these centres and then add them to the existing products.

Though most of these newer initiatives have not yet reached the scale where numbers can be shared, Suneeta Reddy gives an idea of the final vision when she talks of a mobile app, which was recently launched by AHEL, so that patients are seamlessly connected to all parts of the organisation and do not need to wait for appointments, etc.

“It’s a whole new different world, using technology as an enabler,” she sums up.

Did she ever feel the burden

Of the four sisters, Shobana Kamineni calls herself “the most politically incorrect,” the most likely one to argue with her father but claims her father encourages her to question him. In fact, she points out that this is the spirit of AHEL; the AHEL site has a prominent feature for patients, exhorting them to 'Ask us: Anything, Anytime.'

Her explanation for why the sisters work well together is that there is a healthy but “loving competition” between them. “They might not admit it but it’s there. I may be the most aggressive but they too are competitive in their own way.

And this competition has made us better than what we’d each be individually. Because without competition, we’d be complacent. This competition (between us) has got the best results for AHEL.” Perhaps this competitive streak has seen her set a blistering pace of growth in the pharmacy business, which is presently the fastest growing business within AHEL: in Q1FY15, revenues in stand alone pharmacies were up 27 per cent, EBITDA was up by 33 per cent. It has grown to become not just the largest pharmacy chain in the country but also acquired a unique position among the top five retail companies in India due to the sheer size

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cover ) of its retail operations and geographic presence.

Which explains why Shobana Kamineni was redesignated as Executive Vice-Chairperson, AHEL with additional responsibilities to oversee the planning, design and execution of new projects and lead the Apollo Global Projects Consultancy Division.

All while continuing to spearhead Apollo Pharmacy related initiatives. She also remains a Whole Time Director on the Board of Apollo Munich Health Insurance, the company she founded, yet another business with a very strong growth potential.

A national level squash player, Shobana Kamineni recalls her initial days in the organisation when she used to decline early morning meetings because she liked to put in two hours on the squash courts. And in her father, she sees the best teacher-mentor, right from the time he taught them to swim when they were children. His method was to give them a 10-minute lesson and then push them into the pool, completely believing in their ability to achieve anything. And in the same vein, he empowered each daughter when allocating them responsibilities within the Group. His immense belief in their abilities gave them self-confidence to perform and live up to his expectations.

Sangita Reddy: The HR - IT backbone If strategy, finance and new projects are taken care off by the elder siblings, it fell to the youngest daughter, Sangita Reddy, to steer the human resources (HR) initiatives of AHEL. Healthcare, like any service-oriented sector, is manpower intensive and finding the right talent, managing their expectations and grooming them for the evolution at AHEL has been her mission.

Today, after the July reorganisation, as Joint MD, she has even more on her plate.

Her responsibilities have expanded beyond HR and de facto operations to include

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They (her sisters) might not admit it but it’s (competition) there. I may be the most aggressive but they too are competitive in their own way. And this competition has made us better than what we’d each be individually Shobana Kamineni, Executive Vice-Chairperson, AHEL

IT, and retail service formats of AHEL. These include the Group's foray into the wellness segment through wellness centres (which offer a blend of modern and complementary medicine like aromatherapy, pranic healing, yoga, and meditation), Apollo Health & Lifestyle Limited (AHLL) Clinics (family-focused primary healthcare services), and Cradles (boutique-birthing

centres). In addition, she continues to be the Chairperson of Apollo Knowledge, the education vertical of the group.

She believes that the reorganisation will enable AHEL to understand and respond to the changing healthcare ecosystem where customers (patients) are demanding the same level of service from healthcare providers as they get from

other service industries like banking etc.

She sees the change at three levels, “Firstly, today we have an impatient patient; one who is more empowered and enlightened and has access to a large ecosystem of knowledge as well as other patients who have been through the same procedure.”

At the treatment level we no longer have one doctor treating

ENRICHED

15 39 COLLEGES OF NURSING AND HOSPITAL MANAGEMENT

MILLION LIVES FROM 120 COUNTRIES

one patient, but teams of doctors treating a single patient.

So she feels the future of healthcare lies in the concept of care teams at multi-speciality hospitals, who are empowered by care pathways and capabilities of multiple doctors and multi-disciplinary teams. And technology will enable this seamless transition.

The third level of change is geography, where the care is moving from the hospital to the clinic to the home because patients want care closer to home in a less scary, more familiar environs. Which is why home-care is going to be big, she points out. But even homecare will change from just having a nurse or caregiver basically 'patient-sitting' to become more enabled and empowered, thanks to connected health devices, etc.

Sangita Reddy's area of responsibilities, HR and IT, will play a key role in implementing AHEL's response to these changes. Because these changes will change the way healthcare employees work. They too will have to be empowered and have greater awareness. As she says, on one hand we have a shortage of skilled manpower and on the other, there is a need for skills in newer areas like geneticists, statisticians, population disease analysts, IT specialists in robotics who can train clinicians to perform robotic surgery and the like.

She encapsulates her slogan for what will set AHEL apart from other players in one pithy sentence: clinical differentiation on quality that you can see, feel and touch for the patient and healthcare provider. To a patient this means less pain, smaller scars. For providers, it means pushing the envelope to achieve greater clinical excellence, with zero compromise on quality and better efficiencies. She firmly believes her part of this vision is to lay the foundation for the way AHEL would like to connect with patients, beyond the physical walls of their premises, via emails, cell phones etc.

This, in a sense, will be

(

FOCUS:LEADERSHIP

her contribution to the AHEL legacy. “I would like our legacy to be that we created the way for IT enabled connected health services. It’s not just about building health cities but also about providing thought leadership which gets replicated across multiple establishments,” she says, explaining how she spent seven-eight years working with the different ministries of the Government of India because she wanted to ensure that India leapfrogged the initial problems US had when it rolled out its electronic health records (EHR) system.

The journey started way back in 2004, when the Union Government tied up with Apollo Hospital Group subsidiary Apollo Health Street Ltd (AHSL) to standardise the capture, storage and dissemination of health information as well as to network all healthcare facilities in the country in an ambitious project called 'Health Unite' inspired by a US legislation. (http://pharma.financialexpress. com/20040226/healthnews02. shtml) The AHEL team worked pro bono for the next seven to eight years and the result was that the government, on their recommendation, made the Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT) available for the country. In a culmination of her and her team's efforts, in August 2013, the Ministry of Health & Family Welfare (MoH&FW) released EHR standards for India as part of its move towards an integrated healthcare system for the country. Today, she has the satisfaction of playing a major role in providing vital direction to the country's EHR framework.

Of all her father's traits, she says she has been influenced most by his innate ability to stay positive, humble and focused even after all his achievements in these past years. She speaks of his vision to increase awareness on NCDs. Translating the scale of his vision into reality will need tremendous investments,

that we are there, that even on holidays nothing shuts down.

It also sets an example for the staff. This is possibly one of the greatest management lessons I have learnt from my father,” says Preetha Reddy. She also gives a lot of credit to their mother, who “has been the binding force of the family.

I don’t think the family can be what it is or exist without the way she is … keeping everyone together within a strong value system.”

Generation next

Today we have an impatient patient; one who is more empowered and enlightened and has access to a large ecosystem of knowledge as well as other patients who have been through the same procedure Sangita Reddy, Joint Managing Director, AHEL

but when his daughters ask him how AHEL can fund this plan, he looks them in the eye and says, “When people are dying simply due to lack of awareness, we need to find a way to do it.” AHEL is already moving forward to make this a reality and while these moves may not impact AHEL directly, they will impact the health bottomline of the country.

Sangita Reddy believes that the day countries start tracking their health indices the same way they track their

GDP, will be the beginning of the change of the healthcare scenario.

AHEL remains the first love All these achievements could not be possible without a passion for the job and the sisters readily admit that their commitment to AHEL has always come first. And as readily give credit to their families for accepting this reality. As Sangita Reddy laughingly puts it, “It’s the

first love. In fact, the first in everything. Sunday morning rounds at the hospital are an accepted fact of life for my family. But I believe we've found ways to balance our official roles and our families.”

Preetha Reddy recalls how her father’s gentle reminder that “Sickness has no holiday” would have all of them abandon their Sunday chores and join him at the hospital.

“Today, this is part of the culture at the Group. It is reassuring for patients to know

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The next generation is already gearing up to step up to the fore. As Suneeta Reddy puts it, “They are right now in look-and-learn mode.” Her daughter, Sindoori, the eldest grand daughter, was involved in setting up the women and children hospital of the Group while Shobana Reddy's daughter, Upasana, is spearheading the wellness initiative.

Likewise, Preetha Reddy's son Karthik too is already engaged in some of the projects in Group. Sangita Reddy's eldest son, Anandit, a mechanical engineering graduate from the US, is a team member on AHEL's medical device project, helping design and roll out a healthcare mobile app. After a year on this project, he plans to head back to the US for an MBA. Vishwajit, his younger brother, is leaving for management studies in the US while their youngest sibling, Viraj, currently in the 11th standard, has expressed an interest in becoming a doctor and could possibly be the first in Gen Next to be a medico.

At the 33rd annual general meeting of AHEL in late August, Dr Reddy revealed that that the family council, constituting of himself, his four daughters, as well as external advisors, are in the process of mapping out roles, based on expertise and aptitude, for the next generation of the promoter's family. Very clearly, Dr Reddy's legacy is in safe hands. viveka.r@expressindia.com

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IN IMAGING

ROLE OFIMAGING IN

ORTHOPAEDIC SURGICAL INNOVATIONS Dr Murali Poduval, Additional Professor, Derpartment of Orthopaedic Surgery, JIPMER, Puducherry elaborates on how advances in imaging have led to innovations in orthopaedics

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An MRI image of the lumbar spine shows a large disk prolapse

O

rthopaedics is a technology-intensive science. I use the word science rather than discipline. There’s a reason why I do so. The science of orthopaedics requires it to be innovative and progressive, it requires input from various sources. It requires engineering expertise, software expertise, technical brilliance and adaptation of principles of biomechanics, and also clinical acumen and surgical execution. In using the term discipline, these attributes will not be accurately represented.

The earliest innovation that influenced the progress of orthopaedic surgery was undoubtedly the X-ray radiograph. The surgeon was actually able to see what he was going to treat. That probably set the scene for developments in the years to come. William Conrad Roentgen is credited with this innovation with the demonstration of a hand using the device in 1896. The ability to see ‘coins in a purse’ and ‘bullets in a human body’ was initially curiosity and soon turned into an exacting clinical science heralding huge advances in clinical management in all disciplines.

X-rays are used in orthopaedics in a variety of ways.

The first and most important use is as a first line diagnostic tool. No orthopaedic examination must be considered complete without a radiograph of the concerned area. X-rays are used during surgery to determine position of implants and confirm correct site and accuracy of surgical procedures like pedicle screw insertion in the spine. Full length radiographs provide excellent information

about limb alignments. These also help us in planning surgical procedures like correction of deformities and joint replacement arthroplasties.

Recent times have seen the advent of computerised and digital radiographs which enhance clarity and simplify interpretation. These permit viewing specific regions of the bone and also making measurements on the screen, which can then be used for diagnostic, research or clinical purpose. The integration of computerised radiography into PACS systems makes it possible for the clinician to instantly access the patients images, in a paperless manner, on his screen, in his office immediately.

Contrast radiographs have been used for long in orthopaedics. Contrast radiography involves arthrograms that are extremely useful in paediatric orthopaedics to visualise the dislocated hip and also in the elbow in very small children. Contrast venography and arteriography may be often essential steps prior to operating in high risk areas like malignant tumours enveloping major vessels in the extremities. In acute trauma, diagnosis of the vascular injury in the immediate post trauma limb can be made by digital subtraction angiography or CT angiography.

Both contrast CT and MRI have been used successfully to provide angiographic images that are very useful in clinical practice.

During surgery, real time visualisation of the surgical procedure is possible because of the invention of the image intensifier. This has revolutionised trauma surgery and improved outcomes to a great

extent in the past few decades.

The image intensifier produces real time radiographs that can be interpreted in light of the procedure being performed. It the most important tool currently in use in orthopaedic surgery and fracture fixation. It also permits intraoperative fluorography. In an imaging-intensive speciality like orthopaedics, the image intensifier is a boon indeed. It has been the basic tool guiding the development of an entirely

specialised field of minimally invasive surgery in orthopaedics.

However this was not enough. X-rays provided only a two-dimensional visualisation and that had its limitations in interpreting complex structures like the acetabulum and pelvis. It was as late as 1972 that the first CT scanners became available. I would personally consider these to be the single-most important imaging innovation that helped

guide orthopaedic surgical management in the last century and a half. CT scans, though initially used in the imaging of the head, were soon available to scan the whole body. Hounsfield is credited with the introduction of the CT scan.

Today, high precision CT scanners generate accurate images of bone in two and three dimensions. They are invaluable in studying fractures around joints, in reconstruct-

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IN IMAGING

A hip fracture seen in a plain radiograph and reconstructed 3-D CT images

ing anatomy of the joints, and in pre-surgical planning of many orthopaedic procedures.

CT scan inputs are used to plan customised implants using the CAD/CAM principles. This is an example of how engineering and medicine have a beautiful symbiotic function in enhancing patient care.

Finer CT cuts and faster spiral high definition CT scanners permit creation of beautiful 3-dimensional models of the bony anatomy. These are extremely useful in managing intra-articular fractures of the hip and pelvis providing excellent data on retained intra-articular fragments and displacement of fracture fragments.

Newer innovations permit real time capture of imaging data on the C-arm or the O-arm and generate real time 3-dimensional images akin to 3-dimensional CT scan images on the monitor. These can then be fed into a navigation system and the accuracy of surgery can be improved.

3-dimensional CT data is also used to design patient specific instrumentation for total knee arthroplasty wherein customised bone cutting jigs are manufactured for each patient based on his/her anatomy.

CT scan images can also be fed into a navigation system to increase accuracy of implant placement. Most commonly, this application is used in pedicle screw placement in spinal

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A digital X-ray

A multi-planar CT reconstruction of the hip

surgery and in joint replacement surgery.

Positron emission tomography (PET) is a variant of tomography that uses a radioactive labelled dye to help distinguish between infection and tumours lesions. It is not a widely used modality.

Soft tissue imaging has been an important component of muskuloskeletal imaging.

Whether it be imaging of infections, tumours, degenerative conditions or of sports and ligamentous injuries, Magnetic resonance imaging and ultrasonography are the procedures of choice. Magnetic resonance imaging (MRI) has been used to advantage in orthopaedic surgery since many years now. It helps the orthopaedic surgeon image the spine and joints extremely well. One can visualise the vertebral bodies, their destruction patterns, distinguish

between metastases and infections, effectively visualise and distinguish between intramural and extradural pathologies as well as image different disc pathologies. It has been used to image ligament injuries in the knee and shoulder and to determine soft tissue involvement and staging of muskuloskeletal tumours. MR imaging is an essential diagnostic procedure in muskuloskeletal oncology. It helps plan accurate biopsy, determines intra-medullary and extra-medullary spread of the tumour and also helps plan resection margins. MRI helps judge response to chemotherapy. Recent advances in MRI include dynamic MRI sequences and high definition dedicated MRI to image the hip and other joints, special sequences are now available to image cartilage and measure its thickness and degeneration.

A C-arm image intensifier capture intraoperative image

A 3-D CT reconstruction of the Spine

IN IMAGING These are extremely useful to orthopaedic clinicians in diagnosis and management of hitherto under-diagnosed conditions like femoro-acetabular impingement and osteochonditis dissecans. A major disadvantage of MRI was the inability to perform it in the presence of metal in the body.

MRI is contraindicated in the presence of pacemakers, artificial heart valves and steel implants including dental caps and vascular clips. Titanium is however compatible with MRI. Recently, in the aftermath of the failure of the metal and metal hips, a new technique has been developed using MR technology to image the severe acute lymphocytic vasculitis associated lesion (ALVAL) reactions to metal debris. These metal artifact reduction sequence (MARS) MRI is now being used to routinely image these metal on metal artificial hips to look for reaction to metal debris. MRI arthrograms and angiograms are also being used routinely by clinicians now. Dynamic MRI has been extensively studied in spinal imaging. Improvements in MRI imaging are guiding advanced cartilage surgery too.

MRI is the workhorse of orthopaedic imaging in so many different ways that it has become an indispensable tool in the hands of the clinician.

Ultrasound is relatively less understood amongst these imaging techniques for its applications in orthopaedic surgery. Muskulosteletal ultrasound is now a specialised technique. It is used both for diagnostic and therapeutic applications. It can be diagnostic in paediatric disorders and is used as a diagnostic and highly reliable screening tool in developmental dysplasia of the hip.

It is used for imaging of rotator cuff tears in the shoulder, in screening joints for infection in children, and also in imaging many sports disorders. It can be used to give guided injections into tendons and periarticular structures thus increasing accuracy of needle placement for these therapeutic injections.

Thus we see how imaging technology works hand-in-hand with clinicians planning the

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management of an orthopaedic case, helping not only diagnose, but also plan the management.

As imaging technology became more refined, newer methods were found to make patient management efficient, safer and more specific. The accuracy of implant placement, the efficiency of minimally invasive

As imaging technology became more refined, newer methods were found to make patient management efficient, safer and more specific

surgery, newer implants, customised implants, all hinge on accurate imaging as the basic requirement.

The future too will show that imaging technology guides the advent of newer innovations in orthopaedics and allied sciences.

IN IMAGING INSIGHT

Digital imaging for high-end oral dentistry treatment

DR SANDEEP SHARMA Sr Dental Consultant, Axiss Dental

Digital imaging holds several benefits over traditional oral X-rays. As more and more dental clinics are established in India, conventional radiography is expected to be rapidly replaced by digital imaging technology, writes Dr Sandeep Sharma, Sr Dental Consultant, Axiss Dental

D

igital technology is the cornerstone of the information and connectivity revolution of our times. The advent of digital technology-enabled super fast communication and revolutionised several facets of our lives. No wonder, that the digital revolution is often described as the third industrial revolution as it changed the way we knew many things. The old music records were converted into CDs, mail became email, film making bid adieu to film reels and computers and smartphones became the central feature of our lives.

We have also effectively bid goodbye to photography as we knew it, turning a new page with digital camera.

The field of medicine has not remained untouched by this digital revolution. Like in every other field where digital technology has been used, in the field of medicine too the benefits of digital radiography have been immense. From revealing more detailed, clearer X-Ray accounts to better shareability of films to extreme ease of storage, digital radiography has helped make diagnosis more accurate and convenient.

Digital radiography has been used widely in medicine. However, when it comes to oral dentistry, the use of digital imaging is a relatively later phenomenon.

Yet, the advent of oral digital technology has enabled dentists or orthodontics to devise better treatment mechanisms for patients. Cosmetic dentistry too has benefitted from it. More and

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more dental clinics today are accepting digital imaging as a superior alternative to conventional film imaging.

Digital imaging in oral dentistry The physical process for digital radiography is actually similar to traditional dental X-rays that use film. With digital radiography, your dentist inserts a sensor into your mouth to capture images of your teeth – but that’s where the similarities between conventional and digital dental X-rays end. Although it resembles the film used for bitewings and other X-rays, the digital sensor is electronic and connected to a computer. Once the X-ray is taken, the image is projected on a screen for your dentist to view.

Digital radiography allows the clinician to store images of the teeth and mouth on a computer unlike the traditional XRay hard film that has to be carried around. The high resolution digital images can be zoomed in to focus more an area, they can be superimposed to get greater clarity of the condition, and can also be transferred easily to another destination through email.

The storage becomes super easy as the film is simply stored in the computer, and doesn’t need to be carried around.

This makes diagnostics more efficient and convenient and allows for easier patient communication. The clinicians can better communicate images electronically, allowing for easier referrals as well as easier insurance claim submissions.

BENEFITS ACCRUE FROM USING DIGITAL RADIOGRAPHY Less radiation

Shorter dental appointments

Higher quality images

Transferring dental records Environmentally friendly

Advantages of this type of system include the ability to gain cephalometric analysis for orthodontics, to gauge the size and special relationships of the teeth, jaws, and cranium. This analysis assists in better treatment planning. In India, the use of digital imaging in oral dentistry is yet to become a common practice.

However, our clinics are equipped with most advanced

digital radiography technology for better diagnosis and treatment.

Here we list some of the benefits that accrue from using digital radiography as against traditional film X-rays: ◗ Less radiation: The equipment used in digital radiography exposes dental patients to much less radiation. In fact, digital X-rays use up to 90 per cent less radiation than film X-rays. While conventional dental X-rays are relatively safe, digital radiography is an excellent option for those who take X-rays on a regular basis or for those who are concerned about radiation. ◗ Shorter dental appointments: Digital radiography can also shorten your dental appointment! With traditional dental X-rays, you’ll have to wait while your dentist develops the film. With digital radiography, the sensor develops the picture almost instantly and projects it onto a computer screen right before your eyes. ◗ Higher quality images: The standard size of traditional Xrays can make viewing difficult, but digital radiography has done away with the “one size fits all” mentality. Once on the screen, digital X-rays can be enlarged or magnified for a better visual of the tooth’s structure. Brightness, contrast and colour can also be adjusted, allowing your dentist to see small cavities easier. If you need a hard copy of your X-ray, digital images

can also be printed out. ◗ Transferring dental records: Digital images can be e-mailed to a dental specialist for immediate review.

Digital X-rays are taking away the expense and time needed to copy files and mail them to another dentist, making it easier to transfer dental records or get a second opinion. As more and more clinic turn to electronic patient charts, computers may eliminate the need to mail dental records altogether. ◗ Environmentally-friendly: Digital dental X-rays are better for the environment! With digital radiography, no chemicals are used to develop film.

There’s also no wasted space of a darkroom and no need to store film, which can pile up in a dentist’s files.

This enables the dentists to see overall health of teeth and mouth; it helps to measure the health of bone and the condition of infection; it assists in planning exact treatment by offering precise and clear images. It is faster than existing equipment and remarkably reduces exposure to radiation by 60 per cent. In India, the market for dentistry is growing rapidly. According to global market analysis conducting agency MarketResearch.com, in 2010, the Indian dental imaging market exceeded Rs five billion. This is growing rapidly year-on-year. Over the next ten years, a major portion of the dental imaging market is expected to go digital.

INIMAGING

Dose View 3D: An intuitive path to commissioning QA The water scanning phantom comes with a series of advantageous features THE DOSE View 3D is a 3-axis water scanning phantom that fuses robust hardware with easy-to-use software for superior beam commissioning and quality assurance (QA) measurements.

Its features are: ◗ Robust construction provides foundation for accuracy, consistency Manufactured with a rigid, onepiece aluminum frame and stainless steel leadscrews, the Dose View 3D provides a durable platform for repeated QA testing. This construction ensures consistent measurement accuracy within +-0.1 mm per axis. ◗ Precise, three-point leveling The Dose View 3D’s three leveling screws are mounted above the phantom’s scanning volume, making it easy to finetune leveling even when the phantom is filled with water ◗ Fewer cables, faster setup, better data A fast-acquisition electrometer and motion controller are mounted on board the Dose View 3D, reducing the length of detector cables required for testing. This lessens setting time and opportunity for cable leakage, streaming setup. ◗ Durable, accurate stepper motors The Dose View 3D’s 5 stepper motors maintain superior precision over the phantom’s lifetime, minimising degrada-

Dose View 3D provides a durable platform for repeated QA testing EXPRESS HEALTHCARE

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INIMAGING tion even after 30,000 repetitions. ◗ Convenient wireless pendant An intuitive wireless pendant allows for easy vault operation without restricting movement around the phantom and linear accelerator. The pendant’s audible and visual cues and backlit display makes configuring and controlling the Dose View 3D a straightforward process for any user. Fine-tune positioning with 0.1 mm per -press step mode ◗ Thorough, automatic phantom drain The automatic drain feature and advanced suction drain lets users empty the Dose View 3D while cleaning up the rest of their QA material. The advanced suction drain ensures that you return to an empty tank, not a quarter-inch of standing water. ◗ Keeps cables organised during testing Cable carrier keeps the

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motor connections compact and unobtrusive throughout the entire range of motion. ◗ Reference detector holder The modular detector holder can be used in three length configurations to accommodate a wide range of field sizes. A carbon fiber support tube prevents reference detector vibration during scanning. ◗ Sample detector holder A series included holders can be positioned either horizontally or vertically while maintaining a consistent origin location using the Detector Alignment System

Contact

Doseview Pendant Doseview

Rosalina Advanced Radiotherapy No. 127, Bussa Udyog Bhavan, Tokershi Jivraj Road, Sewri West, Mumbai - 400015, Maharashtra, India Telephone: 02224166630/24173493, Email: support@rosalina.in, Web: www.rosalina.in

INIMAGING

Pune to host CT Fest 2014 This year’s programme focuses on neck, chest and abdomen, across both modalities, CT and MRI, and their value and advantage in different diseases and organ imaging TH

THE 4 edition of MSBIRIA's CT Fest makes its way to Pune, the cultural capital of Maharashtra. Like last year, the focus is on cross-sectional imaging with the lectures based on both CT and MRI and the advantages of each of the modalities applicable to different diseases conditions and organs imaging.

The event has an array of

Focus is on cross-sectional imaging with lectures based on both CT and MRI and their advantages

speakers this year including Dr Barton Branstetter, Professor of Radiology in ENT, Pittsburgh Medical Centre, US, and Dr Ashley Guthrie as well as Dr Sapna Puppala, Leeds Teaching Hospital from the UK. Alongwith international faculty, it also boasts of renowned national faculty such

as Dr Bhavin Jankharia, President, IRIA; Dr Sanjay Vaid; Dr Anbarasu A, Chief of MRI, SRL Hi-Tech Scans, Coimbatore. and Dr Karthik Ganesan, Radiologist, SRL Mumbai amongst others. Some of the highlights at the conference which will be held at JW Mariott, Pune are:

◗ Resident corner: Teaching sessions for resident students after the main sessions by professors of radiology on chosen topics for an hour ◗ Spotlight speakers: Five abstracts selected by the scientific committee on topics of CT and MRI pertaining to the neck, chest and abdomen will

be presented ◗ Poster presentations: Post er presentations on interesting cases, case reviews, protocols, and other topics pertaining to CT and MRI of the neck, chest and abdomen.

It promises to be a 'mustnot-miss-event' for doctors and residents alike.

I N T E R V I E W

‘We have multiple international speakers coming to CTFEST’ Dr Sanjeev Mani, Hon. Secretary, MSBIRIA, shares details of this year's offerings at CT Fest, in an interaction with Express Healthcare What is new at CT Fest this year and what are your expectations?

This year the event has moved from Mumbai to Pune and is being held at JW Marriott from October 31 -

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November 2. The focus is on neck and chest CT this time and we are having Dr Barton Branstetter from the University of Pittsburgh as our keynote speaker this year.

Since we are in Central

Maharashtra we are looking at getting a large participation from resident doctors as the programme has been created with them in mind.

What are this year's highlights? What will be the 'never before' segments at the event this time?

Honestly it's tough to create a new "never before" segment in an event every

year but somehow we have managed to do that. We are featuring a residents corner this time that runs on Friday and Saturday with senior professors teaching basics and applications of clinical

INIMAGING

radiology to these students in small groups. This will be an interactive section with student participation and many students have already signed up.

very first time and he will be speaking on chest CT along with Dr Sapna Puppala. In the abdominal section, Dr Ashley Guthrie from UK and Dr Karthik Ganesan of SRL Mumbai will be discussing

abdominal CT and MRI. It's a great mix of international and national faculty taking us through the role of CT and MRI in neck, chest and abdominal imaging.

What is the message you would like to give the participants, exhibitors and visitors at CT Fest 2014?

MSBIRIA committee requests all to come to CT fest for an academic feast on CT

and MRI imaging to Pune.

With the programme already ready and more than 300 visitors registered with still a month to go, we believe that this will be an event to remember.

Moving UP! International and national faculty will take us through the role of CT and MRI in neck, chest and abdominal imaging How many exhibitors and participants will we see at CT Fest this year?

Besides Sanrad and Philips, Siemens and GE Healthcare are the major sponsors at this event. Other companies include Vilas Book House, Bhalani Book House, Agfa, Magnus Healthcare and Imaging Products India.

Who are the national and international speakers at the event?

Once again, we have multiple international speakers coming to CTFEST. Dr Barton Branstetter from University of Pittsburgh will be discussing role of CT and MRI in neck imaging along with Dr Anbarasu and Dr Sanjay Vaid. Dr Bhavin Jankharia is with us for the

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IN IMAGING

Allengers RollScan: Revolutionising orthopaedic imaging It is a mobile imaging system engineered to handle the most demanding orthopaedic/surgical imaging needs in the OT/OR THE TERM ‘orthopaedics’ was coined by Nicholas Andry, a French Physician in 1741 from Greek terms ‘orthos’ that means correct/straight and ‘paidion’ which means child. Though the name initially implied to treatment of children’s deformities, today it has advanced to become a whole new and diversified field of healthcare.

Today’s healthcare environment requires products and services that can deliver and manage the ever changing challenges of patient care, be it cardiology, radiology, urology, neurology or orthopaedics.

The application of orthopaedics has been fast developing with the advancement of technology thereby helping thousands to get back in action by regaining their mobility and thus enhancing their quality of life. New innovations have also further progressed in the field of orthopeadics.

Right from hip/joint replacements, ligament repair techniques, musculoskeletal repair, reconstruction to acute orthopaedic surgeries, all are done under the eyes and nose of CArm image intensifiers, which tend to emit much less radiation as compared to the earlier times when specialised orthopaedic surgeries had to be done with Xray guided images or fluorescent screens. But now the orthopaedic surgeon can view/review his ongoing surgery through fluoroscopy-guided facility available in C-Arms.

Allengers, a well established in the field of cardiology and radiology, also has an innumerable installations in orthopaedics that includes High & Line Frequency X-ray Machines and C-Arm Image Intensifiers. Allengers C-Arms have been appreciated not only for

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RollScan is compact and saves a lot of OT space

its versatile range but also for providing technologically advanced, patient and user friendly fluoroscopy systems.

With over 27 years of expertise and innovation in the manufacturing and sale of diagnostic range of medical equipment, Allengers continues to improve since it rolled out its first mobile X-ray machine and today has an approx 36.5 per cent share in the X-ray imaging market.

Today’s application needs are achiev-ing previously considered impossible diagnosis and the credit goes to the innovations being made by medical equipment manufacturers.

Allengers basket of C-Arms includes HF 49,49R.59,59R, in various combinations based

upon X-ray generator capacity, imaging chain, size of intensifier, type of X-ray tube, etc. And in the X-ray basket it has models like the ceiling suspended Xray systems, mobile X-ray systems, ceiling free and floor to ceiling X-ray systems, etc.

Allengers (Chandigarh) India, which was founded in the year 1987, has always been instrumental in bringing cost effective solutions for the medical fraternity, be it C-arms, X-Ray systems, mammography, lithotripters, cathlabs, TMT, OPG, ECG, monitors and the latest being the DR Systems and the new version of C-arm in the “RollScan Series”( A truly mobile C-Arm).

RollScan is empowered

with high powered 1K x 1K imaging system along-with a wireless keyboard which makes it more user friendly to handle any kind of data entry without any restrictions of space. Allengers RollScan is a truly reliable mobile imaging system, engineered to handle the most demanding orthopaedic/surgical imaging needs in the OT/OR, bringing a new level of freedom and flexibility. As RollScan is an integrated unit and it eliminates the need for the monitor trolley in the OT thereby making it compact due to which it saves a lot of OT space. This compact design of RollScan adds to the convenience of operating and maneuvering this machine from one

OT/OR to another. A Wi-Fi key board and mouse adds for its seamless operation.

Allengers RollScan which caters to diverse application needs orthopaedicians / surgical specialists is based upon 50KHz HF technology. The other areas of application being: trauma, pain management, urological procedures specially with C-Arm compatible ESWL ( Lithotripter ), vascular surgery, gastro and neuro applications.

With radiation safety features provided like “Last image hold, pulsed fluoroscopy, fluoro timer warning,” the specialist can be at comfort on the surgical procedure underway.

With RollScan, Allengers continues its passion for excellence and commitment in providing cost effective solutions for the medical fraternity.

Allengers has notched up several significant achievements over the last 27 years particularly in the field of orthopaedics and radiodiagnosis.

Since then Allengers has a successful presence in 70 countries and are having a substantial customer base of more than 25000 installations which is a testimony of the confidence it’s customers have in brand Allengers.

Allengers has always been in the forefront in exploring newer options and creating specimens of great work and application and is committed to improving the 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.

Visit www.allengers.com to learn more about their products and services.

INIMAGING I N T E R V I E W

‘The printer can help reduce the cost of printing by 50 per cent’ Recently, Ricoh India unveiled an innovative printing solution that can print medical images like X-Rays on plain paper instead of conventional films. M Neelam Kachhap catches up with Manoj Kumar, Executive VP & CEO, Ricoh India to understand how this printing solution will help in bringing down the cost of healthcare delivery

Elaborate on the use of DICOM in India?

Digital Imaging and Communications in Medicine (DICOM), has revolutionised the practice of Radiology.

DICOM has enabled advanced medical imaging applications that has “changed the face of clinical medicine”. From the emergency department, to cardiac stress testing, to breast cancer detection, DICOM is the standard that makes medical imaging work for doctors and patients.

Ricoh’s DICOM printing solution was showcased during the 5th International conference on Transforming Healthcare with Information Technology – 2014 in Kolkata organised by Apollo Hospitals.

The solution drew the attention of many doctors and clinicians present. They appreciated this innovative solution which will help decrease the cost of healthcare, which has always been a major challenge in India.

The DICOM Print Solution offers many advantage as compared to conventional XRay Digital printers. There are no consumables (processing kits) to be bought, inventoried, and stored and maintenance required for this solution and no environmental headaches due to chemical processing of the film. Physical storage space needed for the images is far less than for films and low

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cost solution for generating duplicate copies for insurance, reference and case studies.

How would Ricoh MPC2003SP printer impact the cost of healthcare delivery in India?

One of the major challenges that the Indian diagnostic and healthcare industry faces is high print cost of medical imaging. It is also tedious to manage multiple printing devices for different medical images, and administration of various output sheets like films and papers. This conventional method and its higher running cost forces the diagnostic industry to compromise on the profits in order to ensure the customer retention. Now with Ricoh’s entry to Medical Image Printing, the cost can be reduced by 50 per cent which will help the industry to address the above concerns.

Ricoh DICOM print solution is designed specifically for healthcare sector, to meet the needs of medical image printing across the various departments and not limited to radiology only.

Using this solution all medical images from different modalities, like X-ray, CT, MRI, Ultrasound, Cath Lab, Endoscopies etc can be directly printed on plain paper by Ricoh MPC2003SP

printer. This coloured printer has been specifically customised for this process to maintain the quality of the print out.

Ricoh DICOM print solution is designed specifically for healthcare sector, to meet the needs of medical image printing across the various departments

In an era when hospitals are inching towards paper free existence how is your product relevant?

While it is our endeavour to move towards paper less environment, few necessities will always be there. Print out becomes essential when clinicians wants to review the images for diagnosis, to discuss the condition with patient and most importantly the patients will be unsatisfied without a print out of any report.

What is the market that this product will address?

Our solution can be attached to all the medical image equipment that are digital. It will address the need of hospital and diagnostic centres.

What percentage of this market would you be looking at?

Current market is low, however, expanding rapidly.

We have developed this solution after lot of R&D and are confident about the quality of our product.

Currently, we do not see any competition in India and so far the response has been very good. We have already

installed this solution in various large and established healthcare organisation.

What is the cost advantage of using your printer?

The printer can help reduce the cost of printing by 50 per cent. The unique thing about our solution is that the customer has no capital investment in the equipment and no requirement of individual purchases of consumables as Ricoh will be managing the maintenance and supplies during the contract period. We believe that clinicians should use their productive time with patients’ rather managing printing devises, and it should be left to experts What are the technical requirement for your product? Can it communicate to all imaging products of all brands?

The product used in this solution is MPC 2003, which has been specifically customised for printing medical devises and no other product can be attached to it.

However, from the hospitals perspective, we can attach our solution with all the medical modalities without disturbing the existing system. Further, with one solution we can connect various medical imaging devices. mneelam.kachhap@expressindia.com

INIMAGING I N T E R V I E W

‘Pencil beam therapy is the latest technology by Mitsubishi Electric’ Rajeev Sharma, Head-Corporate Services and Strategic Planning, Mitsubishi Electric India shares details of his company’s offerings for the healthcare sector, especially the technologies which are revolutionising radiation therapy in India. He also speaks about Mitsubishi Electric’s strategies for India, in an interaction with Lakshmipriya Nair

What are the global trends in radiation therapy?

Radiation therapy has played an increasingly dominant role in multidisciplinary management of cancer, about half of all the cancer patients receive radiation therapy, either as part of initial treatment or as palliative treatment. Radiation therapy technology has taken giant leaps, bringing comfort for patients. The radiation therapy devices market is growing as the global number of cancer patients increases, states a new report by pharma industry analysts Global Data.

■ Evolution and improvement in radiotherapy techniques Researches and developments in radiotherapy have led to precision of treatments, improved outcomes and reduced treatment-related side effects. Specific developments have been in the areas of intensity modulated radiotherapy (IMRT), stereotactic body radiation therapy (SBRT), 4D imaging, particle therapy and nanotechnology.

■ Personalised approach radiation therapy Radiotherapy is getting more bespoke and tailor-made to fit each patient’s requirement like its particular clinical circumstances and anatomy.

Introduction of tumour marker testing and molecular and biological imaging techniques are expected to help already personalised

printer The P93E is an A6 monochrome thermal printer, which accepts standard composite video and comes equipped with a host of features making it the ideal choice for an array of medical applications.

The printer incorporates a high-density 325dpi thermal head and has a page resolution of 1280 x 500 pixels, ensuring that even intricate detail can be accurately reproduced.

radiotherapy treatments to be even more focused.

What are your offerings for India in this arena?

■ Particle beam therapy The innovative particle beam therapy system for cancer treatment is the most advanced technology. The new system will feature a compact, singleroom design that meets the growing global demand for more cost-effective therapy solutions.

■ Superconducting magnet for MRI By employing a remarkable magnetic field adjustment technology, Mitsubishi Electric has achieved the world’s highest level of magnetic field homogeneity in a 1.5 Tesla superconducting magnet for MRI. The company has also achieved the world’s first superconducting magnet with zero boil-off of liquid helium.

■ Black Diamond Colour Video Printer Equipped with a 423 dpi thermal head, the CP31W printer provides optimum print quality with vivid, smear-free gradation. It is also exceptionally fast - 16 seconds for S -size and 25 seconds for L-size output. The CP31W is equipped with a selection of gamma curves to handle ultrasonic diagnosis systems, endoscopes and other sophisticated medical instruments, simplifying user gamma curve fine-tuning and colour adjustment. The printer features a ‘hassle free’

As Mitsubishi Electric starts its innings in the Indian healthcare space, it is bringing in products that will revolutionise the industry all-front access design including automatic loading for ribbon cartridge replacement, an internal wide-mouth paper catcher, and built-in lighting to track print status. Whatever your medical requirement, Mitsubishi’s CP31W delivers both quality and convenience.

■ A6 size high speed monochrome thermal

What are the areas of application for particle beam therapy system?

Mitsubishi Electric offers two types of particle beam therapy system: the Proton Type, which produces a proton beam by accelerating the positively charged particle (ion). It results from stripping a single electron from a hydrogen atom and can be used for proton beam treatment. The other one is the Carbon and Proton Type, which accelerates the nucleus of elements with an atom heavier than a proton, such as carbon and helium, and can be used for heavy ion beam or proton beam treatment.

Using beams of accelerated protons or heavier ions like carbon, cancer cells and tumours could be killed without causing extensive damage to the surrounding healthy tissues.

The process also eliminates the major drawback of conventional radiation therapy using X-rays.

How will this technology assist in delivering better

healthcare outcomes?

PBT systems are customised to the end users’ needs every time they are sold, with a list of features that can be added to them. This fluidity in setting up the systems works in client’s favour, as they don’t end up with features that they don’t need, and also, they can control the costs.

What are your other technologies for enhanced radiation therapy?

Pencil beam therapy is the latest technology developed by Mitsubishi Electric. It’s an advanced version of particle beam therapy which uses a carbon ion beam with drastically reduced spot size to more accurately and efficiently irradiate complicated tumour volumes. The system enables the delivery of individual layers of pencil beam spots to precise locations, eliminating the need for beam collimation and compensators to adjust the target area.

What are your plans for the Indian market?

As Mitsubishi Electric starts its innings in the Indian healthcare space, it is bringing in products that will revolutionise the industry.

There is no immediate plan of setting up R&D in India as excessive researches and innovations are being done in Japan, but Mitsubishi Electric is testing the market for its advanced products. lakshmipriya.nair@expresshealthcare.com

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INIMAGING I N T E R V I E W

Orthopaedic research in India has a long way to go Dr Ashok Shyam, Chief Researcher and Head - Indian Orthopaedic Research Group and Founding Trustee - Indian Orthopaedic Research Society talks to M Neelam Kachhap about the orthopedic research environment in India and the ongoing progressive work in the field How is the research environment for orthopaedics in India?

There are two kinds of research in orthopaedics (and generally in medicine). One is clinical trials, that we all hear of so often. These are research projects on drugs, medications or implants wherein the company producing it conducts a trial to study the effectiveness or safety of the product. This is done mostly as a part of drug/implant development process and involves preclinical trials (basic science and animal studies) and clinical trials (four phases of it). In this area, the research is generally outsourced from multinational or national pharma/implant companies.

In these trials the sites involved just collect data and send to the parent company and they analyse and publish the result.

Few years back clinical trials were thriving in India (albeit due to wrong reasons like lack of monitoring protocols, easy availability of permissions etc), however since the last two years, the Drug Controller General of India (DCGI) has laid down strict rules and now clinical trials follow strict protocols.

Though the number of trials have decreased, quality trials with best ethical practices are now being done, which is a very good start.

The other kind of research is what we call ‘academic research’. This is done by universities, institutes and organisations where the goal is

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purely academic and the aim is to improve the current surgical or clinical practices to achieve best form of patient care. As you notice, the clinical trials are a prerogative of pharma/implant companies which will do research only if they have a product related to a disease (which may involve them having selective biases).

In comparison, academic research involves studies on surgical methods, implants and medications (independent of the influence of companies).

This research is generally done by ‘clinician scientists’ who are orthopaedic surgeons with special inclination towards academic research. Few years back (until 2009), academic research was largely neglected in India due to lack of various factors like lack of infrastructure, funding, training in research methods, mentorship, interest, and lplatforms to present this research. We, at IORG, describe it as ‘research apathy.’

This situation has been changing, albeit slowly in the last four to five years, with the new breed of clinician scientists showing interest in academic research and opportunities arising due to change in policies of academic bodies and also the government.

In developed countries, academic research is done through co-operation of three entities namely the universities, government and the industry. Although this co-operation still does not exist in India (as far as orthopaedics is concerned),

promoting academic research and supporting clinical scientists. Thus, there is a wave of positive change in both clinical trials (they are becoming more regulated and safer) and academic trials (they are becoming more relevant and supported).

Although orthopaedic research in India has a long way to go, we are certainly on the right path.

Individual clinicians scientists working in the private sector are doing cuttingedge research, especially in metro cities there has been recognition for academic research by the government and universities.

Academic bodies like Indian Orthopaedic Association, Maharashtra Orthopaedic Association etc are showing great interest and try to fund academic projects. Private institutes like Sancheti Institute in Pune, Ganga Hospital in Coimbatore etc have come to forefront in

How many centres are doing cutting edge research in orthopaedics?

Here I would talk about ‘academic research’ only where the centres themselves design the studies and conduct research with the aim of improving patient care. Few centres that come to my mind are Sancheti Institute for Orthopaedics and Rehabilitation, Pune; Ganga Medical Centre & Hospitals, Coimbatore; PGIMER, Chandigarh and AIIMS, Delhi.

These centres have specially promoted academic research and also training in academic research. For example; the Sancheti Institute has a special academic research division that is fully equipped with independent staff including biostaticians and clinician scientists. They conduct regular research training workshops in Pune to promote the next breed of clinician scientists, both in orthopaedics and in the rehabilitation sector. This centre is producing cuttingedge research in joint replacement, paediatric orthopaedics, and also spine

surgery with original publications in all these fields.

The centre has the distinction of developing the first indigenous knee replacement prosthesis (fully researched and developed in India). This research was initiated in early 2000 and development of the implant has reduced the cost of knee replacement for Indian patients by 50 per cent. Ganga Hospital is a world renowned centre for orthopaedic research and is doing exemplary work in the fields of spine surgery and compound fractures. In addition to these centres there are individual clinicians scientists working in the private sector who do cutting edge research, especially in metro cities like Mumbai, Delhi, Hyderabad etc.

Tell us about the legends in orthopaedics who have done great research from India?

As mentioned earlier, Dr KH Sancheti from Sancheti Institute in Pune, developed the first indigenous knee replacement prosthesis for the Indian population. Dr Parag Sancheti, following his father’s footsteps, has written many book chapters and papers related to joint diseases and arthroscopy. Dr S Rajasekaran from Ganga Hospital has written landmark papers on tuberculosis of the spine and treatment of other spinal diseases. He has also been instrumental in developing the ‘Ganga Score’ for assessment of compound fractures. Dr SM Tuli from Vidhyasagar Institue of Mental Health and Allied Sciences, New Delhi is a

RADIOLOGY

leading authority in osteoarticular tuberculosis.

Dr Anil Jain from Delhi (Current Indian Orthopaedic Association President) is a legend in spine research and is instrumental in uplifting the Indian Journal of Orthopaedics.

Dr GS Kulkarni from Swathiyog Prathisthan, Miraj has done great research on orthopaedic trauma and is the author of a prestigious textbook on orthopaedics.

Dr Sudhir Babhulkar from Nagpur is known for his pioneering work in the field of avascular necrosis of femoral head. Dr Arun Mullaji (Perhaps one of the most academically cited orthopaedic surgeons from India) has a body of literature that will make many academic giant envious. Likewise, there are many upcoming clinical scientists who are now positively impacting the research scenario in India and we hope to have many more legends on the list.

Most of the ortho research happens in the area of joint replacement and implants.

What are the other concern areas that need focus?

It’s not true that most of the research happens in joint replacement, but definitely the share of joint replacement research is increasing. I think the reason is we are still trying to find the best implant and best surgical procedure. So we are trying to continuously improve the literature in this area. Also, lot of companies are involved in this research and produce original articles to support their claim. There is obviously a need from the academic research to verify these claims and also provide original research on safety and efficacy of devices and surgical procedures. The number of patients who will require this surgery is exponentially increasing in India, supporting the need for more research in the field. The other fields that form a good part of literature are orthopaedic trauma, spine diseases, sports injuries (arthroscopy) paediatric orthopaedics, orthopaedic

oncology and basic orthopaedic science. There is enough research on all of these subjects except basic science.

We need to focus on this area in a very big way and the scope of this area is vast. Areas like study of new technologies, their impact of basic pathophysiology of orthopaedic diseases, use of nanotechnology in orthopaedics, study of biomechanics and also genetic level studies etc. also need urgent focus currently. The world is moving towards the amalgamation of these new techniques and technologies in medical science and we have huge potential to make a mark in this area. This will require increase co-operation between these different branches of science and technology to come together with orthopaedic clinical science.

Training opportunities should be provided to clinical scientists and basic scientists.

We have all the ingredients, the need is to put them together to achieve the best results.

Why was there a need for a group like the IORG? The Indian Orthopaedic Research Group (IORG) was founded in 2007. I realised that India as a country and Indian orthopaedics as a faculty has huge potential to become international leaders in research. But very few centres were doing original research and in general we were relying heavily on Western literature to guide our practice. There was an urgent need to develop Indian orthopaedic literature, and to do that the next generation of orthopaedic surgeons had to be inculcated with principles of orthopaedic research. Also, we had a centre in India with huge amount of data that could be studied and published. Surgeons in India were doing world-class surgeries, however they could not translate that into research publications due to many factors like time constraints, lack of training in conducting and publishing research etc. This is where we

India as a country and Indian orthopaedics as a faculty has huge potential to become international leaders in research

thought we could make a difference. We formed IORG on the principles of academic philanthropy for pursuit of knowledge. We realised that as individuals we could lag behind but together we can definitely collaborate and make an impact. If every surgeon from India contributes his or her orthopaedic knowledge to a common pool, we would be able to draw patient specific conclusions from this pool of knowledge. With these goals in mind we started IORG. How does IORG help budding researchers?

We categorised three main areas of focus namely research, education and dissemination of knowledge (RED principles as we call them) and started working on them simultaneously. For research, our focus was designing studies relevant to our patients in India and providing help to interested institutes and individuals in conducting academic research. For this, we started helping in study designs, data collection, data analysis and writing manuscript. Till now we have been able to provide help and publish more than 112 studies in both national and international journals. For institutes we started setting up ‘academic research divisions’ which will the institute independently perform academic research

activites. We provide training and capacity building for the these divisions and supervise their work.

The second main goal was eduction, specifically research education. We realised that to compete with international standards we will need special education for orthopaedic research which will aim towards developing ‘clinician scientists.’ With this aim, we started conducting workshops in research methodology, research publications and also medical thesis writing. These workshops are conducted regularly and are gaining popularity. We also started the Orthopaedic Research Club where postgraduates and trainees can meet us and discuss their problems in research and get help.

Orthopaedic writers club is our online initiative where we help orthopaedic surgeons to learn and actually write a scientific manuscript. Our website provides other tools like statistical support, study designs and also free articles which are needed for research.

The third principle is dissemination of knowledge and is currently our strong focus. After we develop an awareness and interest in research and train students, we also need to provide them platforms to publish there original research. We started two initiatives to do this, one was an online discussion forum and the other was starting scientific journals.

The online discussion forum has grown and developed itself as the best example of ‘academic philanthrophy’. In the forum we have around 10,300 orthopaedic surgeons (from India and across the world). Here we share our knowledge, discuss problems faced in managing patients and receive comments and opinions from this huge pool of orthopaedic knowledge. We have also started our own journals to provide platforms for Indian surgeons to publish their research. Our Journal of Orthopaedic Case Reports in world renowned and has submissions from across the

globe. Our Journal of Medical Thesis is the first and only journal in the world dedicated to medical thesis. Our other Journals are Asian Journal of Arthroplasty and Arthroscopy, International Journal of Paediatric Orthopaedics, Trauma International and Hand International. We are starting the first journal in the world dedicated to bone cancer research named ‘Journal of Bone and Soft Tissue Tumors’.

The attempt here is not only to provide our surgeons a publication platform but also to develop journals of international standards where surgeons from other countries can also publish. One of our most unique initiatives is the Journal of Orthopaedic Complications which aims to prevent and treat complications and complex cases of orthopaedic surgery.

All our journal articles are available to all orthosurgeons for free. The general practice for many top orthopaedic journals today is to sell every article at a price range of $20 to $39. We realised that this greatly inhibits the dissemination of knowledge.

So we decided to give open access to all our journals and make it available for free to surgeons across the world.

This move adds to the financial burden if we go with conventional scientific publishers hence we decided to self-publish all our journals.

We developed the resources and started all these journals with optimal cost effectiveness. IORG is also an example of financial philanthropy. It does not receive any support from any pharma/implant company but is mostly self-funded by IORG members. Contributions from members and few individual philanthropists help us run our activities. We hope our aim of achieving academic excellence and developing best research literature will help us provide best treatment to our patients and establish India as an academic force in orthopaedic world. mneelam.kachhap@expressindia.com

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INIMAGING HIGHLIGHTS

New methods enhance quality of myocardial perfusion imaging MPI is an important tool in the diagnostics of coronary artery disease and in determining its severity NEW METHODS that enhance the quality of myocardial perfusion imaging were developed in a recent study completed at the University of Eastern Finland.

In her PhD study, Tuija Kangasmaa, Lic. Phil., invented a method which makes it possible to reduce the imaging time by upto 50 per cent, making the scan session easier for the patient.

Furthermore, the study also created two additional methods which correct errors resulting from patient movement during the scan. The methods were validated and they have already been taken into use in hospitals all over the world.

Myocardial perfusion imaging (MPI), which is used to assess the sufficiency of myocardial blood flow, is an important tool in the diagnostics of coronary artery disease and in determining

its severity. The scan is usually performed in two phases involving a stress myocardial perfusion imaging scan and a rest myocardial perfusion imaging scan. The patient is given an injection of a radioactive substance, which gets absorbed in those parts of the heart muscle that have normal blood flow. The scan is performed by using a gamma camera which detects radiation coming from the patient.

The quality of images obtained

by MPI are dependent on a variety of factors, the most significant ones being image noise, photon attenuation, Compton scattering, collimator-detector response (CDR), and patient movement.

Problems in image quality resulting from the above factors can be corrected by means of reconstructionbased compensation methods, but this is not always straightforward. The study focused

The methods were validated and they have already been taken into use in hospitals all over the world on the testing of methods which seek to reduce the imaging time and to correct image problems caused by a long imaging time. The possibility to shorten the imaging time makes the scan easier for the patient and makes it possible to scan a larger number of patients during one day. The study investigated the possibilities to shorten the imaging time by using collimator

response compensation and by performing the stress/rest MPI scans simultaneously by using different radionuclides.

In gamma imaging, a collimator is needed to convey the radiation coming from the patient in the desired direction; however, the use of a collimator also impairs image quality. Collimator response compensation was found to improve the quality of MPI so significantly that it was possible to reduce the imaging time by half while still obtaining the same image quality as with traditional computational methods and full imaging time. Furthermore, a new method for reducing errors associated with collimator response compensation was invented. The study established that it is possible to combine the stress and rest MPI scans, but this requires the use of accurate scattering compensation methods in

order to compensate for the cross-scattering of different radionuclides.

For many patients, even the shortened imaging time is too long and they tend to move during the scan. The study also developed and tested two motion correction methods.

The methods were successful in correcting even major errors caused by patient movement, and they resulted in error-free MPI images. The computational methods validated and optimised in the study have been integrated into a commercial MPI image reconstruction package, and are currently in clinical use in dozens of hospitals both in Finland and all over the world.

The results were originally published in Nuclear Medicine Communications, International Journal of Molecular Imaging, and Annals of Nuclear Medicine.

EH News Bureau

CURATechnologies introduces DReam DR systems The technology reportedly offers better results, durability, and lesser radiation than X-ray CURA HEALTHCARE has introduced DReam digital radiography (DR) system which reportedly offers a unique single detector design used in all positions without physical movement of detector reducing investment for two detectors. It comes with a flat panel technology providing the great image quality.

Radiation emitted by DReam is apparently very low ensuring patient safety, especially for paediatric patients as it

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DReam is very useful for emergency, trauma and accident cases and has very high patient throughput like upto 300 patients per day emits 25-50 per cent lesser radiation as compared to other systems. DReam is very useful for emergency, trauma and

accident cases and has very high patient throughput like upto 300 patients per day. The complete system works on a

15 amps power supply saving high power consumption and takes in least floor space requirement of 110 sq ft due to its unique design.

Balasubramaniam, CEO, CURA Healthcare said, ‘The entire concept of going digital makes the process quick and very efficient. With such technological advancements, services provided are better with accurate results. The new digital radiography technology is superior, cost effective and

much healthier than the existing technologies available for both patients and radiologists.

CURA aims to bring in such ground-breaking technology accessible to everyone and change the medical healthcare scenario for better.�

CURA aims to take DReam and such medical equipment and instrument solutions to smaller towns and provide the right healthcare.

EH News Bureau

INIMAGING

New ceiling-mounted tube option for Carestream's DRX-Ascend Imaging System The new feature will provide versatile positioning for a variety of imaging exams CARESTREAM HAS added a ceiling-mounted tube option for its DRX-Ascend System in a bid to provide versatile positioning for a variety of imaging exams. The DRXAscend System also offers a floor-mounted tube stand, wall stand and a choice of an elevating float-top table or non-elevating table. The new ceiling-mounted tube option is currently available for order.

“The DRX-Ascend delivers cost-effective, fully featured imaging that allows hospitals, imaging centers, orthopaedic practices and urgent care clinics to select a configuration that satisfies their imaging workflow and budget,” said Heidi McIntosh, Global Marketing Manager for X-ray Solutions. “DRX-Ascend users and other healthcare providers are interested in a ceilingmounted tube because it can deliver flexible patient posi-

tioning that helps technologists perform imaging exams in less time, which can lead to greater productivity,” she added.

The DRX-Ascend System can be configured with DRX1and DRX-1C detectors. Both detectors fit into the standard Bucky used in X-ray wall stands and tables. In addition, Carestream’s small-format 25 x 30 cm detector, the DRX 2530C, can be used for orthopaedic and tabletop exams. Customers can also opt to install a fixed 43 x 43 cm detector for the wall stand.

Carestream’s multi-colour touch panel screen mounted at the tube stand gives technologists remote generator control, displays image previews and allows review of previous images for the current patient. The DRXAscend system offers several detector holders to help tech-

nologists perform cross-table lateral exams as well as other specialty views. Facilities can use a single DRX detector with the system or opt for two or more detectors to maximise productivity and efficiency.

The DRX-Ascend offers users the benefits of Carestream’s advanced image processing software and a consistent user interface across Carestream’s computed radiography (CR) and digital radiography (DR) systems facilitates a smooth transition from CR to DR technology.

Carestream’s DRX family of systems offers mobile X-ray imaging systems and DR rooms, and equips healthcare providers convert existing X-ray rooms and portable systems from CR to DR using DRX detectors.

EH News Bureau

Siemens Healthcare India wins Imaging Companyof the Year Award The award, given by Frost & Sullivan, recognises best practices adopted by Siemens Healthcare, India in the Indian diagnostic imaging industry SIEMENS HEALTHCARE India was awarded the ‘Imaging Company of the Year’ for 2014 at Frost & Sullivan’s 6th Annual India Healthcare Excellence Awards held in Mumbai. The award acknowledges best practices adopted by Siemens Healthcare, India in the diagnostic imaging industry. The awards programme followed a rigourous methodology to recognise superior planning and execution of product launches, strategic alliances, distribution strategies, technological innovations, customer services, healthcare

delivery services, and mergers and acquisitions. Other crucial factors used to evaluate the nominees included leadership qualities, strategy, growth, service, innovation, integration, marketing, and financial performance. This process saw external jury members, eminent personalities, and key opinion leaders in the healthcare industry rate each company across 8-10 parameters based on research data provided by Frost & Sullivan and the jury members’ own understanding of the market as a subject matter expert.

Nominees were evaluated on factors like leadership, strategy, growth, service, innovation, integration, marketing, and financials

Speaking about this honour, Richard Guest, CEO, Siemens Healthcare, India, said, “We are the trusted partners who support our customers to fight the most threatening diseases, to raise quality and productivity in healthcare and to enable access to healthcare. We would like to thank Frost & Sullivan and the esteemed jury for awarding us the Best Imaging Company of the Year, which resonates with our contribution to the healthcare industry.”

Congratulating Siemens Healthcare, India on the award, Jayant Singh, Director, South

Asia and Middle East, Healthcare and Life Sciences Practice at Frost & Sullivan, said, “The success of Siemens Healthcare is a combination of comprehensive range of solution offerings, single-handed focus on innovation, quality, and reliability, and focus on training and after sales backed by an excellent customer support network. It is a pleasure to recognise the efforts of a company like Siemens Healthcare, which offers innovative and quality healthcare solutions to the country.”

EH News Bureau

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STRATEGY DEBATE EMERGING TECHNOLOGIES:

ROBOTIC VS PATIENT SPECIFIC IMPLANTS The debate on robotic vs patient specific implants for knee arthroplasty is getting hotter by day as more studies with conflicting prospective are published. An elite group of Indian orthopaedic surgeons share their insights on the same

BY M NEELAM KACHHAP

I

nnovations in knee arthroplasty concepts have always been targeted towards patients as means of achieving more consistent outcomes.

However, the best match between new technology and clinical experties is the key to achieve good surgical outcomes. Currently, two new technologies - robotic techniques and patient-specific implants are making waves in the orthopaedic market.

Precision and alignment are the core of orthopaedic surgery and takes a fair bit of practice to master the art. The advent of robotics for clinical surgeries was hailed as the next breakthrough in medicine but somehow that hype has not translated into rapid adoption by surgeons. Orthopaedics has its fair bit of robotics. A new class of robotics for precision sculpting is now in the market. They bring the advantages of accuracy, precision and rapid reaction to the surgeon. These intelligent tools are said to simplify difficult and heavily instrumented procedures. Some of the technologies present in this category are The Acrobot Sculptor (Stanmore Implants Worldwide), Mako Rio (Stryker Corporation) and the Precision Freehand Sculptor – “PFS” (Blue Belt Technologies)

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Dr Klaus Radermacher from Helmholtz-Institute in Germany seeded the idea for patient-specific templating in the 1990s. Recently, a lot of a renewed interest is centred around this image-to-implant technique. It involves three-dimensional (3-D) surgical planning of the knee arthroplasty with unique custome cutting and drilling.

The approach relies on CT or MRI imaging to customise the knee arthroplasty by capturing the patient-specific knee anatomy including the cartilage, and results in custom-fitted positioning guides.

The images are also used to design and manufacture custom implants using rapid prototyping technology.

Some of the products in this category are Patient Specific Instruments (Zimmer, Inc); Visionaire patient-matched instrumentation (Smith & Nephew), OtisKnee (OtisMed), and Signature (Biomet).

Many of these technologies are not widely accessible in India. But some surgeons have tried these innovative technologies. They provide their perspective on utilising these technologies in India.

PSI DIFFERS from navigation (computer-assisted) in that it shifts the bone landmarks required for surgery from intraoperative to preoperative planning . Many studies have shown that it has little impact on surgical procedure. As far as I know, no study has assessed implant survival, function and patient satisfaction rates. Besides, the pre-operation planning in PSI is done by an engineer hence chances of error do creep in.

Advantages of both PSI and navigation are that both are theoretically more accurate. However, the prohibitive cost of both the technologies is their biggest disadvantages. Also the being a new technologies, there is very little evidence to prove efficacy.

Computer-assisted total knee replacement (TKR), patient specific implant (PSI) and patient specific navigation - Is it ready for prime time?

The answer is a big NO. I feel both, PSI and computer navigation in TKR, are mostly used as a marketing tool, both by the implant companies and corporate hospitals to increase the volume of surgeries and implant usage.

It brings in a snob value to a well performed TKR done by routine eye-balling as by most surgeons. The number of people doing it is very minimal and a lot needs to be done still to see its usefulness and usage by most surgeons.

DR DEEPAK INAMDAR Chief Consultant Orthopedic and Joint replacement surgeon, Orthoone, Bangalore

COMPUTER ASSISTED TOTAL KNEE REPLACEMENT (TKR), PATIENT SPECIFIC IMPLANT (PSI) AND PATIENT SPECIFIC NAVIGATION - IS IT READY FOR PRIME TIME? THE ANSWER IS A BIG NO

DR RAJESH DHARIA Consultant Joint Replacement Surgeon, Mumbai HUMAN being is a very advanced robot created by God! Man-made robot has several limitations and will only work as per the programme and cannot ever perform anywhere close to humans as far as knee replacement surgery is concerned, simply because the variables are too many ! Besides the exorbitant cost of the robot, it may even be dangerous. Recently, I met a professor at IIT who is into robotics for factory machines and he too was of the opinion that since the knee moves during surgery and deformities are variable and gaps are variable it

DR AK VENKATACHALAM Consultant Joint Replacement Surgeon, Chennai

THE goal of the surgeon during a total knee replacement is to get neutral alignment. However, studies have shown that even experienced surgeons don’t always achieve this perfection.

Hence computer navigation systems were introduced about a decade ago to achieve perfect alignment. In this system, pins were drilled in the thigh and leg bones away from the knee. These pins were attached to sen-

could be dangerous.

The other variety is the computer navigation for knee replacement which is being currently overused and being used more for marketing by some surgeons especially in Mumbai! It is neither cost effective nor particularly surgeon friendly, besides there is no software for revision surgery.

The patient-specific instrumentation or the trumatch is better in the sense that it reduces surgical time and almost guarantees good component positioning even for an inexperienced surgeon .

However one has to send the MRI of the knee to the US to get the patient-specific jigs manufactured and it takes approximately four weeks for this and costs around Rs 50,000 in addition to the cost of the implant!

The trumatch technology is better and is a good alternative for those cases where navigation has to be used due to the inability to use routine jigs!

If the time period for manufacturing patient specific jig reduces and the cost is also affordable then it comes across as the best logical choice for all cases of knee replacement. It is safer because the medullary canal is not violated and this reduces chances of embolism.

The jigs are made by proper meas-

sors. The sensors relayed information to a processor located elsewhere. The monitor of the processor displayed the accuracy of the bony cuts and bony alignment. Based on these, the surgeon could intra-operatively fine tune the cuts and positioning to get perfect alignment. As mentioned previously, the surgeon had to shift his gaze back and forth from the operating field to the computer monitor located elsewhere. This computer navigation system also requires intensive capital investment.

A different approach toward this goal was adopted with PSI. This required additional pre-operative imaging. The images were transferred electronically to engineers elsewhere.

The engineers used computer-aided design to manufacture custom fit cutting tool for each patient. These patient specific instruments were shipped to the surgeon after an interval of a few weeks. Hence there is a time lag involved between the planning and execution in this process.

Many patients don’t want to wait.

This is where the new technology comes into picture.

I have recently introduced the ‘I-Assist’ for knee replacement. It has

THE TRUMATCH TECHNOLOGY IS BETTER AND IS A GOOD ALTERNATIVE FOR THOSE CASES WHERE NAVIGATION HAS TO BE USED DUE TO THE INABILITY TO USE ROUTINE JIGS!

urements and in addition, the experienced surgeon can compensate for any defects that may exist!

The idea of all these gadgets is to improve the bony cuts and component positioning ! This is one aspect of surgery! Others being asepsis, ligament balancing, cementing technique, hemostasis and other multiple factors for which there is no option other than a skilled, trained and experienced

BONY DEFORMITIES WITHIN THE KNEE AND OUTSIDE PRECLUDE USE OF ALL PREVIOUS MODES OF INSTRUMENTATION.THE USE OF CONVENTIONAL INSTRUMENTS WHICH RELY ON INTACT STRAIGHT BONES IS IMPOSSIBLE

gone beyond patient specific instruments. Robotic knee replacement was not feasible in India because of the high costs.I was in favour of patients specific instruments before but I have now moved on to surgical guidance system. Earlier navigation systems required the back and forth transfer of the surgeon’s gaze from the operating field to a computer monitor else-

orthopaedic and joint replacement surgeon!

The cost of the robot to deal with knee replacement surgery goes into crores! Training doctors, paramedics and OT staff will also take the cost to new levels! Maintenance and upgradation of software and technology would be a separate issue! We are currently at infancy with regards this aspect!

It would be experimental for a long long time!

We already have results of knee replacements with longevity of 20-25 years, and these are without using computer navigation or robotics or patient specific instrumentation !

Therefore, one has to really have a very strong technology which can better these results! Otherwise why change? Therefore the logic of trumatch, which only helps the surgeon without unnecessary burden to speeden the surgical time and improve upon the desired component positioning percentile wise is acceptable. This also reduces the implant inventory.

It's like a tailor-made suit rather than a readymade size option where one gets small, medium, large, extra large and double extra large .

where, several times intra-operatively.

The device integrates into the operation by requiring no complex imaging equipment and additional surgical incisions.

A sizeable number of young patients have additional complications in the leg that make a knee replacement difficult. Patients from Asia and Africa present with malunited thigh and leg fractures secondary to a previous accident. They have developed post traumatic knee arthritis as a result of these accidents. Bony deformities within the knee and outside preclude use of all previous modes of instrumentation. The use of conventional instruments which rely on intact straight bones is impossible. Conventional computer navigation is also inapplicable as it requires intact bone within the knee joint. PSI is also impossible to design with bone loss and extra articular deformities. It is vital to get perfect alignment as there is a positive correlation between accuracy and long term survival of the implant.

A functional total knee replacement has to be well aligned, which implies that it should lie along the mechanical axis and in the correct axial and rotational planes.

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STRATEGY

DR KIRAN KHARAT Senior Consultant, Joint Replacement Surgeon, Pune

INCORRECT alignment will lead to abnormal wear, early mechanical loosening, and patellofemoral problems.

There has been increased interest of late in total knee arthroplasty with robotic assistance.

Some cadaveric studies from Korea have shown that robotic knee surgery is more accurate compared to conventional surgery.

Conventional surgery achieves neutral alignment (within 3° of the mechanical axis) only 75 per cent of the time, and coronal suboptimal alignment greater than 3° correlates with worse outcomes.

Currently, two systems have been approved by the US Food and Drug Administration (FDA) and are commercially available in the US—RIO

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(MAKO Surgical, now owned by Stryker Corp) and ROBODOC (Curexo Technology).

The current MAKO system is a semi-active system controlled by the surgeon. It provides both auditory and haptic feedback, limiting milling of the tibia and femur to certain regions. Prior versions required rigid fixation to a frame, but newer systems have a dynamic tracking feature that results in better implant positioning primarily in unicompartmental knee replacements.

However it takes an average of 25 minutes longer to perform using the Robodoc system. An early trial reported a 41-minute setup time for the robot, 7.5 minutes for registration, and 34.8 minutes for robot-assisted burring. By the tenth case, however, surgeons were able to shave 20 minutes from the entire procedure to average 120 minutes for the entire surgery.

Overall, the use of robotics for TKAs and UKAs has demonstrated the ability to improve component positioning in some cases; however, no study has demonstrated improved functional outcome in near-term follow-up. This may be due to limited sensitivity of clinical outcome measures or limited follow-up period.

Longer term follow-up will be needed to demonstrate whether the improved positioning will result in clinically significant improvements in patient outcomes.

Custom cutting blocks are an alternative approach to improve alignment over conventional techniques, but one early study reported

ROBOTIC SYSTEMS AND CUSTOM BLOCKS HAVE SEVERAL DRAWBACKS. THEY OFTEN REQUIRE A PREOPERATIVE CT TO PERFORM THE NECESSARY IMAGE REGISTRATION,THUS EXPOSING PATIENTS TO ADDITIONAL RADIATION OVER A TYPICAL PREOPERATIVE TKA EVALUATION

that their use does not lead to improved component alignment. However, time in the operating room was less with the blocks than with conventional approaches.

Robotic systems and custom blocks have several drawbacks. They often require a preoperative CT to perform the necessary image registration, thus exposing patients to additional radiation over a typical preoperative TKA evaluation. All robotic procedures have been found to require additional surgical time in most circumstances. This raises concern about the correlation of surgical time

with infection risk. In addition, the learning curve can be substantial, with a decrease in surgical time within about 20 cases. Finally, depending on the type of registration used, there can be a risk of pain or fracture from the fixation system.

Perhaps the largest question underlying robotic surgery is the costbenefit trade-off. Incorporating robotics into a practice requires the upfront capital expenses for acquiring the robot, the additional costs for servicing the robot, and the generally increased cost of disposable equipment used for each surgery. The initial capital requirement can approach the $1 million mark for some systems. In an era of cost-benefit awareness, substantial evidence supporting improved clinical outcomes must distinguish systems that are truly beneficial from systems that support the marketing of a robotic service line.

Clinical outcomes, as assessed by WOMAC and Hospital for Special Surgery functional scores, were no different between the groups at follow-up (one year for the bilateral knee study and approximately 3.5 years for the randomised study).

Robotic assistance has the potential to be an exciting new addition to the long list of technologies that have incrementally improved the practice of arthroplasty, however newer implants have evolved with better minimally invasive instrumentation and soft tissue friendly features with infinite sizing options allowing a more natural knee kinematic range of motion.

IT@HEALTHCARE INSIGHT

Mobile device convergence in healthcare

RAFAEL HERNANDEZ Industry Marketing Leader EMEIA, Honeywell Scanning and Mobility

Rafael Hernandez, Industry Marketing Leader EMEIA, Honeywell Scanning and Mobility speaks on the growing implementation of mobile converged devices in healthcare while elaborating on the ways to enhance and optimise these technologies

S

martphones have transformed the way healthcare providers communicate, and these mobile devices are poised to revolutionise the way hospitals deliver care in 2014 and beyond.

Texting long ago surpassed voice calls as the favoured method of communication among the general population, and it is rapidly gaining favour in hospitals. Doctors and nurses already exchange patient-related texts on their own personal phones at many facilities, and as more hospitals issue mobile devices to employees, the ability to communicate quickly as well as access and update patient data on the move has become a critical function.

Deploying mobile, flexible, and reliable IT tools to caregivers is a top priority for provider organisations that not only need to meet new regulatory and technology requirements, but want to do so efficiently. At Cedars-Sinai Hospital in California, for example, the combination of smart phones and a new software solution to help priori-

tise alarms resulted in faster response times for emergency conditions, and a 50 per cent reduction in overhead pages.

Laboratory values are received 10 minutes faster and nurses are able to spend more time at the bedsides of patients who require their attention, according to a case study published by the Robert Wood Johnson Foundation.

The passage of the ‘The Health Insurance Portability and Accountability Act’ (HIPAA), Health Information Technology for Economic and Clinical Health (HITECH) Act, and the Patient Protection and Affordable Care Act (PPACA, or ACA) have established new incentives to promote technology adoption, and created new regulations related to outcomes, patient safety, and documentation. In response, hospitals and other healthcare facilities have deployed a dizzying array of technology, from electronic medical record (EMR) systems and networked med-

ical monitoring devices, to bar code scanners for medication administration at the bedside and hospital-provided mobile phones to improve team communication. While these efforts have provided improvements in patient safety and data sharing, they have also produced a patchwork of point solutions and a belt-full of hardware (pagers, pendants, VOIP phones, scanners) for nurses and doctors to carry.

In the case of EMR

systems, these technology initiatives have also produced complaints from caregivers that they are tethered to desktops or bulky workstations on wheels (WOWs) in order to update patient charts and view test results.

For nurses, this onslaught of new technology has only added to the stress and occasional chaos of the hospital floor. As an increasing number of electronic medical devices have been added to hospital rooms to help monitor patient vitals and deliver medication, the number of alarms and alerts has gone up exponentially.

This has resulted in what is known in the industry as alarm fatigue, and it can have deadly consequences.

Any visitor to a hospital can attest to the nearly non-stop barrage of beeps, buzzes and overhead pages.

Most of these alarms are not critical — an oxygen sensor may have detached from a patient’s finger, or a

wire came unplugged. According to data from The Joint Commission, as many as 85 to 99 per cent of those alarms do not actually require staff members to take any action. Clinicians begin to ‘tune out’ those alarms over time, and if a particular piece of equipment generates a high number of unnecessary alarms, nursing staff have even been known to turn down or turn off those alarms. That can result in fatalities. According to the FDA, there were more than 200 deaths linked to alarm monitoring between 2005 and 2010.

In some hospitals, alarms have been integrated with existing pager systems, but these solutions don’t provide enough alarm data for nurses to accurately gauge the severity of the alert, and may notify multiple nurses, who then have no way of knowing who else may be responding to the call.

Telemetry nurses are generally tasked with monitoring these alarms, viewing patient data on screens at the nursing station and functioning as virtual air traffic controllers when it comes to dispatching staff to respond in person.

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IT@HEALTHCARE Nurses spend time walking back and forth to the nursing station between visits to patient beds to assess patient status.

New mobile solutions are emerging that will help hospitals optimise their efforts to improve communications. Care teams are replacing old VOIP phone systems with smart phones. EMR systems now feature support for mobile devices based on Windows, Android, and iOS platforms, and some even support two-way voice queries via smart phones.

Medical devices are being integrated into hospital data networks. Providers want to consolidate these capabilities to produce tangible benefits for both staff and patients, and in a way that is more cost-effective and efficient than their legacy solutions.

What is needed is a fully integrated, converged mobile device that can allow nursing staff to access EMR information, respond to alarms and alerts, communicate with patients while on the move, scan bar coded patient wristbands and medications, and share information with other caregivers in real time.

The converged mobile device Legacy solutions have left nurses and other caregivers saddled with an array of proprietary devices including pagers, VOIP phones, bar code scanners, voice pendants, and other hardware. Migrating to a converged mobile device can lighten the load for the nursing staff, both literally and figuratively. By doing so, hospitals can reduce the complexity of the nursing IT tool belt and prevent medical errors caused by alarm and alert fatigue.

By consolidating functions on one device and providing quick access to medical records, drug information, and instant communication with physicians and co-workers, these solutions also empower nurses to make better, faster decisions. Mobility allows nurses to respond promptly to alerts and patient requests, armed with real-time chart data and medical equipment readings. They can also query

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tend to be more expensive than off-the-shelf consumer phones, but are intrinsically more durable, offering extended battery life, high-grade scanning functionality, longer service and maintenance contracts, and longer device life. The decision on which approach to take typically depends on which mobile device operating system the hospital has chosen to support, their device upgrade/refresh strategy, security requirements, remote management requirements, and their choice of mobile device management solution. physicians and other nurses much faster than they could using overhead paging and voice calls, which helps them to provide better care. These converged devices can also reduce technology complexity and costs for already overtaxed hospital IT departments that currently have to support multiple devices and systems.

For the healthcare environment, a converged mobile device is not just a consumer grade, off-the-shelf smart phone. While these applications do run on the familiar Android, iOS and Windows mobile platforms, they must include a hospitalgrade bar code scanner; provide extended battery life sufficient to last an entire shift on a single charge; be rugged enough to be dropped to concrete without shattering the display; and be able to withstand regular cleaning with caustic, hospital-grade disinfectant cleansers.

Operationally, these devices must be able to run a variety of healthcare applications and support multiple messaging platforms so that healthcare organisations can glean the full benefits of mobility. Optimally, users of a converged mobile device in a hospital setting should be able to: ◗ Receive a phone call from a doctor/clinician ◗ Send a secure text message to another clinician ◗ Scan a bar code on a patient wristband, blood bag, medication, or medical chart ◗ Enter patient data directly into the electronic medical record (EMR) system

◗ Look up a drug using a pharma application such as Eprocrates ◗ Receive and respond to alarms and alerts from medical equipment and patient rooms ◗ Talk directly to a patient who has pressed the nurse call button These devices act as an adjunct or complement to existing workstation on wheels (WOWs) solutions, which would be used for heavier documentation activities that require a full keyboard.

The combination of converged mobile devices, WOWs, and desktop systems can provide nurses and physicians with multiple entry points to the EMR, offering the flexibility to use whichever device is most appropriate to the envi-

Deploying one mobile device that allows the nursing staff to interact with doctors, patients, and other nurses, can improve both patient care and staff efficiency

ronment or situation.

There are two basic approaches to adopting true converged mobile computing in a healthcare setting and which approach a hospital selects will depend largely on their choice of mobile operating system platform. For organisations that have deployed or are planning to deploy Apple iPhones, there are protective sleds available that can provide ruggedisation, enhanced bar code scanning, improved battery life, and other capabilities. These sleds enable consumer-grade iPhones to function like enterprise-grade mobile computers and bar code scanners.

Typically, they provide additional battery power and drop protection, as well as the ability to resist strong hospital disinfectants.

By using the iPhone platform, users still have access to the familiar touch screen user interface as well as communication and telephony tools, e-mail access, and standard apps. Using the protective sleds allows these hospitals to also gain the benefits of more reliable and faster bar code scanning, along with increased durability.

For organisations with a Windows or Android-based environment, there are purpose-built, rugged nursing smart phones and other mobile devices available that provide robust integrated bar code scanners, wireless connectivity (both cellular and WiFi), and multi-application support for enterprise-grade healthcare solutions.

These purpose-built devices

Better care, lower costs Regardless of whether the facility deploys a purpose- built device or iPhones equipped with scanning sleds, deploying one mobile device that allows the nursing staff to interact with doctors, patients, other nurses, and a full suite of patient care and messaging applications can improve both patient care and staff efficiency, while simultaneously improving the overall work environment.

An emerging class of alarm management solutions that help filter the data arriving from connected medical devices in patient rooms, when combined with these converged mobile devices, can help nurses better prioritise and respond to room-level alarms and alerts. These solutions provide more detailed information directly to the nurse’s smart phone, allowing them to determine which alerts require immediate attention with a quick glance at their mobile devices.

They also have the flexibility of responding to the alert with an in-person visit, a text message, or a voice call. Many legacy VOIP phone and pager solutions did not support text messaging. With a converged device, if a patient presses the nurse call button, a nurse can call that patient directly from another part of the hospital, find out what they need, and even dispatch another staff member to handle the request via text.

By empowering the nursing staff with these mobile devices, hospitals can reduce alarm fatigue, improve patient safety

IT@HEALTHCARE and quality of care, reduce the noise created by audible alarms and overhead paging, and ensure caregivers have access to all of the information they need to complete their duties without walking back and forth to the nurses' station.

By routing nurse call requests through the smart phones, hospitals can even monitor the level of responsiveness and adjust staff scheduling accordingly. Work flows can also be automated using converged devices. Notifications can be quickly sent to nurses, physicians and other team members when patients are ready to transition from one stage of care to another, and staff collaboration can be enhanced.

By putting multiple methods of communication in the hands of clinicians and nurses

on a single device, staff can securely communicate and securely send information to each other no matter where they are in the facility. Using the messaging capabilities on the phone, staff can send and respond to queries in less time than is typically required when they rely on voice calls or physically locating the other staffers.

Consider that in many hospitals, simply asking a question of another staff member and receiving an answer may require a combination of walking the floor to search for a colleague, calls and call-backs, and overhead paging. According to a study by the Wood Johnson Foundation1, nurses waste as much as 60 minutes of each day tracking down physicians for a response. These delays can be virtually eliminated with smart

Using converged devices creates a less expensive deployment model

mobile devices. All of these factors combine to improve patient satisfaction scores.

The improvements to staff efficiency and patient safety and care enabled by this type of mobile computing solution can have a direct impact on the likelihood of physician referrals.

Using converged devices also creates a less expensive

deployment model that involves purchasing and supporting fewer devices. Instead of requiring IT staffers to maintain expertise and support capabilities for VOIP solutions, mobile computers, bar codes scanners, and other hardware and their accompanying applications, the IT department can shift to a more software/appcentric model, centrally managing a uniform fleet of mobile devices that run a variety of clinical applications in any combination appropriate for the individual user. From a cost perspective, that eliminates the expense of maintaining licensing for proprietary solutions.

Conclusion The use of mobile technology in the healthcare industry is already widespread, but as new government mandates around

outcomes, patient safety, and data security take effect, and changes in the health insurance market put more price pressure on providers, the multitude of legacy point solutions in place at most hospitals has become unsustainably inefficient and costly to support.

Converged mobile devices that leverage modern smart phone platforms and can run a variety of emerging healthcare applications can eliminate this inefficiency. Consolidating the mobile functions already in place at most hospitals — the nurse call systems, drug/ patient bar code scanning solutions, VOIP phones, pagers — onto one device with a familiar user interface can make nurses more productive and responsive, improve patient care and safety, and reduce IT support costs.

HIGHLIGHTS

Healthcare key market for fingerprint biometrics systems in India India’s fingerprint biometrics market projected to grow at a CAGR of 35.1 per cent during 2014-20 THE MARKET biometrics devices in India is growling rapidly due to data thefts, government programmes and need for advanced security systems. India is one of the fastest growing biometrics markets of the world, where majority of the market revenues are generated by government, travel and transportation application.

According to a report from 6Wresearch, the share of these industries is likely to decline due to increasing penetration and adoption in other application markets such as healthcare, banking and finance, retail and commercial offices. In India’s biometrics

market, fingerprint biometrics technology has dominated the market and is anticipated to maintain its lead in future as well. Ease of usage and higher affordability are the factors which have spurred the market for fingerprint biometrics technology in the country According to 6Wresearch, India’s fingerprint biometrics market is projected to grow at a CAGR of 35.1 per cent during 2014-20.

Sagem Morpho is the leading supplier for the fingerprint biometric systems in the government application, whereas eSSL Security accounted for majority of shipments for finger-

print based time and attendance systems. The report, ‘India Fingerprint Biometrics Market (2014-2020)’ estimates and forecast, overall India biometrics market by revenue and volume, fingerprint biometrics market by revenue, volume, application such as government, travel and transportation, banking and finance, healthcare, retail, commercial offices and others. The report also gives insights on competitive landscape, market share, product matrix, price point analysis, competitive benchmarking and positioning, latest market trends, drivers, restraints and opportunities.

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IT@HEALTHCARE INSIGHT

Technology touch for a healthy life

VAMSICHARAN MUDIAM Country Manager, Cloud Solution, IBM India/SA

Vamsicharan Mudiam, Country Manager, Cloud Solution, IBM India/SA shares his insights on leveraging technology and its advancements to enhance healthcare

I

T in healthcare has proven to be a disruptive force. Over the years, advancements in technology have grown at an exponential rate, driving enormous value for providers and patients in India. Healthcare solutions, technology and consulting from IT organisations are enabling the healthcare industry to achieve greater efficiency within their operations; collaborate to improve outcomes; and integrate with new partners for a more sustainable, personalised and patient-centric system focused on value.

The healthcare ecosystem is the convergence of otherwise separate entities, such as life sciences organisations, providers and payers, as well as social and government agencies. This convergence, along with enhanced connectivity and mobility, has resulted in a tremendous surge in healthcare related data that can provide insights and inform actions.

Data is growing and moving faster than healthcare organisations can consume it.

Researchers estimate that health information is doubling every five years, and 80 per cent of medical data is unstructured but clinically relevant.

This data resides in a variety of places like lab and imaging systems, physician notes, medical correspondence, online portals and social media

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communities, insurance claims, CRM systems and finance.

Healthcare challenges in India, such as providing care to an increasing population, patients residing in remote locations, chronic illnesses and revolutionary but expensive treatments, are burdening the healthcare and pharma system in place. The massive amounts of data and ever expanding treatment options are making it difficult to balance patient care with controlling operational costs. Additionally, market forces and policy reforms around the world are putting pressure on health systems to provide better health outcomes to more patients - at a lower cost.

A way to accomplish this is to make better use of health information and mine it for new insight. The combination of mobile, cloud and Big Data technologies are making a mobile health ecosystem possible while putting the patient centre-stage. Coupling the power of mobile devices and cloud technologies, based on open standards, is enabling health systems around the world to awaken to an entirely new way of delivering health services more efficiently.

For example: In the current healthcare scenario, one can visit four hospitals and receive four different courses of action.

Hospitals need help amalgamating treatment data, tracking outliers, assessing risks

and applying financial analysis to procedures and processes.

Big Data analytics helps hospitals analyse patients’ data and standardise the way to deal with medical issues. It is known as evidence-based medicine and is enabling hospitals to better predict disease risk, improve medication adherence, and take pre-emptive measures before patient’s condition deteriorates.

A new wave of healthcare professionals who prefer to work with mobile devices parallel an increasing number of consumers using mobile apps to monitor their own personal health. The healthcare providers can now take a mobile-first approach to drive increased efficiency and most

importantly, deliver better patient care. By combining smart phone features with relevant data on the go, an ecosystem of healthcare providers, partners, vendors, patients and clinicians can quickly, easily and securely share authorised images, patient health information, test results and any other necessary medical information.

Cloud technologies are enabling hospitals and pharma companies to adopt systems for a mobile audience and provide avenues to tap into critical data from anywhere, at any time and any device. All this while keeping operational and capital expenditure outlays to the minimum and providing a back-up resource to scale oper-

ations up or down as and when required. For instance, pharma companies often encounter seasonal peaks and troughs in their business. The “pay-asyou-go” cost structure of the cloud model help organisations align their IT needs according to the demands of the business.

In a mobile/cloud-centric health ecosystem, geography will no longer present an obstacle to deliver diagnosis or even treatment. The constraints of physical location and the high costs of maintaining hospital facilities will be eventually mitigated. Instead, care will be moved into whatever location that best suits the patients and their circumstances, be home, office or primary care environment.

The private-sector health IT industry has aggressively invested billions of dollars in new technologies, using advances in cloud computing, big-data analytics, and naturallanguage processing to create advanced and sophisticated systems that turn a "data deluge" into insights leading to better care for patients. Communities that transform their healthcare system with ambition, vision and innovation will outperform and attract new businesses, jobs and foster economic development. These communities have the opportunity to leapfrog their peers while encouraging care that promotes access, lowers costs and increases quality.

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HOSPITAL INFRA FAQs ON HOSPITAL PLANNING AND DESIGN | MEDICAL EQUIPMENT PLANNING | MARKETING | HR | FINANCE | QUALITY CONTROL | BEST PRACTICE

ASK A QUESTION What is the significance of conceptual drawings?

◗ EQUIPMENT PLANNING SERVICES

DR ANURAG BASU, Howrah

Conceptual drawings are based on the client’s brief and the government norms. They would be made on the proposed project and discussed with the client.

These drawings would detail: ◗ Locational “block relationship” of various departments ◗ Floor wise layout ◗ Mapping of vertical and horizontal circulation (elevators, staircases and corridors) ◗ Site location in the area, roads, parking etc.

What is the scope of market research?

DR DEENU DAYAL, Allahabad Scope of market research should cover the: ◗ Objective of the assignment ◗ Healthcare scenario of the area ◗ Profile of the area/city/state ◗ Primary data analysis ◗ Current market research What are the steps of equipment planning in a hospital?

SAKET JAIN, Bhopal

Phases in equipment planning are: ◗ MEDICAL EQUIPMENT PHASES Phase 1 — Medical equipment planning Phase 2 — Equipment specification Phase 3 — Vendor development Phase 4 — Technical and cost comparators Phase 5 — Negotiation and ordering of medical equipment Phase 6 — Installation and commissioning

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What are the operational activities of a hospital on a day-to-day basis?

LEELA DAYAL, Delhi

Day-to-day operational activities of any hospital would include the following points: ◗ Day-to-day operations management ◗ Corporate relationship management ◗ Identifying key areas for business development ◗ Streamline the operations ◗ Delegation of authority ◗ Customer relationship management/Customer service ◗ Manpower management (clinical and non-clinical) ◗ TPA co-ordination ◗ Patient screening ◗ OPD/IPD management ◗ Billing/admission/discharge management ◗ Inventory management ◗ Quality management ◗ Record maintenance etc.

I am planning a 500-bedded hospital, how can I do

manpower planning for it?

DR SAXENA Ahmadabad

Workforce planning is a systemic process to ensure that an organisation has the right talent at the right location to enable innovation and cost optimisation.

An effective workforce plan should: ◗ Align to business strategy ◗ Identify the changing needs of workforce in the near future, potential gaps, innovation and cost ◗ Depend on the area and what kind of department is available at your hospital ◗ Consider processes and changes that will impact the ability to attract and retain key talent For planning and proper implementation of manpower planning you can go for consultancy firms.

It will save your time, energy, cost and will give you accurate results.

TARUN KATIYAR Principal Consultant, Hospaccx India Systems

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

LIFE PEOPLE

Dr HS Chhabra to take over th as the 15 President of ISCoS

Gagandeep Singh takes charge as Fortis CFO

He is the first Indian to be elected to this post DR HS CHHABRA, Chief of Spine Service & Medical Director, Indian Spinal Injuries Centre was recently elected as the President Elect of International Spinal Cord Society (ISCoS) during the Annual ISCos meeting held in Maastricht, Holland.

He will take over as the 15th President of the Society in 2016, thus becoming the first Indian to be bestowed this designation.

Dr HS Chhabra was bestowed with the Society Medal last year. He is also the Chair of the Prevention Com-

mittee of ISCoS. He has pioneered the ISCoS database: ASCoN Pilot Project which would help collect data with a view to implement prevention programmes and is the Editor-in-Chief of the forthcoming ‘ISCoS textbook on Comprehensive Management of Spinal Cord Injuries’ in which 80 chapters under 10 sections are being contributed by 60 authors. The book would be launched and released globally during the ISCoS Annual Scientific Meeting in Montreal in May 2015.

He has successfully com-

pleted two tenures as Chair of Education Committee of the Society (2008 to 2010 and 2010 to 2012) during which he was instrumental in launching the elearnSCI.org project as its Chief Coordinator and Editor-elearnSCI.org. elearnSCI.org is a web-based educational resource for all health professionals, involved in spinal cord injury management. It specifically addresses the problems related to the limited access of up-to-date SCI training and learning materials and resources and also addresses the current lack of

professional development opportunities for practitioners working in SCI management and rehabilitation.

ISCoS (formerly International Medical Society of Paraplegia) promotes the highest standard of care in management of spinal cord injury throughout the world.

Through its medical and multi-disciplinary team of professionals, ISCoS endeavours to foster education, research and clinical excellence.

ISCoS has a membership of over 1,000 clinicians and scientists from 87 countries.

HOSPITAL CHAIN, Fortis Healthcare has announced that Gagandeep Singh Bedi has been appointed as its new CFO. "The Board of Directors of the Company at its meeting held on September 24, 2014 has appointed Gagandeep Singh Bedi as the Chief Financial Officer of the Company with immediate effect," informed Fortis Healthcare in a BSE filing.

Bedi's appointment was announced after his predecessor Sandeep Puri resigned from his post in the beginning of September.

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TRADE & TRENDS

Swati Bagga: In pursuit of society’s welfare Swati Bagga, a second-generation entrepreneur is all set to take her father, Sushil Bagga’s legacy, the SB Group of Companies to greater heights with the pan-India launch of multinational medical giant, Welfare Medical in India A WOMAN who wears many hats- the young and dynamic, Swati Bagga is the Executive Director of SB Group Of Companies and Director-Marketing for Welfare Medical India.

A second-generation entrepreneur, she is the daughter of Sushil Bagga, Chairman and MD, SB Group of Companies.

With a strong educational background, Swati, a Bachelor in Business Administration (BBA) from IILM, New Delhi and MBA with specialisation in Marketing & Information Technology, from University of London (UK), is a talented young lady who has also mastered several forms of cultural activities. Right now, she has her hands full with the responsibility to launch the multinational “Welfare Medical” throughout India.

Swati’s first innovative venture was in the year 2006 when she started Sunrise Afforest & Bio –Fuel Development Industries, under the Banner of SB Group. Her primary focus was biofuels, also known as green fuel and afforestation in Madhya Pradesh with a huge land bank. With a futuristic vision, Swati’s primary aim was to produce soya and green fuel to save the environment from harmful chemicals. Through

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her company, she was also successful in generating rural employment for the locals.

Swati draws this inspiration from her training as a certified F1/F3 racer driver. A determined and passionate young lady, she is the only woman owner of the Supercar Prancing Horse “Ferrari” and The British Leopard Jaguar “F - TYPE” in India.

However, this 28-year-old, is not only passionate about swanky cars but also knows the technicalities by-heart.

She has a diploma in advanced motor sports development and racing technology and is trained by W.R.C racers from the ‘World Racing Champion’ league under MRF Racing School. As a teenager, Swati won numerous racing competitions in India and also various national karting championships, before she emerged as a trained racer.

She has also been awarded the youngest “winning racer” who set the fastest time in the prestigious Race of Champions –I, II & III (R.O.C) The only Indian woman to have completed training at the BMW, M Power Drive held at the Buddh International Circuit on BMW M Series Cars (Sports Performance) in 2012, Swati was yet again the only woman driver, driving

the Italian legendary bull Super Car “Lamborghini Gallardo” at Lamborghini Track Day, held at Buddh International Circuit making a lap record at the speed of 270 kms/per hour (Kph).

Currently, with a strong marketing team, Swati is ready to drive the launch of the multinational medical giant, Welfare Medical in India.

“Looking at the current healthcare scenario of India we are resolute on providing the best medical solutions at a very reasonable price. Our company’s aim is to provide the country with world-class medical products. We believe in high quality products which

With a futuristic vision, Swati’s primary aim was to produce soya and green fuel to save the environment from harmful chemicals

are cost effective,” says the new entrepreneur on the block.

Welfare Medical comes with a wide series of products in the range of -: ◗ Surgical Stapling Line ◗ Minimal Invasive Technology ◗ Ligating Devices ◗ Anaesthesia – Critical Care Confident about her inventive marketing tactics, Swati aims to project Welfare Medical India as the “One stop shop” for all medical devices.

“The company’s objective lie in the welfare of the society and because of the same the company is named Welfare Medical India. We have performed extensive research, with in house testing/quality testing, before we launched our company worldwide. Now we are fully equipped to beat any challenge that comes our way. Our products are in compliance with international standard regulations and they are produced under state-of the-art quality standards,” says Swati Bagga.

“We pledge to serve the country with full determination so that the people can invest their trust in us without any hesitation and take our name with full confidence. We are also working towards launching more cost-effective

products under our banner which will be available soon in the market,” Says the idealistic business -woman.

As a confident child, Swati, was a very popular face in the Indian modelling circuit. She appeared in various commercials for several national and international brands. She was also the chosen face to launch the Kellogg’s Cornflakes in India. Furthermore, the award winning filmmaker, Mira Nair also approached Swati for her movie Salaam Bombay, which she had to refuse, as education was her priority at that time. A multi-tasker, Swati has many awards and merits to her credit. She was a badge holder of “The Most Admired Student” during her school days at DPS Mathura Road and Modern School New Delhi.

Swati has been the guest of honour for UNICEF India. At the tender age of 10 she was approached to deliver a speech to the Lt Governor of Delhi, Dave, for the upliftment of the girl child and their rights. A woman with many feathers in her crown, Swati’s current mission is to commence a successful drive for Welfare Medical India and make it the most prestigious name in the field of medical products.

TRADE & TRENDS

Advanced clinical parameters in haematology analysers

KANCHAN JESWANI Product Manager-Hematology, Transasia Bio-Medicals

Kanchan Jeswani, Product Manager-Haematology, Transasia Bio-Medicals elaborates on the role of haematology analysers in improving diagnostic capabilities in healthcare TODAY’S HAEMATOLOGY analysers offer diagnostic capacities which go well beyond the scope of routine screening and so offer even greater patient safety. While routine haematology is a given in all analysers, specialty testing is possible now for platelets, immature cells of all three cell lines and body fluids. One can also individualise testing by using clinical applications to streamline further analysis and treatments, thus improving cost efficiency. As the technology advances so does the availability of new analysers with advanced clinical parameters. Few such clinical parameters are NRBC enumeration, immature granulocyte, immature platelet fraction, and reticulocyte haemoglobin, among others:

XN 1000

XN-1000 Cellavision DM96

Nucleated Red Blood Cells (NRBC) The routine determination of NRBC with every CBC replaces the manual white blood cell correction and ensures a reliable corrected white blood cell count, even at high cell concentrations. It also helps in early recognition of additional critical developments, even at low cell concentrations. It is a prognostic marker for disease severity or progression, e.g. in the case of intensive care patients or those undergoing transplantation and in neonates. NRBC enumeration gives a better assessment of ineffective erythropoiesis and severity in thalassemia or sickle cell anaemia thus aiding in optimising blood transfusion.

Immature Granulocyte (IG) count IG provides a valuable tool for physicians for concluding a di-

XN 3000

agnosis or requesting further patient investigation. With the exception of blood from neonates or pregnant women, the appearance of immature granulocytes in the peripheral blood indicates an early-stage response to infection, inflammation or other stimuli of the bone marrow. Being able to detect them quickly and reliably opens doors to new diagnostic possibilities for related disorders. The determination of circulating immature granulocytes aids in early and rapid discrimination of bacterial from viral infections particularly in children, detecting bacterial infection in neonates, and the early recognition of bacterial infection and sepsis in adults, which is of vital importance in particu-

lar for intensive care patients.

The IG count of paediatric patients, especially premature neonates or neonates younger than seven days, has to be taken with care due to their immature immune systems and the greater number of immature cells in the circulating blood.

Immature Platelet Fraction – IPF The Immature Platelet Fraction (%IPF) is a modern parameter that measures young and thereby reticulated platelets in peripheral blood.

IPF levels rise as bone marrow production of platelets increases. Therefore its measurement provides an assessment of bone marrow platelet production from a pe-

ripheral blood sample, in a way similar to how a reticulocyte count provides a measure of red cell production. It is particularly useful for supporting the diagnosis of autoimmune and thrombotic thrombocytopenic purpura, and for distinguishing these from bone marrow suppression or failure. In the case of the latter, the %IPF value would be low. The %IPF can also be a sensitive measure for evaluating thrombopoietic recovery during aplastic chemotherapy. In some specialist hematology and cancer centres, for instance, %IPF is taken into consideration in platelet transfusions. Transfusions may only be considered when the %IPF values are not rising as this would in-

dicate poor intrinsic thrombopoietic activity. Its usefulness in monitoring after chemotherapy and haematopoietic stem cell/ bone marrow transplantation has been suggested.

Reticulocyte Hemoglobin Equivalent – RET-He Measuring the haemoglobin content of reticulocytes, RETHe (Reticulocyte Haemoglobin Equivalent), is a way of diagnosing and monitoring iron deficiency anaemia . It can indicate whether there is enough iron available for erythropoiesis and gives an indication of the quality of erythropoiesis.

It is often used for patients with nephrological disorders, Anaemia of Chronic Disease (ACD) {chronic inflammatory

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TRADE & TRENDS process, chronic infection}, Iron Deficiency Anaemia (IDA) and paediatric patients developing IDA due to the growth phase. Ret-He Indicates the trend of the current iron status. It is often used together with ferritin. A high or normal ferritin value alongwith a low RET-He value can suggest functional iron deficiency while low ferritin values alongwith low RET-He suggest a classic iron deficiency. Since ferritin is falsely increased during the acute phase of diseases, inflammation should be checked, e.g.

by CRP. RET-He is used for

monitoring erythropoietin (EPO) and/or IV iron therapy.

If the value increases it indicates the therapy is having a positive effect.

The clinical usefulness of the Ret-He parameter has been proven and it is now an established parameter in advanced haematological analysis. 'Reticulocyte haemoglobin content' is recommended in nephrology guidelines such as the European Best Practice Guidelines (EBPG), National Kidney Foundation Kidney Disease Outcome Quality Initiative (NKF KDOQI).

Manual cell counts, smear preparation, manual staining are replaced and giving way to automated haematology analysers

Red cell Precursor Nucleated Red Blood Cells (NRBC) Immature Granulocytes (IG) Immature Platelet Fraction (IPF) and Reticulocyte Hemoglobin Equivalent (Ret-He) These advanced reportable parameters of clinical significance are now available in Sysmex XN Series instruments to help doctors provide better healthcare for patients.

In addition, Haematopoietic Progenitor Cells (HPC) percentage is also available in XN20 models which is helpful in haemopoietic stem cell transplantation.

Manual cell counts, smear preparation, manual staining are being replaced and giving way to automated haematology analysers with parameters and slide maker and stainer. Manual differential counts on peripheral blood and body fluids can also be automated on an analyser such as Sysmex Cellavision DM96 with pre- classification of leucocytes, pre characterisation of parts of red cell morphology, platelet estimation, verified by medical technologist and preparation of digital slides, if required.

Riester launches latest stethoscope at Medicall 2014 The technology and clarity of Riester’s stethoscope got the attention of the key opinion leaders in the medical industry of South India RIESTER INTRODUCED the latest stethoscope in India at the Medicall 2014 show. The 12th Medicall Expo was held in Chennai from August 1-3, 2014.

Medicall is India’s premier hospital needs and equipment exposition and the biggest of its kind in India.

Medicall brings the latest, appropriate and affordable technologies, for the benefit of all hospitals including smaller hospitals, clinics, nursing homes and physicians setting up group practice. The annual conference saw over 10,000 doctors, medical professionals and related people attending the conference and expo.

Riester’s new stethoscope with constructed cardiophon 2.0 and duplex 2.0 assign nothing less than a quantum leap in the quality of acoustics. Auscultation (listening to the internal sounds of the body) is significantly disturbed by interfering side noise. Therefore during the construction phase of the cardiophon2.0 and the duplex

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2.0 special attention has been paid to the design of the binaural and the ear-tips. The contact pressure of the binaural can be adjusted individually; the ear-tips are pivotable and made of extra-soft material. Altogether the ear canal is perfectly sealed against external side noise. In addition, disturbing noise due to the friction between the ear-tips and the ear will be avoided, even if the stethoscope is moving.

Riester stethoscopes are manufactured to an uncompromisingly high quality standard.

The production of the binaural for example is automated. This guarantees a perfect production of the binaural at the ear.

The chest-pieces are manufactured using latest CNC-technology to minimise any tolerances – a precondition, which allowed the novel sound pickup system of cardiophon 2.0 and duplex® 2.0. The continuously high level of quality is guaranteed by multiple quality checks under our 1SO:9001

quality management along with the trademark German art of precision.

For such a regular but key diagnostic tool, the technology and clarity of Riester’s stethoscope got the attention of the key opinion leaders in the Medical industry of South India. Riester’s presence at Medicall through their channel partner

‘Naik Meditech’ saw the exhibition booth being visited by key doctors and professionals from the Apollo, SRM TVS group, Manipal GKNM, and many other prestigious groups in the four southern states of India.

Govardhan, the Senior Sales Manager for South East Asia/ India/ Gulf had this to

says, “Riester’s products are crafted with typical German precision and a lot of attention is given to every minute aspect of the product design and manufacturing. Riester’s products are the best tools that doctor can depend on for precise diagnosis. A premium product with proven reliability, it is also user friendly. No wonder many medical professionals are staunch loyalist of Riester range of products. With the launch of the stethoscope, we intend to bring a change in the very basic tool that every doctor depend on.

Contact Sunil Balan Marketing Manager Halma India B-1, Boomerang, Chandivali, Andheri (East), Mumbai – 400 072 Board : +91 22 6708 0400 Mobile: +91 77381 61211 E-mail : sunil.balan@ halma.com Website: www.halma.com

TRADE & TRENDS

Japanese protective wear for healthcare staff to handle Ebola HOGY’s unique five-layer precaution set to be made available in India by Medinippon MEDINIPPON HEALTHCARE, an Indian company with Japanese equity has introduced personal protection equipment (PPE) in India. It is made with Japanese technology for protecting the healthcare personnel from life threatening contagious diseases such as Ebola haemorrhagic fever.

The PPE is made of a unique Tigalyer & Surrem technology

by HOGY Incorporation, Japan. The protective gear comes with significantly high fluid and pathogen barrier while allowing the wearer to

comfortably work wearing it.

The water repellant nature of the PPE and the anti-fog coated goggles give the utmost protection and comfort to the doctors and paramedical staff while handling contagious materials or screening people in the airport or patients with suspicious infection in the hospital or isolation units, said K Balasubramaniam of Medinippon.

Sterile surgical gowns with five layer Tigalyer & Surrem finishing for surgeons and scrub nurses will also be soon made available in India said

Katsuo Sasaki

Katsuhiko Sasayama

Sasaki, Technical Director, Hogy Incorporation, Japan. In Japan, 80 per cent of the surgeons and nurses use HOGY sterile gowns during surgical procedures and the Japanese healthcare personnel who handle contagious materials use

our PPE because there are no pin holes like the regular machine stitched gowns. Our gowns are sealed by ultrasound technology and therefore the body fluids will not come into contact with the surgeons and scrub nurses, if they use HOGY

products, providing them a total protection from life threatening viral diseases such as Ebola which spread by body fluids, if the wearer sticks to the appropriate wearing, removing and disposing protocols, he added.

According to Sasayama, Global Sales Head, HOGY, Japan, the demand for their product after Ebola outbreak has increased tremendously and physicians performing interventional procedures such as Endoscopy also have started using the protective wear nowadays.

Contact K Balasubramaniam, Mob: +91-9884900198; Email: mail@medinippon.jp website: www.medinippon.com

Disposable gloves market see boom in healthcare sector: Frost & Sullivan Marked improvement in awareness adds thrust to the market growth THE FRENETIC pace of economic growth in Asia-Pacific is enhancing consumer awareness about products, which, in turn is leading to better compliance and uptake of disposable gloves. A thriving healthcare sector, particularly in Southeast Asian countries, has been a shot in the arm for the market.

New analysis from Frost & Sullivan, Analysis of the AsiaPacific Disposable Gloves Market, finds that the market

earned revenues of more than $309.8 million in 2013 and estimates this to reach $435.7 million in 2018. Australia and Indonesia are the two key revenue contributors. The study covers the product segments of surgical and examination gloves, industrial gloves, automotive gloves, critical environment gloves, food industry gloves and retail gloves.

Countries such as Thailand, Malaysia and Singapore have emerged as medical tourism

hubs and expectedly, there is a discernible rise in the availability of medical insurance facilities and number of hospitals.

This growth, along with the large population in these countries, has augmented the demand for medical disposable gloves, which constitute at least 50 per cent of the total number of disposable gloves sold, globally.

“Being highly price sensitive, the market holds considerable potential for glove manufacturers that are able to deliver quality products at affordable rates,” said Frost & Sullivan’s research analyst. “As the region is home to a number of low-quality manufacturers

that compete on price, the competition is stiff.”

Despite their cost consciousness, consumers are willing to test out new products such as nitrile gloves due to the allergic reactions common to traditional latex gloves. Nitrile gloves have proven to be far superior to rubber gloves due to their high resilience, higher elasticity and elastic memory, and less propensity to wear and tear.

“Already, more than 30 per cent to 35 per cent of all disposable gloves sold in the region are nitrile,” noted the analyst.

“The higher adoption rates and prices of nitrile gloves are boosting the overall revenue

growth rates of the disposable gloves market.”

With the regulatory environment becoming stricter and higher proliferation of media and various sources of information, industries, employees, and management are acknowledging the need for quality disposable gloves. The influx of educational material will continue to highlight the value of using the appropriate type and quality of gloves for each application. Overall, the market is exhibiting high growth prospects due to the improving awareness regarding health and hygiene, compliance levels, and economic outlook for countries in the region.

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

‘Our products meet the stringent requirement of healthcare professionals’ Retd Commander Manoj Kumar, CEO, Hitex Healthcare talks about his company's offerings for India's healthcare sector and its future plans, in an interaction with Express Healthcare How long have you been operating in the Indian healthcare market?

Hitex Healthcare was established in India during 2011, under technical collaboration with DINAHITEX, Czech Republic, a leading European manufacturer since 1992 of medical disposables and nonwoven medical textile products. All their products are CE certified for conformance with the council directive 93/42/EEC on medical devices and other harmonised standards as per Czech and EU regulations.

Their factories are certified according to ISO 9002, ISO 14001:2004 and ISO 46002 compliant with ISO 13485 Quality Management Systems. Hitex Healthcare is a part of Dina International, having its global headquarters at Moscow, Russia. The group’s turnover is more than $100 million. Dina International has many verticals like turnkey hospital projects, trading, manufacturing etc.

How are your offerings suited for the Indian healthcare scenario?

Healthcare in India is changing at a fast pace.

Reputed hospitals are going in for accreditation like NABH. Our products meet the stringent requirement of healthcare professionals and play a role in bringing down cases of hospital acquired infections (HAI), infant/maternal mortality rate (MMR/IMR), surgical site infection etc. Our drapes/

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gowns etc are made of medical grade laminates and non-woven fabric as per international standards. They have far superior barrier control as compared to conventional drapes/gowns etc made of linen.

What are the USPs of your products which make them the right choice for infection control in hospital settings?

We have the complete range of drapes, gowns, accessories etc for each type of procedure which can create a sterile field which is essential to provide a barrier to passage of microorganisms and hence reduce chances of infection.

The USP of our product can be divided under three headings: ◗ Raw material: We manufacture our own laminates at Czech Republic.

Usually hospitals end up using disposable drapes made of SMS, spunlace or spunbond non wovens which do not provide 100 per cent protection against strikethrough. Bi-laminates and trilaminates ensure best safety in OR. Hospitals across the world are shifting from linen to SMS, and from SMS to laminates. These laminates are impermeable and provide complete protection against body fluids such as blood, pus, saliva etc. We source other raw material like SMMS from world leaders, Ahlstrom. All other components are sourced from reputed manufacturers having requisite certifications. ◗ Production: We have invested in class 100,000 D clean room facility at our Una

Our client list extends from government hospitals like AIIMS, PGI Chandigarh, Armed Forces Command Hospital etc to private hospitals like Fortis and Max

plant which is validated through accredited laboratories on regular interval. We have imported semi-automatic drape making machine which is probably one of its kind in India. Our production team has been trained by European professionals and we manufacture in accordance with ISO 13485 and EN 13795 standards. With unique fluid collection pouches and proper folding of the drapes, it becomes easy for OR staff to drape the patient in a very less time and can save precious time in the OR. Saving OR time translates to higher revenue for the hospitals. We have tied up with Microtrol Sterilisation for sterilisation of our products. ◗ Technical knowhow: We have technical collaboration with Dina Hitex which is one of the leading manufacturers in the European market. We have the distinct advantage of launching products which have been developed by the R&D department of Dina Hitex.

How are your products adapting to the changing requirements in healthcare?

Customisation plays a crucial role! As surgical procedures have been changing, we also have kept pace with the changes and customised our products to suit the surgeons’ requirements. Our computerised drawing and production system is flexible enough to incorporate the changes required in the final

product. Our tie up with leading surgeons at key hospitals provide us continuous inputs on the latest trends in the healthcare industry.

Who are your clients in India?

Our client list extends from government hospitals like AIIMS, PGI Chandigarh, Armed Forces Command Hospital etc to private hospitals like Fortis, Max etc.

In addition, small nursing homes, maternity centres etc are also our regular customers. Apart from India, our products are also being used at leading hospitals in Nepal, Mauritius etc. Recently, we have started operations in Bangladesh. Further, we have exported more than 25. 40 ft containers to Europe.

Are there any new products that you plan to introduce in the Indian market?

We will be starting production of gowns using Ultrasonic Sealing technology.

Further, we plan to launch Customised Procedural Trays (CPTs) for the Indian market.

We are doing good volumes in these products in Europe and we believe that CPTs will perform well in India as well.

One of the researches currently in progress is to use modified cellulose in drapes.

Dina Hitex has tied up with a leading medical research company in France and has started marketing the advanced Margin Drapes in Europe. We will launch Margin Drapes in India at an opportune moment.

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, POSTED AT MUMBAI PATRIKA CHANNEL SORTING OFFICE.