VOL.7 NO.12 PAGES 106
Market Is it the right time to invest in Bahrain? Knowledge Stem cell therapy to treat brain injury LIFE Caregiving simplified
www.expresshealthcare.in DECEMBER 2013, `50
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INSIGHT INTO THE BUSINESS OF HEALTHCARE
VOL 7. NO 12,DECEMBER 2013
Chairman of the Board
CONTENTS
Viveck Goenka Editor
KNOWLEDGE
Viveka Roychowdhury*
Stem cell therapy to treat brain
Assistant Editor
injury
Neelam M Kachhap (Bangalore)
PAGE 27
Mumbai
Embryoscope enables the doctor to analyse
Sachin Jagdale, Usha Sharma,
the embryo quality and select only the best
Raelene Kambli, Lakshmipriya Nair,
embryo’
Sanjiv Das
PAGE 29
‘IBS is associated to impaired quality of life
Delhi
and high healthcare costs’
Shalini Gupta
PAGE 29
‘The gap between healthcare supply MARKETING
and demand is enormous in India’
PAGE 30
Deputy General Manager Harit Mohanty Assistant Manager
RADIOLOGY
Kunal Gaurav
Fujifilm Sonosite conducts workshop on Ultrasound Assessment of Shock PAGE 36
PRODUCTION
Jaslok Hospital conducts 320 successful
General Manager B R Tipnis
MRgFUS treatments
Manager
Piramal Imaging enters into a strategic
Bhadresh Valia
PAGE 37
partnership with Ci-Co Healthcare
PAGE 37
Senior Executive Scheduling & Coordination
IT@HEALTHCARE
Rohan Thakkar Photo Editor
‘The system is a very affordable,
Sandeep Patil DESIGN Deputy Art Director
PAGE 11
into most companies’ budgets’ PAGE 38
MARKET
‘Everything you write is instantly
Surajit Patro
Xcode wins $30,000 grant from GC-TBC programme PAGE 17
Chief Designer
ConvaTec & Narayana Health in collaboration
electronically recorded’ PAGE 39
PAGE 17
Pravin Temble Senior Graphic Designer Rushikesh Konka Layout Vivek Chitrakar
HOSPITAL INFRA
Healthspring launches seventh community medical centre in Vashi, New Mumbai
PAGE 18
CII and MCGM join hands to fight diabetes in Mumbai PAGE 19 Narayana Health launches rural cancer surveillance program
CIRCULATION
PAGE 19
Transasia Bio-Medicals provides diagnostic setup at Reliable Hospital
Circulation Team Mohan Varadkar
reliable and a proven technology that will fit
RAHI Care to set up nephrology centres through PPP
PAGE 20
PAGE 20
Strengthening the foundations PAGE 42 Dynamics of hospital design PAGE 46 Building healthcare infrastructure: The new approach PAGE 53 4th edition of HBI to highlight growth potential of hospital infra sector PAGE 54 ‘We expect that over 3000 professionals will attend the three-day event’ PAGE 54
Sanofi and PVR Nest partner for ‘Healthy Children, 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 news under 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.
DECEMBER 2013
happy children’ initiative PAGE 21 ‘This collaboration aims to make the treatment of cornea surface disease more accessible’ PAGE 22 Philips Innovation Campus observes ‘World Prematurity Day’ PAGE 23 Bangalore Baptist Hospital conducts Master trainer's workshop on healthcare communication PAGE 23 IHS conducts webinar on 'Assessing Global Healthcare Market Access Risk' PAGE 24
LIFE
CT Fest 2013 gets a good response PAGE 25
Caregiving simplified PAGE 65 People PAGE 66
www.expresshealthcare.in
EXPRESS HEALTHCARE
7
EDITOR’S NOTE Balancing cost, quality and patient safety Private equity (PE) players continue to bet on the
ASIA'S GDP IS GROWING AT EIGHT PER CENT ANNUALLY, COMPARED TO OECD GROWTH RATE OF TWO PER CENT, MAKING FOR ROBUST FUNDAMENTALS. THIS HAS CREATED A PREDICTABLE, DEFENSIBLE, YET FAST GROWTH INVESTMENT ENVIRONMENT
governance practices as well.
Indian healthcare delivery sector. And why not,
And indeed, this would be an idea whose
since the sector is one of the rare ones expecting
time has most definitely come. Most PE investors
to grow at a very healthy 22 per cent annually,
insist on a fair amount of hand-holding to help
slated to touch $160 billion in five years.
start ups evolve to the next level. Primary
In fact, savvy PE players who latched on the
healthcare chain, Wellspring Healthcare was one
sector very early in its growth cycle have seen
of the first to attract such funding and even
valuations almost double in the past five years.
though their basic idea seemed quite outdated at
For example, Singapore-based healthcare focused
the time (rejuvenation of the idea of a family
PE firm, Quadria Capital is reportedly set to buy
doctor), their business model and clinical
ICICI Venture's 67 per cent in Kolkata-based
procedures have stood the test of time. The
Medica Synergie. As per media reports, the deal
same will happen for newer start ups like Pune-
is worth Rs 160 crores, almost double the Rs 90
based MyDentist which aims to set up a chain of
crores that ICICI Venture paid in 2007 when it
dental care clinics.
acquired stakes. If this deal goes through, it will
But success always starts with a blueprint, a
be one of the biggest in the sector and could be
sound infrastructure which can stand up to due
a rain-maker of sorts.
diligence. And much of this infrastructure lies in
Quadria has already invested in the Indian
the physical set up of hospitals. Today, hospital
healthcare assets when it bought out Milestone
infrastructure is a booming business yet fraught
Religare's portfolio which included cancer clinic
with many challenges. Still the projected growth
chain Healthcare Global Enterprises and KIMS,
and returns of this sector are too promising;
a multispeciality hospital. In fact its website
besides the fact of course, that we as a nation,
spells out the obvious. Asia's GDP is growing at
will need to put in place a system to meet the
eight per cent annually, compared to OECD
healthcare needs of our population.
growth rate of two per cent, making for robust
With PE and other sources of funding
fundamentals. This has created a predictable,
entering the sector, we hope that the urge to cut
defensible,
corners will reduce because this has been a
yet
fast
growth
investment
environment and many players like Quadria are bound to invest more heavily in the future as well.
major tripping point in the past. In fact, this is the theme of the conference at the upcoming Hospital Build & Infrastructure
Many more such deals were struck in the past
India
Expo
(HBI):
'Healthcare
systems
year: Kids Clinic ($16 million from Sequoia
design/operations for ensuring patient’s safety
Capital), Ivy Health and Life Science ($12 million
disaster mitigation and quality care'. Going with
from DEG) and Fortis Healthcare ($100 million
the theme, this issue of Express Healthcare has a
from IFC). It is good news that many gaps in
special hospital infrastructure segment, with
India's healthcare delivery chain are being
industry experts giving their views on the best
financed by such deals. As PE players are known
practices to balance cost with quality without
to track their investments with an eagle's eye,
compromising patient safety. Here's hoping that
we hope that along with finance they infuse
the event gets this message out to as many
sound management principles and corporate
stakeholders as possible. Viveka Roychowdhury viveka.r@expressindia.com
8
EXPRESS HEALTHCARE
www.expresshealthcare.in
DECEMBER 2013
Health and hygiene are a clear priority for the healthcare sector, but it’s also important to create a comfortable environment for patients, and good working conditions for staff. Tarkett has a solution for every area, from brilliant colours for children’s wards to static-control for an operating theatre, from traffic and stain-resistance for reception to slip-resistant and waterproof floors. Hygienic and ultra-hard, easy to clean and maintain, our floors offer optimum return on investment while reducing staff workloads and improving patient comfort and care. www.tarkett.com
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Letters QUOTE UNQUOTE
Informative article Your recent article EHR penetration is growing at 13.5 per cent is very helpful to a company like ours. Got details about healthcare IT penetration in India. Please do post such articles frequently. Pushkar Sadalagi Marketing Executive Axiom Healthcare IT Consulting Bangalore
helps us to gather information about the changes and development of healthcare industry and in particular that of the delivery sector of this industry. Your editorial column of November -2013 issue, where you have commented on the correlation in-between Dr Saha’s wife death and the tragic death of 93 patients due to fire at AMRIDhakuria is really worthy and in one word - marvelous. Please keep it up !!
A worthy magazine I am a regular reader of Express Healthcare and we have subscribed the same for our library. It really
INSIGHT INTO THE BUSINESS OF HEALTHCARE
Head Office Kunal Gaurav The Indian Express Ltd., 1st Floor, Express Towers, Nariman Point, Mumbai-400021. India Tel: 67440519 / 502 Fax: 022-22885831 Mobile No: 09821089213 E-mail: kunal.gaurav@expressindia.com kunalexpressindia@gmail.com
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CHENNAI: Dr Raghu Pillai The Indian Express Limited,
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EXPRESS HEALTHCARE
“A healthy population is an essential element of inclusive development and nation-building. Universal access to quality healthcare is not only a social necessity; it is also an imperative for economic growth and prosperity. An unhealthy population imposes enormous social and economic costs on society and hinders sustainable development.”
M Hamid Ansari, Vice President of India
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IMPORTANT Important: Whilst care is taken prior to acceptance of advertising copy, it is not possible to verify its contents.The Indian Express Ltd., cannot be held responsible for such contents, nor for any loss or damages incurred as a result of transactions with companies, associations or individuals advertising in its newspapers or publications. We therefore recommend that readers make necessary inquiries before sending any monies or entering into any agreements with advertisers or otherwise acting on an advertisement in any manner whatsoever.
DECEMBER 2013
MARKET UPFRONT University of Michigan Health System and AIIMS collaborate
EH News Bureau
DECEMBER 2013
INSIDE
T
he University of Michigan Medical School is expanding its collaboration with All India Institute of Medical Sciences (AIIMS). The new agreement includes the research of cancer, immunology, genetics trauma and disaster medicine. It was signed by Prof Mahesh C Misra, Director, AIIMS, and Mary Sue Coleman, President, University of Michigan.“Universities are at the forefront of globalisation and co-operation," said Coleman, who visited India recently. "Collaborations among our universities draw on the strengths of diverse perspectives to encourage the sort of crossfertilisation that is the basis of creativity and innovation," he added. The expanded alliance with AIIMS is expected to help fulfill U-M’s mission to facilitate health research, education and collaboration with global partners for the benefit of communities worldwide. Misra added that the new agreement or MoU would have great impact for his institute. “AIIMS will benefit immensely from our collaboration in gastroenterology, liver, paediatric surgery, acute care surgery, organ transplantation. Our efforts are to jointly attract national and international funding," he said. The first MoU between the institutions was signed in March 2012 for trauma care and marked the beginning of the partnership. “We’re aiming to develop a robust platform for collaboration that will facilitate research on diseases common to both our countries and the education that will strengthen our abilities to improve health,” said Joesph Kolars, the Medical School’s Senior Associate Dean, Education & Global initiatives.
Xcode wins $30,000 grant from GC-TBC programme The grant would be used for improving medication adherence and saving lives through technological innovation
www.expresshealthcare.in
Pg 17
‘This collaboration aims to make the treatment of cornea surface disease more accessible’ Professor Sheila MacNeil, University of Sheffield (UK)
Pg 22
EXPRESS HEALTHCARE
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A An archipelago of 40 islands, the Kingdom of Bahrain is located off the coast of Saudi Arabia in the Persian Gulf. With a total area of 735.8 sq km, Bahrain is geographically divided into five main governorates. Manama (the Capital) and Muharraq is home to majority of the population (1,234,571), 50 per cent of which are expatriates. Over the past century, Bahrain has carved a niche for itself in a range of fields from trading through oil exploration to finance and education giving it a sophisticated, forward-thinking outlook. Boosted by the economic and political reforms as well as higher oil prices Bahrain's economy has, in the past few years, seen promising growth. The Kingdom's prosperity is due as much to higher oil prices as to the deep economic and structural reforms being implemented. In the past few years, the reform process has led to an increased private sector involvement in the economy and reduction of government intervention, to create a more transparent and businessfriendly environment for all businesses based in Bahrain, whether commercial or financial. The reform process is broad and touches every segment of the economy, including the education and healthcare sectors. "The government of Bahrain sees healthcare as paramount to the Kingdom’s evolution into a
JACOB THOMAS
Transport Minister & CEO, Bahrain Economic Development Board
Director Operations, KIMS Management International
CEO, American Mission Hospital, Bahrain
Fast growth in the GCC offers a wealth of opportunity for Indian healthcare providers. Bahrain also has a FTA with the US that Indian manufacturers can take advantage of
The healthcare spend in Bahrain is roughly around 4.5 per cent of its GDP and 70 per cent of this is financed by the Government
The diseases of the elderly and chronic medical diseases like diabetes and hypertension are big time challenges of the future
service-oriented economy, a place where high skilled practitioners and comprehensive facilities are the norm," says HE Kamal bin Ahmed, Minister of Transport and Chief Executive, Bahrain Economic Development Board.
(MOH) is the major financer and provider of health services. Healthcare spending in Bahrain remains robust with total expenditure on health (3.8 per cent GDP in 2011) (WHO). "The healthcare scenario in Bahrain is still predominantly government driven and funded. The healthcare spend in Bahrain is roughly around 4.5 per cent of its GDP and 70 per cent of this is financed by the Government," explains Jacob Thomas, Director Operations, KIMS Management International. As good as it may seem Bahrain has yet to reach the standards of the developing nations in healthcare spending. "Bahrain’s healthcare expenditure as a percentage of GDP is higher than the Gulf Cooperation Council (GCC) average; however, its per capita expenditure on health is marginally lower than the region’s average," says Sanjay Vig, MD, Alpen Capital (ME), UAE. According to WHO, private health expenditure (per cent of GDP) in Bahrain was 1.10 as of 2011. The private healthcare sector in Bahrain caters primarily to the non-Bahraini population and there has been an increase in the utilisation of private healthcare by the Bahraini population in the recent years. Health insurance is in its infancy in Bahrain with a huge potential for growth. Currently, some large employers pay annual levy to the Minister of Health and private
sector employers contribute three per cent to Government Organization for Social Insurance (GOSI) for employee’s occupational accidents and disease. Private health insurance is provided by a small number of local and international insurance companies. The market is sure opening up and more private sector players are expected to set up base in Bahrain. As Vig explains the market in Bahrain is small but has positive potential for growth. "Given its low population base, the market size of Bahrain’s healthcare services is the smallest market in GCC. The market expanded at a CAGR of 15 per cent over 2004-09 to reach $0.6 billion. The outpatient segment accounted for over 83 per cent of the market in 2009, while inpatients accounted for the rest," informed Vig.
Healthcare scenario Bahrain’s healthcare system is modern, technologically-advanced and comprehensive. The quality of life and other healthcare indicators have raised Bahrain above its other Gulf neighbours and it is considered as one of the healthiest countries in the region. Bahrain has managed to control communicable diseases and reach almost 100 per cent in its immunisation coverage of basic vaccines. However, Bahrain is witnessing a continued rise in the chronic non-communicable diseases such as cancer, cardiovascular diseases and diabetes. These now are the major causes of death in the country.
Healthcare financing The Ministry of Health
INDICATOR (2009) Outpatient Market Size (USD Bn)
0.5
Inpatient Market Size (USD Bn)
0.1
Total Number of Beds
2,086
Total Number of Inpatient Treatments Total Number of Outpatient Visits Average Length of Stay (days)
104,681 5,607,697 5
Source: Alpen Capital
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EXPRESS HEALTHCARE
DR GEORGE CHERIYAN
KAMAL BIN AHMED
www.expresshealthcare.in
Infrastructure The Kingdom of Bahrain currently provides universal healthcare free to Bahrainis and at subsidised rates to non-Bahrainis. The Ministry of Health provides healthcare services through 21 primary healthcare centres and two clinics spread throughout the five governorates of Bahrain. Secondary and tertiary care is provided through the 891bed Salmaniya Medical Complex which is the main hospital in the country and has extensive outpatient services. In addition, there is DECEMBER 2013
M|A|R|K|E|T
SANJAY VIG MD, Alpen Capital (ME), United Arab Emirates
Hospital, Bahrain Specialist Hospital, Bahraini German International Medical Centre, Ibn Al-Nafees Hospital, International Hospital of Bahrain,etc.
Regulatory reform The Economic Vision 2030 provided a clear direction for the continued development of
the Kingdom’s economy and pointed to the need for the regulation of the whole healthcare system by an independent health regulator. In 2010, the Bahraini government instituted the National Health Regulatory Authority (NHRA) to regulate health service provision across both the public and
private sectors in Bahrain. “A major achievement which Bahrain can boast of is the setting up the NHRA which is an independent healthcare regulator set up to ensure regulation of the healthcare system and the healthcare delivery by regulating healthcare professionals, facilities where health care services are
provided (hospitals, clinics, centres, pharmacies, etc.) alongwith the medicines and drugs that are used in the delivery of healthcare,” informs Thomas. “The government has a 2030 vision that encompasses education, economic development and healthcare to encourage private public
There is urgent need for increasing private sector participation as healthcare expenses are expected to increase substantially
a 214-bed psychiatric hospital, 130-bed geriatric hospital and five satellite maternity hospitals taking care of the needs of the patients. Another major healthcare provider is the Ministry of Defence through the Bahrain Defence Force Hospital (BDF). The hospital provides services to members of the Bahrain defence force and their families as well as emergency care to the public and cardiac care services to the whole population. The 349-bed Shaikh Mohammed Al-Khalifa Cardiac Centre provides advanced cardiac care services to the people of Bahrain. The newly constructed King Hamad University Hospital with 300 beds is the latest addition to the government repertoire. Managed by the Bahrain Defence Force, the hospital offers its services to all and is set to become the Centre for Organ Transplant Surgeries and Trauma in Bahrain. As compared to the government sector, the private healthcare sector is currently limited however it is growing very rapidly. “There are six main private hospitals in Bahrain with the American Mission Hospital being the oldest in the GCC established 115 years ago by American Missionaries,” says Dr George Cheriyan, CEO, American Mission Hospital, Bahrain. Other prominent private healthcare providers are The Bahrain Royal Hospital (KIMS), Awali DECEMBER 2013
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HEALTHCARE SYSTEM OF BAHRAIN Taxes
Central Government
Block budget allocation
Payment Population and Employers
Public provider Payment
Ministry of Health Ministry of Defense
Private provider Ministry of Interior
Payment Patient
Premiums
Private Pharmacies
GOSI/GOPF
Private Health Insurance Companies
Contributions GOSI: Organisation for Social Security GOPF: Organisation for Pension Fund Source:WHO study
partnership in the provision of healthcare to the citizens and the public living in Bahrain. There has been reforms in the governance of the healthcare sector in Bahrain by establishing an independent body NHRA,” says Cheriyan. “Their role is to oversee standards, licensing of healthcare workers, monitoring quality and acting as an ombudsman dealing with patient complaints and investigating incidents that lead to unexpected morbidity or mortality. They are also responsible for supervision in monitoring standards of new healthcare facilities and sanctioning new ones depending on need,” he adds. Like its neighbouring countries, Bahrain too has introduced compulsory health insurance for all expatriates. "The most important regula-
Financial Flow
tory reform expected is the announcement of compulsory health insurance for all. As a first step, it is expected that the expatriates would be compulsorily insured like in Saudi Arabia and Abu Dhabi. The expatriates constitute about 50 per cent of the population in Bahrain and this announcement would be a major impact for the industry,” says Thomas.
Encouraging private sector participation Bahraini government realises that the only way to ease the burden on government health facilities is to open up the sector. "With rising medical costs, a fast growing population and higher incidence of health-related problems, GCC governments seek to transform the model through private sector partici-
Service Flow
pation – public-private partnership (PPP) as well as purely private ventures. Setting up private facilities reduces the governments’ burden to fund capital, while private players as managers of public facilities enhance the quality of services through their expertise,” explains Vig. In an attempt to open up its healthcare sector and encourage private investment, the government will bring in new laws and existing rules and regulations will be updated to bring them more in line with international trends. These new laws will ensure that there are no obstacles in the way of private investments making licensing easier. Further, the government is also trying to woo the investors by providing lucrative incentives."Bahrain is offering incentives to private players in healthcare by guaranteeing minimum cost coverage. The authorities guarantee reimbursement of cost of minimum patient visits to hospitals even if the minimum number of patient visits is not met. These measures are expected to boost private sector start-ups,” informs Vig. Entry of private players is also expected to modernise existing infrastructure, boost capacity for catering to rising demand as well as enhance operations and efficiency to offer high-quality services at affordable and competitive prices.
Attractive investment destination Bahrain maintains a liberal and trusted business environment and boasts of unrivalled access to the
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markets of the GCC which comprises Bahrain, Kuwait, Oman, The Kingdom of Saudi Arabia, Qatar and the United Arab Emirates (UAE). “Fast growth in the GCC offers a wealth of opportunity for Indian healthcare providers. Our markets have a combined value of $1.5 trillion, expected to reach $2 trillion by 2020, and have increasingly sophisticated mass-affluent populations on the lookout for cutting edge medical technologies and treatments,” says Ahmed. The Kingdom enjoys a reputation as the ‘Gateway to the Gulf’, with the best market access to the economies of the GCC countries, a market which now exceeds $ one trillion. As an investment destination and operating base, this has given Bahrain an edge over other countries. With its strategic location next to GCC’s largest market – Saudi Arabia, this trend is expected to continue as increasing number of Saudi patients visit the country. Bahrain also enjoys a liberal social climate, good shopping and minimal travel restrictions attracting about two million tourists a year, mostly from neighbouring Gulf countries. The healthcare services market in Bahrain is focussed and expecting major reforms becoming the choice for medical tourism in the Gulf. Bahrain's healthcare facilities are at par with other facilities around the world as several healthcare facilities in Bahrain have received accreditation from the US (Joint Commission International) and Canadian (Accreditation Canada) authorities. Bahrain has the most favourable tax regimes in the world with no corporate tax, no personal tax, no capital gains tax, no withholding tax and no restriction on the repatriation of capital, profits or dividends. “Bahrain offers an attractive and supportive business environment, including competitive tax rates, transparent regulation, excellent transport connections by air, sea and road to the other countries of the GCC, and a highly skilled local workforce, making it an ideal platform from which to access the GCC market. Bahrain also has a free trade agreement (FTA) with the US that Indian manufacturers can take advantage of, particularly as India and the US do not currently have a FTA in place,” says Ahmed. DECEMBER 2013
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The Kingdom is also negotiating a FTA with India which may take shape soon. “The countries of the GCC, which include Bahrain, Saudi Arabia, Qatar, UAE, Kuwait and Oman, and India, are currently negotiating a FTA which is anticipated to be completed in the near future,” informed Ahmed.
Impetus for growth Key growth drivers for the healthcare sector in Bahrain are the changing population matrix and rising chronic diseases. Bahrain's population is currently made-up of working age group. This will convert to ageing population in 20 years and will need maximum healthcare support. The changing mix of population can further be expected to change the epidemiologic profile and the burden of disease in the country. “The key drivers of growth in the healthcare sector is the changing demographics of people living longer, thereby the diseases of the elderly and chronic medical diseases like diabetes and hypertension are big time challenges of the future. Obesity in the young is also a major issue that in increasing the incidence of diabetes. Bahrain has one of the highest incidence of diabetes in the world,” explains Cheriyan. “Increasing incidence of lifestyle-related diseases in GCC is expected to drive per capita spending on healthcare. GCC nations are witnessing a paradigm shift in lifestyle with drastically changing eating habits. High per capita income coupled with sedentary lifestyle and dietary patterns has increased the incidence of obesity,” opines Vig. “All GCC countries exceed the global average obesity ratio of 10.0 per cent of total population among males aged 20 years and above and 14.0 per cent among females. According to WHO, obesity is a major risk factor for diabetes and cardiovascular diseases. Notably, the International Diabetes Federation reveals that GCC countries are among the top 12 globally for diabetes prevalence. The average cost of these lifestyle-related ailments is higher and extends over a longer term leading to higher healthcare related spending,” Vig says. Apart from this, increasing penetration of health insurance will also drive up the demand for healthcare. “The key driver of this sector DECEMBER 2013
would be increased penetration of healthcare insurance. Bahrain, like other GCC countries has high rates of CVD and lifestyle diseases like hypertension, diabetes, and obesity due to lifestyle related reasons. This is another major factor driving healthcare utilisation,” opines Thomas. Health insurance is also rapidly gaining significant share in the insurance market of the region.
In addition, the rising income and enhanced spending capacity allows the people to seek specialised medical services and latest medical surgical procedures, such as transplants. High literacy rate resulting in higher treatment/ intervention awareness will also be a major factor for higher healthcare spend. New models of healthcare delivery such as short-stay surgical centres and spe-
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cialised clinics are also gaining popularity. Growing number of healthcare providers in GCC are focusing on clinics and ambulatory centres due to their lower capital requirement and quick return on investment. “Expanding highincome and expatriate population bodes well for clinics and ambulatory centres due to their close proximity to residential locations and wide array of medical specialities.
Besides, the centres include an operation theatre and generally have the facility to transfer a patient to a bigger hospital in case of an unmanageable emergency. We expect clinics and ambulatory centres to continue gaining traction given the potential demand for healthcare services in such regions and institutional interest in this segment,” says Vig.
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Key challenges A major challenge for a private healthcare service provider is the public sector dominance in the healthcare space. However, lately the government has taken steps to open-up the sector for private investments and will offer minimal resistance in future. “While governments subsidise healthcare cost at public facilities, spending at private clinics is an out-ofpocket expenditure. This leads to low utilisation rates of private facilities, which in turn questions sustainability. There is an urgent need for increasing private sector participation as healthcare expenses are expected to increase substantially,” says Vig. Another area of concern is specialised manpower. Although, Bahrain has four medical universities: the Arab Gulf University, the Royal College of Surgeons of Ireland, the College of Health Science, and AMA International University and industry bodies like Tamkeen that provide high quality, efficient and comprehensive training programmes, there is still a huge talent gap in the healthcare sector. “The major challenge facing the industry as of now is availability of qualified and experienced manpower, be it doctors, nurses and other related medical manpower. Licensing of medical manpower and the time taken for the same is also sometimes a challenge when the requirement of such manpower is
PROJECTED INCREASE IN THE DEMAND FOR TREATMENT BY 2025 Projected Increase in treatments needed by 2025. % Cardiovascular Cancer CNS disorders Diabetes Musculoskeletal diseases Mental disorders Sense organ diseases Genitourinary diseases Road traffic injuries Digestive diseases Non-infectious respiratory diseases Nutritional deficiencies Occupational injuries Skin diseases Other non-disease conditions Dental and gum diseases Other injuries Infectious diseases Endocrine disorders Maternal and perinatal conditions Congenital anomalies Deliveries
232% 197% 172% 170% 162% 151% 150% 134% 130% 125% 124% 121% 120% 120% 119% 117% 115% 111% 99% 82% 59% 25%
Average increase 128% Source: Health Sector Improvement and Increasing Patient Choice Project Team analysis (2005)
imminent,” says Thomas. Agreeing, Cheriyan says, “The major challenges of the industry is the supply in locally trained manpower and the self reliance from foreign trained doctors and nurses. Government and private funding into healthcare with uncertain returns or the private investor is yet another challenge.” Explaining it further, Vig
says, “Concerns about insufficient medical staff have amplified amid high dependence on expatriate medical personnel.” “High proportion of expatriates in medical staff poses a challenge of difference in culture, medical practices and patient care. In addition, they are subject to high attrition as they view their residence in the GCC as a
learning experience for international exposure and later move back to home countries or developed markets for higher paid jobs,” he adds.
The future In future, private healthcare will see a surge. According to a report, ‘Mapping healthcare financing’ ageing population, population growth combined with disease mix trends, will result in a steep change in healthcare demand, with ~ 130 per cent more treatment needed in 2025. Cardiology (~230 per cent more treatments) and cancer (~200 per cent) will grow the fastest. A s s u m i n g no difference in the breadth and depth of care provided today, these three factors combined will drive an estimated 504 per cent increase in healthcare expenditures over the coming 20 years, reaching BD 1,148 million in 2025. "Healthcare has always been changing, be it new technology or new techniques. It would be the same for Bahrain. But in particular about Bahrain, we feel that private healthcare will have a major role to play in the future and from the present role as primary, secondary and high secondary healthcare provision, private healthcare could move into the provision of tertiary and even quaternary care in a few areas,” opines Thomas. Another care model expected to emerge in future is the home healthcare model. “The future of healthcare will be care that is provided closer to home and eventually at home as it is much cheaper. Technology will transform the way in which this care is provided. Care will be more ambulatory driven with hospitalisation only for the more serious illnesses. Patients will be responsible more and more for their own health with healthcare providers offering the support to manage their chronic disease to improve the quality of life. In a country as small as Bahrain tertiary care will be centralised into a few hospitals only,” foresees Cheriyan. mneelam.kachhap@expressindia.com [The author visited Bahrain at the invitation of The Bahrain Economic Development Board (EDB)]
References Health Systems Profile-Bahrain Regional Health Systems ObservatoryEMRO, WHO 2007 Alpen Capital's GCC Healthcare Industry report December 13, 2011 WHO Country Case Study: Bahrain Health Care Financing, July 30, 2008
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www.expresshealthcare.in
DECEMBER 2013
M|A|R|K|E|T Videocon Telecom introduces mobilebased Ayurvedic health service
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ideocon Telecom has introduced specialised Ayurvedic mobile health service for its subscribers. This wellness service is developed in collaboration with JIVA Ayurveda Group and offers specialised Ayurvedic treatment to the masses. This mobile-based Ayurvedic health service will provide access to top Ayurvedic doctors roundthe-clock and is exclusively available by dialling 535133, which is chargeable at Rs 6/min. To bring the health service to the masses, Videocon Telecom has partnered with Think Health Services a provider of mobile health and wellness related products and services. Through this service the subscribers can speak with a ‘Certified Ayurveda Expert’ to discuss health problems and seek treatment advice. Post consultation, they can order their medicines directly on the phone. The medicines will be delivered to their homes across 1300 cities all over India on a cashon-delivery basis. The service is managed through an Ayurveda Telemedicine Centre with a panel of over 150 doctors. This one-of-its-kind service will enable the subscribers in receiving the consultation and treatment right onto their mobile phones. Arvind Bali, Director and CEO, Videocon Telecom said, “We are pleased to roll out the M-health service for our subscribers. This new service shall enable our subscribers to get in touch directly with certified Ayurvedic doctors round the clock and discuss their health issues and seek treatment advice. Now, with this service, one can access health related help and consultation anywhere and anytime, and can also order medicines which are directly delivered to their doorsteps.” EH News Bureau
DECEMBER 2013
Xcode wins $30,000 grant from GC-TBC programme The grant would be used for improving medication adherence and saving lives through technological innovation
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code Life Sciences, a Chennai-based biotechnology start-up has received a $30,000 grant from The Grand Challenges in Tuberculosis Control (GCTBC) programme to deliver an out-of-the-box mobile innovation for enhancing TB medication adherence. The GC-TBC programme is an initiative by IKP Knowledge Park Hyderabad, in partnership with the United States Agency for International Development (USAID), and the Bill & Melinda Gates Foundation to identify, fund, and nurture technology driven solutions that will assist TB control. Xcode has been awarded the grant to deliver 'health signals', a mobile education system that aims to improve TB medication adherence by connecting peer educators and caregivers from local
communities with TB patients. Available in multiple languages, Xcode will combine specialised information on nutrition and medication to be delivered simultaneously to patients and peer educators to enhance the treatment of the disease. The service will also enable caregivers to keep a track of their patient’s medication adherence. Xcode’s mobile education system is being implemented in association with The Revised National Tuberculosis Control Programme (RNTCP), the state-run tuberculosis control initiative of the Government of India. The RNTCP incorporates the principles of directly observed treatment-shortcourse (DOTS), the global TB control strategy of the World Health Organization. Xcode envisions that mobile technology in health-
care is likely to improve the convenience, cost and the way customers communicate with their physicians, besides increasing access to healthcare in the near future. As a part of the grant, Xcode will also get the opportunity to work with IKP, USAID and The Bill & Melinda Gates Foundation for two years to help establish their proof-of-concept and leverage the collective experience of global mentors, resources and their network. Additionally, IKP, USAID and the Foundation will help with access to networks and marketing channels to commercialise the innovation. Vikraman Venu Saranyan, VP, IKP Knowledge Park said, “IKP is currently funding 15 innovations to help address the problem of TB Treatment adherence. Most solutions use mobile media platforms, but
the solution from XCode is unique in that it uses TB survivors to educate patients and instill the importance of following the treatment regimen. Their partnership with VHS and reach in the field makes them an ideal candidate. If they are successful in developing a prototype, IKP will provide an additional $ 100,000 to further refine and deploy their solution to address this unmet need." Commenting on the grant, Saleem Mohammed, CEO and Co-founder, Xcode Life Sciences said, “Through this novel initiative by IKP, USAID and The Foundation, Xcode will endeavour to transform the lives of TB patients in India and leverage our strength to create a sustainable way to improve TB medication adherence in the country.” EH News Bureau
ConvaTec & Narayana Health in collaboration Launch Advanced Wound Clinic and Limb Salvage Centre in Bangalore onvaTec a US-based multinational company in wound management, ostomy care, critical and continence care, in joint venture with Narayana Health, has launched ‘Advanced Wound Clinic and Limb Salvage Centre’ located at NH Health City campus in Bangalore. The joint venture clinic reportedly has state-of-art technologies essential for prevention and healing of chronic ulcers and is aimed at maintaining higher limb salvage rate comparable to the leading centres in the world, with facilities for assessing peripheral circulation and predicting wound healing. The centre was inaugurated by the Chairman of Narayana Health, Dr Devi Prasad Shetty who said, “Our initiative with ConvaTec would be one of a kind venture that would create a specialty clinic focusing on Wound Management in the country. This synergy will initiate new benchmarks and new best technological
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and medical trends in our country.” Speaking at the occasion John M Lindskog, President, Asia Pacific, ConvaTec said, “Through the ‘Advanced Wound Clinic and Limb Salvage Centre’ we aim to bring the best facilities and wound management technology to patients. I am quite certain that it would change the way foot ulcers are perceived and treated in India.” “The clinic is a ray of hope for patients suffering from foot and limb associated www.expresshealthcare.in
diseases. Amputations and complications are preventable, provided appropriate diagnosis and management is done at the right stage and with the launch of this clinic we aim to educate the patients and reduce these complications,” said Dr Ramesh Tripathi, Vascular Director, Narayana Institute of Vascular Sciences. Commenting on the partnership, Anand Shirur, MD, ConvaTec India and China, “An upsurge in incidences of limb associated complications
necessitates the requirement for wound management and centres. This initiative will enable us to expand footprint for the benefit of the people across the country and fulfill the tenets of care required for foot diseases.” The Centre’s Wound Management Plan includes a standardised record of clinical assessment and etiology of the wound. The model of care would be to apply a stepwise approach implementing advanced wound management modalities as a part of the wound care algorithm. All aspects of care from initial presentation to treatment and evaluation would be documented. Following assessment, treatment goals would be agreed with the patient and a time frame for their achievement set. Underlying factors which could influence the potential for wound healing would be addressed to ensure all round care as well as treatment. EH News Bureau EXPRESS HEALTHCARE
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HealthKartPlus expands its footprint Service now available to consumers in Bengaluru
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ealthKartPlus, online pharmacy network and medicine application, has announced the expansion of its drug delivery services in the Bengaluru region. The company is also planning to expand its services in other cities. Followed by Bengaluru; the service will be introduced in other metros in a phased manner. With this approach, the company aims at making orders of medicines more convenient and accessible to its consumers across all major cities in India. The online pharmacy network HealthKartPlus is a platform to connect local pharmacies directly to consumers. Also, it provides consumers with value added information about their medicines. It keeps consumers informed on how their medicine works, explains the side effects, interaction with other drugs and potential contraindications –besides giving information on more economical substitute available for the same generic salt. The company has also made its app available for free across Android, iOS and Windows 8 for users. On the occasion, Prashant Tandon, Founder Healthkart said, “We are really excited to start our service in Bengaluru. HealthKart Plus has received extremely good reviews in Delhi/NCR for its service and utility as a pocket chemist app. This is a one of a kind service in India and Bengaluru, being the technology hub of the country, is the obvious choice for our second location.". EH News Bureau
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Healthspring launches seventh community medical centre in Vashi, New Mumbai To offer residents of Vashi and surrounding areas access to world class family physicians with all facilities under one roof, seven days a week
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ellspring Healthcare, under its brand, Healthspring Community Medical Centres, launched its new centre in Vashi, New Mumbai recently. Dr Sanjiv Naik, Member of Parliament, Bharat Nakate, Corporator, Dr Gautam Sen, Chairman & Co Founder Wellspring, Dr Vijay D Patil, Chancellor, Padmashree DY Patil University and Kaushik Sen CEO and Co-Founder, Wellspring Healthcare were present during the event. “The Vashi centre is poised to benefit residents and corporate at large. Today, I can proudly say the centre has been blessed by some of the best professionals in the field,” said Dr Sen. The Healthspring Centre boasts of well-appointed, modern and healthy waiting space, access to proprietary emergency response system, experienced doctors along with well-trained nursing team and support staff, a well-equipped treatment room for minor procedures and relevant diagnostics (radiology and pathology)
(L to R) Dr Sanjiv Naik, Member of Paliament; Bharat Nakate, Corporator; Dr Gautam Sen, Chairman & Co Founder, Healthspring; Dr Vijay D Patil, Chancellor, Padmashree D Y Patil University facilities. It also offers home visits by well-trained medical team and electronic medical records for all patients. Healthspring has reportedly tied up with specialists and hospitals across Mumbai to provide higher-level care when necessary. Emphasising on online medical records and practicing care, Dr Sen said that it incorporates the latest interna-
tional protocols and evidence based medicine. “We envision Healthspring as the institution patients can trust over all others, in every situation: a modern and ethical family doctor set-up supported by a 24×7 call centre, in-house pharmacy and pathology laboratory, online medical records – and practicing care that incorporates the latest international protocols and evidence based
medicine,” he said. Kaushik Sen, CEO and Co-Founder, Wellspring Healthcare said that Healthspring has a complete patient-centric focus, which has driven the careful design of community medical centers, each of which has wellqualified doctors available seven-days a week. “At Healthspring, we want people to begin a new patient-doctor relationship. Healthspring’s doctors follow the latest evidence-based pathways and international care protocols, to deliver quality care consistently, Most important, we have a focus on appropriate care – ruling out over-diagnosis, but making sure we don’t miss out anything important either,” he pointed out. Sen further says, Healthspring initiated a unique business model that brings back the concept of family physician in a modern setting, which is developed with an objective to deliver premium healthcare in India. EH News Bureau
Survey: Complexity of managing Type 2 diabetes is currently underestimated Around 800 physicians from Japan, China, India and South Korea participated in the poll
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oehringer Ingelheim and Eli Lilly and Company announced results from a poll conducted with almost 800 physicians treating people with Type 2 Diabetes (T2D), in Japan, China, India and South Korea. 360 respondents were from India. As per the results of the online survey, 79 per cent of the physicians surveyed believed that the complexity of managing T2D is currently underestimated. However, the physicians also opined that despite these complexities, high quality, structured patient education can help to improve health outcomes and significantly
improve quality of life in people with T2D. 90 per cent of physicians polled agreed that both healthcare practitioners and patients could gain from additional medical information and patient support materials. The survey also highlighted the importance of managing cardiovascular risk in T2D. 94 per cent of total respondents and 92 per cent of the Indian physicians who polled claimed that the management of cardiovascular risk influenced their decision when prescribing an oral antihyperglycaemic treatment. Half of the total physicians and 59 per cent of www.expresshealthcare.in
Indian respondents surveyed ranked ‘number of doses per day’ as the factor that influenced them the most when prescribing an oral antihyperglycaemic agent, in addition to the management of blood glucose. 39 per cent of Indian physicians surveyed ranked risk factors like obesity, smoking and hypertension as the most important challenge and 46 per cent ranked drug interactions as the least important challenge while managing T2D. “More than 60 per cent of the world’s diabetes population lives in Asia and physicians treating Type 2
Diabetes in this region acknowledge that this is a complex condition,” said Professor Klaus Dugi, Corporate Senior Vice President Medicine, Boehringer Ingelheim. “Despite the numerous challenges Type 2 diabetes can present in the face of rising prevalence, results from this survey show that healthcare professionals in Asia are evaluating the full spectrum of available treatments, dosing regimens, risk factors and co-morbidities to achieve the best possible health outcomes for their patients.” EH News Bureau DECEMBER 2013
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Premia Group forays into healthcare
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remia Group has now entered the healthcare sector with the launch of Premia Healthcare. It has taken over a running hospital from Saloni Healthcare at Palwal, a 115 bed facility, spread over five acres. Premia Health Care, Palwal, reportedly the only highly equipped medical facilities centre within a radius of 60 km, aims to provide comprehensive healthcare facilities and services to approximately one million people of the region. Premia Healthcare is the brain child of Tarun Shienh, Chairman and MD, Premia Group. On the occasion of the launch, he said, “With Premia Healthcare, we will work towards evolving the Indian healthcare sector to the next level by giving Indian masses access to world`s finest high quality integrated healthcare services. This endeavor is aimed at bringing the best quality healthcare services to the doorstep of those who need it the most and at a price that is quite within the reach of a common man. Indian healthcare services have long shown a maturity that is expected considering the tremendous growth trajectory India has embarked upon and this effort from Premia is just the next logical step in the continuing train of developments." "The reason we chose a city like Palwal for our Health Care foray over other metropolitan cities is because it suits our aggressive growth philosophy via an inorganic and nonmaterialistic business route. Beside this, I feel it's my social obligation to make quality healthcare services accessible to regions where there is a dire scarcity of quality healthcare," adds Shienh. Hence, apart from tier II and II cities expansion, the group is keen on expanding its footprints in other cities of India where there is a need of quality healthcare facilities. EH News Bureau
DECEMBER 2013
CII and MCGM join hands to fight diabetes in Mumbai Two lakh Mumbaikars to be screened for diabetes across city
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n the occasion of the World Diabetes Day, Confederation of Indian Industry (CII) and Municipal Corporation of Greater Mumbai (MCGM) launched a ‘Drive against Diabetes’ campaign. This is a unique public private partnership (PPP), initiated to raise awareness on the growing incidence of diabetes and to mobilise all stakeholders to join the fight against diabetes. Corporates like Apollo Hospitals, Apollo Munich, OneTouch, Abbott, SANOFI and several others came forward to support this unique PPP model in initiating the Drive Against Diabetes. Sunil Prabhu, Mayor of Mumbai, inaugurated the noble social initiative in Mumbai. The initiative aimed to screen around two lakh people across Mumbai. Around 500 kiosk have been established in order to conduct the screenings. MCGM will also support by providing over 700 paramedics who will be mobilised across the city to test individuals across industries. The private sector came forward to provide screening
kits including glucometers, strips, swabs, lancets, information booklets and questionnaires alongside training and capacity building for the paramedics. Speaking on the occasion, he expressed concern on the steady rise of the incidence of the disease and said, “Today diabetes is one of the major conditions affecting people’s health and lifestyle, it is estimated that by 2030 the diabetic population will be around 10 crores. Out of which 6.2 per cent are expected to be suffering from diabetes and 15 per cent from blood pressure. Within India, Mumbai is leading this race – the city experiences a hectic work culture, high levels of stress and fewer sleeping hours. During tomorrow’s drive we expect that even if 10000-12000 people are tested positive for diabetes, we will incorporate that in the MCGM’s database and an SMS alert will be sent to them after three months suggesting next level of detailed diagnostics. The testing of two lakh people in a single drive is a record in
itself but I will be happy if five lakh people are tested in the next drive and fewer are diagnosed positive for diabetes.” Manisha PatankarMhaiskar, IAS Additional Municipal Commissioner (Western Suburbs) Municipal Corporation of Greater Mumbai added; “MCGM started its drive against diabetes in 2011, under which 21700 people were diagnosed with diabetes at the dispensary level. 25645 and 34782 were diagnosed positive at MCGM run hospitals and major public hospitals in Mumbai. Currently there are more than 86000 patients on the MCGM diabetes database, out of these 15 per cent who are at the initial stage are being suggested lifestyle modifications and 61 per cent and 22 per cent detected with controlled and uncontrolled diabetes respectively are under the MCGM medical care programme. But the ambition is to create awareness of diabetes and not to focus on numbers.” Shobana Kamineni,
Chairperson, CII National Committee on Public Health and Executive Director - New Initiatives, Apollo Hospitals Enterprise in her address mentioned, “Diabetes is a silent killer as there are no symptoms; hence it becomes important for each one of us to get ourselves checked. We will ensure that Mumbaikars are made aware of healthy dietary habits and easy to adopt lifestyle changes. CII members and corporates have already come forward to conduct several of these screening camps engaging paramedics across Mumbai. Registered data from all screenings will be collated and analysed to generate a report which will include generic recommendations as well. I would like to thank MCGM and all our partners for an overwhelming response to come forward and lead this drive. Your support has been magnanimous and united and it has been a pleasure to ideate and propel this initiative to a meaningful end.” EH News Bureau
Narayana Health launches rural cancer surveillance program Mazumdar Shaw Medical Foundation collaborates with Narayana Health to launch the program arayana Health announced the launch of Rural ‘Cancer Surveillance Program’ in partnership with Mazumdar Shaw Medical Foundation. The program launched by Dr Devi Shetty, Chairman, Narayana Health and Dr Kiran Mazumdar Shaw, Chairman and MD, Biocon will work towards creating awareness and conducting preliminary screening of head and neck cancers in several rural pockets of Karnataka. The foundation of the programme is based on the statistics that highlights the huge urbanrural healthcare divide that exists in our country. The first phase of the pro-
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gram will be initiated across three villages of Atebele, Anekal and Gigini in Karnataka, which will be led by the Department of Head and Neck Oncology at Mazumdar Shaw Cancer Center at NH Health City. The focus will be to educate the community at large about the early signs and symptoms of mouth and throat cancer as its prevalence in rural India is increasing owing to the tobacco chewing habits. Dr Shetty said, “Over 70 per cent of India’s population lives in rural India but have access to only one-third of the hospital beds. Also, diagnosing and treating head and neck cancer requires specialist www.expresshealthcare.in
doctors. Since, 80 per cent of the specialist doctors live in urban parts of the country catering to about 20 per cent of the population, early diagnosis of this disease in rural India is difficult. Thus, leading to a worrisome situation that close to 75 per cent of cancers are diagnosed only in its stage IV resulting in poor rate of treatment and survival. This initiative is a step towards reaching out to the population living in villages to ensure that everyone has access to timely diagnosis and quality healthcare.” The programme aims to reach out to the rural community, educating the people about the early warning signs
of cancers, screening for common cancers and undertaking preventive measures. Dr Moni Kuriakose, Head of Department – Head & Neck, Oncology, Mazumdar Shaw Cancer Centre said, “Awareness levels among people residing in Urban India is higher than in rural parts and thus detection of the diseases is early unlike in rural India. However, this programme aims to bridge this gap and we aim to roll-out this by our team of doctors who will be going to rural areas. This will facilitate early diagnosis and better outcome of the treatment among patients in rural India. EH News Bureau EXPRESS HEALTHCARE
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RAHI Care to set up nephrology centres through PPP To ensure renal care in collaboration with Uttrakhand and HP
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AHI Care has been appointed by the governments of Uttarakhand and Himachal Pradesh to setup dialysis facilities under the PPP model with their respective states. The setting up of the nephro-dialysis centres is part of the state governments' initiative to provide quality renal care under the PPP model. As part of this initiative, RAHI Care will be setting up state-of-the-art, sixmachine, haemodialysis units at Mandi and Dharamshala Zonal Hospitals. “In our experience, active participation of the government and private sector proves successful in increasing the ‘accessibility and affordability’ of treatment, which is evident from the success of similar project implemented by RAHI Care at Haldwani in PPP with Uttarakhand Govern ment,” said Shaurya Abhilashi Tayal, MD and CEO of RAHI Care. RAHI Care has developed and operates 17-machine NephroDialysis unit at Haldwani, Uttarakhand which reportedly performs in excess of 1300 dialysis per month. The facility was originally conceived as 13-machine facility and was recently upgraded to cater to increasing demand. “RAHI Care’s endeavour is to ensure quality healthcare which is available, accessible and affordable for everyone and strive to adopt international best practices and innovate to improve and restore the lives in a best possible manner. The team comprises specialist doctors with more than 15 years of multi-disciplinary experience,” further added Tayal. EH News Bureau
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Transasia Bio-Medicals provides diagnostic setup at Reliable Hospital Gujarat CM, Narendra Modi inaugurated the hospital and was impressed with Transasia’s offerings
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ransasia Bio-Medicals has provided diagnostic services through its equipment at the recently launched Reliable Hospital which was inaugurated in the village of Balasinor, Gujarat by Narendra Modi, Chief Minister of Gujarat. The Chief Minister was taken through the lab setup by Jotwani, Sr VP-Sales & Marketing, Sales & Marketing for Transasia. He was reportedly impressed with the extensive diagnostic instruments which play an integral role in the basic pathological
AK Jotwani, Sr VP - Sales & Marketing, Transasia, with Gujarat CM, Narendra Modi at the inauguration
AK Jotwani with TBM instruments at Reliable Hospital
setup of the hospital. Instruments provided by Transasia include EM 360, EC5 Plus V2 (Biochemistry), XS 1000i (Hematology), Urodipcheck 300 (Urine Analysis), Vesmatic cube 30 (ESR), Elan 30s (Immunology), Medica EasyStat and Medica Easylyte (Critical Care) and CA 50 (Coagulation), which are integral for the diagnostic profiling of the patients. The inauguration programme was telecast live on many national news channels. The 200 bed hospital is spread over an area of 25 acres. As part of phase one, the hospital has commenced its services with 100 functional beds. The opening ceremony was reportedly attended by over 12,000 delegates from all walks of life and nearby villages. Transasia thanked Rashidbhai, Chairman, Reliable Hospital for trusting the company in providing the entire diagnostic setup for the hospital, thereby giving it an opportunity to contribute to the well-being of the people of Balasinor, Gujarat. EH News Bureau
International award to Family Planning Association of India The award was given for its contribution to the field of sexual and reproductive health and rights
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he Family Planning Association of India was awarded by the Governing Council of International Planned Parenthood (IPPF) recently for its contribution to the field of sexual and reproductive health and rights. Family Planning Association of India is a founder member of IPPF which works in more than 172 countries with 154 Member Associations across the globe. IPPF being a global leader in the field of sexual and reproductive health and rights provides support to all the Member Associations. Accordingly FPA India is one of the Member Association affiliated to IPPF. The Governing Council Award was given in a function organised by IPPF at
The Hallam Conference Centre, London. The award was handed over by the IPPF President, Dr Naomi Seboni and the Director General Tewodros Melesse and received by Sujatha Natarajan, President FPA India and Vishwanath Koliwad the Secretary General. While handing over the award the contribution of FPA India in the field of sexual and reproductive health and rights including family planning was highly appreciated. After receiving the award a short film of four minutes duration about FPA India and its activities was screened and then Sujatha Natarajan President FPA India thanked the Governing Board Members of IPPF who have continuwww.expresshealthcare.in
ously supported FPA India in its endeavours. She said FPA India is a big family and whenever anything good or bad happens with us the first person to support us is our FPAI Branch. This is because of our relationship, hard work and the strong bonding among volunteers and staff. She thanked one and all in IPPF and FPA India without whose support this award would not have been possible. Vishwanath Koliwad, Secretary General FPA India, on receiving the award said that “This award belongs to those volunteers and staff who have worked hard at the grass roots level day in and day out reaching the unreached. The result of their tireless work whether
measurable or not as service statistics, ultimately results in realisation of rights. I am receiving this Award on their behalf. This belongs to all the volunteers and staff of FPA India back in India. Having received the Award, I am also accepting a challenge of achieving higher and higher results since the bar is pushed up. We will try our best. While making efforts we will keep up the standards, values and ethics of IPPF. We will never compromise on the quality of services.” The Governing Council Award ended with a dinner attended by the Governing Council Members of IPPF and six Regional Directors and invitees. EH News Bureau DECEMBER 2013
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Sanofi and PVR Nest partner for ‘Healthy Children,happy children’ initiative The student-led campaign will reach out to 2,00,000 children from 200 schools by using art and cinema anofi India joined hands with PVR Nest for its ‘Healthy children, happy children’ initiative to launch a student-led campaign on children’s health. The program titled CineArt ‘Healthy children, happy children’ aims to bring together leading Indian pediatricians, with NGOs and artists in the field of creative learning, to mentor 2,00,000 school children from 200 schools (an equal mix between public/privately held schools and NGO/community schools) in four cities—Chennai, Delhi, Hyderabad and Mumbai, on critical aspects of children’s health. By utilising nonauthoritarian and creative techniques in schools using art and cinema, the programme intends to make children’s health education real, innovative and participatory. Reportedly, 600 health workshops using experiential learning methodologies like puppetry, theatre, storytelling
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and capacity building exercises, will be tapped to sensitise children on relevant health topics like hygiene, environment, play and exercise, disability and discrimination, vaccination, ergonomics, among others. Joanna Potts, Commercial Operations Officer (COO)Sanofi India stated, “Through our new ‘Healthy children, happy children’ initiative, we aim to diversify and adapt our healthcare offer to young Indian patients, with innovative products, services and awareness initiatives. We are delighted to partner with PVR Nest for a first-of-itskind interface between pediatricians, NGOs and artistes for this innovative, year-long school awareness programme on health. We are looking forward to seeing children-inaction during the school health workshops, and also, during the making of original ‘Healthy children, happy children’ health films and
publication.” The year-long educational programme on child health will result in the formation of around 200 ‘Healthy children, happy children’ School Clubs. The clubs will have an outreach within schools, as well as to parents and communities outside, to sustain health education and awareness. A film making process wherein eminent film makers will be training selected students from shortlisted schools, to make original health films is another step that would be implemented.
PVR cinemas across the country would display them with key messages on children’s health. Reportedly, the launch event at Delhi was attended by leading Delhi pediatricians, school founders and students of the 50 participating schools, and graced by Dr Syeda Hameed, Member, Planning Commission, Government of India, as the Chief Guest. Special Guests and speakers also included Dr Rajeev Seth, President, Indian Academy of Pediatrics Delhi, and eminent theatre
actor, Shivani Wazir Pasrich.The programme opened with an original children’s theatre production on health, and also saw the launch of a special campaign film featuring children, to drive home the message of health. Talking about this initiative, Renaud Palliere, CEOInternational Business, PVR said, “We are extremely happy to partner with Sanofi India to create education and action on the very important issue of children’s health. We look forward to developing a sustained partnership with India’s leading pediatricians, schools and experts who are participating in this program. As a film exhibition company, we will provide the best possible outreach to the original films the students will make during this campaign, through our presence in 37 cities country wide.” EH News Bureau
Bangalore Baptist Hospital at Devanahalli Home Minister inaugurates the new hospital
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angalore Baptist Hospital, Devanahalli and the District Disability Rehabilitation Center (DDRC) were inaugurated at Devanahalli by the Home Minister of Karnataka KJ George. Speaking on this occasion, the minister appreciated the extensive social and charitable works by the Christian community for the public. He stated that BBH has achieved tremendous growth, from a small 80 bed hospital to a 300 bed facility, within a short span. Supporting facts and figures were also shared. He also said that the most noteworthy of BBH's achievements is that the services rendered by them are towards the poor, needy and the downtrodden. He added that the true meaning of service is reflected by BBH's approach i.e. compassion and holistic care. In view of the extensive
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service offered by the BBH towards the public, the Government is reportedly extending support and aid in various social uplifting and philanthropic activities through various state and
national level programmes. He announced the appreciation and support extended by UT Khader, CM Siddharamaiah who has offered to introduce financial support from the www.expresshealthcare.in
Government. On behalf of the government he appreciated all the good work and wished all the best for the future endeavours by BBH. Several other dignitaries also spoke highly about the
service being rendered by the Bangalore Baptist Hospital. Rs 12 lakhs spot donations were announced for the DDRC. EH News Bureau EXPRESS HEALTHCARE
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‘This collaboration aims to make the treatment of cornea surface disease more accessible’ Recently, the University of Sheffield (UK) entered into a partnership with LV Prasad Eye Institute to develop new understanding and tools in the area of tissue engineering. Professor Sheila MacNeil, Professor of Tissue Engineering, Department of Materials Science and Engineering, the University of Sheffield (UK) explains the purpose, benefits and vision of the partnership to Raelene Kambli You have joined hands with LV Prasad Eye Institute, Hyderabad to develop a new technique for delivering stem cell therapy to the eye. Can you throw more light on this collaboration? LV Prasad Eye Institute is truly world-leading in terms of its pioneering, ground breaking work in the field of research and technology and has helped patients deal with a whole range of eye problems. We knew of them by reputation and thus, chose to work with them to develop a new technique which will help in the repair of eyes damaged by accident or disease. To keep the cornea clear and scar-free, there are specialist stem cells located at the front of our eyes called limbal epithelial stem cells. The loss of these specialist cells leads to the growth of surrounding scar type tissue over the eye which results in reduced vision or even blindness. There are very few specialist centres around the world which are equipped to culture limbal epithelial cells from the unaffected eye, place the cells on small pieces of donor human amniotic membrane, grow these for several weeks in culture and then transplant these to the eye post removal of the scar tissue. Thus, in the last 15 years, limited numbers of patients have been able to access specialist treatment for this condition.
INTERVIEW
How are these funds going to be utilised?
We are working together to simplify this technique. There are two steps in the development of this technique – regenerating a new corneal epithelium from a very small piece of the unaffected eye and producing a synthetic membrane as an alternative to the human amniotic membrane which can be stored and ready for use by surgeons anywhere.
What will be the benefit of this collaboration? What is your role in this collaboration and how will LV Prasad Eye Institute contribute? The main benefit of this collaboration will be to make the treatment of cornea surface disease more accessible to more surgeons and therefore more patients. Corneal disease is the fourth most important cause of blindness worldwide (Source:WHO). In India, particularly, damage to the clear surface of the cornea is very common. Unfortunately, as mentioned earlier, access to this treatment is limited. There are relatively very few centres that have surgeons who are in a position to treat these patients. Thus, the therapy, which will be developed as a result of the collaboration, will help in curing patients who have damage in the front of their eye due to some accident or more rarely due to a disease. Dr Virender Sangwan, Clinical
Director of LV Prasad Eye Institute, has already tested out the first concept that a corneal epithelium can be regenerated on the eye starting with very small pieces of tissue. Now, together we have completed the development of a synthetic sterilised biodegradable membrane which can be stored at -20°C for at least a year before use. The University of Sheffield is taking the lead in developing this biodegradable membrane and Dr Sangwan of LV Prasad is working with us closely to confirm that what we develop will be appropriate for clinical use and he will lead the first clinical study in man once we’ve completed the development of this material.
Who has funded this project? This UK-India collaboration project has been funded by the Wellcome Trust Foundation. This is
THE THERAPY, WHICH WILL BE DEVELOPED AS A RESULT OF THE COLLABORATION, WILL HELP IN CURING PATIENTS WHO HAVE DAMAGE IN THE FRONT OF THEIR EYE 22
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a charitable foundation that funds breakthrough research, this time on an international basis. It has funded a small team of researchers on this project for three and half years.
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These funds have been utilised to fund research staff both in India and in the UK to develop the carrier and evaluate it in the laboratory and to do extensive tests to make sure that it will be fit for purpose for a clinical study in man. We are now near the end of the three and a half year project and the funds have supported a small team of researchers both in the UK in Sheffield and in LV Prasad to work very closely together to develop the biomaterials, evaluate them extensively, check that they can actually support the culture of cells and cells growing out from tissue explants and subject them to a battery of tests, which include sterilisation and storage for long periods of time. In brief to complete all of the work that is necessary before such membranes can be tested safely in patients.
You say that with this collaboration you will work towards simplifying this technique and making it more affordable and accessible for patients in India. Can you elaborate on this effort? Standard treatments for corneal blindness are corneal transplants or grafting stem cells onto the eye using donor human amniotic membrane as a temporary carrier to deliver these cells to the eye. But we have developed a synthetic sterilised biodegradable membrane as an alternative to human amniotic membrane. This membrane can be sterilised and stored in a vacuum pack until needed and then combined with a small explant of the patient’s tissue from the contralateral eye for immediate use by surgeons anywhere thus making the treatment accessible. Also, we have used very simple materials (materials currently used in dissolvable sutures) in developing the synthetic membrane and the technology of producing the membranes is not itself expensive. Thus, we hope that once we have verified the success of the technique, we can make it available at a relatively low cost. That is the motivation behind our research, making regenerative medicine affordable. raelene.kambli@expressindia.com DECEMBER 2013
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POST EVENT
Philips Innovation Campus observes ‘World Prematurity Day’ Organises an awareness session with Dr Karthik Nagesh, neonatologist and pediatrician on the topic ‘Developmental care for premature babies’
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n the event of ‘World Prematurity Awareness Day’ - November 17, Philips Innovation Campus organised an awareness session with Dr Karthik Nagesh, renowned neonatologist and paediatrician on the topic “Developmental care for premature babies” at Bangalore. Dr Nagesh, Founder, Managing Trustee of the ‘Foundation for Newborns’, a trust that does charity for sick babies and promotes newborn health, spoke on the occasion and said, “Babies born too soon need a good start in life. Hence, we should do whatever it takes to reduce the burden and mortality associated with prematurity by spreading awareness on the need for their safe delivery in
institutions where they can be cared for.” Preterm birth is emerging as a global crisis. Every one in 10 babies born worldwide is preterm. Off all the preterm babies born in the world, one fourth are in India amounting to over 35 lakh children born premature. “Each premature baby requires immediate and individualised attention. However, their requirements are quite simple. Preterm babies need warmth, oxygen and need monitoring of sugar-level,” said Dr Nagesh. Antenatal steroid injection and proper handling and efficient medical care can reduce the mortality due to prematurity. Another important intervention is Kangaroo Mother Care (KMC), which borrows
its name and technique from kangaroos and other marsupials is also estimated to save 450,000 lives each year. KMC allows mother's own body to serve as a low-tech incubator for the provision of critical newborn care by wrapping the babies to their bare chests. Mothers are also encouraged to initiation breast-feeding immidiately, which helps to protect the newborn against severe infections and provides essential nutrients. Anxious parents of preterm babies can deal with the difficulties of handling a premature baby if they are wellinformed and work closely with care givers. With emphasis on integrated development care for neonates, Philips showcased
a range of products to promote family centred care including positioning aids like Bendy bumpers, Prone Plus, Snuggle Up, Fredrick T Frog, and Wee pee Diapers for premature neonates. Demonstrating the products, Srikanth Muthya, Director, Healthcare said, “Each product is developed with seven evidence-based core measures in mind: healing environment, partnering with families, positioning and handling, protecting sleep, minimising stress and pain, optimising nutrition, and safeguarding sleep.” He also added, “Philips has extended beyond basic therapeutic devices and moved into cognitive developmental care for premature new borns.”
Bangalore Baptist Hospital conducts Master trainer's workshop on healthcare communication Training was conducted with the help of videos, group discussions, role play and role modeling
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angalore Baptist Hospital organised the Master trainer’s workshop on healthcare communication recently at their Hebbal premises. The workshop was a great success and was attended by 38 healthcare professionals from more than 15 hospitals across India. This was the fourth national workshop that was conducted in Bangalore. Earlier workshops have been conducted in New Delhi, Bangalore and Kochi. So far around 125 master trainers have been trained. The most striking feature of this programme was that the sessions were taken by doctors who have a 'hands on' experience and videos and roleplays were designed based on real life experiences. ‘Effective communication’ forms the foundation on which good clinical care is
established. 70 per cent of the errors in a hospital happen because of communication gaps. Many studies also show that patients get well faster if they are treated by doctors who are effective communicators. But in India, communication skills are neither taught nor assessed during their professional training. Bangalore Baptist Hospital has developed training modules for training of health care professionals. The training www.expresshealthcare.in
addressed issues like “How To Have Effective Communication In PatientDoctor Interview”, “How To Be A Good Listener”, “Non Verbal Communication”, “How To Manage Patient Expectations”, “Different Personality Types”, “Breaking Bad News”, “How To Disclose Medical Errors”, “How To Develop Assertive Communication Styles” and “Handling An Aggressive Patient”. In this workshop, training
was conducted with the help of videos, group discussions, role play and role modelling. To spread this knowledge, Bangalore Baptist Hospital has joined hands with Consortium of Accredited Hospitals of India to start workshops at national levels to “Train the Master Trainer”. National Accreditation Board for Hospitals & Health Care Providers has endorsed this training. Faculty included: Dr Ajay Shetty, Consultant Urologist, Sakhra World Hospital; Dr Badari Datta, Consultant ENT Surgeon & Head of Quality, Bangalore Baptist Hospital; Dr Kingsley R Gnanadurai, Consultant Physician, Bangalore Baptist Hospital; Dr Rajnish Samal: Consultant Obstetrician & Gynaecologist, Bangalore Baptist Hospital; Dr Deepak Abraham, Professor of Surgery, CMC, Vellore. EXPRESS HEALTHCARE
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POST EVENTS
IHS conducts webinar on 'Assessing Global Healthcare Market Access Risk' It focussed on understanding the conceptual framework of risk assessment, cost/pricing and market trends in healthcare and pharma
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webinar on 'Assessing Global Healthcare Market Access Risk ' was conducted on November 7, 2013, by IHS. The webinar aimed to give an understanding on the conceptual framework of risk assessment, cost/pricing and market trends pertaining to the healthcare and pharma sectors. Gustav Ando, Director, Healthcare and Pharmaceutical Group and Praful Mehta, Senior Healthcare Analyst, IHS were the speakers. Express Pharma was the Strategic Media Partner to the webinar. Ando gave an overview of the global pharma market and its complexities. He highlighted that the focus has shifted from mature markets to emerging markets. He said that growth in emerging markets are being driven by factors like rising demand, improving healthcare environment, relatively low market access cost base etc. Speaking on the fast growing segments in pharma, Ando informed that great sales growth are expected in areas like obesity, HBV/HCV and rheumatalogy while there will be a decline in cardiology, and CNS markets. He also opined that poor capital allocation is a major concern that can derail the progress of
the pharma sector globally. Continuing with the analysis, Mehta said that while the emerging markets offer a lot of growth opportunities for pharma players, the market condition in each country is different. They are producing unique challenges and hidden opportunities. Hence in order to achieve success in emerging markets it is essential to identify key growth areas; secondly, understand the risks and challenges in the market concerned and lastly, devise strategies to optimise the opportunities and tackle the challenges. He said it is important to understand the target patient population, regulatory environment and healthcare models available so that adequate resources can be deployed to create an effective strategy for the specific market which is being targetted. Ando suggested that risk can be a framework to create an effective strategy that will help to capitalise the opportunities. Moving on to market access, Mehta said that it is driven by a) ability to pay for new drugs; b) willingness to pay for new drugs and c) uncertain random events. He informed that economical, financial and political risks
Tops five challenges in emerging markets, according to IHS ● Lack of reimburse-
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ment and public funding system Lack of healthcare infrastructure for delivery of healthcare products and services Lack of affordability Price pressures Local competition
IHS recommends six strategies that can be deployed for success. They are: ● Close collaboration
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with governments through effective risk management strategies Sales excellence through own sales force Local manufacturing Distributions through local distributors and wholesalers Targetted key account management Outcome based pricing
largely impact market access to drugs. He also informed that regulatory reforms are also taking place in these markets and sophisticated pharmaconomic models will decide the success in these markets. On the India front, Ando commented that the country's pharma and healthcare sectors are plagued by two major concerns i.e. poor influx of capital and poor healthcare infrastructure. Moreover the country's market is highly regionalised which adds to its complexity. Factors like India's intellectual property policy, compliance issues are seen as barriers to growth by MNC pharma However, he opined that it is a market that cannot be ignored and he foresees that in the coming time “MNC pharma companies would be testing the waters much more”, he said. He also recommended PPPs, regionalised strategies and specialised partnerships and collaborations as a means to achieve more success. He sees significant growth opportunity in the field of branded generics. His final take was that while the healthcare system in India is being transformed, pricing of drugs and reimbursement are areas that need more attention.
Business leaders call for accelerated private sector engagement to improve health in India Focus on the role of private players in achieving Health MDG goals
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n the eve of Children’s Day in India, at a business forum on health called “Reaching the Health Millennium Development Goals (MDG): The Critical Role of India’s Private Sector,” held at the Trident Hotel in Mumbai, business and health leaders called on companies to accelerate efforts to save children’s and mothers’ lives in India. If the business community stepped up its efforts and
targeted key health areas, it could help India achieve global targets for reducing maternal, newborn and child deaths in India and save millions of lives, business leaders said. “In India, a large number of maternal, neonatal and infant deaths that occur are from preventable causes and can be averted by timely interventions, not just by government but civil society and the corporate sector www.expresshealthcare.in
too,” said Nita Ambani, Chairperson of the Reliance Foundation, who delivered an opening keynote address. “This will require forging smart, strong and sustainable partnerships with each other and demolishing sectoral barriers to act as one for the national agenda.” “India has a big challenge to improve health and nutrition overall and especially maternal and child health,” said Vinita Bali,
CEO and MD, Britannia. “We believe business has a significant role to play in driving positive outcomes in these areas and must step up to this challenge.” Actress Priyanka Chopra, UNICEF Goodwill Ambassador, applauded the call for increased private sector action. “This discussion on child and maternal health is crucial, and I congratulate the organisers of this event,” Chopra said. “As part of the DECEMBER 2013
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POST EVENTS entertainment industry, I believe we can use our voices individually and collectively to empower and equip communities, mothers and adolescent girls with knowledge and information about child and maternal health and enable them to demand important services.” The event featured remarks from more than 30 business, health and government speakers, including Ambani, Bali and Chopra and business executives from numerous companies, such as Tata, Hindustan Unilever, Bharat Biotech, Apollo Hospitals, Zuventus, MSD, McCann Health, Novartis, Johnson & Johnson and Lowe Lintas. Speakers included leaders from government, UNICEF, the World Bank, the Bill & Melinda Gates Foundation and the American India Foundation. The event sought to mobilise business to reduce mother and child deaths and improve India’s sanitation
and hygiene challenges. India struggles with the highest number of newborn, child and maternal deaths in the world and is not on track to meet global targets called the MDG, which aim to reduce the maternal death ratio by three-quarters and the death rate of children under age 5 by two-thirds by the end of 2015. Globally, one in every five children who dies before reaching her fifth birthday is an Indian child, and one in every five women who dies of pregnancy-related causes is an Indian woman. Also at the event, the conference organisers released investment cases, calling on companies to focus on their newly required corporate social responsibility(CSR) spending on seven critical health areas. The country’s new CSR legislation requires large companies to spend at least two per cent of their profits
every year on CSR. The investment cases suggest that the health MDGs can be reached and the lives of millions of children and mothers saved if the business community focused its CSR funds and investments on those seven areas. The seven areas are: newborns; pneumonia and diarrhea, which are leading causes of child deaths in India; mother and child nutrition because malnutrition is the leading underlying cause of child deaths in India; women’s empowerment and reproductive and maternal health; water, sanitation and hygiene; and frontline health workers. The cases cite specific products, services and awareness campaigns that companies should support. “India’s new CSR policy coincides with the urgent deadline that we’re facing to achieve the health targets pursued by India and the world,” said Leith
Greenslade, Vice Chair of the UN Secretary-General’s Special Envoy for Financing the Health MDGs. “If India’s business community focused its CSR spending, investments and efforts on the seven areas highlighted today, India could move quickly toward significantly reducing maternal and child deaths and achieving the goals.” “Success is possible but will depend on the private sector taking a greater role and focusing its efforts where they will have the greatest impact and save the most lives,” said Dr Krishna Ella, Chairman and MD, Bharat Biotech International, which develops and manufactures vaccines and medicines. “Diarrheal diseases have excellent proven solutions available for prevention and cure and deploying them will save the lives of several hundred thousand children each year.”
CT Fest 2013 gets a good response Over 350 delegates from across the country attend the event
DECEMBER 2013
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he CT fest was held from October 25-27 at The Westin, Mumbai. It was a well attended affair with more than 350 delegates from across the country, and predominantly from Maharashtra, Gujarat and the southern states. Dr Parvez Masood, Dr Alison Smith and Dr Jonas Rydberg were the international faculty along with Dr Deepak Patkar, Dr A Anbarasu and Dr Karthik Ganesan from India, amongst others who delivered lectures on various topics in neuroradiogy and abdomen. It was the first time probably that an event was held across three days on systems rather than modalities. Lectures on stroke, tumours, spine were delivered by the faculty describing both CT and MR protocols and advantages of each modality for each disease. An interesting panel discussion was held with international faculty, Dr Sunanda Anand (neurologist at Nanavati Hospital, Mumbai) and Dr Rajeev Mehta with discussions on stroke evaluation and management decisions based on imaging find-
Dr Alison Smith, one of the speakers at CT Fest
Delegates attending the conference www.expresshealthcare.in
ings. The residents and consultants gave a very positive feedback from residents and consultants. They described the programme as a wonderful teaching experience that will help them enhance their skills. Good material was presented by resident doctors, especially those from MP Shah Hospital, Jamnagar under Dr Nandini. The help of their professors in planning the slides and abstract presentation helped them win most of the prizes at stake in the abstract and poster competition. The theme next year is 'neckchest- abdomen' and the venue is the Marriott, Pune. It will be held during November 7-9, 2014. Since Pune is well connected, the organisers expect a good response from their MSBIRIA members. Dr Amit Kharat, Dr Vijay Kadam and Dr Ritu Lokhande form the local team managing this event. Dr Sanjay Vaid and Dr Anbarasu are part of the national faculty on board for this event. More details about the programme is available at www.msbiria.org EXPRESS HEALTHCARE
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EVENT BRIEF Clairvoyance 2013
Hospital Build & Infrastructure India Exhibition & Congress
Date: December 7-8, 2013
Date: December 12-14, 2013
Venue: Convention Centre, New Campus, Tata Institute of Social Sciences, Deonar
Venue: Pragati Maidan, Delhi
Organisers: School of Health Systems Studies, Tata Institute of Social Sciences Summary: Clairvoyance is organised annually by the School of Health Systems Studies, Tata Institute of Social Sciences. This year the theme of the conference is ‘Re-imagining Health and Healthcare in India’ with various sessions related to health financing, health sector reforms, workforce management in hospitals, IT and quality in hospitals, innovations in public health, role of social determinants and international trade. These various sessions will give a perspective into the past, the present and the future of health sector in India. In keeping with the ideal of the institute, the sessions will challenge the old perceptions, evaluate the present and envisage the future. Contact Dr Abhiraam Mehendale, Dr Nehal Shah Tel: +919029885185/ +919869733282 Email: 2013clairvoyance@gmail.com Website: www.tiss-clairvoyance.in
Organisers: Informa Exhibitions Summary: The Hospital Build & Infrastructure India Expo (HBI) is a premier trade event on hospital infrastructure, planning, supplies and healthcare development targeted at those directly involved in the investment, planning, design, build, operations and management of healthcare facilities covering public and private hospitals, clinics and specialty centres. Contact Guru Prasath KR Group Exhibitions Director Informa Exhibitions Tel:+91 22 4059 8577 Mobile: + 91 9004345356 Email: Guru.Prasath@informa.com
66th Annual conference of Tamil Nadu and Pondicherry Chapter of IRIA Date: December 13-14, 2013 Venue: Scudder Auditorium, CMC Campus, Bagayam, Vellore Organiser: Department of Radiology, Christian Medical College, Vellore and the Vellore subchapter of the TN & PY chapter of IRIA Summary: The 66th Annual conference of Tamil Nadu and Pondicherry Chapter of
IRIA will lay emphasis on the ongoing and upcoming trends in the field of radiology and diagnostic imaging. Contact Department of Radiology, Christian Medical College, Vellore Tel: 0416 228027 Email: registration@iria2013vellore.in; radio@cmcvellore.ac.in
healthservices@ficci.com
Green lean six sigma certification training for healthcare Date: January 4-12, 2014 Venue: Hyderabad Last date to register: December 9, 2013 Organisers: AUM MEDITEC
FICCI Health Insurance Conference 2013: “Health Insurance Vision 2020: From Regulation to Development” Date: December 13, 2013 Venue: FICCI, New Delhi Organisers: FICCI Summary: The FICCI Health Insurance conference will try to articulate the building blocks of the next paradigm which will comprise numerous structural changes including regulatory, legal, product-related, new operating entities, partnership with providers etc. Participant profile: Government representatives, health insurance industry, life and, non-life insurance industry, healthcare providers, NBFCs, insurance brokers, agents etc Contact FICCI Health Services Division FICCI Federation House, Tansen Marg, New Delhi Tel: 011 2373 8760 - 70 (Extn. 220/246) Fax: 011 2332 0714, 011 2372 1504 E-mail:
Participant profile: Hospital CEOs/COOs, management executives, hospital operations managers, quality in charge, MHA/PGDHA/MBA final year students Summary: This program module shall focus on Six Sigma methodologies, lean concepts in healthcare systems and service delivery
sub-specialities of radiology, from India and all over the world, will enlighten the delegates with their work and vast experience. IRIA 2014 promises to be an academic event which will enhance the clinical acumen and imaging skills of radiologists. Contact Dr Bhupender Ahuja Organising Chairman Ahuja Ultrasonography Centre Dr Sarkar Market, Delhi Gate Tel: 0562-3092959, 21052605 Fax: 0562-2150296, Mob: +91 98370 44202 Email: drbahuja@gmail.com
Green lean six sigma certification training for healthcare Date: February 1-9, 2014 Venue: New Delhi
Contact Meeta Ruparel Email: meeta@meditecindia.com/meetaruparel@hotmail.com
67th Annual Conference of IRIA-2014 Date: January 23-26, 2014 Venue: Hotel J.P. Palace & Convention Center, Agra Summary: The 67th Annual Conference of Indian Radiological & Imaging Association-2014 (IRIA-2014) will be organised by IRIA Uttar Pradesh state chapter. Scientific deliberations will be the most important facet of this conference. Luminaries in the various
Last date to register: December 27, 2013 Organisers: AUM MEDITEC Participant profile: Hospital CEOs/ COOs, management executives, hospital operations managers, quality in charge, MHA/ PGDHA/ MBA (Hcm) final year students Summary: This program module shall focus on Six Sigma methodologies, lean concepts in healthcare systems and service delivery. Contact Meeta Ruparel Email: meeta@meditecindia.com/ meetaruparel@hotmail.com
To tie up with
for Media Partnerships Contact kunal.gaurav@expressindia.com 26
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www.expresshealthcare.in
DECEMBER 2013
W H AT ’ S INSIDE
‘Embryoscope enables the doctor to analyse the embryo quality and select only the best embryo’ PG 29 ‘IBS is associated to impaired quality of life and high healthcare costs’ PG 29 ‘The gap between healthcare supply and demand is enormous in India’ PG 30
MARKET 11 KNOWLEDGE 27 IT@HEALTHCARE 38 HOSPITAL INFRA 40 LIFE 65
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KNOWLEDGE Stem cell therapy to treat brain injury Encouraging results with non-invasive stem cell therapy for traumatic brain injury (TBI) pave the way for a new therapeutic era for patients with brain injuries, including TBI and stroke, finds M Neelam Kachhap
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Traumatic brain injury (TBI) affects nearly 1.6 million individuals annually in India. Most of them are victims of road traffic accidents, others get TBI due to falls, violence or unintentional injuries. Most often TBI leaves the patient disabled and most of these patients are either young or the only breadwinner of the family or both. This creates a significant financial and social burden for the caretaker and the patient. However, most of the existing treatment for traumatic brain injury are limited to restricting further damage. Rehabilitation is required for the patient to relearn basic skills such as walking or talking to improve their ability to perform daily activities. Stem cell therapy to repair or replace damaged brain tissue is a new area of research. In numerous studies, stem cell implantation has substantially improved brain function in experimental animals with brain trauma. A study published by Dr Toshiya Osanai of Hokkaido University Graduate School of Medicine, Sapporo, Japan has shown that stem cells
Dr Himanshu Bansal and his team used stem cell therapy successfully to treat a young male patient with traumatic brain injury were injected in brain-injured rats via the carotid artery travel directly to the brain, where they greatly enhanced functional recovery. The therapy shows preclinical promise and its application is being researched around the world. Recently, Dr Himanshu Bansal and his team from The Institute of
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Spinal Injury & Stem Cell Research, Uttarakhand reported encouraging results of a young male patient with TBI. The patient, suffering from severe disability for the past one and half year following an accident, has successfully undergone noninvasive autologous stem cell transplantation and is the first successful case reported
from North India. The patient was bed ridden, suffering from altered sensorium with complete visual loss, severe cognitive dysfunction and lack of movement in limbs. He regained full consciousness, reasonable memory, communication abilities and purposive movements in limbs after stem cell therapy.
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DR HIMANSHU BANSAL Founder Director, Institute of Spinal Cord Injury, Rudrapur and Mother Cell Stem Cell Research & Solutions Uttarakhand
Many studies have also shown that implanted stem cells have substantially improved cerebral function with brain trauma
The case A 20-year-old, Ram Choudhary hailing from Pune had a road accident in 2012 and suffered severe brain injury. He was admitted at a prestigious private hospital in Pune and was on ventilator with tracheostomy. Doctors gave him only guarded prognosis even for survival and he remained unconscious for three months in the hospital where he underwent two neurosurgical procedures. He had marginal recovery but he was now in altered sensorium. He had to be on Ryle’s Tube feeding and urinary catheter with no useful limb movements and no verbal response. He had no vision, hearing or speech. Choudhary needed to be assisted in his daily activities. He did not show any improvement despite all available treatment in the last one year and ultimately the possibility of stem cell therapy was considered after discussions with his family. At this stage the parents had no hope for the patient and were left with no choice. They consulted Dr Bansal and he agreed to treat the patient with stem cell therapy. “Research has shown clearly that stem cell after transplantation migrate to the injury sites, transdifferentiate into new neurons and hence replace lost cells. It also prevents further axonal injury in fresh injuries and promotes axonal regrowth by secretion of growth factors, induction of angiogenesis and by modulation of the systemic immunologic response. Many studies have also shown that implanted stem cells have substantially improved cerebral function with brain trauma,” informs Dr Bansal. This treatment was chosen as a last resort for the patient on compassionate grounds. Glasgow Coma Scale (GCS) score of the patient when he reported to Dr Bansal was E2 M4 V1. “We evaluated him clinically on MRI and found right fronto parietal craniectomy with moderate to severe gliosis in right frontal and right temporal region and dilation of lateral ventricle old contusion in right frontal parietal cortical region,” he explains.
The process The stem cells were processed at Dr Bansal's lab and the patient received the transplant at the Apollo Hospital, Noida. Approximately 240 ml of
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20-year-old Ram Choudhary from Pune bone marrow was harvested from iliac crest. This bone marrow is processed in a closed system for volume reduction. Volume reduced sample is processed to have rich 5 ml fraction of mononuclear cells (haemopoetic stem cells and mesenchymal stem cells and endothelial progenitor cells) and adjoining supernatant plasma which is rich in platelets and growth factors. The sample is further processed to recover lost Very small embryonic like stem cells (VSELS) the most useful and powerful cells. Finally, 0.5 ml of this end product is sent to the lab for expansion of mesenchymal cells in human grade media at 4 degree Celsius. These cells are then injected to the patent on a monthly basis by retrobulbar/intrathecal and intrarterial route for six months. “The typical yield, on an average, per 60 ml of bone marrow varies from 320-380 million MNC, 15 to 18 million Cd 34+ve o.5 million MSCs and 1 million VSEls. Further, 40 ml of the bone marrow sample which was sent to lab is expanded for Mscs. These mscs are expanded at four per cent oxygen only upto three passages normally we get 50-75 www.expresshealthcare.in
millions at end of three passage,” Dr Bansal says. Support therapy in terms of Ayurevda and supplements of Vitamin B1 and Vitamin B12, Vitamin B3 nicotinic acid were also started along with vigorous rehabilitation and intensive physiotherapy.
Prognosis After the third treatment sitting, patient started showing improvement in his brain functions. He became oriented, was gradually able to recognise family and friends and started moving his hands and legs purposefully. By the fifth month, patient started showing considerable improvement, started verbalising, was able to communicate with his parents and able to walk with support. He could perform semi-assisted activities of daily living, and his memory recovered significantly. Vision improved to finger counting in the right eye and good perception of light in the left eye by sixth month. “It may take him a couple of months to be more active,” Dr Bansal opines.
Outlook The belief that brain injuries aren't curable has been proved wrong as stem
cell therapy has become one of the means to tackle the situation. “The need to help accident victims led us to work on compassionate grounds for the option of stem cell therapy,” says Dr Bansal. “There has been a pressing need to help the rising number of people who were disabled following road accidents. Most of the people who manage to escape from death after a road accident find it very difficult to lead a normal life as their neurological functions get disturbed to a large extent. According to Institute of Road Traffic Education, the numbers of these are mind boggling. About 1.4 million people in India face road accidents out of which 40 per cent die and the other 60 per cent are left with serious injuries, most of them related to head. Till now there wasn’t a treatment which could claim its ability to address these concerns. Stem cells transplant have raised a hope for the millions who are left with the aftermath of these accidents,” he adds. “This is an eye opener that there is a possibility of reactivating brain cells following injury with very gratifying clinical results. To our knowledge few attempts like this have been made across the world. This is the first reported successful case from India,” he adds. “These stem cells are non-invasive, display contact inhibition and are non-malignant. These are safe for transplant,” explains Dr Bansal. Till date seven patients across Delhi at various private hospitals like Rockland and Karla have received this therapy. The cost per sitting is about a lakh rupees followed with other expenses making this an expensive treatment option. However, Dr Bansal says that poor patients who need the transplant are also treated at substantially low rates. However, a lot more need to be understood about stem cell therapy in head injuries including the time of intervention and quantity of cells to be used depending upon the injury. "We're planning to carry out a pilot study in treating head injuries with stem cells,” says Dr Bansal. “Stem cell therapy has a reasonable perspective for a clinical application in traumatic brain injury, the translation of the existing findings requires extensive additional experimental studies,” he concludes. mneelam.kachhap@expressindia.com DECEMBER 2013
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‘Embryoscope enables the doctor to analyse the embryo quality and select only the best embryo’ The Embryoscope- a new technology in the field of in vitro fertilisation (IVF) has been slowly picking up momentum. Dr Hrishikesh Pai, Gynaecologist & Infertility Expert, Lilavati Hospital, Mumbai talks about embryoscope as a technique, its multiple benefits and the way forward, in an interaction with Raelene Kambli What is embryoscope? Does the technique increase the chances of pregnancy? The embryoscope enables the specialist to monitor and even film the entire process of fertilisation, inside the incubator without disturbances to the embryo culture. It is an advanced incubator that not only maintains the necessary conditions like the right temperature required for the embryo during the in- vitro process but also captures the images of the embryonic development, as it is equipped with a camera.The development can be seen for five days and after checking pros and cons, only the best egg is transferred into the womb thereby improving the overall success rate.Thus, it has proven to be a revolutionary technique.
Can you shed some light on the progress of this technique in the field of in-vitro fertilisation? The most challenging part of IVF is selecting the best embryo in order to ensure pregnancy. Currently, embryologists need to remove the embryo from a standard incubator to check on the development of the embryo under the microscope, at fixed time-points over
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Are there any precautions that need to be taken by the specialist? There are standard hygiene precautions that need to be taken care of by the specialist, like proper sterile conditions, use of disposable syringes etc.The temperature and humidity is already controlled and the air is filtered through carbon and HEPA filters.
three to five days. However, the embryoscope overcomes the shortcomings of the current IVF protocols and eliminates the need to disturb the embryo culture to study it. In IVF, often women are implanted with two or three embryos at one go, which leads to twin pregnancy or triplets.The embryoscope enables the doctor to analyse the embryo quality and select only the best embryos.Thus, there is a much better chance of making the IVF treatment successful.
Does using this technique increase the cost of IVF services in any way? What is the difference?
What are its benefits?
What growth prospects do you anticipate for the technique in the future?
The embryoscope is a blessing in disguise for patients marred by the handicap of infertility. It is a time-lapse system that gives the parents-to-be more information about the embryo. It provides a record on film of the beginning of the future baby’s life. It improves IVF treatments and offers undisturbed culture in a stable environment.Thus, there is a much better chance of making the IVF treatment successful using embryoscope.
How many embryoscopy cases have you performed so far? What is the approximate success rate
Yes, there is an additional cost that has to be incurred for embryoscope.This is because the equipment used is expensive and the maintenance is very high.
How many IVF experts in India practice this technique? Currently, there are 8 to 10 doctors practising embryoscopy in India.
you can assure a patient through embryoscope? Embryoscopy has been performed on more than 150 patients so far.The success rates are about 30 to 40 per cent per attempt in combination with laser assisted hatching in women less than 35 years of age who have had previous IVF failures.
Embryoscopy is the latest developed technology in the IVF treatment which has proven to be very effective.The instrument provides a unique opportunity to develop new parameters for future embryo scoring and improve embryo assessment in IVF. Majority of the people have now started using this technique instead of the standard IVF process.The technique is spreading fast and has become more routine and acceptable now. raelene.kambli@expressindia.com
‘IBS is associated to impaired quality of life and high healthcare costs’ Irritable Bowel Syndrome (IBS) is a functional disorder that affects many and impact their quality of life adversely. Dr Pere Clave, Associate Professor of Surgery, Hospital de Mataró Universitat Autònoma - Barcelona and a renowned gastroenterologist, on a recent visit to India, sheds light on this health condition, its causes and the ways to manage it, in conversation with Lakshmipriya Nair What are the causes of IBS? What is its impact on life expectancy or the quality of life? The pathogenesis of IBS is not fully understood and involves the interaction DECEMBER 2013
between genetics and external factors that may alter bowel physiology, mainly motility and sensation, changes in mucosal permeability, enteric microbiota and microinflamation. It may also may alter the psychosocial profile of subjects
and their susceptibility to gut dysfunction and symptoms through connections between the enteric and central nervous system, the brain-gut axis. Therefore, the symptoms of the patients with IBS are caused by motility disorders, by alterations in perception and visceral hypersensitivity, and also by psychological and psychosocial factors. IBS causes severe symptoms in 25 per cent patients and is associated to impaired quality of life and high healthcare costs as patients with IBS visit many physicians and are submitted to multiple explorations before a proper diagnosis and treatment of the
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condition.
What is the incidence rate of this disease? How susceptible are Indians to this disorder? IBS as a chronic functional bowel disorder in which abdominal pain or discomfort is associated with a change in bowel habit and clinical symptoms of disordered defecation or distention.The prevalence among general population is high (up to 25 per cent), mainly in females (3 females/1 male). Studies found similar prevalence among countries and ethnic groups.
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What can be done to prevent the onset of this disease? Are there any lifestyle changes needed? Some patients develop IBS following an acute episode of acute gastroenteritis; however the majority present a more insidious onset of IBS symptoms. IBS is a chronic and relapsing disease, and the natural history of the condition is characterised by cyclic periods of symptoms over time and, in addition, a significant group of patients with IBS develop symptoms of other functional gastrointestinal disorders such as dyspepsia or gastroesophageal reflux. Studies found a significant increase in the stressors (daily hassles, stress, stress coping styles, changes in eating habits, reduction in sleeping time or psychological abuse) score just before relapses than earlier average scores.
How can it be diagnosed? Are there any tests that help to do it? The first step of the diagnosis is to identify the symptom complex of IBS. This can be done by using the international criteria that have evolved in the
last 30 years from Manning criteria to the Rome criteria and now the Rome III criteria. The Rome IV version is now in preparation.The second step is to identify alarm features and exclude organic diseases, which have similar clinical presentations, mainly inflammatory bowel diseases and malabsorptive diseases in young patients, and colon cancer in middle aged patients. The Rome III criteria appeared in 2006 and the IBS symptom complex is defined by recurrent abdominal pain or discomfort associated with two or more of the following symptoms: a) improvement with defecation; b) onset associated with a change in frequency of stool, and c) onset associated with a change in form of stool.The diagnosis of IBS requires symptoms during the last three months and onset in the previous six months.The experience with the Rome criteria has demonstrated that IBS is a safe diagnosis and patients diagnosed with this condition seldom suffer an organic disease during follow up. The likelihood of diagnosing an alternative GI organic disease during
IBS IS A CHRONIC AND RELAPSING DISEASE, AND THE NATURAL HISTORY OF THE CONDITION IS CHARACTERISED BY CYCLIC PERIODS OF SYMPTOMS OVER TIME AND, IN ADDITION, A SIGNIFICANT GROUP OF PATIENTS WITH IBS DEVELOP SYMPTOMS OF OTHER FUNCTIONAL GASTROINTESTINAL DISORDERS SUCH AS DYSPEPSIA OR GASTROESOPHAGEAL REFLUX
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muscle relaxants in patients with pain and bloating.This therapeutic trial is a very relevant step in management of IBS and up to 75 per cent patients will present mild symptoms and respond to treatment.
Who are more susceptible to this disease? (age group, social strata, etc) Is it a hereditary condition? Overall, there is very limited evidence of a genetic association with IBS; the most replicated association is with some genes potentially involved in the minimal degree of inflammation and changes in gastrointestinal mucosal permeability. So, in most patients IBS in 'NOT' a hereditary condition.
Any new treatments or drugs that assist in treating the condition more effectively?
prolonged follow-up of IBS patients is very low, two to five per cent during the six year follow-up, and 2-9 per cent at the 30 year follow-up.
How can it be cured or managed? What are the challenges in handling this disease effectively? In patients with mild symptoms, a positive diagnosis of IBS can be established using the Rome III criteria and a therapeutic trial guided by primary symptom characteristics should be maintained several (8-12) weeks. It includes fibre and osmotic laxatives in patients with constipation, antidiarrheal agents in patients with diarrhoea, as well as antispasmodic drugs and smooth
I’m visiting India to explain a new study with the compound otilonium bromide.The OBIS study is an International, phase IV, randomised, double blind, parallel group, and placebocontrolled study that were performed following the regulations of the European Medicines Agency.The OBIS study was conducted in 38 centres in 8 European countries including 356 adult patients of both genders diagnosed of IBS.This placebo-controlled double-blind study shows that otilonium bromide is safe, well tolerated and superior to placebo in reducing the frequency of abdominal pain, severity of abdominal bloating and protecting from symptom relapse in IBS. These results further confirm that patients with IBS can improve during and following treatment with otilonium bromide. lakshmipriya.nair@expressindia.com
‘The gap between healthcare supply and demand is enormous in India’ Ravi Ramamurti, D’Amore-McKim School of Business, Northeastern University, Boston talks to M Neelam Kachhap, about his research on Indian healthcare and innovations in healthcare delivery that can help US healthcare to achieve a 50 per cent cost reduction
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Lifespring, Vaatsalya, and Apollo Group (which played an important role establishing the corporate model for hospitals and for establishing accreditation standards). We don’t claim that these are the only Indian hospitals that deserve to be studied.
Why did you choose to study only private providers?
Tell us about your research project?
ed by other hospitals.
We (Vijay Govindarajan and Ravi Ramamurti) wanted to understand how some private Indian hospitals were able to provide high quality medical care (comparable to Western standards) at very low prices (compared to Western costs) using scalable models to serve both rich and poor patients. We were aware that on an average the conditions of healthcare in India leave a lot to be desired, especially for the poor. Our study focused on innovators whose models might be replicat-
What was the aim of the study?
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The study's aim was to extract lessons for other hospitals in India, as well as in other developing countries, and even for hospitals in the West.
Which hospitals participated in the study? The article is based on nine hospitals that we studied: Aravind Eye Care System, LV Prasad Eye Institute, Narayana Health, Care Hospital, HCG Oncology, Deccan, www.expresshealthcare.in
Much of the innovation in healthcare delivery in India is happening in the private sector — both for-profit and not-for-profit, thus we choose to study private sector.
What were the key findings of the study? We found that these hospitals configure their assets efficiently (hub-and-spoke design, with focused hospitals for particular medical conditions), task-shifting, and a frugal mindset, backed by many cost-saving process innovations. These hospitals DECEMBER 2013
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have shown that costs can be lowered dramatically while improving quality. These are not conflicting goals, as is often assumed.
What is the significance of these findings? The methods of mass production and lean production, rather than ‘craft production’ (in which each product is unique and custom-made for each customer), can be applied to healthcare to bring quality healthcare to more people affordably. Countries like the US can learn valuable lessons from these Indian hospitals. Indian hospitals are delivering high-quality care at 5 to 10 per cent of US prices. Of course, the US is not India, so its costs will always be higher. But even with all the constraints, cutting US healthcare costs in half is not preposterous. After all, it’s been done in other industries, sometimes in less time (think computers or consumer electronics).
What effect will this have on the current healthcare sector in India? We hope more Indian hospitals will adopt the practices of the hospitals in our article. The gap between healthcare supply and demand is enormous in India and we cannot afford to copy Western approaches to healthcare that waste scarce skills, equipment, and facilities.
What is your impression of the
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THERE IS ENORMOUS UNMET DEMAND FOR HEALTHCARE THAT CANNOT BE TACKLED BY ‘BUSINESS AS USUAL’. HOSPITALS HAVE TO FIND INNOVATIVE WAYS TO PROVIDE QUALITY SERVICE AT LOW COST WITH SCALABLE MODELS. THEY HAVE TO STRETCH THE AVAILABLE RESOURCES TO DO MORE WITH LESS healthcare sector in India? There is enormous unmet demand for healthcare that cannot be tackled by ‘business as usual’. Hospitals have to find innovative ways to provide quality service at low cost with scalable models. They have to stretch the available resources to do more with less. Not-forprofit hospitals must apply modern management methods and be financially disciplined, following the examples of Aravind Eye Care System in Madurai and LV Prasad Eye Institute in Hyderabad (among others). For-profits should remember that serving both rich and poor patients can help hospitals simultaneously achieve high quality and low cost.
Many providers feel that the government should pay for the healthcare delivery and the private sector should deliver healthcare. Do you think this is a logical, viable
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solution to India's healthcare delivery problem? This is an important question, but it is beyond the scope of our article. One thing we would point out is that India must not blindly copy Western models of health insurance, which are threatening to bankrupt their governments. Also, as government regulations are tightened in India they must not blunt the incentive for hospitals to innovate.
What are your recommendations for a better healthcare delivery in India? Get rid of artificial barriers to producing more well-trained doctors, nurses, and setting up hospitals. In India, there is no shortage of demand for healthcare; all the bottlenecks are on the supply side, including the politicization of medical education. mneelam.kachhap@expressindia.com
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RADIOLOGY HIGHLIGHTS
Fujifilm Sonosite conducts workshop on Ultrasound Assessment of Shock The workshop aimed to educate the role of point-of-care ultrasound in critical and emergency cases, introduces world’s first ultrasound kiosk - X-Porte in India
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FUJIFILM SonoSite conducted its first international workshop on Ultrasound Assessment of Shock on November 12-13, 2013 in Mumbai and introduced its newest product, X-Porte—
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touted as the 'World’s First Ultrasound Kiosk'. Dr Diku Mandavia, Senior Vice-President, Chief Medical Officer, FUJIFILM SonoSite Inc, shared, “Patients in shock have high mortality rates; therefore, diagnosis and initial care must be accurate and prompt to optimise patient outcomes. India is adopting latest technologies and point-of-care ultrasound technology has been gradually integrated into emergency and critical care departments.” The workshop is an initiative by FUJIFILM Sonosite to train acute care physicians
on effective use of point-ofcare ultrasound techniques in shock assessment and identification of potential causes of shock, and resulting patient management and care. The training programme includes a combination of hands-on ultrasound training, lectures by leading experts on shock assessment and pre-course teaching materials. “Point of care ultrasound has transformed the way we manage critically ill patients by augmenting physicians’ clinical skills with visually enhanced condition assessment, patient management and critical decision making.
Dissemination of knowledge and skills on effective use of point of care ultrasound in acute care is of paramount importance in providing quality of care when it matters the most,” said Dr Sanjeev Bhoi, Associate Professor of Emergency Medicine, Emergency Medicine, JPN Apex Trauma Center, All India Institute of Medical Sciences (AIIMS), New Delhi. “Since 2006, we have had a mutually beneficial partnership with Sonosite India and have conducted several high quality workshops on aspects pertaining to regional anaes-
L to R: Dr Diku Mandavia, Senior Vice-President, Chief Medical Officer, FUJIFILM SonoSite with other faculty at the first international workshop on Ultrasound Assessment of Shock
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thesia and central venous access. These workshops have certainly disseminated knowledge among anaesthetists on the utility of ultrasound guidance to improve precision and reliability of nerve blocks and venous access”, said Dr TVS Gopal, Director, Axon Anaesthesia Associates, Dept of Anaesthesia, Care Hospitals, Hyderabad. “The Academy of Regional Anaesthesia of India has conducted three national conferences to educate anaesthetists across the country of pertinent recent advances in this field, specifically, ultrasound guidance for nerve blocks, which is being hailed as the current
gold standard,” Dr Gopal added. FUJIFILM SonoSite's XPorte Ultrasound Kiosk reportedly integrates highresolution ultrasound imaging synchronously with 3D animations that enable 'any user, any time of day' to use POC ultrasound in patient management. This unique design was developed by SonoSite in partnership with Henry Ford Hospital Chair of Surgery, Scott Dulchavsky, who has pioneered medical training tutorials for astronauts. Real-time learning on the product enables any and all members of a healthcare team—nurses, mid-level providers, and even a physician-hospital administrator—
to be empowered to take advantage of X-Porte's highperformance visualisation. Speaking on the occasion, Pavan Behl, Director and General Manager - India & Middle East, FUJIFILM SonoSite India said, “Timely and accurate care of critically ill patients in India is a challenging task and to manage such situations, we at FUJIFILM SonoSite India work towards bringing quality point-of-care ultrasound to the patients in hospital and out of hospital through our cutting-edge products, education and training.” “We believe that education and training combined with technical talent, critical decision making ability, and
Imagination together make point-of-care ultrasound a lifesaving tool and improving care delivery and patient satisfaction in India. For this purpose, we have partnered with leading Indian institutions, associations and medical centres to provide pointof-care ultrasound training to physicians, nurses and other clinicians and helping deliver the best possible care to the society. Going forward, we plan to hold many more similar workshops in various cities to provide education and training to physicians wanting to integrate point-ofcare ultrasound in their daily practice,” Behl added. EH News Bureau
Jaslok Hospital conducts 320 successful MRgFUS treatments The hospital also inaugurated an Acute Care Unit
aslok Hospital recently celebrated the successful completion of 320 treatments of MR Guided Focused Ultrasound Surgery (MRgFUS) reportedly the highest number so far in India. Jaslok’s MRgFUS unit has treated successfully over 320 patients [highest number in India] suffering from uterine fibroids, uterine adenomyosis, prostrate cancer, bone metastasis, lumbar facet arthropathy etc.
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The department is headed by Dr Shrinivas Desai, Director, Radiology. This is a no touch, revolutionary technique that removes growths and tumors with a high fre-
quency ultrasound. Most significantly, it is a non-surgical approach to those illnesses where surgery was considered imperative. It also inaugurated its
MRGFUS IS A NO TOUCH, REVOLUTIONARY TECHNIQUE THAT REMOVES GROWTHS AND TUMOURS WITH A HIGH FREQUENCY ULTRASOUND
Acute Care Unit in the department of Infectious Diseases. Jagdish Chanrai, Trustee and Kanta Masand, Managing Trustee inaugurated the new unit. The Acute Care Unit is a highly specialised isolation unit that looks at treating high risk communicable diseases. Dr Om Shrivastav, Director, Department of Infectious Diseases heads this department. EH News Bureau
Piramal Imaging enters into a strategic partnership with Ci-Co Healthcare Have signed an exclusive licensing agreement for commercialisation of Florbetaben F18
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i-Co Healthcare and Piramal Imaging have entered into a strategic partnership and exclusive licensing agreement whereby Ci-Co Healthcare will obtain market authorisation from the Korean Health Authorities and commercialise the PET amyloid imaging agent, florbetaben F18*, in South Korea. Ci-Co Healthcare has assigned the manufacturing and supply of florbetaben F18 to DuChemBio, a radiopharmacy network in Korea.
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Beta-amyloid neuritic plaques in the brain, which researchers believe to be important biomarkers for early detection of Alzheimer’s disease, are clumps of sticky, microscopic protein that build up in the
space around nerve cells. Piramal Imaging’s PET amyloid agent florbetaben F18 is an injectable drug that in conjunction with PET/CT or MRI/PET scanners identifies beta-amyloid plaques in the human brain.
PIRAMAL IMAGING’S PET AMYLOID AGENT FLORBETABEN F18 IS AN INJECTABLE DRUG THAT HELPS TO IDENTIFY BETA-AMYLOID PLAQUES IN THE HUMAN BRAIN www.expresshealthcare.in
“Piramal Imaging is committed to building a global presence in nuclear medicineand making florbetaben F18 available to patients around the world. Ci-Co Healthcare shares Piramal Imaging’s dedication and we look forward to a strong partnership that will allow both companies to achieve its goals,” said Dr Ludger Dinkelborg, Member of the Board, Piramal Imaging SA. EH News Bureau EXPRESS HEALTHCARE
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‘Everything you write is instantly electronically recorded’ PG 39
IT@HEALTHCARE ‘The system is a very affordable, reliable and a proven technology that will fit into most companies’ budgets’ The recent partnership between UST Global, a provider of end-to-end IT services and solutions and Agencyport Software, brings the latter's specialist policy administration system, OPEN Core Platform: Health to the domestic and international medical insurance markets. Bipin Thomas, President, Health Group at UST Global talks about this partnership, its recently acquired system for underwriting, accounts and claims, and his company's future plans, in an interaction with Lakshmipriya Nair Give us more details about the partnership with Agencyport? What is the rationale behind the move? UST Global has become the preferred partner for Agencyport and their OPEN Core: platform. This platform is a fully configurable, nimble, turn-key end to end solution for the medical insurance market globally. As UST Global continues to expand in countries around the globe, healthcare is a common theme everywhere. Partnering with Agencyport gives us the ability to offer system solutions for many prospective customers globally, as well as addressing markets within the US such as regional health plans, Third Party Administrators and Accountable Care Organisations.
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What are the features of OPEN Core platform that makes it unique? What gives it an edge over its competitors? This platform is a fully configurable, nimble, turn-key end to end solution for the medical insurance market globally. OPEN: Core leads in the market for many reasons including its architecture, web based design, multi-currency, multi-lingual capabilities, the strong company foundation behind the product and a preferred partner working hand in hand with Agencyport to further the systems usage and functionality.
How much would it cost the users to implement this solution?
How would the partnership enhance UST's portfolio?
The system is a very affordable, reliable and proven technology that will fit into most companies’ budgets who
The partnership gives an end-to-end system solution for UST Global to provide its current and future customers. UST Global has partners in many areas of technology that enhance or provide our customers in certain areas, this partnership now does the same for payers. The beauty of the system is its multicurrency and multi-language capabilities.
THIS PLATFORM IS A TURN-KEY END-TO-END SOLUTION FOR MEDICAL INSURANCE MARKET
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are considering upgrading, changing or adding system functionality.
How do you plan to market this solution (strategies)? Has anyone already implemented it in their organisation? UST will be joint marketing the solution through the US and globally. UST Global is working side by side with Agencyport to further the systems usage and functionality in the US and beyond.
Do you have any other products that cater to the healthcare vertical and allied areas? UST Global partners with many companies that target the healthcare vertical, such a Verizon Health, Visensia, Pega Systems, McKesson as well as Kony.
What kind of opportunities exist for IT players in India's healthcare market? As the need for the governments’ population health management increase and the private healthcare sector becomes more familiar with various health insurance vehicles, the Indian market offers a wealth of opportunity for IT players who have the knowledge, skills, strategic alliances and partnerships to fulfill the need.
What are the challenges in healthcare and allied sectors that can be mitigated through the help of good implementation of IT services? Similar challenges in the healthcare sector are pervasive globally. Access to quality care, access to healthcare data, analysis of that data for health management, protection of that data from a security perspective and interoperability and communications between all of the participants in the healthcare eco-system.
What are your other plans for the Indian market? Are you looking at any other strategic alliances? We look for strategic alliances globally where capabilities can be re-used in multiple markets. This is true with all of our partners. lakshmipriya.nair@expressindia.com
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‘Everything you write is instantly electronically recorded’ Scotland-based This-tel, is poised to enter the Indian healthcare market, with its digital pen to transform healthcare. The pen allows written information to be scanned and transmitted to a central server. The company will collaborate with Indian-based IT firm Crane Global Solutions to distribute its products in India. M Neelam Kachhap chats with Steve Forsyth, Founder CEO, This-tel to know more about the innovative technology How does This-tel digital pen work?
How does this technology help healthcare professionals?
The pen works and feels like a traditional pen, but captures everything you write as digital data in real time, with built-in Bluetooth and USB capabilities keep you connected, requiring minimal to no additional training or changes to your business processes required. ■ Write on any surface: With the natural feel of a regular pen you can write on any surface that has the proprietary microdot pattern. This unique pattern works with the pen’s built-in camera to determine precise positioning on any surface, ensuring fast and accurate data capture. From whiteboards and paper sheets, to tablets and displays, or even a variety of mobile devices, the pen tips are suited to fit the desired surface, allowing you to always write digitally. ■ Precision positioning: The digital pens provide exact positioning on any microdot patterned surface, be it paper forms, whiteboards or glass displays. Additionally, pressure and absolute time for each position are all recorded. When this signature information is combined with our world-class handwriting recognition capabilities, the resulting editable text far exceeds any other OCR solution. ■ Transfer in real time, anywhere: Captured data can be sent in real time via Bluetooth to different devices, such as computers, servers and mobile phones, or synchronised via USB on a computer with data delivery to e-recipients and decision makers in seconds. ■ Reliable and durable: With more than 10 years of experience providing easy-to-use, intuitive, reliable and durable digital pens for an array of purposes and environments, This-tel is the one to trust.
Innovation in data capturing by a doctor, nurse, ANM etc. by providing the flexibility to continue using paper-based forms while still enabling electronic data capture in a form which allows data mining. Imagine if everything you wrote with pen and paper was captured and saved digitally. For healthcare professionals the benefits are obvious: ■ There is very little training needed – after all, it’s pen and paper ■ The time saving due to no manual data input means lower costs and more time available to spend with patients ■ Pen and paper are lightweight, easy to carry, and always ready to use ■ Because you are not stuck behind a computer, you can enjoy a more natural patient interaction. Our technology simplifies life by: ■ Converting text or forms filled out by hand into digital data within seconds ■ Downloaded directly to your database for instant, accurate records without having to manually input them ■ You still have the paper copy so you have duplicate records – all with the same effort Doctors: There is no need for training or to change habits or behaviors – just keep using pen & paper as you do now, and everything you write is instantly electronically recorded. Healthcare managers: It improves overall efficiency of your facilities, saves money, and frees staff to help ensure that more patients can benefit from the highest standards of care. Nurses: It lets you electronically record everything in one step instead of two, requires no training and frees up more time for you to work with patients Mobile care workers: Digital pen and paper gives you better mobility, improves your connection with patients and saves you a lot of time.
What are the hardware and software requirements for using This-tel digital pens? The system is a B2B software as a service (SaaS) solution and can be installed on the clients servers or they can use our hosted service, at the user end all that is needed is an internet ready hosted device (Mobile, tablet or PC) that the pen can connect to via it USB cradle or Bluetooth. DECEMBER 2013
What are the advantages of using your product?
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modate and see an additional patients. ■ Presents the most cost-effective strategy to prevent, and early diagnosis and treatment of diseases ■ Integrates healthcare at all levels and also private practitioners and major providers of healthcare ■ Gives more control over concerns regarding ethics, medical negligence, commercialisation of medicine, and incompetence ■ Reduces the cost of medical care and thereby reduces the threat to healthy doctor relationship ■ Increasing speed and efficiency of data capture and easily digitise information ■ Being simple to implement at clinical sites and cost effective for sponsors ■ As data can be converted different formats and sent over net in encrypted form, performing data analytics is just clicks away and also maintaining confidentiality ■ Reduces the time to a huge extent. ■ Have both the hard copy and electronic version of that hard copy close to instantly ■ Maintenance of data integrity and accuracy ■ Track not only how many calls they respond to but what exactly occurs during the transportation to the hospital process ■ Also enables staff to : ❖ Be more in control of the administrative time ❖ Less stressed ❖ Have more personable approach in their work with the patient
■ Decreases consultation and adminis-
Tell us about the pilot run at the cancer hospital at Hyderabad.
trative time for both new and existing patients. That implies that staff and clinicians have the capacity to accom-
It is a comprehensive tertiary cancer centre, serving not only the state of Andhra Pradesh and also to the
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neighbouring states. It provides free treatment to approximately 10,000 new patients and 50,000 follow-up patients every year. The pilot run included: ■ Using Digital Writing Solution, it seamlessly mapped both old and new patient records by unique patient identification number. On fly submission, using digital pen of claims data for patients enrolled in both government and non-government healthcare schemes. ■ The various aspects of computerisation of total work right from registration of the patient into hospital to claim submission. The solution will also look into aspects of computerisation of all services i.e. OP counter, IP counter, casualty, labs, radiology and billing (as mentioned in the scope). ■ Track material right from their procurement to dispensing to the patient based on his/her healthcare schemes. Track medical equipment utilisation for both material and resource. ■ On fly generation of MIS reports, both pictorial and tabular form to be submitted to government health department.
When did this pen come into the market? How many hospitals currently use this product? The pen came into the market in 2001 and is presently used in hospitals in Europe, US South America and Asia.
Where can an Indian doctor buy this product and how much does it cost? The product is sold as a B2B product to government’s national health authorities and private hospitals worldwide but for India it is sold through our strategic partner Crane Global Solutions in Hyderabad.
What is your expectation from the Indian market for this product? Our expectations is to roll it out to every government and private health facility in India.
How will this technology evolve in future? The future is already here as we have future proofed the solution and you can now complete handwritten forms on mobiles, tablets, PCs. So our user can now fill in forms on paper or digitally from wherever they find themselves, so whether it’s a hospital facility or a remote rural locations we can transfer the data directly to databases and decision makers in seconds. mneelam.kachhap@expressindia.com EXPRESS HEALTHCARE
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“Choosing the right partner now can give us a competitive edge for years to come.” Chris, 52, hospital manager
uild spital B s at Ho India 2013, u t e e M 6 tructure & Infras G, Booth No.2 lhi, India .7 o De N w e N Hall , n Maida Pragati cember, 2013 e D 4 -1 12
At your side at the hospital: Dräger.
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Strengthening the foundations The importance of infrastructure in healthcare cannot be overemphasised. As a result, this year’s theme for HBII 2013 is ‘Creating healthcare designs which would assist in providing safe, sustainable and cost effective healthcare services.’ Express Healthcare, the Media Partner for this event, talks to some industry experts and garners their perspectives and views on this pertinent issue AYANABH DEBGUPTA CEO, Medica Synergie
Healthcare infrastructure should stand the test of time
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ccording to the WHO concept of safe hospital, “One which will not collapse in disasters, killing patients and staff and can continue to function and provide its services as a critical community facility when it is most needed.” Hospitals are the most important buildings within a community, referred to as ‘essential facilities’. They are buildings that are intended to remain operational even in the event of extreme environmental conditions. Moreover, hospitals are affected both directly and indirectly in a disaster, i.e. directly due to the impact of external disasters like earthquakes, cyclones, floods and also due to manmade disasters like fire (medical gas leakage/faulty electric wiring, chemical spills). Secondly, indirectly it is called upon to provide enhanced quantum of services and manage mass casualties. But when a hospital fails, the affected communities are left without even basic emergency care. Hence, this calls upon an imperative need among healthcare organisations in building safer healthcare establishments. In the course of creating safe healthcare structures, various intricacies needs to be taken into account. In the planning phase itself one needs to create a matrix of features focused on patient safety like the location, soil type and the kind of disaster the region is prone to, design specifications, resilience of materials
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used, type of beams, columns, slabs, load-bearing walls, braces or foundations, space planning for optimum output and presence of alternate sources of energy for 24X7 provision of basic lifeline services. Fire safety has been quite an alarming issue in recent years due to increasing reports on fire mishaps within hospitals. Such incidents can be minimised by encouraging awareness on fire safety measures among healthcare personnel and provision of fire safety structures like alternate fire exits on each floor, presence of ramps, fire alarms in walls, peepholes in doors or smoke detectors in ceilings. In case of high-rise buildings, separate electric circuits for lift installation, lighting of passages, corridors and stairs and for internal fire hydrant system, underground water tank for fire management, and availability of fire fighting equipment at all floors are needed. For earthquake prone areas, various safety features if adapted during designing and construction phase (reference to IS codes 1893, 4326, 13827, 13828 and 13920) like use of RCC construction materials wherein concrete resists compression forces and reinforcing steel resists tensile forces produced by an earthquake, opting for base-isolated foundation which allows the building to withstand a magnitude 7.9 class earthquake and still remain functional are extremely necessary. Moreover,
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adopting the concept of strong column weak beam design with well anchored shear walls and horizontal lintel band are certain options that are cost effective and help minimising the seismic effect. Additionally, cyclones and floods seem to occupy a larger proportion among natural disasters creating havoc worldwide, destructing various establishments including healthcare setups which are otherwise supposed to remain functional to manage the after effects. Adoption of smarter design and construction techniques like aerodynamic circular building designs with reinforced clear span roof and radial truss array or hif roof or high gable roof, use of heavier foundation, reinforced windows with impact glass to prevent the entry of wind and water, and reinforced walls by means of reinforced concrete band as well as use of flood damage-resistant materials which include glazed brick, concrete, concrete block, glass block or stone (with waterproof mortar or grout); steel trusses, naturally decay resistant lumber, metal doors, cabinets, and window frames can provide stronger and safer structures. Thus, good quality of design and construction is the most significant factor ensuring safety and durability and for an important establishment like hospital, costly one is that which fails to stand in time of its utmost need. DECEMBER 2013
Configure. Perform.
Succeed.
l Build Hospita ia 2013, t a s u Ind Meet 6 tructure & Infras G, Booth No.2 lhi, India e .7 o D N Hall , New Maidan Pragati cember, 2013 e 12-14 D
Your optimal workplace An efficient working environment is the first step toward any successful ICU design concept. But every day can bring on a new and different challenge. That’s why today’s intensive care environment requires maximum flexibility and performance, but also superior ergonomics. Dräger supply units Agila and Movita help you streamline your workflow while allowing unobstructed access to your patients. No matter how things may change from day to day, you can make the most of your potential with Dräger.
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RAM REHEJA Director and Head- Architecture & Design, Raheja Realty
India is waking up to the concept and benefits of patient-centric design
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ealthcare designing and construction has undergone a lot of changes in all parts of the world with respect to safety and sustainability. India is slowly waking up to the concept and benefits of patient-centric design. In this dynamic environment, healthcare organisations are slowly adapting to the new opportunities they have to position their facilities in delivering the best patient outcomes. Surveys show that people make judgments about the quality of care they receive based on the condition of the healthcare environment. Healthcare facilities are a lot more than just buildings; they are home to critical health services such as public health laboratories, blood banks, rehabilitation facilities or pharmacies. It is a place where a person feels safe and taken care of. Therefore, the safety norms in such projects
RATAN JALAN, Founder and Principal Consultant, Medium Healthcare Consulting
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map with all details of exits in case evacuation is required. With the help of sustainable architecture, a green design can successfully blend beauty and functionality together to save our planet for the coming generations. Green architecture is the need of the hour and when designing healthcare facilities it becomes even more important. The process of sustainability is two-fold; using materials which are less harmful to our environment and using the natural resources effectively to ensure limited usage of those
GREEN ARCHITECTURE IS THE NEED OF THE HOUR AND WHEN DESIGNING HEALTHCARE FACILITIES IT BECOMES EVEN MORE IMPORTANT
materials. This can be done by designing the building in a way that maximum sunlight enters the building and also add open spaces to ensure proper ventilation. Features like rain-water harvesting, waste- reduction plants, preferable medical waste treatment and disposable should be added during construction to help in recycling. Though cost is always an important factor in any project, the difference in expense between building a safe and an unsafe hospital can be negligible. But that tiny investment can be the difference between life and death, or between a community’s impoverishment and its sustainable development. Since hospital design is so detailed, a system of estimating floor areas and costs by function has evolved to enable the financial assessment of clinical needs ahead of the completion of detailed design work.
Design innovation is the need of the hour in healthcare architecture ospitals should be built as places to promote healing, not just as places for providing treatment. Any hospital design should start by an understanding of patients and the speciality. There has always been a disconnect between doctors, designers and hospital promoters. In the course of planning, there comes a stage when creative dominates over functionality, leading to tradeoffs, which during design stage seem too trivial. However, these are the tradeoffs that lead to problems at a later date. Some of the examples will make the point clear. When a hospital is being built, one of the points of contention is always the number of columns and beams. Most of the promoters always like to minimise the number of columns and beams to make the hospital seemingly ‘look good’. What they fail to take into account is the load bearing capacity of the structure. In addition, there is always a temptation to fill as many beds as
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are a lot more stringent than other buildings. A few features are mandatory when designing the building to ensure that the patients are safe in case of disasters such as fires, earthquakes, etc. Since, such buildings are air-conditioned, there should be adequate open spaces in the form of windows and balconies on each floor for evacuation. Considering that hospitals have a lot of inflammable materials, the storage areas should have proper exits and ventilation. The staff should be aware of the emergency drills and every floor should have a
possible in the design. This leads to inherent compromises, including safe means of patient egress in case of an emergency. Mechanical, Engineering and Plumbing, commonly referred to as MEP services is one of the commonly ignored areas. Promoters use all creative means to prove that the building is lower in height to comply with less stringent fire norms. On the flipside, HVAC, which is a fairly large percentage in the overall electrical cost, is never a point of deliberation. It is not at all difficult to create a hospital with proper ventilation to minimise AC. The same is true for natural light as well. Medical gases, again, account for a fraction of the overall project cost, but there is always a long drawn discussion on minimising the medical gas requirements. Sometime back, I was involved in creating a niche boutique healthcare facility and there were quite a few meeting on interiors. Right from the overall design, which focused a lot on www.expresshealthcare.in
natural light to the choice of materials, everything was based on functionality of the place. For instance, the carpets inside the room were certified by international bodies proven to minimise risk of infection and had easy to clean, non-adherent surface to minimise the adherence of dust or any foreign bodies. While recently working on a project, we realised that on the schematic drawing, all doors opened inside the washroom. We have to take into account the fact that a patient could faint inside the washroom and fall on the door. It would be extremely difficult to open the washroom in such circumstances. Any hospital design has to consider some of these elements and incorporate the same in the overall design. A recent trend in healthcare industry is the emergence of single speciality hospitals, that we refer as ‘focused factories’. While the idea of creating a focused facility is quite innovative, this does not always translate in design except the
aesthetic treatment. Consider for instance, the furniture. A facility focused on obstetrics would need to have different furniture, for instance a chair with firm cushions to enable the expectant mother to be firmly seated, while a facility treating arthritis patients would need to consider the height of the same chair to enable patients rest their knees without any discomfort. A facility treating obese patients on the other hand would need to take into account the width of the same chair and the safe working load. When I used to be the President at Asian Health Services, a healthcare architecture and consulting firm, we released a recruitment advertisement aimed at young architects. I still remember the headline. It said, "Wanted architects who can help in curing patients." Design innovation is the need of the hour in healthcare architecture industry and in the same context, we need to stop being selfish and focus on patient requirements rather than ‘ours’. DECEMBER 2013
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MEETA RUPAREL Director, AUM MEDITEC
Safety management is vital while planning healthcare infrastructure ospital administrators and management executives, face a constant challenge to achieve customer satisfaction and at the same time meet the stakeholder requirements for maintaining a balance between costs and quality of service delivery. Sometime ago, a fire in a hospital in eastern part of India resulted in a toll of approximately 89 casualties! Eventually it led to stringent steps like termination and/or withdrawal of the hospital license, litigations against the hospital management and compensations to the victims’ families and to the injured. Compensation may provide a temporary monetary relief but cannot in any form replace a member loss of that family.
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Safety management is a very important aspect of planning in every form of hospital infrastructure. Safety management as a whole includes aspects of not only fire safety, but also security measures in terms of safety from other unsafe encounters like thefts, pilferages, extortion, riots and natural calamities.
In circumstances in which hospital operations are disrupted or disabled, the adverse impact of disasters can be instantly compounded, many a times with catastrophic results. Different disasters/accidents present different challenges, and each hazard requires a different strategy/ set of resources and a differ-
SAFETY MANAGEMENT AS A WHOLE INCLUDES ASPECTS OF NOT ONLY FIRE SAFETY, BUT ALSO SECURITY MEASURES IN TERMS OF SAFETY FROM OTHER UNSAFE ENCOUNTERS LIKE THEFTS, PILFERAGES, EXTORTION, RIOTS AND NATURAL CALAMITIES
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ent approach to mitigation. It is important to acknowledge that there are no universal design guidelines/thumb rules to protect buildings from all such events. I therefore initiated writing a book on hospital facility safety which is scheduled to release soon, i.e.; in the year 2014. The intent of this book is to provide guidelines for planning, de sign of hospitals and primers for existing ones for hospital facility safety and to ensure patient safety as first priority and motivate staff to practice a similar culture. The purpose of this book is to consider design options to make hospital buildings resistant to natural hazards in addition to the other general design considerations and recommended hazard mitigation measures for risk reduction.
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INSIGHT
Dynamics of hospital design CJ Kosalraman, MD, Infrabees Project Management Consultants enlightens on ways and means to build world class healthcare projects by implementing innovative, efficient and economical ideas
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CJ Kosalraman Managing Director Infrabees
ealthcare projects are the most challenging building type and complicated to execute in the construction industry. It takes many months of meticulous planning and collective team work amongst promoters for the successful completion of any hospital on time/within budget. It is very critical to engage experienced consultants to pursue an integrated design project. An efficient as well as innovative approach is also vital to make key decisions for meeting the project cost/time for your signature hospital projects.
Need for hospital planning consultants On an average, in tier II and III cities, the amount of time spent by a doctor in planning/coordination/procurement etc. for their hospital construction is nearly 25-50 per cent of their daily productive time. Doctors lose almost ~Rs 30-50 lakhs worth of billable time in the project duration apart from losing patients’ confidence due to their non-availability as a result of ending up entangled in managing various construction vendors. Still the hospital may fall short of their vision due to inadequate planning. Consultants are constantly updated on these latest requirements and follow best industry practices to deliver projects. With unskilled labour pool becoming unavailable and construction schedule getting aggressive it is more apparent that pre-fabricated building components/mechanisation is inevitable. Also the finished product is much superior, has less wastage and green credits are very much possible. Hospitals in particular can start operations many months in advance there by generating revenue and return on investment (ROI) earlier than planned. A green hospital is a money saver for the promoters in reducing overall operational expenses for
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many years to come. World class healthcare projects, when implemented well, are built with the following critical steps: (a) pre-design/strategic review, (b) operations planning in pre-design, (c) design (d) MEP engineering, (e) project management, (f) building information modelling, (g) medical equipment planning (h) pre-cast construction, (i) vendor & tender management and (j) statutory approvals.
What is pre-design? Pre-design and strategic review stage of a project involves (a) Ideal site selection choosing a conveniently and easily accessible location to the general public, preferably having two roads abutting the site. We need to ensure that the site area is suitable to construct a hospital of the desired builtup area (FSI, height and setback norms to be ascertained) including scope for expansion in future. It is recommended that the site zone is preferably ‘commercial’ or a zone where the local regulations permit the construction of a hospital at www.expresshealthcare.in
the location without any conversion (b) Concept vetting involves choosing the type of hospital you want to build (i.e) secondary or tertiary care/single or multi speciality/light house specialities and its dependent facilities, etc. (c) Market study is a necessity to identify the requirement of the immediate and surrounding localities to test out the owners’ concepts. Its results may change the concepts to suit the projected needs of the catchment area. If required, study of households in the target area is also undertaken to crossverify the real demographic needs for planning the facility in such a way that it matches the needs for success. The study will help forecast earnings/expected returns, first cut project estimates, and potential competitions in the catchment area (d) Project sign-off at this stage helps to decide on the hospital type and size, the acceptable speciality mix, tentative project budget and expected outcome. This becomes the basis for financial closure to be undertaken by the promoters and will
commence the execution of the well planned design for your healthcare facility.
Why should operational planning start early? Operational planning in the pre-design stage of a project involves (a) an operational planner who considers different parameters to maintain a synergy between departmental locations and operational/functional process flow. Operational planner will coordinate between the project team and the medical team during the project, from concept to commissioning. He/she will involve every departmental custodian at the initial stage for specific details (b) Key points include departmental location, functional cohorting between OPD, IPD areas from diagnostic and supportive services in addition to infection control measurement/ BMW management process, compartmentalisation of departments, and zoning concepts (c) Critical parameters for consideration are bed count and matrix, progressive utilisation of different departments and man power DECEMBER 2013
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Precast construction
planning. They also include differentiate in-house departments and outsourced relationships. (d) General design considerations include appropriate functional segregation of OPD (15 per cent-20 per cent), in-patient units (40 per cent - 45 per cent), diagnostic services (15 per cent 20 per cent) and supportive services (15 per cent - 20 per cent) so that mixing of patient flow is avoided. Some of the best practices that you may follow in your design of hospital includes separation of critical areas, concept of zoning, ventilation standards, effective use of daylight, isolation wards and other spatial requirements. We need to make sure that clean corridor and dirty corridor should not be adjacent. They should facilitate traffic flow of clean and dirty items separately. Adequate number of hand wash basins should be provided within the patient care areas and nursing stations with a view to facilitate hand washing practice. Separate arrangements for garbage and infectious
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waste removal from wards and departments in the form of separate staircases and lifts should be made. It is best practice to provide airlock and anteroom before entering into critical care areas.
What is design? The promoters should make sure to have all the appropriate consultants on the project team before initiation of the design phase. Selection of consultants should be based on references, past experience, and capability to deliver such projects locally. Some of the
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primary consultants needed are Project Manager, Architect, Interior Designer, Structural Engineer, MEP Engineer, Civil Engineer, and Landscape Architect. In addition some of the secondary consultants for kitchen, laundry, lighting, acoustics, security, information technology, NABH/JCI accreditation and green building may also be required. Before starting any hospital design, the promoter should have a budget, a design brief, a time line and site survey plan/soil test reports. A budget helps the entire project team to stay focused on the cost while the
design brief will provide the road map for construction. It is important for the promoters to adhere to a reasonable timeline or schedule so that the project proceeds on track without delay. Any architect or consultant will require a site survey plan/soil test report to commence any feasibility or design process. It provides various features, issues and opportunities on a site and mitigates challenges into advantages for promoter. The design stage of a project involves master planning of site to space programming, leading to concept and detailed design/tender. In master planning, the process involved is preparation of concept design of the area showing circulation pattern, zoning of various land uses and relevant details, as well as development/redevelopment strategy. It also furnishes a report on measures required to be taken to mitigate the adverse impact, if any, of the existing and/or proposed development. Space programming will assist in preparing a
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report on site evaluation, state of existing buildings, if any; and analysis with basic approach to circulation, activity distribution, interconnectivity and external linkages including rough estimate of project cost based on allowable FAR/redevelopment objectives. Concept stage will provide owners with a site plan, a detailed space programme and departmental blocking/ stacking diagrams. These will help decide where to place diagnostics and treatment vs OPD or in-patient floors which in turn is critical for phasing of the hospital. Detailed drawings/tender include preparation of working drawings, specifications and schedule of quantities sufficient to prepare an estimate of cost and tender documents including code of practice covering aspects like mode of measurement, method of payments, quality control procedures on materials, work and other conditions of contract. It is critical to make sure that the FAR/FSI and buildable area is within the building regulations. The road width abutting the property, set back requirements and ground coverage percentage determines the height of your building. Some of the guidelines followed are National Building Code 2005, Development Control Rule’s, DTCP and local bye laws. A very efficient design will incorporate modular design/construction and standardisation where ever possible. For example, modular grid spacing help in keeping structural cost economical as well as standardising typical room sizes. Engineering design and systems can also be made modular and standardised for maximum efficiency/value for money. Promoters should provide prompt sign offs stage wise to continue the project work and keep time, cost, and quality in check. It also helps to generate necessary audit reports; payment processes and project close outs.
What are MEP Services? MEP Services design stage of a project includes scope for (a) Mechanical Heating, ventilation and air conditioning popularly known as HVAC. It ensures temperature and humidity are controlled in addition to infection/contamination control. Care must be taken to
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ensure that dust and impurity controls are in place. There are two types of systems available in the industry, centralised and unitary systems. Both depend on the type of end requirement and usage in a building. In the operation theatre it is advisable to install laminar flow with HEPA filters for suffiwww.expresshealthcare.in
cient fresh air changes. It is acceptable to install fine filtration units with sufficient fresh air changes in special wards such as ICUs. We need to ensure patient wards will require sufficient fresh air and provide cooling for medical equipment based on product requirements. (b) Electrical – Electrical
systems, fire detection and alarms. Its scope includes sourcing and distribution of electrical power, planning the backup capacity and generation source. It is good practice to plan for reducing the energy consumptions using new technologies and renewable energy sources. Ensure proper distribution for meetDECEMBER 2013
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ing the lighting, power and backup power for the building. It is important to design and provide proper earthing system and lighting protection to protect all equipment. Design should make sure that continuous power supply for critical equipment and certain areas are available. It is imperative to plan for a UPS system for critical loads. The design considerations for hospitals should be an easy to operate system, meeting the requirements of sensitive medical equipment and having provisions for alternative/renewable energy systems to reduce energy consumption. (c) Plumbing – Public Health Engineering (PHE) and Fire Protection System (FPS). PHE deals with engineering aspects of water supply, sanitation and drainage, rain water/storm water drainage, water treatment system and sewage treatment system. Design considerations should include ensuring water requirement to meet the hospital’s various requirements and planning sufficient amount of storage. It includes providing for specialised water requirements like RO water, DM water and drinking water. Infection/contamination control in drainage and disposal systems is of highest priority. BOD/COD demands and TSS levels within permissible limits should always be monitored. It is critical for safe disposal of soil and waste drainage with suitable treatment systems. Ensure that provisions for hot water requirement using solar/ alternative energy systems are in place. Any special disposal system for drainage from radiology departments must be included in the design early on. FPS deals with providing the equipment/facilities for fighting fires. It is mandatory to implement smoke detection and fire alarm systems in hospitals. Design to provide enough storage of water and pumping arrangement to fight fire. Provide visible exit signage to ensure safe egress and ensure travel distance requirements as specified by the NBC are met. Providing specific suppression system for equipment rooms and critical areas are best practices. It is very important that comprehensive coordination happens between an MEP engineer and other consultDECEMBER 2013
ants such as the architect, structural engineer and interior designer. Coordination with the architect ensures proper space allocated for equipment rooms, well planned service shafts and compliance for fire protection requirements. Interaction with structural engineer assists in planning the load-
ing for heavy equipment and beam sizing to accommodate services with sufficient ceiling clearance. A good ceiling design results with coordination of false celling layout with interior designer. Some of the guidelines followed are National Building Code, ASHRAE, NFPA and NABH Standards.
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Why is project management ‘mission critical’? It is very important for the promoters to transform their vision into a successful venture. Alongwith numerous hours and efforts spent in planning to build a hospital, a professional team experienced in managing the
delivery of such a vision is a top priority. A single source entity responsible in coordinating the entire project team to meet the budget, time line and quality becomes mission critical. Project management is the overall planning, coordination, and control of a project from concept to commissioning. It shall manage
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all packages not limited to: civil, mechanical/electrical/ plumbing/fire fighting, voice & data, kitchen, medical gas system, signage, interiors – furnishing, fitting & equipment, medical equipment and external works. It has two main components namely, design management (DM) and followed by construction management (CM). While DM coordinates project brief, design of project, material finishes, specification, tender etc, CM takes care of quality, cost and time. One of the critical roles in project management is contract administration which lays out project strategy, project control system, document control protocols and general administration. Design management involves preparing a project brief, design coordination with consultants, design peer review, value engineering and advice promoters on build ability factor which affects the budget. In construction management, the focus is on quality assurance, site logistics, communication/coordination with the entire project team, maintains schedule, manage construction cost, preparation of operations & maintenance manuals and close out. Promoters should appoint a project management consultant prior to beginning a project to help him/her guide through the entire project process and as a client’s representative, safeguard the promoters interest and get the best building product at the end. Building Information Modeling (BIM) is virtual construction of a facility prior to its actual physical construction using a 3D building design software portfolio of interoperable BIM-based products that supports each phase of your workflow. It intelligently connects building components/assemblies, aids to revise the design instantly and provides accurate bill of quantities including real time accurate 3D views/early clash detection. It helps in decision-making throughout the design phase which is important in any healthcare project design. Converting existing 2D drawings of a building into 3D model becomes very easy. Its capability to do instant design revisions is the biggest advantage for the project team. BIM’s 3D modelling helps promoters to assess the merit of any new design pro-
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posal and its effects with all engineering and medical equipment. The virtual walkthroughs help to identify and resolve problems even before walking on site. Most clashes happening between engineering services are identified at design stage itself and resolved even before the construction begins. Any clashes detected later during construction results in delay and costs lot of money for corrective action. In addition, BIM helps to create construction budgets faster and that are near accurate. An owner can efficiently utilise and ultimately achieve major reductions in real estate expenses. Interestingly, BIM enables early commencement of construction and a seamless coordination among the entire project team. Medical equipment planning involves meticulously identifying and ordering appropriate equipment per promoters budget, type of care of hospital, type of purchase, upgradeability, patient safety and uptime guarantee taking into account ‘mean time between failures’ including speed of online/offline servicing. It helps to set out a clear selection criterion to identify and order according to supply time or at the right time of www.expresshealthcare.in
the project stage. Promoters need to make sure that the appropriate service engineer/technicians are available for certain equipment. A key parameter to consider is the year of equipment introduction into market followed by its consumable availability and quick restocking of the same. Prior to selection of equipment, check out the number of similar current installations and client references. At times, promoters have the option of signing ‘buy back option’ for certain major equipment. It is absolutely important that the end users are well trained in using the equipment. The infrastructure requirements for medical equipment such as site area, structural, MEP, etc need to be well planned in advance during design stage. It is prudent to be aware of the operating life span of major equipment and the needed warranty/cost of AMC or CMC. A bio-medical engineer need to be recruited prior to equipment arrival at site and site readiness has to be confirmed prior to delivery.
How to build hospitals faster today? Precast construction is a construction product produced by casting concrete in a reusable mould or form.
Using precast slabs, beams and columns will save considerable cost and time as time-consuming shuttering and scaffolding are avoided. From the longevity of the building to the structural soundness, it is the most revolutionary technology in the construction industry. Exponential development and expansion of our towns and cities brought in a need for faster timetables and lower costs in the construction industry. Lack of labour and an undulating market doesn’t help the construction industry which looks at long term developments. Precast technology is an apt solution for such needs, technology that can be trusted; that is cost effective and has uniform quality. From the longevity of the building to the structural soundness, it is the most revolutionary technology in the construction industry. Precast technology has been used to build everything from manufacturing industries to commercial and residential projects including low-cost housing and even flyovers and bridges. The cost of precast building will depend on the size of the project, location, type of building, floor to wall ratio, shape of building (number of repetitions) and taxation as applicable (ED, VAT, Service DECEMBER 2013
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Tax etc.).
How to manage vendors? Vendor/tender management is most critical for effectively managing any construction project. It involves preparing and implementing strategies and guidelines for the procurement of all project services and materials, taking into consideration any specific conditions of the project in terms of appropriate contractors, design, manpower resources, time, long lead items, local requirements and site conditions. Before issuing a tender, it is advantageous for the promoters to include as much information as possible in it to get the best comprehensive quote. Tender documents should be at least 80 per cent ‘Good For Construction’ drawings with specifications to receive the most competitive and realistic bids. Vendor’s selection must be based on their prior experience of similar building type, past track records and client reference. It is advisable for promoters to visit vendor’s prior works and verify their references. It is always best practice to get three quotes, shortlist two vendors and finalise one for your project. It helps to bring in transparent selection process and inculcates professionalism amongst the entire project team. Promoter should have a team or a PMC to measure and verify bills submitted for payment by vendor. Only consultants will be able to assist promoters in appropriately paying any vendor for works completed. The recommended sequence of managing vendors are as follows: get quotes, finalise price, issue ‘Letter of Intent’, award work order, pay advance to start work, review shop drawings and technical info, make material payment, make work progress payment, issue final payment after consultants certifies bills. It is best practice to demand as-built drawings, warranties and AMCs from vendor prior to final settlement of bills. A completion certificate from the vendor will ensure that all work is in place and assist in warranties initiation. Vendor should provide a team chart or list of key members working on the project.
sure that all required statutory approvals are obtained for your hospital project. Fire/building approval are the most important ones followed by Pollution Control Board, Electricity Board and Water supply. Depending on the size and location of project MoEF/EIA may apply. Always follow implementa-
tion of approved drawings a n d construct only the allowed built up area in a hospital. It is prudent to take time to prepare statutory approval drawings and not submit in haste. If not, too many corrections will delay the schedule of thr project. It is smart to appoint local liaison in
that jurisdiction locally to effectively coordinate with authorities irrespective of appointment of architect/consultants. I recommend promoters to keep their entire ownership documents ready prior to submitting for statutory approval. Interestingly, there is no 100 per cent cookie cutter or
no ‘one size fit all’ model for hospital design. Each hospital is unique just like its promoters, their vision, mission and their standard operating procedure. Doctors/promoters should take first mover’s advantage in embracing innovative ideas to build world class facilities and stay ahead of the curve!
General recommendation on approvals – infrastructure related only It is important to make DECEMBER 2013
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INSIGHT
Building healthcare infrastructure: The new approach Barun Pal Chowdhury, VP, Design Centre, Shapoorji Pallonji & Co expounds on the changing scenario in healthcare infrastructure, the need to create healing environments and the new approaches that can be utilised for doing so
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Barun Pal Chowdhury VP, Design Centre, Shapoorji Pallonji & Co
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n today's world, hospitals have become a utilitarian environment rather than a place for healing and emotions, where treatment of a patient is carried out, away from family and friends. They have become strongholds which are more frightening than comforting to patients who come for treatment. However, a heart-warming fact is that these institutions are slowly changing into centres of healing, by incorporating spacious Vedic-style gardens and parks, art displays, and other such elements dedicated towards the wellness of a patient. In other words, hospitals are changing from mere functional spaces to wellness centres. Thus, hospitals are effectively transforming into healthcare centres with specific areas for recreation of patients, places for receiving and waiting visitors, facilities for senior citizens, etc., all targeted
towards making the treatment in a hospital a comforting experience and not a scary one, leaving a smile on the patients’ faces as well as on the visiting relatives. One of the architectural historians and writers, Charles Jencks wrote in ‘The Architecture of Hospitals’, that “Architecture can raise the spirits and amplify the positive mood and ethos of an institution.” To incorporate these new concepts, a radical change of thought process is required while designing and building healthcare facilities. And the good news is that architects are getting increasingly concerned with the need to design for these anticipated functional changes. Comfort of the patient is taking precedence over the bureaucratic style of designing. They are increasingly moving away from 'rocket-launching stations' to 'healing centres' or healing environments that
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incorporate a holistic approach. They are progressively looking at ways to combine new technology with old-world sensitivity of healing through nature. This would create an environment that will encourage a quick and peaceful recovery. As hospitals move away from being mere functional spaces towards more specialised treatment and wellness areas with various departments like, outpatients and in-patient, emergencies, OT, ECG and Xray department, ICU, radiology and other diagnostic centres, waste management, food management, laundering, etc., designing and construction of such healthcare centres have become more complex. Hence, there is a need in the healthcare industry to appoint experts and specialists who would understand the changing requirements of players to provide the right design, and quality for their infrastructure. Designing and building such healthcare infrastructure is a complex task. Most of the times, when different entities handle the design and the construction phases, there is a mismatch in the design and the completed product. Now a new and fast evolving mechanism across the globe for delivering healthcare infrastructure is to ‘Design, Construct and Commission’ hospitals. This entire process is known as ‘Design and Build’ and it means that a single entity is entrusted with the entire process from design to completion and commission of the project. This provides a one-stop solution to the healthcare industry rather than a ‘Piece Meal Approach’ of constructing a hospital. Design and Build solutions consider all the constructionrelated issues during the designing stage which in turn considerably reduces the coordination clashes during the construction period. This results in reduction of rework at site, and this in turn ulti-
mately leads to fast work, good quality and quantity, less escalations, less wastage and time reduction. There are many benefits of using the Design-Build method in creating the new concept of healthcare infrastructure, namely: ■ Increased time and cost efficiency – Integration of the various functions such as design, construction and engineering reduce changes, thereby decreasing the cost and time of the project. There is also reduction of potential claims and lawsuits after project completion as the Design-Build team resolves any issues during construction. ■ Quicker communication Turnaround time as well as approvals take less time since it’s the same team communicating with each other. Any design change carried out during construction can be discussed right away. ■ Quality product – Continuous quality control and quality assurance by the design team ensures that quality is enforced during project execution. Healthcare infrastructures which are wellness centres have been widely adopted by the Middle Eastern countries in a big way, where they believe in providing not only value for patients but also being family centric. They have embraced health not just healthcare. They strive for quality and excellence in their healthcare centres. Sidra Medical Centre and Hamad Medical Corporation (HMC) in Qatar is an example of being one of the best healthcare centres in the Gulf countries. These centres have everything under one roof and provide a one-stop solution for all matters related to health and research. They have adopted the Design-Build method for creating such infrastructure as this method was the only one which could and did give them the best results, which is apparent now when you see the final product! DECEMBER 2013
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HBII 2013 SPECIAL
4 edition of HBI to highlight growth potential of hospital infra sector th
Slated to be held at Pragati Maidan, New Delhi from December 12-14, 2013, the expo and conference aims to deliver end-to-end hospital facility products and services under one umbrella
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he 4th edition of Hospital Build & Infrastructure India Expo (HBI) is slated to be held at Pragati Maidan, New Delhi from December 12-14, 2013. HBI is the only trade event in India targeted at those directly involved in the investment, planning, design, build, operations and management of healthcare facilities covering public and private hospitals, clinics and speciality centres. The show is organised by Informa India, part of the England headquartered Informa plc. The Indian healthcare industry is slated to reach $160 billion by 2017 with an anticipated growth rate of 22 per cent annually and HBI aims to provide the necessary platform for professionals to access latest products and technologies and upgrade to
world standards. HBI is supported by Associations like Biomedical Engineering Society of India (BESEI), Federation of Hospital Administrations (FHA), Indian Society of Hospital Waste Management (ISHWM), Indian Association of Structural Engineers (IASE), The American Academy of Healthcare Interior Designers (AAHID), the Indian Institute of Architects (IIA) and National Accreditation Board for Hospitals & Healthcare Providers (NABH). Over 150 Indian and International exhibitors is expected to showcase a variety of products and technologies like hospital furniture items, storage units, waste management equipment, patient transportation/safety systems, hospital security
systems, medical apparel items, hospital management group services, water treatment tools building materials, construction tools, architectural products, engineering tools and catering supplies, cleaning tools and sterilisation products, HVAC tools, IT systems, medical gases, and real estate development facilities in addition to Efficient healthcare equipments. A major attraction at the event will be a global conference on 'Health systems design and operations for affordable, safe and sustainable healthcare services' copresented by Association of Healthcare Providers India (AHPI). The conference will witness the largest gathering of healthcare policy makers, industry leaders, architects, planners, hospital entrepreneurs, academia and biotech-
nology giants! The presence of eminent representatives from governmental ministries brings up the overall business value of the event further. Says Guru Prasath, Group Exhibitions Director, Informa Exhibitions, “The healthcare industry in India has witnessed a massive increase in investment over the last few years which requires a world class forum with multi-track content across the breadth of this expanding sector.” The visitors to Hospital Build & Infrastructure series include key decision makers, policy makers and investors in healthcare projects. Eminent government officials, ministry executives and statutory planners also actively participate in the event. EH News Bureau
‘We expect that over 3000 professionals will attend the three-day event’ Hospital Build India is a important event, organised by Informa Exhibitions, for buyers, suppliers and healthcare professionals, looking for business and also to get an insight about new healthcare trends. Informa Exhibitions’ - Group Exhibitions Director, Guru Prasath, talks to Express Healthcare about why Hospital Build India remains an important event for the Indian healthcare infrastructure and planning industry What is the significance of a trade show such as Hospital Build India? Hospital Build India serves as a vital trade platform for the healthcare infrastructure/planning sector in the region. Over the last three editions, the exhibition has succeeded in bringing
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together major suppliers and buyers on the same platform. Thus, we are glad to have played a constructive role in the strengthening and giving an opportunity to network and engage with the Indian healthcare infrastructure sector.
Hospital Build India is said to be India’s premier event for professionals in the healthcare planning sector—are you doing anything new this year to stay ahead of the competition? During the last Hospital Build India edition, we conducted Round Table Discussion forums/ Interactive Panel discussions and also had Hospital Build Awards for the first time and following its success this feature will be expanded this time. The principle of conference panel discussions is to have an exciting agenda for the conference hosted by over 30 industry leaders which includes some of the influential healthcare professionals from private and public hospitals. I’m confident the conference ses-
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sions will see Hospital Build India 2013 as a catalyst for increased business negotiations and interactions.
What do you think are the market and industry reasons behind Hospital Build India? As investments in Indian healthcare infrastructure continues to rise, Hospital Build India 2013 comes at a perfect time when the industry is gearing up to upgrade and fine tune their strategy, bringing together the suppliers, manufacturers, under one roof. Also there is a need for a platform such as Hospital Build India to showcase the latest innovations and technological advancements available in order to cater to the growth within the industry. DECEMBER 2013
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HBII 2013 SPECIAL INTERVIEW
THIS YEAR WE HAVE INTRODUCED SEVERAL ROUNDS OF PANEL DISCUSSIONS ON VITAL TOPICS, SO AS TO KEEP THE INTERACTION LEVEL WITH THE AUDIENCE AT A HIGHER RATE What makes for a successful Hospital Build India show ? It all sums up to satisfied exhibitors and visitors, business conducted at the event, and all round satisfaction of our industry partners. Hospital Build India exhibition series has had over 90 per cent success rate and we are confident that this year we will be continue to deliver meaningful business results to our exhibitors.
Can you tell us about the Hospital Build India conference and its theme for this year? Yes, of course. Hospital Build India conference has always been an exciting forum to know about the technological advancements and get oneself apprised about latest emerging trends in the healthcare infrastructure/planning sector, with a special emphasis to the India context. This year’s proposed conference theme: “Healthcare Systems Design/ Operations for ensuring Patient’s Safety Disaster Mitigation and Quality Care” The conference is designed in such a way that it focuses on vital issues concerning the industry at large, and discusses about
the possible solutions to face those challenges. We are very pleased with the encouraging response we have received from the industry players and their willingness to actively engage themselves at the conference. This year we have introduced several rounds of panel discussions on vital topics, so as to keep the interaction level with the audience at a higher rate.
Lastly, can you tell us about the exhibition size and participants? Hospital Build India is occupying over 3,000 sq m of exhibition space, represented by 80+ participants. We expect
that over 3000 professionals will attend over the three-day event. We are very pleased with the number of visitor enquiries that have poured in during the last few weeks and are confident that our exhibitors, partners, media and the industry at large will take advantage of this event. I take this opportunity to thank the Association of Healthcare Providers, for extending their full support, industry associations, sponsors, exhibitors, speakers, delegates and the media partners in making us feel proud about Hospital Build India. I wish all round success to our exhibitors and visitors at the event.
Ziqitza@HBII 2013 SWETA MANGAL, CEO, Ziqitza Healthcare
Providing emergency medical services to all Indian citizens
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ndia is a country with the highest number of road traffic accidents. As per WHO by 2020 it will be the diabetes capital of the world. Almost 57 per cent of India’s land mass is vulnerable to earthquakes, 68 per cent to drought, 8 per cent to cyclones, and 12 per cent to floods. Additionally, the ratio of traffic accidents per 1000 vehicles is 21.3 times higher than the world average. 30 per cent of accident victims in India die due to delays in transportation to medical facilities. The above facts indicated that India lacked good EMS ambulance servicDECEMBER 2013
es. The existing system is terribly fragmented and does not meet demand. Some ambulance services are free, while others are not. These ambulances are often unavailable on a regular basis, are in poor condition and do not have appropriate medical equipment or trained paramedics. Ziqitza Healthcare Limited (ZHL) was founded in 2005 with the mission of providing emergency medical services to all Indian citizens. To date we have served 16, 00,000 people across India by providing emergency healthcare servwww.expresshealthcare.in
ices mainly in the form of our network of 860 ambulances and organised numerous emergency camps and workshops to increase emergency response awareness The innovation in our business strategy lies in the emphasis placed on our mission that no one should be denied the right to use our services based on economic status. For this we have introduced a tier pricing model providing high quality medical care at subsidised rates or free to our customers. With substantial success in our private business we observed the poor
quality and efficiencies of ambulances run by the government. We took the opportunity to correct this market inefficiency through a new business strategy, Dial 108 is a government funded privately run service where we began offering state governments the option to privatise their ambulance. We have expanded to 860 ambulances all over India today with this initiative. Another key innovation in our service offering to identifying and filling the gap of ambulances for private hospitals using our ambulance outsourcing service. EXPRESS HEALTHCARE
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HBII 2013 SPECIAL
Dräger’s Design Centre Dräger Medical India has set up a ‘Design Centre’ in a bid to engage their customers who are planners, architects and key decision makers in hospitals and spread awareness about standards/norms that lead to quality infrastructure. It also aims at helping them make informed decisions on optimising their workspace, work-flow requirements layout and infrastructure during their planning stage itself. Express Healthcare offers a sneak peek into the Dräger Medical India’s Design Centre The modular OT at the Drager Design Centre helps the customer to optimise the space avaialble
Customers can refine their ideas with the help of 3D technology at the Design Centre
Significant time and money is needed to create good healthcare infrastructure
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The Design Centre helps customers plan and design their medical workplaces under realistic conditions www.expresshealthcare.in
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‘Dräger Design Centre was built as an in service to our customers’ Nikil Rao, Country Manager, Dräger Medical India, talks to Express Healthcare, about the Dräger Design centre, the motive behind setting it up, its benefits to the customers and his expectations from HBII 2013 and more What is the rationale behind setting up the Design Centre? Over the past decade, the healthcare sector in India has evolved tremendously. Our customers are looking for vendors who will provide care area solutions rather than simply products. Dräger Design Centre was built as an in service to our customers. By looking at customised solutions, they can now plan their facilities and decide their investment plans and priorities. The 290 sq m state-of-the-art Dräger Design Centre enables users and planners to do exactly that and allows them to work together with Dräger experts in order to plan and design their medical workplaces under realistic conditions.
INTERVIEW
Any plans to set up such centres elsewhere in the country?
to instantly design and visualise their concepts. This helps them greatly during the planning of the hospital set up. Moreover, the comprehensive solutions in all areas namely Emergency, Operating Room, Recovery and ICU that are displayed in the Design Centre can help them to decide on their choice of patient care area. The Design Centre also showcases other solutions along the clinical pathway such as a modular operation room. It also offers a training room to accommodate 22 people and an additional meeting facility for eight people.
What benefits can the healthcare players accrue from it?
Sustainable infrastructure is the need of the hour in Indian healthcare. Can a Design Centre like this have a hand in facilitating it to an extent?
Our customers that include hospital planners, architects, end users and hospital owners can decide on the various customised options available and according to their need of infrastructure, optimise their workspace and work-flow requirements. Gas management planning and 3D application tool helps our customers
The Draeger Design Centre provides awareness towards standards/norms that lead to quality infrastructure entailing faster throughputs, paperless solutions, better patient care and hygiene and infection control. We will continuously upgrade the Design Centre in order to provide pioneering solutions to our customers.
The Design Centre in Mumbai has received an overwhelming response since its inauguration on August 14, 2012. We have received hundreds of visitors so far from the entire gamut of our medical fraternity. People from all over the country and from the entire breadth of the medical fraternity have visited the Design Centre. Subsequent to the Design Centre at our Headquarters in Lubeck in Germany, we are very proud to bring the second one here in Mumbai, the Headquarters of India. It is a unique set up and we would therefore house the facility here at Mumbai as of now.
You are exhibiting at HBII 2013, what is your agenda for the event? Any new launches planned at HBII?
One of the key objectives of developing and showcasing the Design Centre is to engage with planners, architects and key decision makers of the hospital layout and infrastructure during their planning stage itself. Significant time and monetary invest-
A training room to accomodate 22 people DECEMBER 2013
ments are made in order to design and create hospital infrastructure. It is difficult to make amendments at a later stage if the development has already begun.
Hospital Build & Infrastructure India is one of the leading hospital infrastructure sector trade shows in India. We would continue our engagement with hospital planners and architects in the show. We are planning to demonstrate our 3-D application tool and provide extensive information of our Design Centre at the HBII 2013.
Neonatal care has an important position in Drager’s offerings www.expresshealthcare.in
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HBII 2013 SPECIAL Bluestream brings GOJO's best products to India In India, GOJO Industries is represented by Bluestream Manufacturing Services Pvt Ltd (BMSPL) in Mumbai since 2005
OJO Industries, inventors of PURELL instant hand sanitiser, distributes PURELL in consumer markets and away-from-home markets throughout the world. In addition, GOJO manufactures and distributes a full line of products under GOJO, PURELL and MICRELL brand names. GOJO has a 64-year history of leadership in improving well-being through hand hygiene and healthy skin. GOJO has products and programmes to kill germs on hands and solve skin carerelated problems in a variety of markets, including healthcare, food service, food processing, manufacturing, automotive, education, government and military. GOJO is a privately held corporation headquartered in Akron, Ohio, with offices in the UK, France, Australia, Japan and Brazil. The product line of GOJO includes PURELL-Purell is an instant hand sanitiser and a leading hand sanitiser brand in America made of 70 per cent Ethyl Alcohol which claims to kill 99.99 per cent of the most common germs that may cause illness in as little as 15 seconds. Other than health-
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care set-ups, the product is used in schools, restaurants and other business environments to help fight the spread of germs. MICRELL: Antibacterial foam hand wash is a quick acting and gentle soap that keeps skin clean and moisturised. GOJO Micrell antibacterial soap is equipped with ingredients that help kill micro-organisms and helps prevent or inhibit their growth and reproduction. Great for use at home, in the office or in industrial workplaces, this soap protects users from spreading diseasecausing germs. GOJO: Rich gentle luxury foam hand wash pre-lathered for a convenient and pleasing experience. Meets guidelines for the use in USDA and US federally regulated food processing facilities, listed with NSF international certified Kosher. It is also green seal and eco logo certified. Effective for the removal of fats, oils and soils commonly associated with food processing. This product is suitable for the use in all areas of the plant. Apart from this, GOJO has a long list of awards out of which some of them are as follows: Circle of Humanitarian
Award from American Red Cross in recognition of donation of PURELL instant hand sanitiser’s during natural disasters such as hurricane Sandy, the gulf coast oil spill cleanup and 2011 earthquake recovery effort in Japan. it has also received Ohio EPA Award, an environmental excellence award for reducing environmental impact through water, waste and greenhouse gas reduction, implementation of environmental management systems. In India, the company is represented by Bluestream Manufacturing Services Pvt Ltd (BMSPL) in Mumbai since 2005. BMSPL serves all verticals of the market segments like the healthcare industry, food processing industry and corporate offices. Highly trained personnel in skin science and infection control, along with PAN India channel marketing, made BMSPL win the prestigious Brand Academy Award 2013 for technology excellence. It was in recognition of its significant contribution to the Indian healthcare technology industry as one of the 'Leading supplier of health, hygiene and skin care products in Mumbai'. The basket of infection
control products for the healthcare segment is completed by Bluestream by adding Bluestream Personal wash cloth-the single use antibacterial wipes, a safer alternative for a person in need of body cleansing while being bedridden or requiring partial assistance. As a single source supplier, Bluestream also carries the following products: ■ GOJO cleaner: The rich cream formula easily removes the heaviest grease, tar and oil which you find in any service centre. It also contains soothing emollients, to treat dry, cracked hands. Just rub in and wipe clean with a towel or a quick rinse ■ GOJO Hand Medic: A hand conditioner especially formulated to meet the harsh demands of professional technicians. It can be used before work, after hand washing and at night, to help maintain the skins natural protective barrier. It’s silicone and scent free. ■ HRT Hand towel dispensers and paper rolls. ■ JRT Toilet Tissue dispensers and rolls. ■ Vectair Air freshener dispensers and refills. Contact: Tel: 022- 3630812/23633055 www.bluestream.net.in
Bluestream to launch Purell Advanced and Bluestream Personal wash clothes at HBII 2013' Rachana Kulkarni, GM, Bluestream Manufacturing Services, speaks about their products and its importance to the healthcare industry, to Express Healthcare Tell us about Bluestream manufacturing's offerings for the healthcare sector? Bluestream specialises in infection control programmes for all the verticals of the industry. For Bluestream, healthcare industry is very important but not confined to it. Health is important to an individual whether he is at a shopping mall, at school, at work or the food that an individual eats and much more. Infections are not only acquired in the hospitals, they are community acquired too. We offer total solutions from skin care point of view for the healthcare sector. We represent GOJO Industries Inc in India. GOJO are the inventors of Purell, worlds leading hand sanitiser
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INTERVIEW
brand. We believe that formulation of a good hand sanitiser plays a very important role in the efficacy of the hand sanitiser. Having taken efficacy (99.99 per cent germ kill from Purell) for granted, it should be gentle to the hands and should be formulated for repeated use without causing dryness to skin, any skin irritations, or any sticky feeling on the hand. Purell offers all of the above and more with a fragrance free formula as you are supposed to use it multiple times a day!
How have they been instrumental in curbing infection in healthcare set ups? Our dispensing systems are such that all our manual systems are guaran-
teed for performance for life. We guarantee our dispensing systems for 'No drip, No leak, No breakage', and our refills being sanitary sealed do not get contaminated even over a period of
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time.Therefore, any of our product – whether it is a hand sanitiser, or a soap or an antibacterial soap maintains its efficacy throughout the shelf life of the product. Soap falls on the sink and accumulates bacteria if there is a leak or a drip in the dispenser. If there is a bulk pour system (which is definitely not advisable in a healthcare setting) the bacteria accumulate in the dispenser itself thereby deceiving the purpose of washing hands. We know a hand hygiene infection control programme designed to achieve these two things will yield better patient outcomes. At GOJO we aim to simplify hand hygiene compliance by delivering a hand hygiene programme that leverages best practices based on research. Throughout our history, we have partnered with healthcare facilities to focus on four critical components of an effective infection control programme: DECEMBER 2013
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HBII 2013 SPECIAL ■ Educating healthcare workers, patients, and visitors on how, when and why to practice good hand hygiene ■ Making products that are easy to use and readily accessible for healthcare workers, patients and visitors ■ Developing products that healthcare workers will want to use and that are proven to help drive compliance ■ Monitoring and measuring hand hygiene compliance By continuously working with healthcare facilities to identify easier ways to deliver optimal infection control and improve skin health, GOJO is one of the world's leading manufacturers of hand sanitising, handwashing, hand moisturising and patient care solutions for the healthcare industry.
What are the company's plans for this segment in the coming fiscal? We plan to raise the standards while watching the bottom line : Making a case for infection control. It is imperative that the focus is on patient safety but our product implementation in a hospital should be able to reduce the present cost incurred. Our clients can ask us for special programmes on infection control to be conducted free of cost in their hospitals during the HBII 2013 show. Also, our clients can log on to www.bluestream.net.in for special offers and discounts.
How long have you been associated with HBII, how has it evolved over the years? We have been associated with HBII since the inception of HBII in 2010. We had participated in HBII at the Bombay Exhibition Centre in Mumbai grounds with a very small stall at that point of time. HBII has evolved into a mature exhibition over a period of time and is very specific a B2B show. We have been seeing clients who have come into HBII without fail every year besides new clients every year.This shows that the exhibition definitely offers a good valueadd to the doctors/ individuals/corporate who have their own hospitals, or a part of a chain of hospitals.
What is your agenda for HBII 2013, are you launching any new products at the event? We will be launching Purell Smart Link programme with Purell Advanced and Bluestream Personal wash cloths at this event. It is a programme which electronically monitors hand hygiene. Bluestream Personal wash cloths are manufactured in India especially to cater to the needs of the bed ridden patients. It is a very carefully formulated product which helps maintain the skin integrity, thus preventing infections.
What insights do you expect to gather from HBII 2013?
We have been fairly present in the West of India, but have not touched the North. We expect to understand the expectations of the healthcare industry in the North better and offer optimal solutions to them to the best of our ability.
What are the unique advantages and challenges in the Indian healthcare market for a company like Bluestream Manufacturing? Our soap formulations are meant for repetitive use and they are biodegradable. We are probably one of the few companies in the world who carry the Ecologo and the Green Seal Certificate on our Soaps. We also have a Green formulation for Purell. Acceptance of the fact that infection control is an issue itself about eight years ago when we started was one of the biggest challenge, besides other small hindrances in making the product available to making the customer see value in bringing about a change from the present system to Purell.Today, with the awareness, at least, all of us have started accepting that infection control is a cause for concern. The unique advantages of Purell formulation is that it gives you a very high efficacy in a very small volume of the hand sanitiser, without being causing a sticky feeling or dryness to the skin. Purell has been the leaders in the hand
hygiene segment in the west for the last 60 years. We would like to bring the advantages of the Purell efficacy for our healthcare professionals. There’s a perception that all instant hand sanitisers are created equal. It’s just not true. While some suggest that a high level of alcohol is the key to a higher level of efficacy, science indicates otherwise. Alcohol, in fact, reaches a point of diminishing return at higher levels.1, 2, 3 and too much can be hard on skin. In reality, it’s actually the total formulation that truly determines efficacy. As a company dedicated to the science of skin care, we knew we could formulate a product that delivered unprecedented efficacy in a skin-friendly formulation without excessive alcohol. And we did.The result is a product that ounce for ounce outperforms other hand sanitizers and kills 99.99 per cent of bacteria on hands, for not just in the lab, while maintaining skin health. One of very common questions asked to us was whether CHG is a must in the hand sanitiser. Our studies show that When tested under realistic conditions, CHG does not continue to kill bacteria after product use.
For more information, please visit our booth no. 7F21 at HBII 2013 or you can write in to us at info@bluestream.net.in
‘The company offers devices and equipment to the medical fraternity in India since 2002’ Anup Ringangaonkar, CEO, Medirail Systems, talks about his company, its offerings for the healthcare industry and his expectationsfrom HBII 2013, in an interaction with Express Healthcare Tell us about Medirail System's offerings for the healthcare sector? Pune-based Medirail Systems engaged in manufacturing of OT, anaesthesia, surgical, ICU pendants, remote operated sliding pendants, bed head panels, railing systems (Both horizontal/vertical), cubical curtains track system, trolleys, quinen warm blankets, anaesthesia ventilator, syringe pumps, venturi suction, LED view boxes and all neonatal equipment like open care baby warmers , Bubble CPAP, high frequency oscillatory ventilator, conventional ventilator and many more essential equipment that are required/ in those critical situations. The company offers all the above devices and equipment to the medical fraternity in India since 2002. These are manufactured in an ISO9001:2008, ISO13485: 2003 DECEMBER 2013
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What are the unique advantages and challenges in the Indian healthcare market for a company like Medirail Systems?
Organisation and are CE Certified.
What are the company's plans for this segment in the coming fiscal? Medirail Systems is planning to launch new products in coming year. These are CO2 Insufflator, surgical lamps, micro processor-based lithotripsy equipment with inbuilt suction and various patient handling devices with a aim to target hospitals who value innovative concepts.
How long have you been associated with HBII? We have been associated with HBII since the last three years and have been participating in various trade exhibitions organised by them since 2010.
Are you launching any new products at the event? We are going to introduce the
demonstrate our innovative concepts and ideas and ensure that our valuable foreign currency is saved atleast in this segment of hospital industry.
world first pendant that incorporates new concepts like the Quinen Warm Blanket incorporated in pendant along with suctioning, ventilation and humidity indication facility.
What insights do you expect to gather from HBII 2013? We expect a huge turnout of hospital owners planning to venture in new hospitals, architects, interior designers, planners to whom we can
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Indian healthcare market is growing day-by-day in leaps and bounds. Doctors having small setup who were initially satisfied with it are now joining hands and are starting hospitals in groups. Simultaneously corporate business houses have also recognised the importance of health industry and have now started investing in it. As a result the market potential is huge. Doctors from mofussil areas have understood the importance of group practice and hence the hospital size have started to broaden. Also, due to price advantage in medical services in India against the European market, medical tourism is increasing, hence, the potential will grow day-byday, add to it the increasing population in India. EXPRESS HEALTHCARE
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HBII 2013 SPECIAL Osworld Scientific Equipments launches Osworld Benchtop Autoclaves They are used in various departments of hospitals and medicinal and pharmaceutical research like microbiology, medicine, veterinary science, mycology and dentistry
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sworld Scientific Equipments. is a manufacturer, supplier and exporter of laboratory and medical equipment for last four decades. Osworld is a ISO 9001:2008 certified company and some of its products have CE certification. Osworld is a manufacturer of quality QC, R&D equipment like autoclave steam sterilizers, stability chamber, walk in stability chamber/cold rooms/freezers, photo stability chamber, B.O.D. incubator, cooling incubator, bacteriological incubator, hot air oven, vacuum oven, deep freezer etc. Osworld is proud to announce its latest development; the Osworld Benchtop Autoclaves that are widely used in various departments of hospitals and medicinal and pharmaceutical research
like microbiology, medicine, veterinary science, mycology, dentistry, etc. In the pharma and medicinal industries, typical loads include laboratory glassware, surgical instruments, medical waste, etc. Front Loading Benchtop Autoclave- TOUCH SCREEN TYPE – Model No OAT-FL Class B, Class N/S Sterilizers from 20 to 50 litres capacity, Temp range 121 to 134 degC Osworld Front Loading Benchtop Autoclave is CE certified. Its other features are microprocessor based digital display, LCD back lit display. The inner chamber has 3 mm thickness and made of stainless steel. Outer cover is also made of mild steel/stainless steel; lid is made of thick stainless steel. Initial auto water fill arrangement in external reservoir for steam generation, low water level alarm, automatic air exhaust cycle helps create partial vacuum in the chamber, vacuum pump for air removal with multiple pulsing, automatic door lock under pressure etc are some of its features. A solenoid valve vents out air
during the process of steam generation. At a preset temperature the valve automatically shuts and thereafter steam pressure builds up. The sterilisation process should continue almost 15-20 minutes.Once sterile time period completes, the steam is automatically exhausted. Drying cycle is provided optionally with print of entire cycle and PC interfacing software facility. Premium Model AutoclaveVertical Type- Top LoadingSingle Handle Type – TOUCH SCREEN – Model no OAT-SHE Class B, Class N/S Sterilizers from 35 to 175 litres capacity, Temp range 121 to 134 degC Osworld Premium Model
Autoclave is used in microbiology, QC and research l aboratory – pharma/medical industry It is CE certified and consists of microprocessor-based Digital Temperature Controller Indicator or TOUCH Screen Model. The autoclave construction is double wall type design, however has an inner chamber for steam, outer as cover. Only steam enters inner chambers for sterilisation. The chambers are made of stainless steel of LM 304/316 grade exclusively provided by Jindal Steel. The equipment has all features required for Class B/S/N autoclaving.
Door – Model no OAT-HR Class B, Class N/S Sterilizers from 100 to 1000 litres capacity, Temp range 121 to 134 degC Osworld Horizontal Model Autoclave is CE certified and mainly used for large requirements. Available in single door/double door model. Contact Osworld Scientific Equipments B44, New Empire Industrial Premises, Kondivita, Andheri East, Mumbai Tel: +91-22-28320880, 28390487 Email: info@osworldindia.com Web: www.osworldindia.com
Large Horizontal Model Autoclave- Front LoadingRadial Locking Type or Sliding
VISITECT CD4: Omega's offering for ART H It is a ground-breaking, disposable, point-of-care test for the determination of CD4 counts in whole blood and helps in enabling ART therapy
IV is a major global health challenge affecting approximately 33 million people worldwide. Five million new cases are reported every year, mainly in the developing world. It remains the primary cause of global disease burden in 12 countries including South Africa and India, where access to healthcare is often limited.
Treatment initiation Antiretroviral therapy (ART) is a possible treatment option to help prevent the loss of immune function that occurs as the disease progresses. Determining the CD4 count is a vital component in the management and care of HIV-positive patients and is required to assess their candidacy for ART initiation.
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WHO guidelines (2009) recommend that once the CD4 count falls below 350 cells/µl, the patient should commence therapy and their health-during-treatment be monitored every three to six months. While 6.6 million people are receiving ART in low- and middle-income countries, this is less than half of those needing treatment (UNAIDS World AIDS day report, 2011). This equates to a growing demand for CD4 testing based on the number of individuals still in need, together with those currently on ART.
Diagnostic challenges Availability of diagnostic testing is one of the major obstacles to timely, highquality HIV treatment. Typically, CD4 counts are www.expresshealthcare.in
Andrew Shepherd, Founder & CEO, Omega Diagnostics
measured in laboratories using flow cytometry. Expensive and sophisticated equipment is needed, as well as highly trained personnel, a clean water supply and cold storage for reagents, necessitating the test to be carried out in centralised locations. Delays between testing and obtaining results can also lead to a significant 'loss to follow up' and often patients do not return to receive lifesaving treatment. In addition, the majority of non-reference laboratories and clinics in countries most affected by HIV cannot regularly monitor CD4 counts and access to testing can be difficult or even impossible in rural areas. Benchtop analysers have been developed for use in rural communities, but issues with elecDECEMBER 2013
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HBII 2013 SPECIAL minutes ■ Proven lateral flow technology ■ Convenient and easy-to-use ■ Room temperature storage ■ Affordable, low cost ■ Perform multiple tests at one time
Results
tricity, maintenance, logistics and training are still a major concern and limit their uptake in rural areas. CD4 testing remains the bottleneck of ART initiation and without timely CD4 testing, ART initiation is hindered, often resulting in an irreversible compromise to the immune system.
Australia, it is based on proven lateral flow technology and provides an affordable, convenient, instrument-free solution for laboratories and remote clinics worldwide, enabling ART therapy to become accessible to every HIV-infected patient. It is manufactured and marketed by Omega Diagnostics Group.
Point-of-care testing VISITECT CD4 is a groundbreaking, disposable, point-ofcare test for the determination of CD4 counts in whole blood. Developed by the Burnet Institute in Melbourne,
Features
■ Finger-prick blood sampling ■ Instrument-free testing ■ Visual ‘TREAT’ or ‘NO TREAT’ result ■ Results obtained in 40
Results are interpreted visually by comparing the colour intensity of the Test (T) line with the Reference (350) line: ■ T line EQUAL / WEAKER than 350 line: CD4 count is =350/µl Presumptive interpretation is ‘TREAT’ ■ T line STRONGER than 350 line: CD4 count is >350/µl Presumptive interpretation is ‘NO TREAT’ ■ C line ABSENT/BROKEN/ IRREGULAR: Interpretation is ‘INVALID’ Repeat the test
PSA oxygen system saves 50 to 70 per cent cost on oxygen consumption bills Sanjay Jaiswal MD, Airox Technologies speaks to Express Healthcare about the importance of oxygen generators systems within a hospital Tell us about the importance of oxygen generators in a hospital set-up? Which are the department that needs oxygen generators mostly? Oxygen generator separates oxygen from atmospheric air which is then purified and supplied to complete hospital of any bed capacity. Generally major oxygen is consumed in departments like Intensive Critical Care Unit (ICCU), neonatal/ pediatric intensive care unit and operation theatres. Sometimes it can be used in rooms and wards of hospital.
Approximately, how many such generators will a 500-1000 bedded hospital require? A 500 bedded multi-speciality hospital generally consumes approximately 100 cylinder (7 M3 capacity) a day. Sometimes it can be more or less which we decide after collecting DECEMBER 2013
INTERVIEW
specific data from the hospital. This supply can be managed by only one generator model like Airox AS-L in our case which would be equivalent to 125 cylinders per day. For 1000 bedded kind of bigger hospital where oxygen requirement is around 200225 cylinders per day, considering redundancy we offer three As-L models. Here one model will always work as back-up.
Any specific infrastructure required to incorporate oxygen generators within a hospital? No specific infrastructure. We just need electricity connection and ventilated premises which should be protected from sun and rain.
You are said to introduce the first PSA Oxygen system in a private hospital. Can you tell us when was it installed and which hospital? We have installed our first oxy-
gen generator in Atma Malik Hospital now Vikhe Patil Medical Foundation, Shirdi,Maharashtra in early 2011.
What are the benefits of a PSA Oxygen system? What about costreflectivity? PSA oxygen system has a lot of
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benefits. The hospital has return on investment in 6 months to 3 years and it saves 50 to 70 per cent cost on oxygen consumption bills. A good quality system if maintained well has a life of 24 years. This system makes a hospital self sufficient on oxygen and takes care of all inflationary hike of future oxygen costing. It is a far safe system as it is in gaseous form and operates just on five bars unlike cylinders which run at 160 bars and are not that combustive like liquid oxygen. This is a compact system and it can be installed on a terrace which saves huge ground floor space required for liquid oxygen. We can always check what the purity of oxygen with the help of an oxygen analyser given along with the system.
What is the market size for oxygen systems in India? This market is divided in two segments, portable oxygen concentrator and oxygen generator. Oxygen generator market size is around Rs 25 crore in India with 50 systems per annum which is growing rapidly every year. EXPRESS HEALTHCARE
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HBII 2013 SPECIAL
Recent trends in haemodynamic monitoring Nihon Kohden recently launched the esCCO, a novel technology to noninvasively measure continuous cardiac output from ECG and SpO2
Anil Srivastava, National Sales Manager Head – Sales & MarketingMedical Equipment Nihon Kohden India
DECEMBER 2013
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ardiac output is one of the most important parameters for cardiac function monitoring, providing an estimate of whole body perfusion oxygen delivery and allowing for an understanding of the causes of high blood pressure. Over the past many years, the market for haemodynamic monitoring products has changed, and growth in this market is being fueled by several factors. One of the major factors is ageing population with an increasing number of cardiac disorders. Because of many factors and other conditions that could benefit from hemodynamic monitoring, growth is also being driven by the demand for less invasive and noninvasive technologies that measure cardiac output continuously, stroke volume and other global parameters of oxygen delivery. Nowadays, volumetric information for fluid management or monitoring cardiac function is getting more and more attention worldwide. There are many methods of monitoring the haemodynamic status of patients, both invasive and non-invasive. The invasive methods are the Fick method and thermodilution, whereas the non-invasive methods are esophageal Doppler, trans-esophageal echocardiography, lithium dilution, pulse contour, partial CO2 rebreathing and thoracic electrical bio-impedance. All of them have their advantages and disadvan-
tages; of these techniques, thermodilution technique is considered to be gold standard for obtaining Cardiac output, although the usage of this technology is on decline due to its invasiveness and associated complexities. The ideal system for continuous cardiac output monitoring would be non-invasive, easy to use, reliable and compatible in all kinds of patients. A number of research studies have been carried out in clinical care settings for the purpose of finding a technique of measurement which is noninvasive, cost effective and with clinically acceptable accuracy. Emphasis is on non-invasive techniques to measure important parameters like Continuous Cardiac Output (CCO) is growing. Recent reports show that usage of the pulmonary artery catheter declined 65 per cent from 1993 to 2004 in the US* (*Wiener RS, Welch HG. Trend in the use of the pulmonary artery catheter in the United states, 1993-2004, JAMA 2007; 298: 423-9). Nihon Kohden recently launched the esCCO, a novel technology to non-invasively measure continuous cardiac output from ECG and SpO2. esCCO is a new technology to determine the cardiac output –Continuously using Pulse Wave Transit Time (PWTT) which is obtained by the pulse oximetry and ECG-signals from each cycle of the ECG and peripheral pulse wave. esCCO provides real-
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time, continuous and noninvasive cardiac output measurement along with esCCI (Continuous Cardiac Index). Ease of operating andease of access to the technology will be the key in future. The ambition in research and development though, was the provision of volumetric information, especially for mid and low care levels, to improve patient care and enhance treatment outcome. With that, the challenge was to avoid any kind of invasive or minimal-invasive calibration. By only entering patient information such as age, gender, height and weight, and an initial NIBP measurement, esCCO determines a reference value for calibration and is ready for start the measurement. Additionally, a cardiac output value obtained by other CO devices such as by pulmonary artery catheter can be used for calibration. Both calibration modes reliably track changes in cardiac output and provide advanced monitoring of a patient’s hemodynamic status, thus helping clinicians in better patient care. For quality patient care, comprehensive management of different hemodynamic parameters is crucial. Both restrictive and excessive fluid management increase risk of morbidity and mortality. Hemodynamics Graph provides a more intuitive approach to diagnostic and therapeutic decision making
in hemodynamic management during Sepsis management. Nihon Kohden has introduced a new monitoring tool of plotting the trend of changes in various hemodynamic parameters of preload, afterload and output indicating the cardiac functionality. Hemodynamics graph helps clinicians easily see the direction and trend of hemodynamic change while imaging the FrankStarling curve, and help to objectively determine the optimal therapeutic strategy based on the Forrester Classification. Blood pressure and Central Venus Pressure (CVP) target graphs can support therapy according to the guidelines for initial resuscitation of sever sepsis and septic shock. Much evidence supports the idea that goal-directed fluid management guided by several hemodynamic parameters will reduce postoperative hospital stay and complications. Contact Anil Srivastava National Sales Manager Head – Sales & MarketingMedical Equipment Nihon Kohden India 308, Spaze Tower-A, Spazedge, Sector-47, Sohna Road, Gurgaon -122002. India Cell : +91-98106-99223 Phone : +91-124-493-1000 Toll free No.: 1800 103 8182
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is the significance of an emergency plan Q inWhathospitals?
What are the steps in equipment planning for a hospital? Q new
Dr Saxena, Raipur
Swati, Bengaluru
An attitude of "it can't happen here" is prevalent in many. But, the lack of an emergency plan A could lead to severe losses such as multiple casualties
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
and possible financial collapse of the hospital. Since emergencies will occur, pre-planning is necessary to prevent disaster. An urgent need for rapid decisions, shortage of time, and lack of resources and trained personnel can lead to chaos during an emergency. Time and circumstances in an emergency mean that normal channels of authority and communication cannot be relied upon to function routinely. The stress of the situation can lead to poor judgement, resulting in severe losses.In addition, an emergency plan promotes safety awareness and shows the organisation's commitment to the safety of workers/patients/visitors.
Healthcare technology management professional's functions are: A Equipment Control & Asset Management
■ ■ Work Order Management ■ Data Quality Management ■ Personnel Management ■ Quality Assurance ■ Patient Safety ■ Risk management ■ Hospital Safety Programs
What is the difference between medical and medical practice management? Q marketing Shalini, Chennai
What should be the design considerations and provisioning of beds in hospital ICU?
Q The basics concept of ICU design is ‘maximum surveillance and easy access to patients’. The A patient is never compromised. All beds in this unit are Kumar, Administrator, North India
to be arranged in glazed cubicles as general ward with a centrally located nursing station. Bed spaces per cubicle have to be 10.5 sq m. Each cubicle should be provided with overhead railing and curtain so that it can be screened off if need be. Each bed has to be provided with minimum four power points (two five amp and two fifteen amp) with proper earthing. Adequate air conditioning (10-12 air changes per hour, 16-27 degree temperature and 60-70 per cent humidity) of the complete unit is a must. Stand by generator connection to ICU is essential. Ward has to be adequately illuminated with separate control for each light. It is preferable to have wall mounted cardiac monitor, piped oxygen supply and separate suction machine for each bed. Conductive floors are preferable because lots of electrical equipment are required to be used.
They are related, but they have quite different roles in practice. A Broadly defined, Medical Practice Management embraces operational matters such as coding, payer selection, accounts receivable, staffing, HIPAA, software, cost cutting, and about a million other issues that are a part of the day-to-day activities of the business/practice. In its purest form, Medical Marketing is about building a positive reputation, getting your phone to ring, getting people to come in for a first appointment and converting them into patients. Practice Management is largely about the wheels that turn inside the practice. And Practice Marketing is the planned process of communications that goes on with individuals who, for the most part, are not yet aware of or part of the practice.
Q What is the ideal nurse-to-patient ratio? Dr Vijay, Thane
What is the authorisation for 200 bed hospitals ICU?
Q Hospitals with 200 or more beds are authorised an ICU on the following scale: A Not to exceed two per cent of the total authorised Vivek, Pune
■
Patient ratios are based on matrices developed in accordance with local and national A benchmarks for ratios as well as established discipline guidelines.
beds. ■ Beds in ICU not to be less than eight to justify its
existence. ■ Hospitals having bed strength of 200-399 will draw
excess of two per cent beds from acute medical and acute surgical wards.
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DECEMBER 2013
BOOK REVIEW
Caregiving simplified Raelene Kambli reviews Amey Goyer's book- Juggling Work and Caregiving and finds that it makes for an informative and interesting read
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aregiving in reality is an act of love and compassion. However, it also takes courage to care for the old and the ailing loved ones on a daily basis. Especially, if one is a working caregiver-life seems to be extremely difficult. ‘Juggling Work and Caregiving' an ebook developed by the American Association of Retired Persons (AARP), sponsored by Pfizer and authored by AARP’s Amy Goyer, is a complete guide for people who have been caring for their ailing loved ones at home while having their own careers. The title of the book is self explanatory and it gives a clear understanding to the readers that the book deals with various challenges a working caregiver comes across. The e-book also gives information on how one can successful trod over these rough patches in life and handle it with aplomb. The book offers useful tips to people who are caregivers on a dayto-day basis and yet need to maintain a balance with their work. The book begins with a foreword by Dr Freda LewisHall, MD, Executive Vice President and Chief Medical Officer, Pfizer, a name well known among international pharma and healthcare experts. She writes, “We believe that caregivers are both essential to our society and under-appreciated within it. Whatever your situation, this guide makes it DECEMBER 2013
clear: You are not alone”. This show of solidarity raises high hopes from the book and urges you to read it. “Although caregiving can be a richly rewarding experience, the role comes with enormous responsibilities — and pressures,” writes the author, while she introduces the subject. The book has 14 chapters that deal with aspects related to caregiving and managing a paid job. Caregiving is an art mastered by experience and the author explains this well in each of its chapters. The topics covered in each chapter are also very pertinent and comprises issues that may arise on a day-today basis in the life of a working caregiver. Written in simple and lucid language which can be easily understood and comprehended, the book offers great insights and keeps you hooked till the last page. In a time, when there are quite a number of books available on caregiving, the book takes a personal approach to solving various challenges with the author sharing her own poignant story as a live-in caregiver to her parents. She also incorporates experiences shared by many working caregivers from America, since this book is written keeping in mind, the working caregivers from the US. Some might wonder that if the book caters to
Americans, what will the lure for Indian readers? Well, the answer is the book itself. Caregiving as an act comes with a set of challenges, issues and solutions which remain similar regardless of the topography. In the first chapter, the author speaks about understanding a caregiver and the challenges faced by them. The second chapter deals with the real tough job of a caregiver juggling their work and caring for their loved ones. The third chapter gives tips on how a working caregiver can plan for their ailing loved ones. Moving on, in the fourth chapter, the author touches upon details that usually caregivers overlook while they juggle through these difficult times but can have far reaching consequences, for instance caring for themselves. Sharing some personal experiences, the author in this chapter helps one overcoming the emotional and physical challenges that a caregiver is bound to face. The author elaborates of this theme in the fifth and sixth chapters as well. Taking a step forward, Chapter 7 and 8 is on how a caregiver needs to manage his/her legal and financial matters. Often, while caregivers are engrossed in providing support and medical aid to the loved ones they tend to overlook details related to medical insurance settlements and other financial matters. Here, the author, in www.expresshealthcare.in
Title: Juggling Work and Caregiving Author: Amy Goyer Edited by: C Sampath & Hannah Paul Publisher: Rosetta Books Developed by: AARP Sponsored by :Pfizer Available for download: Kindle, Apple, Barnes and Noble and Kobo e-tailer stores About the author Amy Goyer is an expert in ageing and family care
a simple way explains how one can efficiently maintain medical bills, settle claims and take care of legal matters while caring for their loved ones. In the latter chapters 10, 11 and 12, the author gives tips on how to maintain a work-life balance when your ailing loved ones live in a separate facility away from home. She also teaches the caregivers to be prepared for a crisis situation. In Chapter 12, the author gives tips on how to manage the hospitalisation of a loved one while handling a paid job. Chapter 13 and 14 deals with life’s most difficult times-when caregivers have to part with the loved ones whom they have looked after for a long time. Indeed, this is the time when most caregivers experience an emotional collapse. Often it seems to be the end of the world for them. However, here the author who also experienced the same pain, advises how to cope with the situation and move forward. The author sums up the book by providing some interesting ways where people can make a new beginning. All in all, the book serves as a simple yet effective guide and reference for caregivers while they take on an important role in their lives. The book is available for free download in the Kindle, Apple, Barnes and Noble and Kobo e-tailer stores. raelene.kambli@expressindia.com EXPRESS HEALTHCARE
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PEOPLE Stevie Women in Business Award 2013 conferred on Kanchan Naikawadi The Director of Indus Health Plus has won the Silver Stevie for Female Entrepreneur of the Year in Asia
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anchan Naikawadi, Director Indus Health Plus recently bagged Silver Stevie for two categories – Female Entrepreneur of the year in Asia, Australia and New Zealand and Female Entrepreneur of the year – consumer product at Stevie Women in Business Awards 2013 recently conducted in New York. The Stevie Awards for Women in Business honour women executives, entrepreneurs, employees and the companies they run—worldwide. The Stevie Awards is a renowned business awards.
Reportedly, more than 1,200 entries were submitted this year for consideration in more than 90 categories, including Executive of the Year, Entrepreneur of the Year, Women Helping Women, and Communications Campaign. Naikawadi said, “I am glad and extremely happy that I received these prestigious awards. A recognition as this would surely take us further ahead and we would continue serving the society with innovative health solutions in our category. We aim to provide quality healthcare at affordable prices to the masses through preventive healthcare checkups. We pride ourselves in facilitating screening, generating reports and providing doctor’s consultation in a single day. An innovative initiative as this to generate awareness of practicing prevention for one’s health has given us a clear visibility in many regions.” “For 10 years we have been recognising the achievements of women in business, and this year’s nominations were the most impressive class the judges have ever reviewed,” said Michael Gallagher, Founder and President of the Stevie Awards.
Dr Gullapalli N Rao receives Outstanding Humanitarian Service Award Recognition for his eye care model and contribution to prevention of blindness
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he American Academy of Ophthalmology (AAO) honoured Dr Gullapalli N Rao, Founder and Chairman of LV Prasad Eye Institute with its "Outstanding Humanitarian Service Award". This award was bestowed on him in recognition of the eye care delivery model he created with the Institute and his contributions to prevention of blindness globally. The award was presented to Dr Rao on November 17, at the AAO’s annual meeting in
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New Orleans. LVPEI’s model of eye care, represented by a pyramid, emphasises the creation of sustainable permanent facilities within communities, staffed and managed by locally trained human resources, and linked effectively with successively higher levels of care. Dr Rao was also the recipient of "International Prevention of Blindness Award" of the Academy earlier.. www.expresshealthcare.in
Dr Krishnamoorthy to spearhead Indian device subsidiary of Bacterial Robotics He will take charge as Director, Clinical Surgery- India
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ova Specialty Surgery's Senior Consultant, Dr Kumaresh Krishnamoorthy will spearhead US-based lifescience biotechnology firm, Bacterial Robotics' soon-tobe-formed device subsidiary in India, called Auricle Solutions, as Director, Clinical Surgery- India. Speaking about the
d e v e l o p m e n t , Dr Krishnamoorthy said, “I am thrilled and honoured to be associated with Bacterial Robotics and take charge of its new India venture. This is a win-win association for all of us, and I look forward to making a meaningful contribution in my new role.” Dr Krishnamoorthy is currently Senior Consultant, ENT, Head and Neck Surgery, Neurotology and Cochlear implantation with Nova Specialty Surgery. Along with Dr Ravi Samy, US-based Chief Medical Officer of Bacterial Robotics, he has been instrumental in introducing the latest surgical techniques and technologies to India.
Fortis cardiologists, Dr Ashok Seth and Dr Vivek Jawali nominated to MCI Dr Seth was nominated by the Delhi Government and Dr Jawali was nominated by the Karnataka Government
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wo eminent cardiologists from Fortis Healthcare, Dr Ashok Seth, Chairman, Fortis Escorts Heart Institute, New Delhi, and Dr Vivek Jawali, Director and Chief Cardiovascular & Thoracic Surgeon, Fortis Hospital, Bangalore, have been nominated to the newly constituted Medical Council of India (MCI), the statutory body that governs the standards of medical education and recognition of medical qualifications in the country. A gazette notification of the Ministry of Health and Family Welfare, Government of India, published recently, announced the names of the council members. Apart from elected members, the Central and State Governments nominate medical professionals of
pre-eminence to the MCI. While, Dr Seth was nominated by the Delhi Government, Dr Jawali was nominated by the Karnataka Government, both for a period of four years. Dr Ashok Seth received the Padma Shree in 2003 and is well known for his contribution to the growth of cardiology, especially interventional cardiology, across the world. He is credited with pioneering a number of angioplasty techniques over the past 20 years and has been training the next generation of cardiologists. A pioneer in minimally invasive surgery in India, Dr Jawali has so far performed over 18,000 complex heart surgeries. He has the distinction of performing India’s first minimally invasive bypass surgery in 1994. DECEMBER 2013
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Hepatic Drainage Territories
Couinaud Segments
Radio-Embolization Planning
MYRIAN® FAMILY OF MODULAR WORKSTATIONS: BASE PLATFORMS SPECIALITY CLINICAL MODULES o PRO (Basic CR/DR Workstation) XT- CARDIAC CT XT-CARDIAC MRI o ADVANCED (Double oblique MPR / XP-LUNG XP-LUNGNODULE MIP, CPR, etc.) XT-BRAIN CT PERFUSION XT-BRAIN MRI o EXPERT (3D Workstation) XP-COLON XP-COLONCAD o EXPERT VL (3D With Volumetry) XP-ORTHO XT- DENTAL o XL-REGISTRATION (Elastic Registration) XL-2D/3D STITCHING XP-FUSION o XL-4D NAVIGATOR XP-LIVER XP-CT CTA sub XL-ONCOLOGY (RECIST 1.0, Modified RECIST 1.1, CHESON) For more details, please contact : JIGISH B MODI PH: 2506 5664, 98670 01110, email: modimedicare@gmail.com Skype: modi.medicare 4/102, DEEP SUNIL, GARODIANAGAR, GHATKOPAR(E),MUMBAI– 400077.
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Conquering new heights in medical technology: Trivitron Healthcare PG 95 Compact Light weight 0.45T Open MRI ELIXBO 545 PG 96-97 BC 601: Terrific tool from Tanita PG 98 Hi_tek: Soaring to new heights PG 99 New age LEDs from Technomed PG 100
TRADE & TRENDS Simplifying HMS Kishore Shinde, VP, Indisoft Consultancy Service gives guidelines on tackling the challenges in implementing HMS
he healthcare industry has been relatively slow in adopting information technology in compared to other sectors. The bigger hospitals have rolled out IT solutions however the smaller hospitals which contribute 60 per cent of the total hospitals has still not adopted IT solutions. IT in today’s age plays a vital role in the healthcare sector as it significantly takes part in improving patient care as computerised healthcare is still in its evolving phase in India. It is important to select the right software which supports the hospital to work efficiently and also make the institution profitable. Once a hospital selects the accurate software, the next important step is to implement the same. However diverse aspects can serve as a challenge during the implementation process. Let us understand those challenges:
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Availability of skilfull staff One of the most common challenge the hospital faces is limited staff expertise and availability. Some hospitals lack a dedicated IT professional staff. The person in charge juggles multiple responsibilities and is unable to solve the issues faced during the software implementation. This can be mitigated using a software which is simple to use, and employs common English language rather than medical language.
Comfortable working manually The senior staffs of hospitals are generally reluctant to IT as they have always been comfortable working manually. They refuse to learn the functions and consider IT an additional burden. This can also be mitigated by enforcement from top management with specified timeline.
Confused vendor
MARKET 11 KNOWLEDGE 27 RADIOLOGY 36 IT@HEALTHCARE 38 HOSPITAL INFRA 40 LIFE 65 94
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The vendors in charge of imparting knowledge to the hospital staffs are sometimes confused and unable to understand the administration guidelines. This is a crucial factor as the vendor needs to have clear idea about the hospital processes before training the individuals; he should know the training priorities and roles defined. This ensures that the products align with workflow as they are designed to support identified goals and objectives. The top management, the vendor involvement in understanding the current process and provide training to all the stakeholders to visualise the gain will help to mitigate this problem.
employees get trained in dummy entries. They get used to updating the master entries where rates of investigations are not properly updated. It is advisable to first get the master data ready and then start the training with all the roles and privileges set so that the employees get used to the workflow from the first day. Here clarity, training and requirement management can help to make the implementation easy.
Connectivity and hardware problems The software cannot be implemented if the network and LAN are not working properly. Both the Hardware and software installation should be done at the same time so that problems at this level get sorted out easily.There should be a good internet connection so the support is available online which will save precious time.
Conclusion It is also not uncommon to find that a year or so after a ‘successful’ HMS implementation, the hospital administration has stopped using it. This might be either because the software was not user friendly or the workflows were not well planned and configured. Changing the way people work and behave can be challenging. There can be resistance for a variety of reasons. Daily meetings with the staff and discussion about their problem areas with the implementation can help them overcome the problem they face. So before getting ready for software implementation the hospital administration should have their priorities in place. There are good software like RxOffice which are easy, user friendly and simple to implement.
Unavailability of master data If the master data is not ready then the www.expresshealthcare.in
(The author can be contacted at 9892869870) DECEMBER 2013
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Conquering new heights in medical technology: Trivitron Healthcare Trivitron has catapulted itself to being a leading manufacturer of medical equipment across the in vitro diagnostics, imaging, intensive care and operating room space
DECEMBER 2013
stablished in the year 1997, Trivitron is the largest Indian MNC in medical technology. It is the only multi-modality medical technology company in India with presence in Cardiology and Implantable Devices (CID), Imaging Sciences, Lab Diagnostics (IVD), Critical Care & Life Support Solutions (CLSS) and ophthalmology. Headquartered in Chennai, Trivitron group's products are now exported to over 165 countries including advanced markets like the US, Europe and Japan. Today, Trivitron Healthcare, through its successful inorganic synergies with local and global firms, has a revenue turnover of Rs 750 crores .Starting off as a distribution firm, Trivitron has catapulted itself to being a leading manufacturer of medical equipment across the InVitro diagnostics, imaging, intensive care and operating room space. The eight in-house manufacturing facilities across Chennai, Mumbai, Pune and Helsinki are 100 per cent compliant with international standards set by bodies like FDA, CE, DCGI and PMDA. In order to expand its manufacturing footprint, Trivitron has built the Trivitron Medical Technology Park in Sriperumbudur, spread across 25 acres of land and currently housing the Hitachi Aloka and Biosystems JV units, serving the value and premium societal segments. The growth of Trivitron has come through a string of alliances with international equipment manufactures such as Boston Scientific, Hitachi Medical System, Johnson Medical (Sweden) and Technolas Perfect Vision. “To continue being India’s largest medical technology company even in future, Trivitron is in the transformation phase from being a pan India distribution company to enhancing the existing manufacturing capabilities with a view to sustain the business in the long run. The company aims to provide cost effective medical technology to people at large, says Veeraraghavan KL, Group CFO, Trivitron Healthcare. With a belief that creativity fosters innovation and working towards this high performance mantra that embodies the organisational culture and its people, Trivitron has inked partnerships with LV Prasad Eye Institute, Anna University, IIT Madras and Sri Chitra Tirunal Institute of Medical Sciences and Technology across Ophthalmology, Imaging, Renal Care
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and Critical Care segments. The company has access to 16 patents in the IVD space and has recently filed a patent application towards a retinal screening device developed for diagnosing early stage diabetic retinopathy in un-dilated eyes. Akshay Karoor, Marketing Manager, Trivitron says, “Enhancing access and affordability to advanced medical technology solutions through global collaborations and long-term customer relations are the key focus of Trivitron Healthcare.” The current product portfolio that are manufactured and exported include the following: ultrasound equipment and colour dopplers, analog and digital X Ray Equipments, X Ray accessories and radiation protection apparels, ECG machines and patient monitors, Modular OT and pendants, infusion and syringe pumps, new born screening equipment and reagents, point of care and home care diagnostics reagents for women's health, gastric disease, diagnostics instruments and reagents for biochemistry/haematology segments and immunoassay/molecular diagnostics products for infectious diseases/women's health/gastric diseases and respiratory disorders. To attain growth and shore up operations globally and improve its market reach, the company has attracted private equity funding over the years, a few of who have had successful exits. Trivitron group has a direct presence in India and is represented by its subsidiaries in the UAE, Sri Lanka,
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Finland and China. 55 per cent of the company’s revenue and 80 per cent of their profit comes from their own manufactured products thus telling the world that India’s medical technology story with local innovation and manufacturing is here to stay. Trivitron plans to achieve their original target of Rs 1000 crores (for fiscal year 2012-2013) by the next financial year with over 65 per cent revenue and 90 per cent profit being contributed by their own manufacturing and innovation initiatives. The company has successfully transformed itself from being a trading company to a manufacturing, distributing and innovating company in its own rights. The company is currently in the process of expanding its presence across the global markets through various marketing and support initiatives. Trivitron’s unique selling proposition is its 24X 7 strong customer support service that combines elements of logistics, engineering and clinical application, making it a service focused organisation. Trivitron is an equal employment opportunity employer. The group has more than 1000 employees on its rolls, backed with a strong management. Contact Trivitron Healthcare #15, IV Street, Abhiramapuram, Chennai - 600 018. Ph: +91 - 44 - 2498 5050 Fax: +91 - 44 - 2498 5757/2467 2782 groupmaraketing@trivitron.com For media queries contact: Eden Menon at 9869810067 EXPRESS HEALTHCARE
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Compact Light weight 0.45T Open MRI ELIXBO 545 Som Panicker, Vice President, Sanrad Medical Systems talks about Sanrad's Compact Light weight 0.45T Open MRI ELIXBO 545
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n India, MRI is considered as a high tech medical imaging equipment where majority of the India population has still no access primarily because most of the MR units are installed in private sector and the high cost of scanning cannot be affordable by common man. In most of the Indian states, the public health system is not able to purchase or maintain a high value medical equipment like MRI systems and so suggesting or selecting a right kind of MRI for such system is very important and it needs special mention of all open and hidden costs of running a high value equipment like MRI. MRI units are generally considered into two segments, namely superconducting which has a field strength of 1T to 3T and the most popular permanent or open systems where field strength ranges from 0.3T to o.45T. Even though superconducting high Tesla MRI has superior image quality due to its high specifications the initial cost, power consumption and maintenance are very high whereas permanent MRIs has relatively low cost, low power consumption and a reasonable good image quality. Superconducting MRI require liquid helium, chiller, high power, heavy duty air conditioning etc making it very expensive to maintain and a rough estimate can be around Rs 25 lakhs towards the comprehensive service contract (CMC) for maintaining such systems in a year. Superconducting MRI requires at least 100-120 KVA mains power supply which makes the electricity charges at least Rs two lakh per month leads to a whopping Rs 24 lakh per year. Another big risk factor is in an event of long power failure or air-conditioning failure, the magnet can Quench (A phenomena where all the liquid helium evaporates suddenly and escapes through the vent value making the magnet lose its magnetism). This sudden failure of the magnet can cost more towards refilling helium a nd the downtime of the equipment incurs extra losses. Adding to this there could be further delay due to non-availability of liquid helium which is normally imported from abroad. Every superconducting MR facility requires liquid helium and there is a shortage of this inert gas all over the world as the resources for this natural
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gas is very limited. This is one of the reasons why most of the manufacturers of superconducting magnets improve to reduce the helium boil off. Today many types of magnets with helium refill frequency ranging from two to 10 years are available, but they are also very expensive and require periodic change of cold head assembly making further periodic investment. For patients it is sometime a scary experience to go into a tunnel like superconducting MRI and this is called claustrophobia. At least one out of ten patients face this difficulty and so the acceptability and popularity of superconducting MRI are not so good like permanent (Open) MRI. In a nutshell, running a superconducting MR system is at least eight times costlier than a permanent MR system and the quality is not so much compromised. Today there is an improvement in technology and image quality of permanent magnet and as a result field strengths of upto 0.45T are available and they are economical to install and easy to maintain. A highend 0.7T permanent MRI is also getting ready for commercial sale from MDT, US. Whenever we think about a public health system or state-run MRI units , the initial cost and running cost are two major factors making the system difficult to run. Considering at least 10 years of an equipment life for an MR system, the running cost of the superconducting MR for a period of 10 years can even equal three times the original cost of the equipment.
Advantages of having a permanent MRI system in a state run or public health system: ■ Low initial cost. It helps to decide the project much faster as the funds can be managed for initial purchase ■ Less space for installation, normally a MRI is installed on the ground floor ■ Easy installation due to less no of components ■ Low power consumption only 20 KVA power needed ■ Low air-conditioning costs only two, three tonne ducted split units for the magnet cooling ■ Easy handling of software ■ Easy handling of patients due to open design ■ No sedation required
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■ Two-year warranty for the permanent MRI system ■ Normally only AMC is recommended ■ CMC charges also less than half of a superconducting system ■ Easy and economical upgrade of software and hardware ■ Availability of high field strengths of up to 0.45T now, 0.7T works in progress also ■ No discomforts for patients due to low noise
A unique product US-based Multi Dimensional Technologies (MDT) is a company (represented by Sanrad Medical Systems, Mumbai) instituted by a group of MR scientists from MIT and Harvard University and they have done many innovations in the field of permanent MRI. MDT’s permanent MR technology has many world’s first including dynamic balancing, high order active shimming and self shielded gradient coil designs. ELIXBO 545 is the world's first 4500 Gauss whole-body permanent magnet open MRI system, which is a milestone in the history of MRI. At 4500 Gauss, MDT's ELIXBO 545 surpassed the open MRI strength limit predicted years ago for permanent magnet systems. ELIXBO 545 MRI system is a brand new product benefiting from the companies' patented dynamic balancing technology, whose design philosophy is based on targeting the electromagDECEMBER 2013
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netic field. This is achieved by integrating the design of magnet, gradient and RF systems into one process. ELIXBO 545 MRI is characterised by its' high-quality images and fast acquisitions, making the clinical applications of advanced technologies feasible in low-fields. MDT is the first company in the world to bring out some of the most talked about innovations in MR technology such as: ■ Divided Current Active Shielding Technology (DCAST) which will reduce the eddy current and residual magnetisation ■ High order Active Shimming (HAOS) helps in preventing field drift and thus improve homogeneity of the magnet ■ High Flux Efficiency Pole Design (HFEPD) technology will help to maintain field strength vs weight of the magnet making ELIXBO 545 one of the lightest available in the world with just 12T weight for the magnet ■ ELIXBO 545 has homogeneity less than 0.9ppm, one of the best so far among permanent MRI designs ■ The gradient strength, which is the critical parameter for high definition quality imaging like EPI, DWI is 25mT/m with a slew rate of 55mT/m/s, making MDT one of the most technically perfect systems
■ Minimum power consumption ■ High Power Gradient Strength and Slew Rate
What makes this product unique?
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The product makes use of protected core technologies. The key to acquire high quality images and establish a stable imaging environment in a permanent magnet system ■ Protected core technology ■ Lightweight magnet design ■ Self-shielded gradient design ■ Active shimming minimising eddy currents and ghosting ■ Flat coil design ■ Best of industry homogeneity close to superconducting systems ■ Image quality matching with high field superconducting systems
Main features and benefits It consists of an intelligent system design ■ The laser-guided patient handling system is designed for patient comfort and scan control convenience. 3D omni-access can position patient body parts optimally ■ Patient comfort space is provided by soft lighting, integrated audio system and ventilation ■ Self-diagnosis and remote diagnosis abilities ensure fast and efficient customer service and long-term customer satisfaction ■ Magnet on-board dual LCD console with controls provides communication, image display and scan control capabilities within the shielding room ■ Equipped with an array of RF coils with multi-channel phased-array capability
Customer advantages ■ ■ ■ ■ ■
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Significant clinical advantages are: Faster - faster imaging speed Higher - higher resolution and SNR Gating - all three types like cardiac, respiratory and pulse Breath Hold Sequences - very useful fro abdominal and MRCP imaging Multi Acquisition - up to four channel design Digital Design - digital Spectrometer makes more accurate and reliable Connects - MDT is a DICOM 3 system makes communication with HIS/RIS Artifact Removal - newer technique like metal artifact removal, respiratory artifact removal More Feasible – ELIXBO 545 MRI makes QD as well as parallel imaging feasible in a permanent magnet system enabling fast dynamic imaging More functions - high field clinical
applications available including EPI and cardiac imaging, Fat water imaging, DWI, ADC mapping ■ Diagnosis feature - supports realtime imaging for MRI-guided therapy ■ Latest developments - MDT is one of the first to introduce high temperature superconducting (HTS) to design highly efficient RF and gradient coils.
Best Technology MRI backed by Sanrad Sanrad after making big success with more than 390 CT installations in India decided to enter in an open MRI market and for this they have evaluated more than 10 new MRI products from various manufactures. “We have carefully examined what a highly qualified Indian Radiologist looking in an MRI and MDT matches their expectations. We have spent more than two years evaluating this product before entering an exclusive agreement with MDT,” says Ratish Nair, CEO, Sanrad Medical Systems. “We want to be number one in our product segment and we have learned from our competitor's success as well as failures and designed our business and product strategy. We have hired some of the best talents with long experience in Open MRI recently to do serious business in India and neighbouring countries,” says Nair. “We are a customer first company and the focus is not just on the product but on customer and what they need from our product and company,” says Nair. In short, MDT is the perfect answer to high field open MRI.
Units installed in India Sanrad Medical Systems installed their first 0.45T unit , mstar 4500 system in India at Megavision, Pune ,seven years ago. After seeing the demo images and going through the data sheets, customers were convinced of MDT's superior design and quality and decided to go in favour of a permanent MRI model mastar 4500. Megavision is one of the premier imaging centre which caters the needs of a large number of patients and highly qualified consultants in and around Pune. With the newly launched model of ELIXBO , Sanrad is poised to become the only serious player in Permanent OPEN MRI market in India hoping to make MRI affordable for common man and thus ideal choice for public health system in India.
Contact Som Panicker Mob: 09920246688 Email: sompanicker@yahoo.com Website: www.sanrad.in DECEMBER 2013
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BC 601: Terrific tool from Tanita Tanita’s BC-601 Segmental Body Composition Monitor is a great tool to identify any physiological and biomechanical asymmetries, tailor your training and fitness regime, and improve the distribution of fat and muscle mass and achieve your personal goals
anita is a pioneer and worldwide leader in body fat/composition monitoring technology and are proud to have sold nearly 20 million fat monitor scales worldwide. Measuring weight alone is not a completely accurate assessment of health or fitness because it doesn't distinguish kilos that come from fat and kilos that come from lean muscle mass. Everyone needs some body fat, but too much fat results in obesity. Tanita Body Composition Analyzers work on non-invasive Bioelectrical Impedance Analysis Method (BIA) – in which a safe electric signal is sent through the body via patented pressure-contact electrodes, housed in a single standalone unit. It measures directly weight and impedance values which are then converted to various body composition readings with the help of regression formulas derived by Tanita after extensive research and validation with Dual Energy X-Ray Absorptiometry (DEXA) methods.
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TANITA BC-601 SEGMENTAL BODY COMPOSITION MONITOR PRODUCT DETAILS: ■ 8 Electrode Segmental BIA Technology ■ Body Fat % ■ Adult and Children's Healthy Range Indicator ■ Total Body water % ■ Muscle Mass & Segmental Assessment ■ Bone Mineral Mass ■ Daily Calorie Intake ■ Metabolic Age ■ Visceral Fat ■ Visceral Fat indicator ■ Athlete and Guest Mode
The innovative Tanita BC-601 incorporates the latest segmental technology that analyses the body in five segments: right and left arm, right and left leg and trunk, providing indepth information on body fat percentages and muscle mass. Segmental body composition analysis is ideal for enhancing your sports performance. It will allow you to identify any physiological and biomechanical asymmetries so that you can tailor your training and fitness regime to improve the distribution of fat and muscle mass and achieve your personal goals. To use, place your feet over the four footplates on the platform and gently pull the hand electrodes on the sides of the platform. The monitor will then send a safe, low frequency signal through your body. Your results are shown in the extra-large LCD colour display and the retractable cord ensures that the handset fits snugly into the main unit for easy storage. Body composition data is automatically stored on a SD card and can be downloaded onto your computer so that you can view and manage your data. So, start monitoring your fat level, as healthy fat level will lead to a healthier lifestyle.
TECHNICAL SPECIFICATIONS: ■ Colour ■ Weight Capacity ■ Weight Increments ■ Body Fat Percentage ■ Total Body Water Percentage ■ Size of Display ■ Memories ■ Electrodes ■ Batteries ■ Warranty ■ Weight Only Mode
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: : : : : : : : : : :
Black and Silver 150kgs 100g 0.1% 0.1% 45 x 125 mm 4 8 Included 1 year Yes
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Hi_tek: Soaring to new heights SK Chauhan, Director, Hi_Tek OTs, elaborates on his company and Hi_Tek's offerings for the healthcare sector
DECEMBER 2013
i_Tek OTs, earlier known as HiTek Medical Solution, was established in the year 2007. It is committed to sustainable development in healthcare industry and through our activities of manufacturing/establishment of modular operation theatres, medical gas pipeline system, ICU, SICU, NICU, air conditioning (air handling units). Upholding the values of good corporate, we at Hi_Tek strive extensively towards provide best medical products/ machines/system to mankind. Safety, health and environment responsibilities are integral to our operating philosophy. We are committed to pro-actively eliminating work related injuries and occupational illnesses, minimising adverse environmental effects, preventing pollution and meeting our community responsibilities while following the
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statuary norms established and levied by Health Department and Government of India. The second to the most common site of healthcare associated infections (HAIs) are surgical site infections (SSIs). These complications of surgical procedures cause considerable morbidity and, when these occur deep at the site of the procedure, can carry mortality as high as 77 per cent. As all of we are aware of that there are several key steps or 'chains' that have to be connected to result in infection. However, for SSIs, the initial introduction of microbial pathogens occurs most often during the surgical procedure performed in the operating theatre (OT). Thus to reduce the risk of SSI, a systematic but realistic approach must be applied with the awareness that this risk is influenced by characteristics of the patient, operation, per-
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sonnel and health care facility. Infection prevention in the operating room is achieved through prudent use of aseptic techniques. Since the inception of modern medical and healthcare practices, we at HiTek OTs analysed that imbibing latest concepts and modern scientific approach in medical healthcare, always deliver optimum positive results, thus compelling doctors community, governments and private corporate to implement such medical and healthcare amenities in their respective hospitals, nursing homes to minimise health hazards and control mortality rate, and we devoted our whole strength towards destruction of health hazards and successfully increase elimination process of SSIs, nosocomial effect of hospitalisation, which also rewarded us by highly prestigious and prominent clients i.e.
Tirathram Sham Hospital Delhi, St Jospeh HospitalGhaziabad, Panacea New Rise Hospital-Gurgaon, ESI Hospital – KK Nagar(Chennai), Jammu, Ludhiana, Delhi, Gurgaon, Chirayu Medical College, SAIMs –Indore are few prominent illuminated names of our client list. At Hi_Tek, compliance with medical, legislative and other requirements placed upon us, is fundamental to the way we do business. In meeting these commitments we will develop, implement and maintain a safety, health, environment and community management system that meets nationally recognised standards and enables us to: ■ Identify, assess and manage risks to health of peoples and the environment ■ Ensure accountability for those responsible for each part medical healthcare segment ■ Set clear objectives and targets and develop plans to achieve continual improvement in performance, and then monitor progress of system installed at various hospitals ■ Provide the resources, tools, machines and training necessary for achievement of medical health objectives ■ Communicate open end with our clients, contractors, suppliers etc. ■ Report openly on our performance and develop plans for continual improvement. HiTek always promotes strong relationships with the communities, peoples in which we operate. The adoption and promotion of our strategic planning is mandatory for all employees of Hi_Tek OTs. while we deliver optimum satisfaction level to all mankind in health segment, and, where appropriate, contractors, suppliers etc. acting on our behalf. We will periodically review this policy to ensure that it remains relevant and effective. EXPRESS HEALTHCARE
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New age LEDs from Technomed Is the preferred choice for respected surgeons
Manoj Kumar CEO, Technomed India
echnomed LED Lighting Technology has come a long way since its inception in the late 1990s. The recent years have witnessed the high functionality of LED OT lights. By combining indepth manufacturing competence with innovative ideas Technomed is committed in manufacturing fully-featured, future-proof surgical operating lights / tables that are bound to satisfy all of the hygienic and practical requirements of surgical procedures. Technomed, with the back support of our respected surgeons/end users, has reached to the stage of leaving behind 'Halogen' and getting forward with surgeons choice of 'LED' with '3 – FINS' To '10 – FINS' giving 40,000 to 2,70,000 Lux and which can be placed on ceiling/mobile and wall mounted.
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Technomed LED after passing through various tests is a preferred choice for respected surgeons. Technomed LED OT lights are in triangular/pentagonal/ hexagonal shapes and also maximises the field of illumination and optimised illumination depth offers impeccable viewing conditions. Technomed LED OT lights are of lightweight aluminium, the nimble body and suspension arms are sleek and easy to reposition. The screen is made of scratch-proof and toughened glass to ensure the finest of light emission throughout its working life. Technomed through its multi-coloured and single colour LED surgical lights ensure a flawlessly lit medical working environment. With flexible ceiling-mounted supply unit that comes with modular elements like
special support arm system that can be reconfigured as desired even after installation, these lights guarantee to throw the best light onto your examinations. Technomed had introduced unique 'Multi-Lens Matrix' that provides excellent distribution of light and at the same time ensures homogeneous illumination of the operating area as it is very important to keep entire operating area clearly visible. Its innovative shadow management control helps surgeons to get a better view in deep cavity procedures, such as deep, narrow wounds. Technomed provides special two hours training to the OT staff during installation of every OT table and OT light, explaining important steps to be taken before and after every surgery. Also, clients from different corners of the country have acclaimed Technomed’s
products for their performance, thanks to its seamless, sealed construction and its scratchproof, easy-to-clean safety glass. Technomed undergo certified manufacturing processes. Not only they have quality assurance, but an extended After sale service that is guaranteed for many years after purchase. Technomed has years of expertise and unmatched strengths in technical innovation that has helped it carve a niche among leading global surgical LED light manufacturers. Contact details Manoj Kumar (CEO) ADD: B-142, Sector – 3, DSIDC Ind Area Bawana , New Delhi-110039 [M] 9999956733 Ph:01127761155 E-Mail: technomed4life@gmail.com www.technomedindia.org
Wonderfloor's PVC floors and wall coverings PVC flooring and PVC wall covering have become immensely popular
he modern-day hospitals, no matter big or small are visibly different from the old-day hospitals not only in terms of the facilities or the equipment but also the interiors be it the lobby area, pre and post care wards, OTs, ICU, procedure room, Xray /MRI, pathology labs etc. The hospital designer/ architects want to provide an interior which is not only appealing aestheticcally but also provide a pleasing and colourful ambience. Above all, this is to be done without compromising on the basics like a long lasting product, easy to maintain, hygiene etc. PVC flooring (commonly known as vinyl flooring ) and PVC wall covering has become immensely popular for all the above reasons.
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PVC flooring PVC flooring is solid, resilient, safe, cost effective, durable, aesthetically pleasant, easy to maintain, ease of wheel chair access/safe trolley/stretcher movements,
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help in reducing the spread of pathogens, do not trap dirt, do not shred particles, can be made monolithic by welding the joints, can be bent at corners/curves, fire retardant, sound absorbent, available in wide variety, shades, designs.
Availability and application PVC flooring is available in a wide range and forms like sheets, tiles and planks. One can select the flooring depending upon the application. For eg. Homogeneous flooring in roll form is recommended for various areas of a hospital like pre and post care/ICU/Cath labs/pathology labs/general wards/passage/lobby area, conductive/ESD flooring for OT/MRI etc, consulting rooms / special rooms can have PVC planks/wood design rolls. For area like fitness centre/rehabilitation area/yoga/aerobics the must be thick and soft cushioned to avoid any kind of jerks, provide a soothing and relaxing movements. The canteen area can be made more colourful by good comwww.expresshealthcare.in
bination of lively shades. Similarly the lifts and ramps can have anti skid flooring.
PVC wall covering Wall is an important area in a hospital which should be aesthetically appealing, easy to clean and maintain. PVC wall covering is the internationally accepted unanimous choice for walls. The PVC sheet, normally 1.0 mm thick is easy to install on a levelled wall surface and is long lasting, washable and hygienic. Before installing PVC flooring, ensure that base the floor surface is hard and levelled. The floor surface can be levelled with a good quality self levelling compound. Further the base floor should be free from surface defects and moisture. In case of wall covering also the wall surface should be free from moisture and levelled. The wall base can be prepared with good quality 'Wall Putty'. RMG Polyvinyl India is India’s largest manufacturer and exporter of PVC flooring. Wonderfloor, the flagship
brand of RMG is India’s largest selling PVC flooring brand in India and is available for wide range of applications. Some popular Wonderfloor products finding application in hospitals are Sigma — 2.0 mm thick, hard wearing, antibacterial homogeneous flooring in sheet form WallPro — 1.0 mm the flexible antibacterial homogeneous wall covering Flotron — 2.0 mm thick, conductive tiles. Bravo — 4.0 mm, anti jerk ,cushion flooring for fitness/gym/aerobics/yoga centre Robust — 1.5/2mm , heavy duty multipurpose flooring Timberland — PVC wooden design planks for consulting rooms / special rooms. Safety — Anti skid flooring for ramps, elevators, wet area Contact Piyush@rmgpoly.com www.wonderfloor.com / +91 97112 00510 DECEMBER 2013
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.
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