Modern Medicare - April 2011 by Infomedia18

Vol 7 No 5

MODERN MEDICARE

April 2011

Editorial

A balanced Budget?

first glance may be deceptive, and the Union Budget Council. The latter, in particular, has strategic significance 2011-12 proves the adage. It may seem to be a ‘no to enhance the much sought-after skilled manpower in the bold moves’ or ‘no big surprises’ Budget, but the healthcare space. On the flip side, the introduction of Minimum Alternate Tax government’s objectives are clearly highlighted with priorities on controlling inflation, achieving fiscal consolidation (MAT) on Special Economic Zones (SEZs) and the phasing out of Export-oriented Units (EoUs) will impact the growth and maintaining growth. Some positives of this Budget on the macro level include of pharma and medical devices units located there. Also, the higher allocation on infrastructure, no change in excise duty, increase in MAT from 18 to 18.5 per cent of book profits will promoting research, increasing local manufacturing and aiding affect the corporate houses, especially those in the healthcare inclusive growth while targeting 25 per cent Gross Domestic sector, which do not have profit after tax. Besides, some of the expectations that remained unaddressed Product (GDP) contribution from manufacturing by 2020. Further, commitment on raising governance standards and in this Budget include ease in availability of cheaper finance making Goods & Service Tax (GST) a reality gives hope. for setting up new hospitals, according infrastructure status to The Budget has proved healthy for the healthcare sector with an healthcare, bringing in land reforms to provide adequate land for increase in allocation by 20 per cent to ` 26,700 crore. However, setting up new hospitals, etc. For some experts’ perspectives on looking at the vast unmet needs as well as international practices, Budget 2011-12, turn to the ‘Roundtable’. Keen to decipher the current scenario of health insurance in the government’s spending on healthcare as a percentage of our GDP still remains minuscule. Though the rollback of intially India and the recent trends in ophthalmic treatments? Take a proposed levy of 5 per cent service tax has brought some relief, look at the ‘Sector Watch’ and ‘Specialty Scope’, respectively. a lot was desired in terms of providing affordable and accessible healthcare services in the country. Other sectoral positives are the rationalisation of customs duty to reduce its impact on certain medical equipment and the Manas R Bastia Editor ` 500 crore outlay towards the National Skill Development manas@infomedia18.in

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I April 2011

Contents

36 Sector Watch Health insurance in India: Need for a wider coverage

20 Experts Speak Dr A Velumani CEO, Thyrocare Technologies Ltd

42 Specialty Scope Trends in ophthalmic treatments: An eye for the future

REGULAR SECTIONS 4 8 14 30

Editorial National News World News Hospital Monitor

24 Roundtable

Beams Hospital, Mumbai: Conceptualising boutique care

In Dialogue Rakesh Joshi Business Development Manager – Medical Business, Texas Instruments India

Personalised Healthcare Differentiated medicare: Say no to ‘one size fits all’ Dr Bhuwnesh Agrawal, Chairman & Managing Director, Roche Diagnostics India

Events Calendar Report

CII’s conference on Public Private Partnership Policy Framework: Way forward for delivering quality healthcare MEDICAL FAIR INDIA 2011: A showcase of talent and technology

67 74 80 84 6

IT @ Healthcare Clinical decision support systems: Promoting evidence-based medicine Dr Aloke C Mullick, Director & CEO, Seed Healthcare Solutions Pvt Ltd

56 Marketing Mantra

Facility Visit Metropolis Healthcare Ltd: Benchmarking against the best

Budget reforms: Hit or miss?

Achieving patient satisfaction: It’s time to think out of the box! Vivek Shukla, Principal – Healthcare Business Consulting, Vivek Shukla and Associates

Highlights of Next Edition Sector Watch: IT in healthcare

Product Update Rx Product Index Advertisers’ List

Specialty Scope: Dentistry Note: ` stands for Indian rupee, $ stands for US dollar and £ stands for UK pound, unless mentioned otherwise

I April 2011

National News

In Brief Abbott’s toolkit to identify fussy eating habits among children Abbott recently announced the launch of ‘IMFeD™’ (Identification and Management of Feeding Difficulties) in India, a new, easy-touse diagnostic tool to help doctors accurately identify and manage children with feeding difficulties. Some studies show as many as 80 per cent of parents report some kind of feeding difficulty in their children. The IMFeD tool addresses this often overlooked condition in young children by applying proven approaches for doctors to properly diagnose children ages two and older. IMFeD has been effectively used in eleven other countries. Until recently, no diagnosis framework was available to help doctors assess and treat their paediatric patients with feeding problems. In India, an observational study is currently being conducted to determine the perceived effectiveness of the IMFeD tool. “The interim data collected helped us classify children into different feeding difficulties and suggests the IMFeD tool will help us effectively manage the conditions,” said Dr Mukesh Sanklecha, Consultant Paediatrician, Bombay Hospital and one of the investigators of the study.

Manipal Cure and Care launches its third clinic in Bengaluru Manipal Cure and Care (MCC) Clinic, a part of Manipal Health Enterprises (MHE), has launched its third multispecialty polyclinic in Bengaluru. The clinic offers a range of world-class healthcare curative, preventive, wellness & aesthetic services, all under one roof. This polyclinic in Banashankari II stage (BSK) is amongst the premium healthcare destinations along with the existing MCC Clinics in Koramangala and J P Nagar. Announcing this initiative, Rajen Padukone, CEO, Manipal Health Enterprises, stated, “MHE is optimistic that these clinics will accelerate its market penetration and reach. This will result in decreased hospital visits for minor ailments.” Speaking on the occasion, Raman Bhaskar, Head, MCC, said, “It is a convenient solution for patients who need not travel to hospitals for basic and routine medical procedures. Our clinics are also seamlessly integrated with our secondary and tertiary care hospitals.”

I April 2011

IFC, Gates Foundation work with Bihar Government to improve health payments system International Finance Corporation (IFC), a member of the World Bank Group, and the Bill and Melinda Gates Foundation are working with the Government of Bihar to find avenues to make government payments to health workers and health beneficiaries more efficient, transparent and timely. Government officials, health practitioners, banks and service providers discussed the findings of a state-wide study of the payment processes associated with state health programmes. The study recommends that health records be maintained in a centralised system called the Health Operations Payment Engine (HOPE). Such a system would provide a variety of benefits—not only to health workers and beneficiaries but also to the state. The HOPE system would also provide an integrated platform that would allow payment service providers and banks to credit incentive payments directly into the accounts of beneficiaries, health workers and private healthcare providers. “Efficient, transparent and accountable payment mechanisms are needed to enforce programme guidelines, specifically ones relating to phased payments for beneficiaries,” said P K Pradhan, Special Secretary and Mission Director, National Rural Health Mission. “IFC’s proposed solution, HOPE, should be taken beyond Bihar to other Indian states.” Jennifer Isern, Head, Financial Sector Advisory, South Asia, IFC said, “With this proposed solution that will ensure timely, accurate payments, IFC hopes to bring much-needed health support closer to those who need it most. Our diagnostic in Bihar identified key opportunities to improve health payments that could be expanded across India.”

GE Healthcare completes acquisition of Orbotech Medical Solutions GE Healthcare, a unit of General Electric Company, has announced that it has completed the acquisition of the assets of Orbotech Medical Solutions Ltd (OMS), a subsidiary of Orbotech Ltd (Orbotech), and a manufacturer of Cadmium Zinc Telluride (CZT) detectors used in GE Healthcare’s innovative Alcyone nuclear medicine technology. “Through the acquisition of OMS we have passed an important milestone in the growth of GE Healthcare’s Nuclear Medicine business. Our ability to manufacture CZT, a key component of GE Healthcare’s Alcyone technology, will help clinicians around the world provide patients with faster and more comfortable examinations at lower dose while maintaining the image quality. We have entered a new frontier of possibilities in nuclear medicine as we use CZT technology not only in cardiac exams, but apply it to other critical areas such the early detection of breast cancer,” said Nathan Hermony, General Manager, Nuclear Medicine, GE Healthcare. GE Healthcare recently announced Food and Drug Administration (FDA) clearance of the use of CZT technology in assessment and early detection of breast cancer in women who are at high risk for the disease.

National News

In Brief Ovarian cyst weighing 15 kilos removed

Fortis collaborates with TotipotentRX to set up stem cell therapy centres

In a path breaking surgery, a tumour (ovarian cyst) weighing about 15 kilos from a 71-year-old woman was successfully removed. Dr Kishore C Kumtakar, Consultant, OBG, Malathi Manipal Hospital, who performed the surgery said “Preliminary investigations revealed that a huge mass (cyst) in her ovaries. The tumour would have been dangerous to the patient if left untreated. Hence, the patient had to be operated immediately to remove the huge ovarian mass.” Informing about this case, Dr Kumtakar adds, “A complex ovarian cyst can cause serious health issues. Often these types of cysts keep growing and become too large, and they have both liquid and solid components within them. Hence, it is important to have routine check-ups, ultrasound and Pap smear for women after 40 years of age.”

Fortis Healthcare (India) Ltd and TotipotentRX Cell Therapy Pvt Ltd, a leading provider of cuttingedge technologies in the stem cell and regenerative medicine market, announced a collaboration to set up centres of excellence offering cellular therapies and stem cell clinical trials, across select Fortis Hospitals. These centres will undertake stem cell clinical research procedures relating to diabetes, cancer, cardiovascular disease and neurological ischemia. TotipotentRX will also set up state-of-the-art cGMP laboratories in select hospitals. As part of the alliance, a Stem Cell Medical Board will be created to oversee the medical research programme, ensure execution and monitor the progress following International and Indian ethical guidelines. Speaking about the partnership, Shivinder Mohan Singh, Managing Director, Fortis Healthcare (India) Ltd, said, “This tie-up is in continuation with our effort to bring the latest in medicine to our customers, in a caring environment and at affordable prices. ” Kenneth Harris, CEO, TotipotentRX (MK Alliance Inc), added, “This collaboration allows us to carry out advanced clinical research, aimed at addressing quality of life improvements for several healthcare challenges in India.”

WHO brings together partners for health in South-East Asia

Nova Medical Centers forays into Mumbai

Ghulam Nabi Azad, Minister of Health & Family Welfare, India, recently inaugurated the conference of ‘Partners for Health in South-East Asia’ organised by the World Health Organization (WHO). Ministers from 11 member states along with highlevel representatives from donor countries attended this conference. The conference was aimed at strengthening collaboration for health and encouraging effective and sustainable partnerships. WHO and partners will now deliberate on priority health issues in the WHO South-East Asia Region. The UN Millennium Development Goals, non-communicable diseases and universal access to health services were some of the issues discussed at the conference. A huge disadvantage for South-East Asia is the staggering and disproportionately high proportion (40 per cent) of the world’s disease burden with about a quarter of the world’s population. Speaking on the issue of social inequalities, Dr Samlee Plianbangchang, WHO Regional Director for South-East Asia, said, “Perhaps the starkest statistic in public health is the difference in maternal and child mortality in rich countries compared with that of less developed countries.”

I April 2011

Nova Medical Centers, (NMC) India’s leading stand alone Day Surgery Centre Group, has forayed into Mumbai by launching its first day surgery center in Chembur. The Chembur centre would be Nova’s fifth center in the country. Thirty leading surgeons from diverse specialties will offer their services in a comprehensive ultra-modern facility. This latest addition from Nova is equipped with state-of- the- art facilities. Built over 13,000 sq ft, the new center has 4 ultra-modern operating rooms, 16 beds with 3 deluxe rooms, 7 OPD consulting rooms including separate ENT and ophthalmology chambers, comprehensive pathology and radiology services, a retail pharmacy and a health check up unit. “The Center is the ideal environment for both doctors and patients,” explained Dr Mahesh Reddy, Co-Founder and Executive Director, NMC. “Everything top doctors need is readily available in an upscale, collegial setting, and all our patients go home at night to rest,” he added. Suresh Soni, Chairman and CEO, NMC described the company’s rollout strategy, “We plan to be in 10 cities by the end of this year. We provide physicians everything they need to get started and succeed. We know how to control costs while maintaining superior quality and efficiency, and we continuously work to improve each center’s performance. We empower doctor-entrepreneurs to start their own practices, and offer shared support services that deliver economies of scale to each center in our network.” Nova has aggressive plans to expand in the Mumbai market. Next in line is the Tardeo clinic which would be coming up soon in the historic Famous Cine Labs complex and other centers would be spread across Mumbai in the coming months.

National News

In Brief Advanced technology for breast cancer treatment now at Hinduja Hospital Hinduja Hospital, one of the leaders in healthcare delivery, has introduced a stateof-the-art digital technology for breast cancer treatment. It is the first private hospital in India and the only hospital in the Western Region of India to have introduced the US FDA-approved digital technology with 3D imaging for early detection of the breast cancer. The introduction of this digital technology will help in the screening for breast cancer in women for early signs of cancer. Announcing the launch of the Digital mammography, Dr Raju Wadhwani, Consultant Radiologist, Hinduja Hospital, said, “Digital Mammography is a very safe procedure that uses low doses of radiation to produce high-quality X-rays to detect breast lesions or abnormalities that are too small or subtle to be felt. The unique features of this technology has made digital technology a reality and invaluable in breast cancer management.”

Minimally invasive procedure saves brain haemorrhage patient at Yashoda A 56-year-old patient from Warangal district was brought to Yashoda Hospital following sudden severe headache and vomiting. Computed Tomography (CT) scan of the brain revealed bleeding inside the brain (sub arachnoid haemorrhage) and a brain angiography, which revealed a large size brain aneurysm on the right side of the internal carotid artery. The patient was referred for an urgent balloon assisted coil embolisation of aneurysm procedure, a unique non-surgical procedure. Dr Randhir Kumar, Yashoda Hospital performed the surgery. In this case, the doctor opted for the endovascular route, which is a less invasive non-surgical treatment of cerebral aneurysm without opening the skull or touching the brain. “We were successful by using a balloon and seven platinum coils of different sizes the aneurysm was completely obliterated. The procedure took 2 hours and the patient was safely shifted to another ward on the second day and was discharged on the third day. The patient is able to perform her routine chores without difficulty,” commented Dr Kumar.

I April 2011

Fortune Magazine’s Global 500 list ranks 3M as the most admired company 3M, the company with a 100-year-old innovation legacy, has proved its strength again with Fortune Magazine ranking it as the Most Admired company in the medical & other precision equipment industry. The ranking is based on the top Global 500 list of Most Admired and Innovative companies, released by the magazine this year. 3M has been the global leader offering innovative products and solutions for medical, oral care, health information management, drug delivery and food safety. The company’s medical specialties employs a wide range of 3M technologies to meet the worldwide needs of the medical device, bioanalytical, diagnostic, cosmetic and consumer health care businessto-business markets. 3M is also the leading global supplier of single-use medical supplies. With expertise in infection prevention and skin and wound care, 3M provides medical products, services and solutions for professionals in hospitals and community settings. In India, 3M Healthcare is an active player in the Operation Theatre (OT) and Intensive Care Unit (ICU) consumables and is largely into infection prevention, skin and woundcare, dental and orthodontics and food safety.

Fortis in a PPP with the Government of Uttarakhand Fortis Healthcare Ltd has recently announced its plans to set up a Cardiac Centre at Deen Dayal Upadhyaya (Coronation) Hospital at Dehradun under a Public Private Partnership (PPP) with the Government of Uttarakhand. The state-of-the-art facility would be the first comprehensive cardiac care facility in Dehradun. The move is in line with Fortis’ strategy of penetrating into India’s tier II cities to provide high levels of clinical quality and compassionate patient care. The facility is expected to become operational by November 2011. Further, Dr Asha Mathur, Director General, Health Services, Government of Uttarakhand, added, “We are pleased to join hands with Fortis Healthcare. With this partnership, we are confident that the people of Dehradun will benefit immensely and the high quality services from Fortis will help save precious lives and improve the healthcare eco-system in the city.”

Global Hospitals ready to perform nearly 100 liver transplantations Global Hospitals Group, with the largest multi organ transplantation centre, recently updated that it has achieved the distinction of becoming the foremost hospital in the world for performing the widest variety of liver transplantations apart from treating all types of liver diseases. Speaking on the occasion, Dr K Ravindranath, Chairman & Managing Director, Global Hospitals Group, said, “In a country like India, it is estimated that more than a lakh of patients are in serious need of liver transplantation, while less than few hundred are receiving transplantation. By rapidly expanding our footprint across the country, we are keen to reach out to over a billion population of India with our services. We will also reach the other billion plus population in other continents like Africa & Europe.”

World News

In Brief Democratic Republic of Congo (DRC) introduces a life-saving vaccine Pneumonia is one of the biggest killers of children worldwide and is responsible for a quarter of all child deaths under five years of age in the DRC. To bring about a change in this incidence, DRC stepped up its immunisation process by including vaccines to combat pneumonia. As per the programme, the vaccine will first be introduced in two of the 11 provinces. The country’s First Lady Olive Lembe Kabila and Minister of Health Victor Makwenge Kaput are joining parents and health workers in Kinshasa to witness the first child being immunised as a part of the official introduction of pneumococcal vaccine into the national immunisation programme. “The introduction of the pneumococcal vaccine and the systematic immunisation could save the life of many children dying from acute respiratory infectious diseases in this country,” said Dr Léodégal Bazira, acting WHO Representative in DRC.

Boston Scientific launches Stent Systems in India Boston Scientific Corporation recently declared its launch of the PROMUS® Element™ Everolimus-Eluting Coronary Stent System and TAXUS® Element™ Paclitaxel-Eluting Coronary Stent System in India. Both Element Systems incorporate the same novel platinum chromium (PtCr) alloy, innovative stent design and advanced catheter delivery system, and represent the Company’s third-generation drug-eluting stent technology. “The new platinum chromium alloy and stent design of the PtCr Element Stent series represent significant innovations in DES technology,” said Ashok Seth, MD, Fortis Escort Heart Institute, New Delhi. “The PROMUS and TAXUS Element Stent Systems give physicians in India a choice of two proven drug and polymer combinations – used in millions of patients worldwide – on an entirely new platform,” said Hank Kucheman, Executive Vice President and Group President, Cardiology, Rhythm and Vascular, Boston Scientific.

I April 2011

Rising patient numbers and novel products set to drive the Chinese anti-diabetics market Driven by the growing diabetic population and the improved healthcare insurance coverage implemented as part of the country’s 2009 healthcare reform, the value of the overall diabetes drugs market in China will triple from $0.7 billion in 2009 to $2.1 billion by 2019, according to a new report from independent market analyst, Datamonitor. One of the key drivers for anti-diabetic drug sales in China is the country’s large diabetic population. According to the 2010 Chinese National Diabetes and Metabolic Disorders Study, the prevalence rate of diabetes in China has reached 9.7 per cent, making China the country with the largest diabetic population in the world. Yifu Liu, a Datamonitor healthcare analyst and author of the report, said, “A number of interlinked factors, including the aging population, urbanisation, dietary changes and decreasing levels of physical activity, will contribute to making this already large population grow further.”

Incubators by IKS give maximum security with minimum gas usage The IVS-9000GC & IVS-9160GC triple gas incubators from IKS have been praised by IVF users not only for their performance but also for their very low CO2 and N2 consumption. IKS International is a highly skilled and experienced organisation based in Rosmalen, near Hertogenbosch in the Netherlands. IKS supplies a comprehensive range of advanced products and services to clinical, biotechnology, pharma and microbiology laboratories worldwide. Due to the novel design of these incubators, the minimum quantity of nitrogen – less than 10 litres - is required to restore the internal environment when the door is opened. CO2 usage is minimised as well. Recovery to a stable condition takes less than five minutes, reducing the impact on sensitive samples.

AirStrip, GE Healthcare collaborate on cardiology technology AirStrip and GE Healthcare have recently announced a collaboration on cardiology technology. The collaboration between AirStrip Technologies and GE Healthcare aims to benefit the physicians. The physicians will now be able to have access to real-time electrocardiograph data on their heart patients via their iPhone and iPads. GE Healthcare manufactures and develops medical imaging, medical diagnostic and patient monitoring systems. AirStrip is a mobile medical-software application developer. Through this partnership, cardiologists are hopeful that they will be able to access data from the GE Healthcare MUSE Cardiology Information System on their smartphones using San Antonio-based Airstrip’s Airstrip Cardiology software. Further, hospitals will be able to purchase the AirStrip programme via GE Healthcare. The goal of the alliance is to give cardiologists the ability to access patient data even when they are working off-site.

World News

In Brief GE Healthcare names Jan De Witte as President and CEO of Healthcare IT GE Healthcare declared steps to more effectively bring its world-class technology and domain expertise to bear while strengthening its ability to help its customers solve some of the healthcare industry’s toughest problems - lowering costs while improving access to quality patient care. Jan De Witte, President and CEO of GE Healthcare’s Performance Solutions division, has also been named President and CEO of its Healthcare IT business. De Witte, who reports to John Dineen, President and CEO, GE Healthcare, succeeds Vishal Wanchoo who was recently named Senior Vice President of Growth Initiatives for GE India. Under De Witte’s leadership these two GE Healthcare businesses will use the knowledge the company has gained over the past 100 years serving the healthcare industry to deliver the right technologies to their respective customers. John Dineen, President and CEO of GE Healthcare said, “Having a single leader like Jan De Witte lead both businesses sends a visible signal to our customers that GE Healthcare is dedicated to growing its IT and solutions offerings, providing them with a unique partner that can deliver the strategic advice they need with outstanding technology.”

Bayer HealthCare selects New Jersey for consolidation plan Bayer HealthCare has finally chosen New Jersey over New York for a consolidation plan of its East Coast business. Though a specific location is yet to be selected in this regard, scouts are sizing up locations near existing New Jersey operations. According to a press release, Bayer HealthCare declared that a site decision will be confirmed within a few months time. “We are very excited about the prospect of having a new site and facility that can house East Coast-based Bayer HealthCare employees from every division and function under one roof,” said Mark Trudeau, President and CEO, Bayer HealthCare Pharmaceuticals Inc., Bayer HealthCare LLC USA and chair of the company’s US East Coast site search committee.

I April 2011

Integration of Maquet’s operation room (OR) table with Siemens angiography systems Maquet, a publicly-listed Swedish Getinge Group company with around 2.3 billion n revenues (2010 fiscal year), recently announced that Siemens Healthcare will integrate Maquet’s operating table ‘Magnus’ in its ‘Artis zeego’ and ‘Artis zee’ ceiling interventional systems. With this integration, we will observe customer benefitting the most with the multidisciplinary use of the hybrid OR – which means it will be usable both for angiographic imaging and for open procedures where extremely flexible patient positioning may be required. The Magnus OR table system is fitted with exchangeable table tops – a fully radiolucent carbon top as well as a highly flexible, segmented table top. The latter allows surgeons the most appropriate positioning of the patient for a wide variety of surgical procedures, including complicated positions, which are particularly occurring in orthopaedics and neurosurgery. Siemen’s Artis zeego is the only robotic C-arm-system on the market, which can adapt to the complete height adjustment of the table for standing or sitting working positions of the surgeon. The integrated solution, which is equipped with an additional floating carbon table top, offers full cathlab functionality especially useful for cardiac and vascular interventions. The table top would also provide 360° radiotranslucency, thereby giving optimum X-ray images.

New endovascular therapeutic hypothermia system launched by Philips Philips recently announced the launch of the InnerCool RTx Endovascular System for cooling as well as warming, and the system provides advanced whole body temperature modulation therapy in a closed-loop system from the inside out. It is a high-performance system, which can rapidly raise and lower the body temperature of certain non-paralysed, awake patients of all sizes in the intensive care setting. This system cools and warms patients with its unique integrated temperature sensor catheter that is placed below the heart through the femoral vein. Once in place, the closed-loop system modulates whole body temperature without fluid introduction or exchange by circulating cool or warm saline. This system also includes a programmable console with an intuitive touch screen interface. It also allows for cooling of awake patients, which helps to avoid the risks inherent with paralytic agents such as masking seizures or inadequate levels of sedation. In addition to the new InnerCool RTx Endovascular System, Philips also offers the InnerCool STx Surface Pad System for cooling and warming, which provides a cost-effective and easy-to-use solution with an advanced design for non-invasive temperature modulation therapy. “The Philips InnerCool RTx Endovascular System brings significant advancements in temperature modulation therapy and makes this technology even easier to use,” said Mike Miller, Senior Vice President and General Manager, Cardiac Care, Philips Healthcare.

World News

In Brief ACO rule: Healthcare industry reacts with cautious enthusiasm The Centers for Medicare and Medicaid Services recently released its long-awaited proposed rules on Accountable Care Organisations. Donald M Berwick, CMS Administrator, said, “American Cornhole Organization (ACOs) are not just a new way to pay for care but a new model for the organisation and delivery of care.” The Medical Group Management Association (MGMA), one of the primary lobbies for physician groups, also commented on this. William F Jessee, CEO, MGMA, said, “The formation of ACOs has the potential to greatly improve the coordination of care received by Medicare beneficiaries, and thus offers the promise of safer, more efficient and effective care,” Karen Ignani, CEO, America’s Health Insurance Plans, said that ACOs presented an opportunity for Medicare and Medicaid in order to build on the successes of the innovative payment systems that exist in the private marketplace for improving the quality and safety of patient care and help put the health care system on a sustainable path.

HP accelerates the transformation of healthcare HP, one of the largest technology companies, recently declared that a new solution portfolio will aim to deliver flexibility and efficiency to health organisations. This new HP Digital Health solutions are based on HP’s extensive portfolio of products, solutions and partnerships. Again, it also enables health organisations to accelerate change and innovation, advance operational efficiencies and further orchestrate care across the ecosystem. In short, it helps healthcare organisations become Instant-On Enterprises. Commenting in this regard, Scott Lundstrom, group vice president, IDC Health Insights, said, “HP’s approach is to ‘instant-on healthcare’ should help to address and simplify the transition healthcare organisations will need to achieve this level of efficiency.” Sandeep Johri, Vice president, Strategy and Solutions, HP Enterprise Business, “HP’s new end-to-end Digital Health solutions portfolio enables clients to efficiently coordinate care across the extended healthcare community.”

I April 2011

Healthcare organisations collaborate for patient data exchange Five of the nation’s leading healthcare organisations and pioneering users of e-health records—Kaiser Permanente, Mayo Clinic, Geisinger Health System, Intermountain Health, and Group Health Collaborative— have collaborated in order to create a new consortium through which there would be secured exchange of their patients’ real-time, digitised medical information on-demand, and to serve as a national model for low-cost, data interoperability among clinicians. The new collaborative called Care Connectivity Consortium was declared recently at a press conference in Washington DC, US, by its five members. “Paper is a horrible way to share information,” said George Halvorson, Chairman and CEO, Kaiser Permanente. “However, as the nation’s healthcare providers move forward with the adoption of e-medical record systems, electronic silos replacing paper silos is not progress. You need connectivity!” Thus, it is the goal of the consortium to tap the collective experience of data sharing and thereby use national health IT and interoperability standards for creating a replicable, affordable model for timely, secure, ondemand, exchange of patient data with the permission of the patient that can be replicated by others.

Healthcare deduction for public school employees ruled unconstitutional A Michigan law that requires public school employees to pay 3 per cent of their pay for retiree healthcare has been ruled unconstitutional. James Giddings, retired circuit court judge has recently released this decision. Giddings commented that the deduction takes money without due process of law. Earlier this year, another Ingham Circuit Court judge had also ruled a similar deduction for state employees unconstitutional. However, the Michigan Court of Appeals said that the state could continue deducting the money, but must put it in escrow. Both cases are likely to go to higher courts.

Children facing obesity menace According to a recent research by the Universities of Bristol, Stirling and Strathclyde, children between the ages of seven and 11 years are at the highest risk of becoming overweight or obese. 19 per cent of the 5,000 children monitored by the universities became overweight or obese between these ages. That is, just 10 per cent put on too much weight between three and seven years, while 7 per cent became overweight or obese between the ages of 11 and 15. Debbie Lawlor, Professor, University of Bristol, suggested that the statistics could be used to determine the best ages to instigate childhood obesity prevention strategies. Meanwhile, John Reilly, Professor, University of Strathclyde, commented, “This research gives us an important insight into the stages of childhood and adolescence when the environment is most obesity promoting.”

Experts Speak

‘Our deficiency is that only 1 per cent of the laboratories deliver quality, compared to 50 per cent of the West’ ...says Dr A Velumani, CEO, Thyrocare Technologies Ltd. He worked as a Scientific Officer in Bhabha Atomic Research Centre (BARC), Mumbai for more than 12 years. He takes us through the busiest thyroid clinics in the country that he pioneered and talks about the need of the hour in the Indian healthcare industry. Arshia Khan The story of Dr A Velumani, Chief Executive Officer, Thyrocare Technologies Ltd, has truly been an inspiring tale of determination and dedication. Born in 1958 in Appanaickenpatti Pudur (District - Coimbatore), Tamil Nadu, in a farmer’s family, Dr Velumani completed his BSc Chemistry from Madras University followed by MSc in Biochemistry from Bombay University. After being awarded a PhD for his research on Thyroid, 14 years of teaching and a long career as a Scientific Officer in Bhabha Atomic Research Centre (BARC) specialising in Radio Immuno Assay (RIA), he was ready to take the first step towards entrepreneurship. He decided to quit his government job at BARC and start his own business. At that time his only assets were his simplicity - driven by truth, his knowledge and seed capital of ` 1 lakh that he received as his Provident Fund (PF) settlement and a dream – a dream of providing the cheapest thyroid-testing facility in the country, and pass on the benefits of low cost to his customers - patients, pathologists, doctors, hospitals and nursing homes. Moreover, his aim was to provide this cost-effective service at uniform rates throughout the length and breadth of India.

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Experts Speak

Dr Velumani’s diary Interesting moments at BARC Great institute for those who want to grow and go. I did exactly the same. Enough politics if you wish to get into it. I had great and affectionate superiors, loving and caring colleagues and also quality projects in hand. I did my MSc and PhD there. When I entered BARC I was a boy and came out as a matured man in 15 years. Except that it was too big an organisation to care for people who deserve it the best, it is a place where I enjoyed working, learning as well as growing.

What interests you more teaching or research? I have lost respect for the word research since I have observed that often the word is misused – by those who wish to do it or have been doing it or having done it or having failed in it. My research pursuits are not for molecules or gadgets or technologies. But my pursuit lies in improving quality, enhancing speed and reducing the cost of healthcare that can be delivered in diagnostics in general and from a laboratory in particular. I enjoy teaching a lot.

The birth of Thyrocare

Fulfilling dreams

Indian scenario

Keeping this in mind, Thyrocare Technologies Ltd was incepted in 1996, in a 150 sq feet area, with an investment of ` 1 lakh. The only instrument for doing thyroid test was ‘gamma counter,’ which costed ` 50,000. He was lucky to find a pathologist who had the machine but was not using it because of few samples to test (5 samples/day). An agreement to keep the machine was made where Dr Velumani agreed to do free thyroid testing for the pathologist for three years. Says, Dr Velumani, “Like that there were 10 pathologists in the city and I had 10 gamma counters and 500 samples a day.” Today, Thyrocare stands at a 50,000 sq feet office in Navi Mumbai with a capacity of 50,000 investigations per day and a franchise network of 600 collection centres across the country. He affirms, “Thyrocare is seen as the world’s largest thyroid testing laboratory, accredited with ISO 9001-2000 certificate, and rated by CAP, NABL & CRISIL as Grade ‘A’, consistent with the highest standards in the Indian healthcare industry.” This nationwide networked, bar-coded and bi-directionally interfaced diagnostic laboratory is valued by the investors at around ` 800 crore. Dr Velumani adds, “Thyrocare grew well when growth was not monitored (200 per cent Compound Annual Growth Rate (CAGR)) from 1996 to 2005) and it has come down to 30 to 50 per cent CAGR in this last 5 years. He continues, “We monitor growth on a monthly basis and I am confident that it would grow atleast 30 per cent year-over-year for the next 10 years.”

Dr Velumani started Thryocare with a dream of providing affordable care to people. But he still feels that the dream has not been fulfilled. As he remarks, “Patients still pay more than what they should. 33 per cent of my services go to an end user at costs that are appreciated. Another 33 per cent reaches them at acceptable costs. However, 34 per cent are overpaying due to the greedy middle men. But may be that is plausible, given the kind of need and greed driving people in the medical industry. Even if I can take 10 per cent from the last category to the first category in next 10 years, I will be very happy.” In this journey, he has observed and learnt a lot from the people and surroundings. He inherits this entrepreneurial spirit not from a single place or person. As Dr Velumani avers, “In life, few of those who failed educated me on what should not be done. In business too, I have seen many failures and studied why they fail and made sure that I do not do repeat certain mistakes. I am a good entrepreneur too.” He continues, “Resistance to change from all levels like by my mind, body, family, employees, vendors and clients, was a big hurdle to cross. But it was necessary to bring and accept change, and hence I changed quite a lot of things. It was, is and will be the biggest challenge any entrepreneur will face. Other issues like insufficient funds, resources, too much of competition – all of them I consider as routine or minor.”

Highlighting the incidence of thyroid cases in India, Dr Velumani elaborates, the incidence of thyroid in the country as a whole is not consistent, just as the rest of the world. Different regions highlight different incidence ratios. As he remarks, “Even in India, the incidence may not be the same in Ganges belt and Krishna Belt or Kerala.” However, the difference in numbers could also be due to lack of studies conducted throughout the country. He informs, “There has not been any organised study in this last two decades, though Dr Kochu Pillai of AIIMS proved that Ganges belt has endemic goitres more than the rest of the country. Worst of the country or globe will have 2 per cent, while best could have 1 per cent incidence. Further, average incidence in the country and worldwide is around 1.5 per cent. In this, 4 out of 5 are women and worst affected age is between15 and 40 years.”

Diagnosing and improvising As far as treatment standards are concerned, thyroid is well standardised globally now for more than 30 years. Nothing much has changed except the knowledge of the disease or disorder, exclaims, Dr Velumani. With regards to diagnostics in general and clinical chemistry in particular, 600 laboratories (out of the 60,000 laboratories) deliver a better laboratory quality than the globally best can deliver since all of them use the best of the global brands for instruments and reagents, and similar quality check programmes. He states, “Our deficiency, if at all we call

April 2011 I

Experts Speak it as deficiency, is only 1 per cent of the laboratories deliver quality as compared to 50 per cent in the West.” However, he feels certain things are necessary for the growth and correct progression of the diagnostic industry. Explains Dr Velumani, “Consolidation of industry, education on what is possible and available to end users, an eye for and consciousness about ‘quality’ improvements in deliverables. Improved interaction and communications among various professional bodies and government departments or peers – without barriers of ego is also a must.”

Moving ahead The industry is slowly but certainly becoming organised. Branded laboratories and reputed pathologists get better attention now. Vendors of reagents and instruments are becoming more aggressive with volume players and hence costs are not going up with inflation (in some cases, they come

down too). Size matters, and major players are adopting an inorganic growth route, but the major problem they face are ‘integration challenges’ due to multicultural nature of member labs. It is certainly encouraging to be in this space in this decade. As far as predicting the healthcare scaenario, Dr Velumani feels volume, quality, cost and speed will play a role in shaping up the industry and every player has to be disciplined to deliver more than what a customer can dream. The race as such is on now for more than 10 years and it has produced results too. By the year 2015, there would be at least ‘ten companies with a valuation of more than 1000 crore (right now hardly any)’ and ‘50 companies with more than 500 crore (right now 5 labs claim so)’ would lead the space with quality that can attract global business to India. As per Dr Velumani, factors aiding the development of the industry in the right direction include appropriate demographic shift, good purchasing

Did you know this? Thyrocare received investments from Bennet Coleman (The Times of India) Group for ` 25 crore in 2006 CX Partners have invested ` 188 crore in the company First laboratory in India to have signed for total laboratory automation Dr Velumani owns and edits ‘Health Screen’ a monthly magazine focusing on Prepatient care Has written and printed ‘Wellness Book,’ which provides complete details of preventive care and has already sold more than 1,00,000 copies in just one year. power, priorites for wellness, availability of technologies at door steps, cost of services reducing due to innovations in Information Technology (IT) and competition and indeed precipitation by sedentary life styles. (arshia.khan@infomedia18.in)

April 2011 I

Roundtable

Budget reforms

Hit or miss? Union Budget 2011 created a roar in the healthcare industry. It received a lot of criticism and faced many protests. However, with the reversal of service tax, the healthcare sector heaved a sigh of relief. Here are some comments on what this year’s Budget offers to the Indian healthcare sector. Dr Asma Mohd Yousuf

ith lot of expectations, the healthcare sector was anxiously waiting to see what effect the Union Budget 2011 will have on the Indian medical world. And the announcement resulted in many frowns and few smiles. The levy of 5 per cent service tax that the Budget 2011-12 proposed initially on treatment and health check-ups at airconditioned private hospitals with over 25 beds and diagnostic labs was a major cause of grievance, such that it was very soon labelled as the misery tax. However, the strong disapproval from the medical fraternity resulted in the rolling back of the service tax. This brought a relief; however, there is still anxiety among the industry people regarding many issues that were not considered in this year’s Budget, and it will take yet another year to address the obstacles in the way of affordability and accessibility of healthcare services.

Dr Ajay Sharma Senior Consultant Dental Surgeon, Prosthodontist and Oral Implantologist, Max Healthcare, New Delhi

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Budget 2011 is good news for healthcare sector as the 5 per cent service tax or so called misery tax, which was earlier imposed on all healthcare services, has been withdrawn by the Finance Minister. This year’s Budget is better compared to the last year’s Budget because the agony for healthcare sector started then as the service tax was levied on all preventive health check-up services. This year the expectation was government will increase the expenditure on healthcare sector. Our country is the second fastest growing economy

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in the world. However, the healthcare expenditure is only 1 per cent of the Gross Domestic Product (GDP), and thus, it does not meet the expectations at all. For better results, the healthcare sector should be included in the infrastructure sector. There should be an increase in the GDP expenditure in this sector by at least 3 to 5 per cent. Besides, there should also be an increase in the Public Private Partnership (PPP) in the healthcare sector. The number of doctors and nurses should also increase. And the number of beds should double the present number.

Roundtable Dr N K Venkataramana Vice Chairman and Chief Neurosurgeon, BGS Global Hospitals, Bengaluru

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Healthcare has gained a lot of importance in the recent years. Our healthcare budgets need to be suited and structured to meet this global demand. Though the allocation of budget to this sector is getting better with every passing year, still more funds could have been allocated this year in order to meet the heavy demands. The challenges for the future are improvisation of infrastructure, adoption of technology, standardisation of healthcare,

computerisation and bringing accountability and developing human resources. In addition, the focus must be on indigenous technology and quality products to make the system self-sufficient. Also, there should be restriction on the taxations so that healthcare costs do not mount. Further, the insurance sector also needs to play a bigger and better role to utilise the budget effectively. And of course, the government’s decision on the reversal of the misery tax is indeed good news.

Dr Prathap C Reddy Founder & Chairman, Apollo Hospitals Group, India

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With great relief, we appreciate the consideration given to the roll back of service tax on healthcare services. Healthcare access to all, and that of the highest standards, has been the driving force for the healthcare sector in India and imposition of this service tax would have been a huge deterrent to this vision. With this roll back, the government has taken

a progressive step that will go a long way in ensuring a healthy nation. The health provider network is encouraged to take the health challenges of the nation with continuous support from the government. We, at Apollo Hospitals, would like to assure that we will continue to play our part in taking healthcare sector ahead through all the means and resources that are at our disposal.

Pradip Kanakia Partner - Assurance, PricewaterhouseCoopers, Bengaluru

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The Finance Minister should be congratulated for his bold initiative in announcing the roll back of 5 per cent service tax on services provided by hospitals and diagnostic centres. This will provide much needed relief to patients who are already reeling from the effects of high inflation. This positive gesture by the government coupled with a responsible behaviour of private healthcare players in reducing the cost of treatment and diagnosis will greatly boost

preventive care and early diagnosis, thereby helping in the control of the mounting burden of chronic diseases in India. Budget 2011 addresses ‘inclusiveness’ as priority, but does not address other priorities like ‘growth’, ‘accessibility’ and ‘affordability’. However, increased spending at macro level through higher allocation on healthcare and increased coverage under the Rashtriya Swasthya Bima Yojna (RSBY) will benefit poor sections of the society.

Dr Rajeev Boudhankar Vice President - Kohinoor Hospital, Kohinoor City, Mumbai

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Despite overall allocation increasing by 17 per cent over last year, this Budget seems to lack the punch for accelerating inclusive development agenda. The proposal for widening of service tax net to cover diagnostics and hospitalisation in air-conditioned hospitals would have created a larger hole in the pockets of patients. This is likely to be brought back at a later date with Goods and Services Tax (GST) but for now it has been rolled back after the strong criticism it received.

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No major initiative has been announced in the Budget for improving the quantity and quality of human resources in health sector, which is one of the major bottlenecks faced by the healthcare sector. On the whole, Union Budget 2011-2012 is a progressive healthcare Budget, mainly for the economically challenged masses and has the potential to improve the health index of the country. However, the transformation expected by the healthcare industry continues to remain unfulfilled in this Budget, as the healthcare industry has again failed to gain the priority infrastructure status.

Roundtable Dr S Manivannan Joint Managing Director, Kavery Medical Centre and Hospital, Trichy

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The Budget allocation of ` 26,700 crore to the healthcare sector represents an increase of 20 per cent over last year’s allocation, which is still inadequate. However, the rationalisation of customs duty, which will reduce the customs duty on certain medical equipment is a welcome change. After considering the withdrawal of service tax levy on healthcare, there is nothing significant compared to last year’s Budget. However, Finance Minister’s announcement that healthcare services will be within the purview of GST may adversely impact the cost of healthcare delivery to the patient, which needs to be seriously debated and discussed with all the stakeholders before introduction. Given the fact that the public/government investment in healthcare is

inadequate, private sector has been investing heavily in the healthcare sector to bridge the substantial gap in the healthcare delivery. However, expectations like the availability of cheaper finance from banking/financial sector for setting up new hospitals, treating healthcare as an infrastructure with concessional rate of interest, longer repayment period due to long gestation period for achieving cash break even and land reforms to make available adequate land for setting up new hospitals have not been addressed. Clear-cut guidelines in this regard would have helped in encouraging the flow of the much needed investments in this sector. However, the clarification that losses from new hospitals will be allowed to offset against profits of existing hospitals being operated by a taxpayer is an acceptable change.

Dr Shivani Sachdeva Gour Infertility Expert & Gynaecologist, Phoenix Hospital, and Founder - Surrogacy Centre India, New Delhi

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Budget 2011-12 has been proactive and better than the last Budget with the rollback of the service tax. Further, reduction in customs duty and countervailing duty on raw materials for syringes and needles to 5 and 4 per cent, respectively, is an incentive for domestic manufacturers. Reduction in import duty on lactose used in homoeopathic medicines from 25 to 10 per cent will bring down the cost of homoeopathic medicines. Reducing the corporate tax from 7.5 per cent to 5 per cent will have positive impact on all corporates including those in healthcare. With increase of minimum excise duty from 4 to 5 per cent, pharma companies that had their products in the

4 per cent rate, will be affected and may raise the cost of medicines. Increase of Minimum Alternate Tax (MAT) from 18 to 18.5 per cent of book profits will affect all organisations especially those in the healthcare sector, which do not have profit after tax. Inclusion of units operating in Special Economic Zones (SEZs) under the scope of MAT may affect pharma and medical devices units set up in SEZs. Health insurance market has emerged as a new and lucrative growth avenue for both the existing users as well as the new users. Further, Indian medical tourism is bringing forex into the country and thus should be given further recognition, exemption and leverage.

Dr Vivek Desai Managing Director, Hosmac India

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The increased outlay towards healthcare in the Union Budget will boost National Rural Health Mission’s (NRHM) efforts in ensuring the reach of quality healthcare to rural parts of the country. These efforts have been further strengthened by increasing the remuneration to aanganwadi teachers, helpers and workers. The ` 500 crore outlay towards the National Skill Development Council presents an enormous scope to enhance skilled manpower in the healthcare arena such as nurses, laboratory technicians, radiographers, dialysis technicians, cath lab technicians, etc. Also, inclusion of unorganised sector workers in hazardous mining and associated industries like slate and slate pencil, dolomite

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mica and asbestos under the umbrella of health insurance will surely ensure more accessibility of basic healthcare facilities. Alternative medicine and disciplines has also got a considerable boost from the Budget. With an increased allocation of 20 per cent as compared to last year’s Budget, we are looking at a total outlay of ` 267 billion for the health sector. This will immensely help the country’s efforts in providing healthcare to all. In the postBudget deliberations, the Finance Minister has indicated that healthcare would be given ‘infrastructure’ status – this will boost the sector, increase private participation and ease a steady flow of funds into healthcare projects. The healthcare sector emerged as one of the beneficiaries of the Union Budget 2011-12.

Hospital Monitor

Beams Hospital, Mumbai

Conceptualising boutique care With a specialised team of doctors, administrators and qualified nursing staff in Minimal Access Surgery (MAS), the hospital plans to expand its services to other cities as well. While doing so the mission of ‘patient care at all times’ will be the main focus. A glimpse of the strategies, investments and services in place. Meghna Mukherjee

ounded in 1994 by Dr Rakesh and Manju Sinha, with a dream to form the neighbourhood’s first ‘Boutique hospital’, Beams Hospital has come a long way. With every milestone added to the plethora of achievements, the ambition to reach even higher and serve

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better has become all the more prominent. The path has not been smooth, but that has never hindered the pace in which the hospital decided to grow. Beams, a foremost chain of surgery centres dedicated to MAS is backed by expertise of more than 15 years. Spread

over an area of 9,000 sq ft, the hospital now plans to extend its services to other major cities as well. Manpower comprises about 11 part- and full-time doctors and 18 nursing staff. Focussing on creating a niche in laparoscopic surgery in gynaecology, urology and general surgery, S Krishnamurthy, CEO, Beams Hospital, says, “Gynaecology

Hospital Monitor

We plan to widen our horizon and introduce eight more centres across the country that will not only focus on gynaecology but also on urology, general surgery and arthroscopy. S Krishnamurthy CEO, Beams Hospital

& obstetrics holds a marketshare of about 13 per cent of the total healthcare industry in India. Within laparoscopic surgeries, we focus more on performing surgeries for fibroid removal, hysterectomies and deliveries. In 2002, 2003 and 2007, we had won the Limca Book of Records and the Guinness Book of World Records for removing the largest fibroid weighing 3.4 kg and the largest uterus weighing 4.1 kg through laparoscopic surgery.”

Investments and expansion plans Functioning expertise was brought into Beams Hospital by Ambit Pragma Ventures, a Private Equity (PE) fund. Now, the hospital plans to expand its services from being a single entity to a 10-centre unit spanning across major cities like Amritsar, Chennai, Hyderabad, Bangalore, Pune, Ahmedabad, New Delhi, Kolkata and Indore. Krishnamurthy explains, “We have been running a successful MAS model for the past 15 years in Mumbai. The cost of setting up a MAS centre is about ` 6-8 crore. Now we plan to widen our horizon and introduce eight more centres across the country that will not only focus on gynaecology but also on urology, general surgery and arthroscopy. The centre at Amritsar has been operational since 2008 and now the centres at Hyderabad,

Patient care at Beams

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Bangalore and Indore have also started functioning. We will follow a similar investment pattern for setting up other centres as well. We plan to start the other centres in the next 12-18 months.” The hospital is also constantly working on enhancing its technological and expert services in the field of laparoscopic surgery. It has received the ISO 9000 accreditation and is now working on achieving the ISO 18000 accreditation, which is for maintaining environmental safety, and is also looking at receiving a process certification for healthcare.

Quick Bytes Picks The fact that a patient can return to his normal life and perform daily activities in a two to three days time is high with MAS.

Services and technological advancements The hospital is a 32-bed MAS centre. About 40 per cent of the patients here opt for short stay service. The hospital’s administration department has issued a policy that all centres across the country will have at least 25 beds. In addition, the hospital is equipped with two operation theatres, one labour delivery room, one ultrasound system, one

high-intensity focused ultrasound, one no touch breast scan and is backed by other high-end facilities. Beams has constantly been working on increasing and exploring new technologies for its services. As Krishnamurthy avers, “We have always ensured that we use the latest technology at our centres. The laparoscopic and anaesthetic equipment are imported from Germany & the US. Upgradation of technologies is done yearly at our fully functional centres. MAS is a technology-based surgery, and hence we need to ensure that all technologies are up to the mark.” Emphasising on the scenario of the current healthcare industry, Krishnamurthy says, “Even today, healthcare is not largely technology based. But we realise its importance in laparoscopy, and hence technological advancement is a must for us.” Explaining the emergency services provided at the hospital, Krishnamurthy explains, “Although occurrence of emergency cases is less in a specialised MAS centre such as ours, however if need be, we are well equipped to handle it due to our association with efficient ambulance services, blood banks in the area that cater to us and also with private and public hospitals in the city in case a patient needs to be shifted to an Intensive Care Unit (ICU).”

Academic lens With a belief to produce the best gynaecologists in the city and the country, Beams Hospital trains students throughout the year under the guidance of doctors in the hospital. Emphasising on the need to train young minds,

Hospital Monitor Krishnamurthy says, “We conduct bi-annual training programmes on laparoscopic surgery for gynaecologists. Till date, we have trained more than 100 surgeons. We have plans of getting the accreditation from the National Accreditation Board for Hospitals (NABH) and also to offer DNB course in gynaecology at our centre.” Besides, the hospital organises a number of activities in the academic arena, wherein specific cases are documented and showcased to the students. “We are also planning to affiliate with some university or institute in the US, based on the Ambulatory Surgical Care (ASC) model,” informs Krishnamurthy.

Serving the society The hospital constantly participates in various healthcare camps and events organised in the city. Commenting on the Corporate Social Responsibility (CSR) activities, Krishnamurthy explains, “We annually organise conferences and camps in our hospital where patients who cannot afford a laparoscopic surgery, undergo the surgery free of cost. About 10 patients in the category of undergoing a ‘free surgery’ are operated every year. Further, we are trying to come up with various such programmes where we can provide quality services and also help those who cannot afford such a surgery. Our aim is to serve mankind through our expertise.”

The winning mantra With upcoming hospitals focussed on providing solution through MAS, the level of competition is on a rise for Beams. Nonetheless, with experienced staff and administration in place, the hospital has managed to overcome them. Krishnamurthy opines, “With more and more centres coming up based on the theme of boutique hospital and MAS, the level of competition is high. There is a compelling case for patients to move to the chain of boutique hospitals, which offer technologically advanced MAS in a personalised and caring ambience. Considering the competitive environment and looking

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at the trend in which more and more specialised boutique hospitals are coming up, I think format such as ours could be a strong competition to larger hospitals in the near future because of the specialised services that we offer alongwith a well qualified, experienced team of surgeons and use of highly advanced, upgraded technology providing complete safety as well as cost effectiveness. Looking at all the factors, the customers will soon know where they need to get treated.” Further, explaining the challenges that Beams faces, Krishnamurthy says, “The single biggest challenge for Beams is to attract the right kind of surgeon to perform surgeries. We have maintained the aesthetic value with which we serve our patients and ensure that they are treated with utmost care and attention. The second challenge is to create awareness about MAS. There is minimal awareness among the population at large about the benefit of MAS. The fact that a patient can return to his normal life and perform daily activities in a two to three days time is high with MAS. Hence, we constantly try to educate our patients on the success level and the advantages of MAS.” The concept of medical tourism is highly recognised at Beams. Providing insights into the related field, Krishnamurthy avers, “We believe in medical tourism. Also, we are in the process of structuring it further. About 2-3 per cent of the patients visiting our hospital are from abroad. We have treated patients from various countries like the US, UK, UAE, Singapore, Kenya and others. We also have a specialised team of doctors who provide online counselling to the patients first and then they are advised to visit the hospital for treatment. For maintaining transparency in our working module, we record the surgeries performed on our patients. We provide the patients with one copy of the record and one is stored at the hospital for further assistance and documentation purposes.”

Tapping the future Beams is far sighted when it comes to providing quality services and better treatment for its patients. Krishnamurthy says, “We are open to tie-ups with individual or group practitioners. We would like to associate local surgeons from bigger hospitals with our centre so that they can provide excellent treatment to our patients. Also, our aim is to create the finest MAS centres in the country five years down the line. With a singlecentre concept that is doing well, we hope that the multi-location centres will help us in building a smaller chain of hospitals, which will cater to serving patients through MAS.” The ability to deliver consistently is a big challenge for most healthcare service providers. Krishnamurthy opines, “With disposable income, a typical consumer’s expectation for healthcare has raised. At present, more and more corporatisation is taking place in the healthcare industry that helps in the formation of more chain of hospitals, which can cater to the ‘secondary level of surgeries’ and will create a niche in the secondary care sector. There are no sure shot models presently where the debate whether government should handle healthcare or the private players can settle. But both these models have their own challenges. In comparison to the healthcare model adopted in the US, India is still trying to reach up to that status. Healthcare in India was previously public based, but now with about 85 per cent of privatisation in the healthcare industry, we can predict that this sector will excel in the near future.” (mmedit@infomedia18.in)

Sector Watch

Dr Asma Mohd Yousuf

With the rise in lifestyle diseases, especially in urban India, the need for an effective health insurance plan cannot be ignored. In the absence of an appropriate health insurance, being sick or meeting with an accident can cause considerable financial trouble. Hospitals providing latest medical facilities and state-of-the-art infrastructure charge duly to the patient. Heath insurance is the tool that can help at large in such circumstances. It may seem like an expense today, but it helps in protecting against a future expenditure that may be considerably higher and unbudgeted for. Unfortunately, in India, this is an underpenetrated market. A detailed analysis.

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Sector Watch

ealthcare has emerged as one of the fastest growing sectors in India, yet there are people who are still unaware of what benefits health insurance policies can provide them. “The healthcare spend in the country is expected to double and touch ` 2,250 billion by 2014. And with just three per cent health insurance penetration in the country, a large part of the sum is poised to be paid out of one’s pocket. India’s insurance market still lags behind other countries in terms of penetration. With the penetration level at three per cent in India it is far behind UK (12.5 per cent), Japan (10.5 per cent) Korea (10.3 per cent) and US (9.2 per cent). In terms of insurance coverage per capita, India stands at $ 1.1 as compared to $ 2313.6 in the US and $ 31.1 in the UK,” informs Antony Jacob, Chief Executive Officer, Apollo Munich Health Insurance, India. In agreement, Dr Pervez Ahmed, CEO & Managing Director, Max Healthcare, New Delhi, says, “It is estimated that only about 12 to 13 per cent of Indians are covered under any form of health insurance (private insurance coverage is approximately three to four per cent only). The Indian health insurance scenario is a mix of mandatory Social Health Insurance (SHI), voluntary private health insurance and Community-Based Health Insurance (CBHI). Health insurance is, thus a minor player in the health ecosystem.”

Growth drivers Research has shown that Indians across all segments and age groups are presently more prone to lifestyle-related ailments and diseases than previous generations. This fact, undoubtedly negative, stands out as the root cause for the potential growth of the health insurance sector. Jacob informs, “The growing percentage of middle class citizens in the country and the increasing healthcare cost is also adding to the growth of the health insurance segment. Changing demographics, affluence and work-life balance has brought about a paradigm shift in the attitude of people, who demand for a better quality of healthcare. Health insurance as a mechanism to finance this need, is therefore, finding greater acceptability. Thus, the market has great

The healthcare spend in the country is expected to double and touch ` 2,250 billion by 2014. India’s insurance market still lags behind other countries in terms of penetration. Antony Jacob Chief Executive Officer (CEO), Apollo Munich Health Insurance, India

prospects, but the need of the hour is to identify products that will suit customers’ insurance needs and win their confidence.” Sanjay Datta, Head-Customer Service, ICICI Lombard General Insurance Company Ltd, India, feels that the biggest target for the insurance companies in the next five years would be to cover 20 per cent of the Indian population. This is expected to be driven by factors like entry of new competitors, increasing consumer awareness, relaxation in income ceiling, low growth in public sector employment and increased efforts of Non-government Organisation (NGO)/self-help groups. He further adds, “Over the past few years, many companies have entered into the market, and the industry is seeing a lot more innovation with product offerings for different segments including senior citizens, corporates, low poverty line and affluent class. Information Technology (IT) has also been one of the significant enablers of growth in the sector. Given the current health insurance penetration levels in the country, at about three to four per cent, there is a significant potential and a long way to go. However, compared to the Western world, it is still at the tip of the iceberg.”

Inclusion – exclusion criteria A typical health insurance policy covers the basic costs in case of hospitalisation due to any accidents/diseases, which does not

form a part of the permanent exclusions of the policy under which an individual is covered. The expenses covered include cost of room, boarding expenses as provided by the hospital, nursing expenses, doctors, operation theatre charges, expenses related to surgical appliances, etc. As a part of the standard plan, coverage for pre and post hospitalisation expenses and specified day-care procedures are also offered. However, the coverage may vary from product-to-product and insurer-to-insurer. Jacob says, “With the development of the sector and increasing awareness of health insurance, some insurers have launched products to cover Outpatient Department (OPD) treatment as well. Apollo Munich has launched Maxima, which covers outpatient treatment expenses like OPD doctor consultations, pharmacy bills, diagnostic tests, dental treatment, optical services and annual health check-up costs along with in-patient treatment. Critical illness riders are available as add-ons to health insurance policies and these cover treatment for diseases, such as cancer, strokes, kidney failure and heart attacks. These riders are subject to each insurer’s policy and underwriting principles.” Explaining further, he adds, “Maternity expenses are widely excluded when it comes to health insurance plans. But lately there are a few plans that have started to offer coverage against maternity expenses after a certain

Growth drivers for health insurance market in India Higher affluence of the Indian middle class Increase in various lifestyle-related diseases Rising healthcare costs growing awareness about the benefits of health insurance Availability of quality healthcare Community-based health plans Increased awareness about healthcare and preventive care in the country Initiatives by government Rise in numbers of patients visiting India for medical treatment Source: Sanjay Datta

April 2011 I

Sector Watch It is estimated that only about 12 to 13 per cent of Indians are covered under any form of health insurance. Health insurance is, thus a minor player in the health ecosystem. Dr Pervez Ahmed CEO & Managing Director, Max Healthcare, New Delhi

amount of waiting period. Apollo Munich too offers maternity expense coverage after four years of waiting period.” Highlighting further, Datta says “Health insurance in India is normally a comprehensive health cover, covering nearly all illnesses and injuries requiring minimum 24 hours of hospitalisation, subject to a few exclusions namely AIDS, STDs, mental disorders, congenital defects. A typical health insurance policy does not cover any medical expenses that are routine in nature or for convenience like routine health check-ups, cosmetic surgery, plastic surgery aestheic treatment, etc. There are certain waiting periods with regards to Pre-Existing Diseases (PEDs) or some named illnesses like cataract, hysterectomy, etc, for a defined period of two years or four years,” As per Dr Abhijit Bopardikar, Director, ReeLabs, Mumbai, “Unlike the West, there are numerous critical and non-critical illnesses that are not covered, which adds to the confusion for the common man regarding the purchase of an insurance policy. The only advantage in these cases is the income tax benefits that come with the purchase of these policies. Many alternate forms of therapies are only partially covered or left uncovered. For instance, the ubiquitous bone marrow stem cell therapy that is possibly the answer to many life threatening hematological disorders are not covered by these agencies. In such cases, raising funds becomes a herculean task and

generally spells doom for the afflicted person and the policy makers as well.” Giving more insights on the reason for such exclusions, Dr Ahmed says, “Anything which occurs or is diagnosed post taking a policy is normally covered. The main reason behind the same is to curtail claim costs; when premiums and penetration are low, then it is a loss making proposition for any insurer.”

Micro and rural insurance Micro-insurance is seen as a boon for the rural Indian population. There are numerous initiatives underway in the country to reduce poverty and it requires not just generation of income for poor, but also protection of these incomes and its resources. Through micro-insurance schemes, the rural poor will not only get access to affordable insurance, but also will be able protect themselves against high-frequency risks, such as serious health conditions, accidents, harvest failures and fires. “Micro-insurance offers an innovative way to combat poverty by helping the rural poor systematically manage the financial risks to their livelihoods and lives. With only two per cent of the poor covered through micro-insurance, there exists a huge untapped market. The demand for microinsurance in India has remained low in a large part because of a mismatch between services offered by the insurers and the needs of the insured. Schemes such as

Over the past few years, many companies have entered into the market, and the industry is seeing a lot more innovation with product offerings for different segments. Sanjay Datta Head Customer Service, ICICI Lombard General Insurance Company Ltd, India

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Rashtriya Swasthya Bima Yojna (RSBY), Arogyashri, etc, which address an important segment, are doing a good job and should be continued and strengthened even further,” explains Jacob. The rural economy is exposed to fundamental risks and has limited access to appropriate risk mitigating solutions. Penetrating the rural market calls for a paradigm shift and significant investment in building a base for the future. The rural market and rural mass in India are exposed to many risks for livelihood as well as for their assets like home, farm equipment, cattle, crop failure, etc. These risks cause financial strain. Rural insurance acts as a cover for all the above mentioned risks. Further, Datta adds, “ICICI Lombard realises that future growth will come from expansion of markets, focussing on volumes in smaller towns and rural areas at a tenth of the cost of urban markets as well as leveraging on established distribution networks. Our pioneering efforts in creating awareness about insurance in rural India include focussed verticals for rural and government to service the unique needs of each market as well as the development of customised products.”

Government intiatives Health insurance is poised to play a critical role by financing medical innovation and technology, and making them readily available within India. This eventually should also leave a strong rub off effect for the government run schemes to enable quality healthcare access utilising the existing healthcare bandwidth. “Government and the regulator have been playing an important role in developing and facilitating growth for the entire sector. The biggest development in this industry was the opening up of the industry following the 1999 Insurance Regulatory and Development Authority (IRDA) regulation. Also, with the proliferation of bancassurance for life and general insurers, changes are visible in the way insurance products are distributed in India. However, health insurance in our country is still underdeveloped but offers huge potential,” elaborates Jacob.

Sector Watch Unlike the West, there are numerous critical and non-critical illnesses that are not covered, which adds to the confusion for the common man regarding the purchase of an insurance policy. Dr Abhijit Bopardikar Director, ReeLabs, Mumbai

He further adds, “Considering the vast majority of population living below the poverty line across the country, the government’s plan this year to increase health allocation by 20 per cent and widen the scope of RSBY is a positive move and may bring in newer opportunities for increased insurance penetration. However, on the private health insurance front, the State should incubate a favourable business and distribution environment for faster penetration.”

Government and private players The liberalisation of the sector along with the entry of stand-alone health insurance companies has triggered a higher level of competitive intensity as well. This has resulted in the industry seeing advanced levels of innovation with various product offerings for different segments including senior citizens, corporates, below poverty line and the affluent class. “With only three per cent of the Indian population covered by health insurance, the market surely requires large scale focus from all the stakeholders, including the regulator, to address the logistic challenges so as to create an efficient distribution network for better accessibility and improved investment opportunities in the insurance sector. For this segment to grow, public and private sector along with the regulator and the government will first need to raise the level of awareness amongst consumers and make people

aware of the importance and benefits of health insurance. Each company will also have to do its bit to raise awareness and also increase the penetration in Tier 1 and 2 cities,” informs Jacob. Insurers also need to work on certain aspects, such as lack of understanding of product features and perceived apprehension in claims procedures and settlement. These factors must be distanced from the consumer’s mind to further fuel growth and uncomplicate health insurance for the consumers. “Currently, more than 60 per cent of the health insurance business resides with four government companies, ie, United, National, Oriental and New India. However, private insurers like ICICI Lombard and stand alone health insurers like Apollo Munich & Max Bupa have a clear focus and in the near future we see an equal split between government and private players,” says Dr Ahmed. According to Datta, “Today, there are a wide range of unique, user-friendly and innovative health insurance plans to choose from, that cover much more than basic hospitalisation. From the popular standard family floater plan on ‘indemnity’ basis, where the insurer is only reimbursed costs incurred, to the policies covering OPD expenses and specialised cover for critical illness, today there are over 30 companies across the general insurance and life insurance space offering a variety of health insurance plans.”

There is a huge potential in the health insurance sector in India but to make optimum utilisation of this opportunity, hospitals and healthcare providers should work together. Dr Uma Nambiar CEO, SL Raheja (a Fortis associate) Hospital, Mahim & Zonal Director, Fortis Healthcare, Mumbai

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Ensuring a healthy future Prevalent lifestyle and work habits have resulted in limited or lack of physical exercise. Enhanced levels of stress and poor food habits have resulted in increase of chronic ailments, such as diabetes, hypertension, obesity, cardiac diseases and gastrointestinal diseases. With health taking a toll, people must ensure that they are ready to face the future securely. That is where health insurance plays a vital role in India. Discussing future prospects of the health insurance segment in India, Jacob says, Overall, the health insurance industry in India is expected to grow at a Compounded Annual Growth Rate (CAGR) of 25 to 30 percent by 2015 to reach a market size of approximately ` 28,000 crore. Increasing consumers’ knowledge and attention to details will also be crucial to the success of insurance companies.” Dr Uma Nambiar, CEO, SL Raheja (a Fortis associate) Hospital, Mahim & Zonal Director, Fortis Healthcare, Mumbai, says, “Small premiums can help in saving lives and reducing the financial burden on account of the huge medical expenses incurred. Therefore, besides educating the masses, it should be ensured that all steps are taken to avoid any malpractice. Proper screening methods should be applied before a person purchases a plan to confirm if the person fulfils the criteria for that plan. Agents should provide every detail about the insurance policy to the customers. Also, people should make honest claims about the declaration of medical bills. There is a huge potential in the health insurance sector in India but to make optimum utilisation of this opportunity, hospitals and healthcare providers should work together.” Health insurance as a mechanism to finance is finding greater acceptability and presenting greater prospects for the sector. However, the success of this industry and its players hinges on the awareness levels of consumers. With growing support from the government in terms of tax exemption, and increased involvement of the private sector to provide better healthcare facilities and insurance cover, this sector shall witness exciting opportunities in the years to come. (asma.yousuf@infomedia18.in)

Specialty Scope

Trends in ophthalmic treatments

An eye for the future Eye care is a serious concern that is often neglected by people. Healthy eyes and good vision are blessings that are often taken for granted. And for a child it is even more valuable because their learning abilities in early years of life depend highly on visual input. Here is an overview on the effect of refractive errors and solutions to rectify them. Photo ©DINODIA

Specialist, PD Hinduja Hospital, Mumbai, says, “Refractive error is the inability of the eye to focus on near, distance or both near and distant images. The common types of refractive errors are myopia, hypermetropia, astigmatism and presbyopia. Myopia is the commonest among all refractive errors. These are treated with glasses or contact lenses.”

Vision care

Dr Asma Mohd Yousuf

‘W

hat we see depends mainly on what we look for’ - John Lubbock However, to see and look, one needs to have a healthy vision. But according to World Health Organization (WHO) estimates, 75 per cent of blindness and 80 per cent of visual impairment is avoidable. Also, a total of 285 million people are visually impaired, of which, 39 million are blind and 246 million have moderate-to-severe visual impairment. About 90 per cent of people with visual impairments live in developing countries, and with India being a developing country, yes, this is a matter of great concern. Refractive errors are silent conditions. They can be detected only on a formal vision test but if not taken care on time can lead to many complications, blindness

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being one of them. Also, a refractive error in one eye is often missed till a very late age. The only way to ensure effective treatment of refractive errors is to recognise them at an early age.

Vital stats Dr Priti Manjunath, Consultant Cataract and Refractive Surgeon, Nethra Eye Hospital, Bengaluru, says, “The prevalence of blindness is 1.84 per cent in urban vs 2.03 per cent in rural population of India. The incidence of moderate visual impairment in Indian population is 8.1 per cent.” She further informs that the incidence of visual impairment is 11.2 per cent higher for those living in rural areas as compared to the urban population. Discussing the common types of refractive errors, Dr Ashwin Sainani, Paediatric Ophthalmologist and Squint

Untreated refractive error is a cause of reduced vision until glasses are prescribed. Visual acuity can be reduced permanently in children who have not been treated for refractive errors in time (before 7 years of age) due to amblyopia. Myopic patients can have reduced vision due to a retinal detachment. Therefore, regular eye checks are needed in patients with family history of eye problems like glaucoma, myopia, diabetes, etc. Associate Prof Dr Eric Papas, Executive Director, R&D and Director, Post Graduate Studies, Brien Holden Vision Institute, Australia, affirms, “Vision, safety and health should always be kept in mind. Eyes should be at least checked annually.”

Spectacles: Then and now Over the years, the quality of spectacles has improved. Mukesh Arora, Contact Lens Specialist, Segal Optics, Mumbai, says, “Today, light weight frames are available. Plastic is mostly used as lenses because it is safe and can be used in various styles of frames.” According to Dr Manjunath, “Modern eyeglass lenses are commonly made from plastic like polycarbonate. These materials

Specialty Scope reduce the danger of breakage and weigh less than glass lenses. Some plastics have more advantageous optical properties than glass, such as better transmission of visible light and greater absorption of ultraviolet light. Also, some plastics have a greater index of refraction than most types of glass; this is useful in the making of corrective lenses shaped to correct various vision abnormalities such as myopia, allowing thinner lenses for a given prescription. Newer plastic lenses can also correct the higher order aberrations that naturally occur on a person’s optical system. These lenses create sharper vision for people who have problems with blurry or dull vision, as well as help reduce the halos, starbursts and comet-tails often associated with night time driving.” Above all, today, there are automated refractors or autorefractors used for examining eyes to provide an objective measurement of a person’s refractive error based on which the prescription for glasses or contact lenses with the appropriate power is made. This is achieved by measuring how light is changed as it enters a person’s eye. However, Arora says, “Autorefractometer is an objective test, and a subjective test is a must in order to confirm the power of the lenses.”

Power of contact lenses Contact lenses have numerous advantages over spectacles. It gives clearer vision as there is no distance between the eye and lenses. They do not fog up with changes in temperature, give more freedom and can be worn by sportsmen during intense physical activities. Describing the benefits of silicone hydrogel contact lenses, Tim Grant, Vice President Professional Affairs, APAC & MENA, Ciba Vision, Australia, says, “Silicone hydrogel contact lenses are good for vision and have better oxygen permeability levels as well. Besides, these contact lenses do not give hazy vision. However, due to the material and manufacturing cost, disposable contact lenses are expensive.” However, Dr Papas informs, “On repeating lenses more than the prescribed time, its health benefits decrease. There

The prevalence of blindness is 1.84 per cent in urban vs 2.03 per cent in rural population of India. Dr Priti Manjunath Consultant Cataract and Refractive Surgeon, Nethra Eye Hospital, Bengaluru

Currently, refractive surgeries are getting more and more advanced and accurate with progress in laser technology. Dr Ashwin Sainani Paediatric Ophthalmologist and Squint Specialist, PD Hinduja Hospital, Mumbai

Vision, safety and health should always be kept in mind. Eyes should be at least checked annually. Associate Prof. Dr Eric Papas Executive Director, R&D and Director, Post Graduate Studies, Brien Holden Vision Institute, Australia

is development of proteins, lipids and bacteria, and thus, its use becomes uncomfortable. The more oxygen permeable lenses are the better will be the eye health. Less oxygen permeability causes corneal swelling. “ All contact lenses are foreign bodies to the eyes and can sometimes give rise to eye problems. The incidence of these complications from lens wearing can be prevented by following stringent lens hygiene. Wearers should view the warning signs and symptoms seriously, and contact an ophthalmologist immediately if red-eye, eye discomfort, reduced vision, sensitivity to light and eye discharge develops.

Orthokeratology Elaborating on what is orthokeratology, Dr Manjunath says, “Orthokeratology is the design and fitting of special gas permeable contact lenses that gently reshape the clear front surface of the cornea, so that one can see clearly even after the removal of the lenses. Unlike a refractive surgery, however, the corneal reshaping effect may

be temporary. Then you have to wear the ortho-k lenses again to maintain the proper corneal shape.” Highlighting further, Dr Papas says, “The lenses used in orthokeratology are hard and are not very comfortable to the eyes. Moreover, orthokeratology cannot be used in case of hypermetropia and astigmatism. Besides, moulding of the cornea itself is a debate among ophthalmologists.”

Refractive surgery “Laser surgeries can change the corneal shape, which can lead to correction of refractive error. There are other types of refractive surgeries like conductive keratoplasty, implantable contact lens, lens exchange and keratotomies,” informs Dr Harshavardhan Ghorpade, Consultant Ophthalmic Surgeon, Fortis Hiranandani Hospital, Vashi, Navi Mumbai, while discussing the surgeries used in the correction of the refractive errors of eyes. He continues to explain, “Today, machines with high laser speed are available. Wavefront-guided lasik, customised

April 2011 I

Specialty Scope

Today, light weight frames are available. Plastic is mostly used as lenses because it is safe and can be used in various styles of frames. Mukesh Arora Contact Lens Specialist, Segal Optics, Mumbai

Silicone hydrogel contact lenses are good for vision and have better oxygen permeability levels as well. Besides, these contact lenses do not give hazy vision. Tim Grant Vice President Professional Affairs, APAC & MENA, Ciba Vision, Australia

Stem cells are used for making artificial corneas. But refractive surgeries are a great advancement in itself. Dr Harshavardhan Ghorpade Consultant Ophthalmic Surgeon, Fortis Hiranandani Hospital, Vashi, Navi Mumbai

lasik, excellent quality keratomes as well as protocols for prevention of infection, inflammation, flap complications and future ectasias have been recognised. Stem cells are used for making artificial corneas. But refractive surgeries are a great advancement in itself.” Adds Dr Sainani, “Currently, refractive surgeries are getting more and more advanced and accurate with progress in laser technology. The future includes LaserAssisted In Situ Keratomileusis (LASIK) in children, LASIK for presbyopia and advances in femtosecond laser. One must realise that a decision to go for contact lenses or refractive surgeries is entirely the patient’s prerogative. It is finally a cosmetic decision and neither options improve vision beyond that they have with glasses on.”

Rate (CAGR) of 3 per cent to reach $ 24 billion by 2016. The market is expected to be driven by the increasing patient population suffering from refractive errors, their increased awareness and the cost effectiveness of vision care devices over refractive surgery. The vision care devices market in India and China was valued at $ 320 million and $ 1,592 million, respectively, in 2009 and is forecasted to grow at a CAGR of 4 per cent to reach $ 420 million and $ 2,034 million, respectively by 2016. Whereas, the global market for contact lenses was valued at $ 7.6 billion in 2009, and is forecasted to grow at a CAGR of 4 per cent to reach $ 10 billion by 2016. In the near future, silicone hydrogel lenses and daily disposables are going to be the key trends in the vision care devices market.

Market report

The visible future

As per a GlobalData report, the global market for vision care devices was valued at $ 20 billion in 2009, and is forecasted to grow at a Compounded Annual Growth

According to the report by GlobalData, currently in China and India, about 41 per cent of the adult population is myopic, which forms a huge wearer

I April 2011

base for vision care devices. The potential contact lens market in these two countries alone will include at least 800 million myopic and 500 million presbyopic people. The advent of modern refractive surgeries have revolutionised the treatment of refractive errors. However, it must be remembered that refractive surgeries does not suit all patients. It is a cosmetic decision just like contact lenses. Orthokeratology has also shown promising results, although infection is a major risk. Even today, spectacles are the safest treatment for refractive errors. Besides using visual aids, timely detection and treatment of refractive errors in children is very important. Awareness should be created on various visual impairments. At the same time, it is also crucial to introduce diet improvement and supplementation programmes. Dr Ghorpade concludes optimistically by stating, “Presently, the overall visual impairment is 0.8 to 0.9 per cent. However, VISION 2020 and National Programme for Control of Blindness (NPCB) aim to reduce it to 0.3 per cent by the year 2020.” VISION 2020 is the global initiative for the elimination of avoidable blindness, a joint programme of WHO and the International Agency for the Prevention of Blindness (IAPB) with an international membership of Non Government Organisations (NGOs), professional associations, eye care institutions and corporations. With the goal ‘A world in which no one is needlessly blind and where those with unavoidable vision loss can achieve their full potential,’ VISION 2020 aims to eliminate the main causes of avoidable blindness and to prevent the projected doubling of avoidable vision impairment between 1990 and 2020. The VISION 2020 initiative is intended to strengthen national healthcare systems and facilitate national capacity building, and with almost a decade to go, let us hope that this aim is successfully achieved. (asma.yousuf@infomedia18.in)

In Dialogue

‘Telemedicine and e-healthcare have immense potential for growth in India’ Rapidly increasing lifestyle diseases in India, hospital infrastructure & healthcare spend are fuelling the growth of high-end electronic medical equipment industry, feels Rakesh Joshi, Business Development Manager–Medical, Texas Instruments India (TI). He underlines the key growth trends in this segment over the next few years. Arshia Khan

Which areas/equipment according to you are likely to fuel growth in the medical devices segment? Growing hospital infrastructure and healthcare spending is fostering the need for high-end devices to enable accurate and faster treatment. The key drivers fuelling growth in medical devices industry are as follows:

significantly in India. Increased diabetic population in India has led to more and more people taking their health more seriously than ever Improved hospital infrastructure: The past decade has witnessed a significant growth in the number of high-end hospitals in urban India. Healthcare has become more

The increasing awareness of healthcare has created a rapidly growing need for innovative medical solutions like portable & affordable ultrasound applications for use in doctors’ equipment, ambulances, mobile triage solutions and remote regions. Semiconductors are set to play a pivotal role in designing and developing portable and affordable medical devices.

Increasing population & affordability: Improving Indian economy and increasing disposable income has led to a significant change in the manner an average Indian views healthcare. Visiting a hospital only in case of severe illness is passé; the new Indian now undergoes regular health check-ups at periodic intervals Increased prevalence of lifestyle diseases: With the shift towards urban lifestyles growing at a rapid pace, the incidence rate of diseases like diabetes, chronic heart diseases, cancer and hypertension has increased

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accessible in these areas. In tier II & III cities, which are yet to witness this growth, the demand for highend medical equipment and quality healthcare is increasing.

What are the trends you foresee in the Indian life sciences segment and how will you customise your offerings to meet the demand of your clients? The Indian healthcare sector has evolved rapidly in the past decade. With changing lifestyles and the advent of high-end technology, healthcare in India is now more organised than ever. From a

medical perspective, TI’s focus in Indian healthcare sector has been specifically in the area of medical electronics. Following are some of the key trends and enabling technologies in this segment: Imaging techniques a. Ultrasound: This has undergone miniaturisation, and become portable. Fusion imaging [merging of two different modalities like Computed Tomography/Magnetic Resonance Imaging (CT/MRI) with ultrasound images]. This has also shown rapid advancement in electronic processing and data acquisition technology b. MRI: Increasing patient comfort and enhancing the diagnostic information highlight the trend in modern MRI equipment. Techniques such as parallel imaging technology are implemented to speed up MRI scanning, thereby enabling shorter breath-hold times, higher resolution and shorter stay time for the patient lying in the scanner for any examination c. CT: A key trend in the CT segment is the shift towards combination scanners, which are primarily hybrid scanners comprising Positron Emission Tomography (PET) and CT imaging capabilities. Real-time imaging will drive applications in this segment.

Devices and implants a. Total demand for cardiac implants will continue to rise, largely due

In Dialogue to the widening use of Cardiac Resynchronisation Therapy (CRT) devices in the treatment of Congestive Heart Failure (CHF). CRT devices are more effective than alternative drug therapies in restoring the blood pumping capabilities of CHF patients along with reducing their risk of disease complications, such as atrial fibrillation. Ultra-low power electronics find applications in this area b. Use of Radio Frequency (RF) technology to control electrical stimulation for neurological stimulators is another trend observed in this segment.

Patient monitoring and management systems a. Certain segments like Electrocardiography (ECG) and neurophysiological monitoring systems have developed rapidly and continue to advance due to higher adoption rates b. Wireless lower-acuity monitors that are the size of a cell phone can be used with Wireless Local Area Network (WLAN) for transmitting the vital signs of emergency room patients who might be ambulatory or moved to other areas of a hospital c. Higher acuity can also be wireless but due to limitations in the size, memory and processing power of wireless technology, these monitors typically transmit fewer measurements than standard, nonwireless monitors. Telemedicine Telemedicine and e-healthcare have immense potential for growth in India, where a major portion of population resides in rural areas, with little or no access to quality healthcare advice/ treatment. Additionally, with increasing lifestyle-related diseases like diabetes, cardiac, etc, it becomes obvious that we need easily accessible technology and a common platform that connects millions of patients, spread across the

country, to medical experts in the time of need.

Defibrillators Use of devices with biphasic technology and low-energy defibrillation is another emerging trend. Multi-directional current in biphasic defibrillators lowers the threshold for successful defibrillation, thus saving more lives. Biphasic defibrillators adjust the waveform according to patient’s needs for delivering the best possible waveform at any given time. Embedded technologies and software The function for embedded systems in medical technology is never-ending. For example, new embedded systems are developed wherein pills containing ‘smart’ processors are taken by patients to repair organs for cell formation or irregularities in cell function. Currently,

Quick Bytes Picks The function for embedded systems in medical technology is never-ending. For example, new embedded systems are developed wherein pills containing ‘smart’ processors are taken by patients to repair organs for cell formation or irregularities in cell function. this is a small industry, but it is possible that embedded systems will be able to perform any medical process in the future, eg, surgeries or X-ray analysis. Multi-core processors for real-time processing are the trends in medical imaging. Software beam formed with the help of Digital Signal Processors (DSP) for ultrasound imaging provides flexibility and reduces hardware cost on high-end equipment.

What is the growth potential for medical electronics in emerging markets like India and China? In an emerging market like India, there is a lot of potential for growth and

demand for medical electronics (of which semiconductors are an essential part). The increasing awareness of healthcare has created a rapidly growing need for innovative medical solutions like portable & affordable ultrasound applications for use in doctors’ equipment, ambulances, mobile triage solutions and remote regions. Semiconductors are set to play a pivotal role in designing and developing portable and affordable medical devices. The connectivity enabled by semiconductor technology (wired or wireless) will drive applications such as telemedicine that will facilitate access to the required level of healthcare. Indian electronics Original Equipment Manufacturers (OEMs) are developing a number of portable devices like digital thermometers, blood pressure monitors, insulin pumps, heart rate monitors, digital hearing aids, etc. in addition to hospital equipment like CT and MRI scanners, X-ray machines, ultrasound scanners, etc.

How has healthcare evolved with technology? The move towards greater adoption of semiconductor technology in the field of medicine has resulted in an improvement in the quality of life and higher productivity. Areas like preventive healthcare, technology solutions for disability and highquality healthcare for diseases are also being addressed. Medical practice is gradually moving out of the doctors’ chamber and entering into other spaces like the Internet and homes. Modern technologies such as telemedicine, ehealthcare and digitisation are enabling more people to remotely monitor ailments without physically visiting a medical facility. Patient data storage and access has become safer and easier, with patient consultation & diagnosis moving to the Internet. Healthcare facilities have started using data servers to monitor and access complete patient information over a common network. (arshia.khan@infomedia18.in)

April 2011 I

Personalised Healthcare

Differentiated medicare

Say no to ‘one size fits all’ People are different and no single treatment suits two different patients despite the presence of same symptoms. This has prompted clinicians and drug manufacturers to move towards providing medication specific to particular patient populations, that is personalised healthcare.

ersonalised Healthcare (PHC) is about providing treatment as per patients’ needs for obtaining better clinical outcomes. It is based on the concept that the treatment will be selected based on patient characteristics that are identified through molecular diagnostic tests. PHC recognises that all individuals are different and that the ‘one size fits all’ approach is not effective. While a drug can be highly effective for one patient, the same might not show the desired results when given to another patient with the same diagnosis. Experts today are able to tailor treatments according to the needs of specific patient populations based on the knowledge of biology, diseases, mechanisms of action of drugs and the biological

Dr Bhuwnesh Agrawal Chairman & Managing Director, Roche Diagnostics India

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differences between patients as well as the characteristics of their disease. This has helped in making healthcare better, safer and more cost-effective. PHC is a key enabler for further improvements in medicine. This will enhance the safety and efficacy of medicines as well as improve patients’ lives, their health, quality of life and survival. Therefore, the prime objective here is to provide PHC solutions, which deliver superior options for diagnosis and treatment to clinicians and patients.

Pioneering PHC PHC is not a new concept. There are a number of excellent examples of successful implementation of PHC in medical practice, and numerous PHC solutions are also available today. However, in recent years, the considerably increasing knowledge of the human body and disease mechanisms has helped in concluding that PHC approach will soon become important. The goal is to provide healthcare professionals with more powerful diagnostic tools and with targeted treatments based on new

insights, at the molecular level, about how diseases arise. PHC is a win-win situation for everybody involved, ie, regulators and policy makers, industry, payers and reimbursers, physicians and providers and, most importantly, patients. For patients, it means better treatment outcomes with safer and more costeffective treatments For regulators and policy makers, it means increased efficacy and safety as well as reduced healthcare costs For industry, it means differentiated medicines and new diagnostic tests For payers and reimbursers, it leads to an efficient use of healthcare budgets and increased cost benefit per patient For physicians and providers, it means obtaining maximum benefit with least toxicity. Today, one in three medicine fails to produce the desired effect, and only about two-thirds of all patients actually benefit from their drug treatment. In fact, one in seven or eight patients actually feel worse after treatment than before. This situation is not particularly satisfactory.It is unsatisfactory for patients or doctors because neither the desired effects nor side effects can be clearly defined or reliably calculated. Also, it is unsatisfactory for health insurers because they have to pay for treatments, the quality of which leaves a lot to be desired in several cases. This gave rise to the concept of PHC, where the treatment is tailored to specific needs of individual patient groups. This new approach to healthcare is facilitated by progress in the field of molecular diagnostics tools, which has been fuelled by identification of new biomarkers, and thereby increasingly favoured by the stakeholders in the healthcare system. This could perhaps be described as a quantum

Personalised Healthcare leap in drug therapy. The relationships between drug response and individual genetic variations called pharmacogenetics provide information that when considered with other factors, helps physicians to better assess the right medication dosage for a patient. People are different, but drugs are not differentiated enough. There is a great need for more effective and safer medicines. PHC should not be (mis)interpreted as that every person receives medicines made just for them. Rather, it expresses the idea that groups of individuals with shared features – eg, genetic characteristics – can be ‘bundled together’ such that treatments can be optimally tailored to their needs. On an average, 20-80 per cent of patients actually profit from the medicines they take. This is because today’s medicines are generally standardised products meant for general patient population – PHC, however, strives to differentiate. Any course of treatment starts with a diagnosis, ie, identifying the patient’s illness as accurately as possible. The more accurate the diagnosis, the more successful drug therapy is likely to be. Here, Roche is in an excellent position since it is the only healthcare company in the world to possess top-class-in-house expertise in both areas. As such, we are extremely well placed to provide ‘custom-made treatments’ that are perfectly suited to patients. With the pillars of diagnostics and pharmaceuticals, the Roche Group is perfectly positioned to pursue the goal of PHC, and over the last few years, has shown examples of how interweaving diagnostic and pharmaceutical expertise pave the way to achieve this goal. Roche’s portfolio encompasses the fields of oncology, virology, metabolism, transplantation and many more, as explained hereafter.

25 per cent of breast cancer patients have HER2 gene over-expression. By measuring the presence of the growth factor, HER2, in breast cancer through a specific HER2 test supplied by Roche Tissue Diagnostics (Ventana), it is possible to determine HER2-positive beast cancer patients who will respond to Herceptin. Colorectal cancer: An excellent example of PHC at work is the KRAS mutation test, which will be made available in India in 2009. This test helps in direct treatment of patients afflicted with metastatic colorectal cancer. Recently, scientists have developed more targeted therapies for colorectal cancer that look at limiting the growth of cancerous cells. One such therapy is the Epidermal Growth Factor Receptor (EGFR) inhibitor (or anti-EGFR therapy), which prevents growth signals from entering the cells, thus stunting the growth of the tumour. The KRAS gene is a defining factor in looking at whether a patient with colorectal cancer can benefit from EGFR inhibitors. Patients with a mutated KRAS gene (35-45 per cent of metastatic colorectal cancer patients) are unlikely to respond to EGFR inhibitors. With the TheraScreen® K-RAS mutation test, doctors as well as patients will have a better understanding of treatment options to employ for achieving greater effectiveness.

Lung cancer: The TheraScreen® EGFR 29 test is designed for detecting 29 of the most common somatic mutations in the EGFR gene and also detects mutations not visible by sequencing. Recent studies in Non-Small Cell Lung Cancer (NSCLC) have shown that some patients carry somatic mutations in the EGFR gene. These mutations may correlate with responsiveness to the EGFR tyrosine kinase inhibitors, a targeted therapy for NSCLC.

Cardiac N-terminal proBNP (NT-proBNP) is an ideal example of all aspects of PHC. It can be used to screen people at risk for Cardiovascular (CV) disease, and also in otherwise healthy people for early detection. For example, after a heart attack or after chemotherapy, it can diagnose Congestive Heart Failure (CHF) and help differentiate heart versus non-cardiac causes of shortness of breath. High levels of NT-proBNP also show a worse outcome, indicating that these patients must be treated more aggressively. It can also be used to monitor and guide treatment – the reduction in NT-proBNP is useful to optimise treatment in selected patients.

Virology Human Immunodeficiency Virus (HIV): The way HIV patients regularly test their viral load is an example of PHC. Patients

Continnum of care- NT-proBNP utility across the spectrum of heart failure

Predisposition Screening

Targeted Screening

Diagnosis

Prognisis

Carvedilol Diuretics ACE-Inh Digoxin

Treatment Stratification

Treatment recurrence monitoring

Oncology Breast cancer: One of the greatest advancements in the treatment of breast cancer is the drug, Herceptin, which targets Human Epidermal growth factor Receptor 2 (HER2)-positive breast cancer, a type of more aggressive breast cancer. However, not every patient responds to this treatment in the same way. Approximately

Prevention

Community based screening NT-proBNP

Early diagnosis

Differential diagnosis, further DX

Management Strategy

after AMI chemotherapy NT-proBNP

Patients with dyspnea NT-proBNP

Patients with LVD NT-proBNP

Differential Treatement

NT-proBNP

April 2011 I

Treatemtn Adjustement/ Optimisation Treatment Optimisation NT-proBNP

Personalised Healthcare can get their viral load tested (along with a CD4 cell count) when first diagnosed with HIV – this acts as baseline. They are then tested again 2-6 weeks after the treatment is initiated to evaluate the efficacy of the therapy. Subsequent tests are carried out every three to four months to monitor longterm therapy to ensure that the patient has not developed resistance to the drug. Hepatitis C Virus (HCV): Hepatitis is a viral infection that can go undetected in the body for years. If left untreated, it can lead to cirrhosis, liver failure and cancer. Tests that diagnose and monitor the virus in blood and treatment with Roche’s drug – Pegasys – have helped many people infected with it. However, not all patients respond equally to this treatment. A Roche Hepatitis C viral load test measures early response to therapy with drugs such as Pegasys, while another test that identifies the HCV subtype provides information to help determine the correct duration of treatment with such medicines. A shorter treatment duration with Pegasys/Copegus will provide patients with the full benefits of therapy while

reducing unnecessary drug exposure. The four-month treatment course will be for patients who are infected with particular strains of chronic hepatitis C (genotype 2 or 3), have low virus levels before starting treatment and who show a rapid virological response by clearing the virus from the blood within the first 4 weeks of treatment. This is a new treatment concept in hepatitis C, which seeks to customise regimens for patients based on how well they respond to treatment. It is enabled by using Roche’s highly sensitive, realtime Polymerase Chain Reaction (PCR) diagnostic tests (the automated COBAS AmpliPrep/COBAS TaqMan HCV Test), which accurately measure the levels of virus in the patient’s blood.

Metabolism Diabetes: Roche Diagnostics provides blood glucose tests, insulin pumps and a whole series of services to tailor insulin treatment to patients’ needs. Osteoporosis: A broad range of tests are made available by Roche Diagnostics

to assess bone integrity and monitor the effects of anti-resorptive therapy with drugs such as Bonviva.

Drug metabolism The AmpliChip CYP450 Test analyses variations in two genes that play a major role in the metabolism of many widely prescribed drugs. This is the world’s first commercial pharmacogenetic product for predicting individual drug response that implements gene chip technology.

Transplantation CellCept is an immunosuppressant manufactured by Roche to prevent the body from rejecting a kidney, liver or heart transplant. The key metabolite in CellCept is Mycophenolic Acid (MPA). An immunochemistry-based test measuring MPA guides optimal patient dosing. This enables doctors to accurately tailor CellCept dosages and safely lower the dosages of more toxic agents, thus further improving the outcome for patients. (Bhuwnesh.agrawal.ba1@roche.com)

April 2011 I

IT@Healthcare

Clinical decision support systems

Promoting evidence-based medicine Clinical Decision Support System (CDSS) assists clinicians at the point of care. This unique support system forms a significant part of the knowledge management technology via its capacity to support clinical processes from diagnosis and investigation through treatment and long-term care. rules to assess the risks of particular medication for a patient subset; clinical guidelines for treatment of diseases; or reminders for timely follow-up. EMRs lay the foundation for patient safety and healthcare quality improvement but CDSS is the tool that delivers these goals.

Photo by: Joshua Navalkar

Design

linical decision support systems (CDSS) provide clinicians and other care givers with information that is intelligently filtered and presented to enable improvement of treatment outcomes. The Institute of Medicine has long recognised problems with healthcare quality, and for more than a decade has advocated using electronic CDSS to improve quality. However, one must not forget that these

Dr Aloke C Mullick (MS Surgery), Chief Evangelist EMR Mavens

I April 2011

health Information Technology (IT) applications are a means to improve healthcare quality, not an end in themselves. Electronic medical records (EMRs) with Computerised Provider Order Entry (CPOE) digitise clinical information. But there can be no major improvements in the quality of care from the use of health IT without proper implementation and use of CDSS. Every year, more than a lakh death are reported in US due to medical errors, including drug interactions. For India, these numbers would be in several multiples of the US figures. Any of the several types of CDSS tools can prevent most of these mishaps. Examples include a pop up alert to potential drug interaction; clinical prediction

Early CDSS systems were derived from expert systems research. Engineers strived to create programs with rules that would allow it to â&#x20AC;&#x2DC;thinkâ&#x20AC;&#x2122; like an expert clinician when confronted with a patient subset. Thereafter, these systems evolved so that they could be used to assist clinicians in decision across routine tasks, warning clinicians of potential problems and providing suggestions as per programmed rule sets. Common features of CDSS systems that are the knowledge base (e.g., compiled clinical information related to diagnoses, various types of drug interactions, allergies and evidencebased guidelines), a smart program linking that knowledge with patientspecific information and a data bus for porting such information into the CDSS engine and convey relevant information outputs (e.g., lists of possible diagnoses, drug interaction alerts or preventive care reminders) back to the clinician. CDSS can be built into the EMR or hosted as a standalone application available on the network, or on a mobile device, like a smart phonebased dosage calculator. Its knowledge base may be available centrally for local use as needed, or locally with constant

IT@Healthcare Segments where CDSS helps Care Segment CDSS Examples Prevention Immunisation alerts, screening alerts, disease management alerts (e.g., Hb1Ac levels to be checked every 3 months) Diagnosis Diagnostic suggestions for a set of symptoms and signs (e.g., The Isabelle ® CDSS system) Therapy

Diagnostic and drug order sets as per guidelines, dosage calculators, drug-to-drug interaction alerts, drug-to-disease interaction alerts, drug-to-allergy alerts, treatment guidelines (e.g., NCCN guidelines for oncology)

Follow-up

Clinical reminders, drug adverse drug reaction (ADR) monitoring, clinical guidelines-based surveillance alerts

upgrades. Practically, a deployed CDSS could utilise any of these computational architectures, methods of access or devices. The way these elements are constructed and deployed will depend on the type of clinical automation systems in place, local vendor solution availability, clinical workflow, security issues and funding constraints.

Settings CDSS has the ability today to support physicians and clinical care givers at all key stages in the care delivery pathway, including preventive care, diagnosis, treatment, monitoring and follow-up. They can include order sets created for particular diseases or patient subsets, based on evidence-based guidelines and/ or customised as per individual clinicians’ preferences, provide access to guidelines and other external clinical content that provides information relevant to particular patients/diseases, clinical Uses of CDSS CDSS intention Automatic reminders for actions that clinical user does not want to remember On demand information in areas where clinical user is unsure on how to proceed Correct clinical users’ errors and/or recommend new plan

reminders for preventive care and alerts that flag potentially dangerous clinical situations needing attention. Commonly, CDSS is used for addressing needs, such as assisting accurate diagnoses, screening for preventable diseases or averting adverse drug events. Controls A key feature of CDSS is the level of control the user has over the decision to use CDSS recommendations. Others include whether the CDSS recommendations are set up to be displayed on demand so that users have full choice to access it as also to accept it. These two control aspects are related and connect closely with how the CDSS advice matches a clinician’s intention. CDSS are designed to: Remind clinicians of things they need to do, but should not have to remember Provide information whenever care givers are unsure about the next course of action

Assist to correct errors clinicians may make and Recommend that the clinicians change their plans. The users’ reactions to CDSS may differ with these diverse intents. An analogy can be seen when a user employs the calendar functions on the PC, an alarm automatically pops up a reminder of something the user intends to do. This automatic notification is the most helpful feature of the calendar application. The spell checker in MS Word provides advice as well as corrects errors, doing so ‘automatically’ while one writes, or ‘on demand’ after one finishes and then accesses the function. Similar Word features make suggestions about changing what has been done. The grammar checker is often accessed on demand to correct grammatical errors. It can also suggest sentence revision, which may be ignored. Many users access the help function in MS Word. However, for most people the automatic appearance of the help wizard (like an automated decision support alert) creates ‘reminder fatigue,’ which leads to it being disabled. Automated alerts therefore should be few and relevant. Users are more amenable to on demand information.

Challenges

CDSS challenges depend largely on how closely the system is tied to what the clinician already intends to do. Clinicians may initially want a set of clinical reminders, and after review assessments agree that they need some more. The timing of reminders is the Match with users’ Clinical examples Issues that need to be key issue after the user has intention required addressed agreed to be reminded. High Drug-to-drug Timing of the Questions like ‘should interactions; dosage reminders and alerts reminders for preventive calculators care pop up in advance of the patient visit or High Treatment guidelines; Information during the patient’s latest evidence base validation; who will update the knowledge visit’? are debated. Other base; speed and ease key user issues are speed of access and ease of access. Even though most clinical Low Critical drug-to-drug Timing; manner interactions of presentation; users recognise the need clinicians’ level of for information, they are control over response willing to access it only if

April 2011 I

IT@Healthcare it can be accessed without wasting time or effort. Difficult or time-consuming access drives away potential users from CDSS. The key issue in pointing out errors or suggesting that physicians change what they had planned to do for the patients is balancing the cliniciansâ&#x20AC;&#x2122; desire for autonomy with improving patient safety. A related issue revolves around how much control users have over the manner they respond to CDSS suggestions. This relates to whether clinicians are forced to accept the CDSS suggestion, the ease with which they can ignore it and the amount of effort needed to override the advice.

Benefits As EMRs join the mainstream, the base for truly achieving the advantages of electronically managed and recorded clinical workflow is put in place. There is really no meaning in creating electronic records without using the vast storehouse of digitally available clinical content to guide and enable truly evidence-based care. An oft quoted example in the West is the importance of prescribing Aspirin in the first 24 hours following acute myocardial infarction (AMI). Hospitals switching from paperbased systems to EMRs with CDSS (in this particular instance with a drug order set for AMI) saw their Aspirin prescribing rates go up from 30 per cent to more than 90 per cent. The system, by suggesting what is clearly established in the evidence base, was just preventing physician oversight, an all too common phenomenon in a busy emergency room. It is, however, relevant to note that for CDSS to achieve its stated purpose of improving patient outcomes, the system needs to be properly designed, carefully implemented and judiciously used. Systematic evaluations of processes of implementation, user satisfaction, and other factors that may affect the outcome of the intervention should be done by experts in the field. There is a need for qualitative evaluations of the physician-CDSS interaction and its impact on the clinician, the workflow, and other organisational processes and outcomes, in order to continuously refine the system and maximise its benefits. Several institutions in the West have treated CDSS as an out of the box system to deploy and use asit-is and suffered from poor usage and negligible benefits in the long run. Others who created a system of constant feedbacks and reviews guiding system redesign and iterations, created a strong culture of CDSS usage leading to improved safety and clinical outcomes. Last but not the least, hospitals must beware of sketchy systems, which depend on non-validated content and poorly designed logic and interaction engines. These systems can actually cause clinical harm, and already have entered the realm of accepted causes of iatrogenic injuries. (acmullick@gmail.com)

April 2011 I

Marketing Mantra

Achieving patient satisfaction

Its time to think out of the box! If hospitals and healthcare providers are assuming that new diagnostic techniques and state-of-the- art infrastructure can bring in the best quality of care and patient satisfaction, they might need to think again. In today’s world, a patient, as a customer, has several choices with regard to healthcare providers, and he may prefer those who provide him a delightful experience rather than a satisfactory and normal experience.

et me give you a secret for marketing of services. It is more about the experience and emotion than it is about the product and its features. Contrary to what I just said, many hospitals and doctors in India believe the reverse to be true. I constantly run into hospital promoters and doctors who brag about the latest equipment they have acquired and its features. They want to ‘differentiate’ their offering based on the tangible assets that they have. Seldom does anyone talk about the excellence in customer experience.

Vivek Shukla Principal - Healthcare Business Consulting, Vivek Shukla and Associates

I April 2011

The irony is reflected in a recent survey conducted in the US. The survey suggests that people choose one hospital or doctor over another based on how they are treated as human beings than any other parameters. In other words, the most important consideration for a patient to visit a hospital is the experience that he will get as a ‘person’. He is now turning into a customer who has expectations from the service provider. He is evaluating the hospital in his head all the time. He now has options. If his expectations are not met, he may go elsewhere and never come back again. Most hospitals have a feedback collection mechanism. I reckon that getting a feedback form filled is not enough. Here are some drawbacks of feedback forms:

The forms are not always filled by the patients. Sometimes the relatives who have come to pick them up at discharge time fill the forms. The forms are generally filled in a hurry as the person is looking forward to go home. The last few experiences that are a key to satisfaction to the patient are not captured in the feedback form. For example, which form captures the behaviour of the ambulance driver if the patient is dropped back in the hospital ambulance? Too often the staff of the hospital influences the patient and his family to get the form filled. The person who gets the form filled is not the same for every patient. Hence, the collection mechanism is not consistent. In large hospitals, some wings have more active feedback seekers than others. Hence, the feedback collection is skewed towards one part of the building. Another myth is that a satisfied customer is equal to a delighted customer. A satisfied customer is the one who has no complaints. But that does not mean that he is delighted with the services. A satisfied customer definitely does not mean that he is a loyal customer. Hence, mere compliance to standard operating procedures is necessary but insufficient in any hospital. There has to be an experience that customers can rave about. You need to give them a story to take home and talk about. When we talk of delight, we talk of going a step ahead of customer’s

Marketing Mantra expectations. For example, the customer may expect the receptionist to be soft-spoken, efficient and well-informed. This is satisfactory and to create customer delight, you will not only have to meet all the expectations, but also will have to provide at least something more.

Complexities Providing delight is a complex issue. Here are some intricacies you can master: Delight has to be created and experienced at the same time. The management cannot be present with the staff at all times. The staff has to be inspired enough to do it on their own as no single person or department is exclusively accountable for providing a great overall experience to the customer. Customer delight is hard to measure. Delight for one person may be just satisfaction for another. Customer satisfaction and delight are always progressive. Whatever is considered to be delightful by customers today, will be considered a simple norm a few years later. When most of the players start providing a service at a particular level of excellence, it becomes a norm and is expected by the consumer. Customer experience is culmination of a series of experiences. In the series, the first few and the last few experiences are more important. A series of good experiences can be undone by a long discharge procedure on the last day of the hospital stay.

Identifying the expectations To be a successful customer-oriented organisation, the hospital must look at the expectations that its customers have from the various ‘points of contacts’. A point of contact is the place or the department that a customer is likely to interact with while undergoing the experience of visiting a hospital. A few points of contacts are the security guard, doctor, receptionist, and lift man, while non-human points of contacts are the hospital brochure and air conditioning. The customer’s experience with each of the point of contact would culminate into a bright, dull or neutral experience at the hospital.

Customer delight as a strategy As said earlier, customer delight goes beyond filling up the customer feedback forms. It goes to the extent of calling them up after they have left your hospital. Moreover, it is not easy to replicate the Herculean effort of providing delight at every step of the service experience. You can certainly stand apart from the rest of the crowd if you are able to put the pieces in place before anyone else. As the Mayo brothers rightly put it ‘Interest of the patient is the only interest to be considered.’ Today, healthcare providers do need to ponder this and customer loyalty or customer delight-centric strategies must be followed. (vivekshukla2006@gmail.com)

April 2011 I

Facility Visit

Metropolis Healthcare Ltd

Benchmarking against the best With cut throat competition, Metropolis Healthcare Ltd knows how to set itself apart. Setting up one lab in each state of India and becoming a preferred partner to the Government are some of its aims. A look at the journey of the organisation and its growth plans. Chandreyee Bhaumik

rocessing over 12 million tests a year and catering to more than 10,000 laboratories, hospitals, nursing homes and 50,000 consultants, Metropolis Healthcare Ltd has earned the reputation of being one of the very few multinational chains of diagnostic centres. It has branches in the UAE, Sri Lanka, Mauritius, Bangladesh, Nepal and South Africa.

Journey so far Since its inception in 1981 as a

I April 2011

Mumbai-based laboratory, Metropolis has come a long way. Visionary leadership, strategic associations with other leading laboratories across the country, strict ethical policies and a penchant for technology are some of the attributes that contribute in making Metropolis one of the largest laboratory chains in the country. Accreditations such as International Organization for Standardization (ISO), National Accreditation Board for Testing and Calibration Laboratories (NABL),

College of American Pathologists (CAP) reiterate the fact that stringent national and international quality requirements are met. This is indeed imperative in a service sector like healthcare. A wide network with 500 collection centres proves the excellence and the commitment of the organisation. It pledges to deliver accurate and timely results across the 4500 routine, specialised and highly specialised investigations that use technologies including Biochip and DNA sequencing.

Facility Visit Further, innovations like Home Health Services help the company to reach out to immobile/weak patients so that going for a check-up or routine or mandatory test is no longer an inconvenience for them. Elaborating on the strength of the company, Ameera Shah, Managing Director and CEO, Metropolis Healthcare Ltd, says, “We provide a completely different experience to our clients as we comply with global standards and not just national. We are in fact the benchmark for several other companies.”

Way it is For any enterprise to survive on the speedy track inhibited with competition, following a business plan is extremely essential. Metropolis located at Worli, Mumbai is the main referral lab. Discussing the business model of the company, Dr Nisha Sana Ahmad, Chief of Lab Services & General Manager Haematology & Haematostatis, Metropolis Group-National, elaborates, “We now have a standalone lab at Churchgate where lab testing is done. This lab caters to South Mumbai. Routine tests are also conducted at the Churchgate laboratory and the specialised ones at the Worli branch. In about one month, we will also be establishing another lab in Thane.” At Metropolis, upgradation of technology is a continuous process. The lab ensures best practices and works with awareness drives and health checkup camps. As, Dr Ahmad avers, “With time we can see an increasing concern in the arena of diagnostics. Since we live in a developing country, the progress has not reached its apex. In India, there are primarily two types of diagnostics. One type takes care of the prevention side of the process, while the other type encompasses the patients when they are actually suffering.” The capability of Metropolis to carry out health check-ups and testing across large geographies ensures that companies/corporate customers or individual customers can be assured of consistent results. The company

There is growing awareness in healthcare, and in the next five years we would be the leading player. Ameera Shah Managing Director and CEO, Metropolis Healthcare Ltd

considers that in the battle against diseases, diagnosis is the first step. The services extended by the company include clinical laboratory medicine, radiology and imaging services, hospital laboratory management, central laboratory services for clinical trials, site management services, home health services, preventive health check-ups and remote pathology testing services.

Vision The company aims to become the global network of highly automated and sophisticated diagnostic laboratories along with cutting-edge technology, accuracy, efficiency, unparalleled customer service and above all a stringent ethical code. Dr Ahmad clarifies, “In this organisation quality is given prime importance. Several accreditations that we have attained help us in maintaining our standards.” Elaborating on this line of thought, she adds, “Another essential requisite in our company is the consultation factor. We do not just receive samples and give reports but also talk to doctors, and arrange consultations

with them.” Discussing the present areas of concentration, Dr Ahmad says, “At present, we are focussing on the way to change mercury thermometers into non-mercury ones.” Metropolis hopes to become one of the most preferred partners for the Government of India with plans to set up at least one lab in each state. This would help in developing a platform to learn and share knowledge. It is not just the national supremacy that matters but the company also desires to position itself among the top three dominant players in South East Asia, Middle East and South Africa.

Hygiene: A prime concern Being a pathological laboratory, hygiene is a prime concern. There is an assigned safety officer, who has to conduct regular programmes in this regard. If there are any blood spills, needle pricks then immediate action is taken so that hygiene is not compromised. Further, a physiotherapist is appointed who takes care of ergonomics ensuring that correct posture is maintained while an

Referral lab at Metropolis

April 2011 I

Facility Visit employee is working at the computer. Further, the officer also sees that in the refrigerators that are only meant to store samples or required solutions food and drinks are not kept. Again, double gloves are worn - one is used for handling the samples and the other is while performing other chores like Lab technicians at work working on the computer. Further, it is also ensured that the person wearing gloves is not allergic to gloves because this might cause harm to the samples under consideration. Also, if a person has any contagious disease, care is also taken in that respect. Dr Ahmad reiterates, “We conduct sputum tests every month to see that the staff dealing with the samples is not infected.”

Money matters Commenting on the investment pattern for the company, Dr Ahmad says, “Investment is not uniform in all the sectors. We primarily have three types of equipment - major equipment, minor equipment and miscellaneous equipment. Most of the major equipment are either bought or rented or on generally it is a ratio of 50:50. Again, minor equipment like centrifuges, incubators are usually bought. The last category, which includes equipments like glasswares, also involve buying. Elaborating on the Return on Investment (ROI) Shah elaborates, “From the gross income, we reinvest ` 30 - 40 crore to our business.”

What sets them apart? Like every aspect Metropolis also has its own share of problems. Ameera clarifies, “Today there are several smalland medium-sized companies in this line, and thus there are at times dearth of proper talent and technology.” She continues, “Since there is growing awareness in healthcare, in the next five years we would be the leading player.” It is the positive vibes of the company that sets it apart from the rest on the same track. Dr Ahmad signs off saying, “When somebody gives us negative feedback we take it positively. We do not consider it as complaint. We feel that it is an opportunity to improve. The tests are then given to the neutral body of quality assurance department. Sometimes the complaint is not valid, but in the process lot of things, which are learnt are considered more important.” Thus, learning from mistakes definitely marks the difference. (chandreyee.bhaumik@infomedia18.in)

I April 2011

Events Calendar

NATIONAL International Congress on Patient Safety

medical products & systems in India. The event aims to take a step forward in contributing to the quality of healthcare.

The event aims to throw light on patient safety priorities in healthcare. It will discuss best practices in patient safety, role of clinicians in patient safety, insurance perspective in patient safety, role of Information Technology (IT) in patient safety, culture of patient safety, communication for patient safety & medical errors and many others.

Date: July 2-4, 2011 Venue: Palace Grounds, Bengaluru Organiser: Orbitz Exhibitions Pvt Ltd Tel: + 91 22 2410 2801/02/03/04 Fax: + 91 22 2410 2805 Email: info@meditec-clinika.com Website: www.meditec-clinika.com

Date: April 21-22, 2011 Venue: Hyderabad International Convention Center, Hyderabad Organiser: Apollo Hospitals, Johnson & Johnson, Philips Tel: + 91 40 2360 7777 Fax : +91 40 2360 8050 Email: patientsft@gmail.com Website: www.patientsafety.co.in

Healthex 2011 Healthex 2011 is an international exhibition on hospital, medical and surgical equipment, materials, supplies and allied services, which aims to showcase the latest innovations in the field of medical technology to the medical experts from all over the country and abroad.

Hospital Management Conference 2011 Hospital Management Conference (HMC) is a research based content driven conference programme that aims to bring up-to-date worldwide hospital management thinking and experience to senior hospital and healthcare managers in India. There will be case studies; interactive panel discussions on trends, challenges, solutions and technologies that will help keep the industry in line with current and future progress.

Date: May 27-28, 2011 Venue: Hotel The Westin, Mumbai Organiser: UBM Medica Tel: + 91 9819166942 Email: shalu.chopra@ubm.com Website: www.hmcindia.in

Meditec Clinika 2011 Meditec Clinika is the third international trade fair for medical equipment and technology showcasing innovative

RUDRAPUR: Uttarakhand, Sept 23-26, 2011, Gandhi Park AHMEDABAD: Gujarat, Nov 14-17, 2011, Gujarat University Exhibition Hall PUNE: Maharastra, Nov 18-21, 2011, Auto Cluster Exhibition Centre

Date: August 5-7, 2011 Venue: Bangalore International Exhibition Centre, Bengaluru Organiser: Bangalore International Exhibition Services Pvt Ltd Tel: + 91 80 65833234 Email: suresh@bies.co.in Website: www.healthex.co.in

Seventh Medicall The event aims to attract the healthcare industry exhibiting a wide range of products including hospital equipment, surgical equipment, rescue and emergency equipment, facility management and support services.

CHENNAI : Tamil Nadu, Dec 16-19, 2011, Chennai Trade Centre INDORE: Madhya Pradesh, Jan 6-9, 2012, Poddar Plaza, Nr Gandhi Hall AURANGABAD: Maharashtra, Feb 17-20, 2012, Garware Stadium India’s premier industrial trade fair on products and technologies related to Machine Tools, Hydraulics & Pneumactics, Process Machinery & Equipment, Automation Instrumentation, Packaging & Auxiliaries, IT Products, Electrical & Electronics, Material Handling and Safety Equipment.

For details Infomedia 18 Ltd, Ruby House, 1st Floor, J K Sawant Marg, Dadar (W), Mumbai 400 028. • Tel: 022 3003 4651 • Fax: 022 3003 4499 • Email: engexpo@infomedia18.in

Date: August 6-8, 2011 Venue: Chennai Trade and Exhibition Centre, Chennai Organiser: MedExpert Tel: + 91 9840326020 Email: medexpert@medicall.in Website: www.medicall.in

April 2011 I

Events Calendar

INTERNATIONAL China International Medical Equipment Fair An international exhibition that will serve the entire value chain for the medical device market. The event aims to exhibit a wide range of medical image devices, medical electronics equipment, surgical devices, ambulence and medical vehicles, outsourcing services, medical optical devices and many others. Date: April 16-19, 2011 Venue: Shenzhen Convention & Exhibition Center, China

Organiser: Reed Sinopharm Exhibitions Tel: +86 10 8455 6695 Fax:+86 10 8202 2922 Email: jin.liu2@reedsinopharm.com Website: www.en.reed-sinopharm.com

World Vaccine Congress Washington 2011 An international exhibition of the vaccine products industry to showcase modern vaccine technologies. The exhibitor profile would include analytical instruments, labware, excipients, equipment, etc. Professionals from the pharma and biotech industry, sales and marketing personnel, technology delivery manufacturers and members of the higher management are expected to attend this event.

and also translate & transmit new knowledge & information to doctors and allied health professionals. The event will also conduct interactive sessions. Date: April 14-17, 2011 Venue: Suntec, Singapore Organiser: The Meeting Lab, Congress Secretariat Tel: + 65 6346 4402 Fax: + 65 6346 4403 Email: info@apc2011.com.sg Website: www.apc2011.com.sg

REHAMEDEXPO 2011 An international specialised exhibition showcasing modern rehabilitation technologies for remedial treatment. An array of diagnostic equipment, medical technology, IT equipment, etc, will be displayed at the exhibition. Professionals and consultants from the healthcare, health insurance, medical sciences, medical software systems, etc, are expected to attend this event. Date: April 25-28, 2011 Venue: EcoCenter Sokolniki, Russia Organiser: MVK - International Exhibition Company Tel: +7 495 995 05 95 Email: info@mvk.ru Website: www.mvk.ru

Date: April 11-14, 2011 Venue: Gaylord National Hotel and Convention Center, Washington DC, USA

IHE USA 2011

14th ASEAN Paediatric Congress

This event aims to be an ideal platform for companies and associations specialising in healthcare and medical industry and all other related industries to showcase and exhibit their products and expertise all under one roof. The trade show will offer its exhibitors an excellent opportunity to increase their brand awareness and promotion.

The 14th ASEAN Paediatric Congress and the 3rd ASIAN Paediatric Otolaryngology meeting will concentrate on topics like trends, issues, priorities in paediatrics

Date: May 10-12, 2011 Venue: Charlotte Convention Center, Charlotte NC, USA

Organiser: Terrapinn Pte Ltd Tel: +61 2 9005 0700 Fax: +61 2 9281 3950 Email: enquiry.au@terrapinn.com Website: www.terrapinn.com

Organiser: Arosa Exhibitions Ltd Tel: +1 980 219 8449 Fax: +1 980 219 8449 Email: gviniconis@arosa-group.com Website: www.arosa-exhibitions.com

FIME International Medical Expo An international exhibition that aims to showcase allergy products, biopsy needles, cardiology equipment, blood pressure equipment, blood bags and many other things. The event hopes to attract buyers and sellers from all over the world. Date: August 10-12, 2011 Venue:Miami Beach Convention Center, Miami, USA Organiser: FIME International Medical Exposition, Inc. Tel: +1 941 3662554 Fax: +1 941 3669861 Website: www.fimeshow.com

BioProcess International China BioProcess International China will be organising its 3rd annual event and will focus on topics like Cell culture, cell line engineering, purification and recovery, process charaterisation, process analytics, formulations and disposables technologies which will be presented by top notch scientists and executives from all around the world. The objective of the event is to provide China and the regional countries with high quality presentations, case studies and strategies that will help the regionâ&#x20AC;&#x2122;s burgeoning bioprocessing and manufacturing industries achieve their potential faster and more efficiently. Date: August 22-24, 2011 Venue: Grand Hyatt Hotel, Shanghai, China Organiser: IBC Life Sciences Tel: + 816 472 0701 Fax: + 65 6508 2407 Email: mlangley@ibcusa.com Website: www.ibclifesciences.com/ BPIChina/overview.xml

The information published in this section is as per the details furnished by the respective organiser. In any case, it does not represent the views of 64

I April 2011

Report

MEDICAL FAIR INDIA, 2011

A showcase of talent and technology The 17th edition of the Medical Fair India, held at New Delhi, witnessed wide participation from both domestic and international players, but the event this year was a low key profile.

A glimpse of the exhibition

Anwesh Koley

ith healthcare spending expected to rise by 12 per cent per annum and contributing significantly to service sector growth trajectory for India, MEDICAL FAIR INDIA 2011, was expected to generate a huge response from the medical fraternity. And it did just that. Over 260 exhibitors from 15 countries across the globe participating in the fair, this business-to-business event proved a strong interactive platform for the medical industry. Industry estimates suggest that by the year 2015, total spending by the Indian healthcare industry could contribute around 8 per cent of Gross Domestic Product (GDP) and would employ around 9 million people. This warrants a steady growth for the medical equipment companies both domestic and international players willing to set base in India. Events like Medical Fair India provide just the opportunity

for medical practitioners and companies to showcase their latest in technology and also to increase their client base.

Opinion bag Speaking about the event, Sarabjit Singh, Director, ARVS Equipments Pvt Ltd, said, “The response from the event was good and we have been getting queries from prospective clients after the event. The event was well organised but we would have preferred a different time of the year. However, the venue at Pragati Maidan was perfect as it is right at the centre of the city, so it makes our work easier to get clients to visit us,” he added. While there were participants from across the country, international exhibitors came from China, Taiwan, Korea and France to name a few. “The number of international exhibitors was substantial and it was heartening to see new technology and ideas being displayed at the fair. However,

we would have liked to have exhibitors from a broader ambit of the medical fraternity; the overall response to the event was good,” said Vinod Kumar Sekar, Executive Director, Green Sol Synergies Pvt Ltd. “The opportunity was great and being the largest medical fair in the subcontinent region, many domestic as well as international players in the medical domain showcased their products,” he added. The medical equipment industry in India has witnessed a flurry of companies from across the globe into India with high-tech products, which has witnessed high demand from hospitals and healthcare institutes. This year’s Medical Fair provided an opportunity for healthcare equipment companies to display their products in the heart of the city. “The fair was a good opportunity for us to find a platform where we can make business,” said Kumar Prashant, Director, Entrack Corporation.

What’s next? While the fair had a lot of positives , there were a few areas which exhibitors felt could have been taken care of. Like, the timing of the event clashed with the annual closing for companies; hence, many of them could not turn up for the fair. “Events such as these should not be held on weekends. I have been attending the Medical Fair for the past five years and can say that a slot during the weekdays would have surely garnered more response,” opined Prashant. The next edition of MEDICAL FAIR will be held from March 2-4, 2012 in Mumbai. (anwesh.koley@infomedia18.in)

April 2011 I

Report

CII’s conference on Public Private Partnership Policy Framework

Way forward for delivering quality healthcare Chanting this mantra the Confederation of Indian Industry (CII) held a conference on Public Private Partnership (PPP) policy framework . The event witnessed a plethora of participants.

Shri Jaynarayan N Vyas, addressing the gathering. (From L to R): Prof (Dr) K V Ramani, Atul Garg, Chairman, CII Gujarat State Council & COO, InteQ IT Services (India) Pvt Ltd; Anju Sharma, Commissioner of Health, Secretary - Public Health & Mission Director, National Rural Health Mission, Government of Gujarat; Dr Vivek Desai, Chairman, CII, WR Healthcare Sub-Committee & MD, Hosmac India Pvt Ltd; Sumita Chakravarty, Deputy Director, CII.

II held its Western region PPP policy framework conference at Ahmedabad recently. It was organised with the objective of bringing all stakeholders on a common platform, and learn and observe certain successful PPP case studies and discuss about the various financial, administrative and legal aspects of the policy. PPP is an important avenue through which certain unmet needs can be met for the healthcare industry. Long-term sustainable partnerships are far and few in this sector, and there is a need for clear and controversy-free guidelines to formulate PPP.

I April 2011

The conference had several lead speakers and most of them highlighted the scenario of PPP and Gujarat with regards to healthcare.

Collaborate to grow In the same vein, speaking on the developments in Gujarat, Jay Narayan Vyas, Minister for Health & Family Welfare, Tourism, Devasthan Pilgrimage Development, said, “Gujarat will lead in the PPP model of healthcare.” He mentioned U N Mehta Cardiology Centre, Institute of Kidney Diseases and the Gujarat Cancer Research Institute as the success stories of the PPP model of Gujarat. The Minister complimented CII in bringing this discussion forum to Gujarat, the most happening state

for PPPs. He also released a white paper on ‘Partnerships in Healthcare: A Public Private Perspective.’ The gap in demand and supply was pointed out by Atul Garg, Chairman CII Gujarat State Council. He mentioned that the major challenge that India is facing is in expanding the demand and supply gap as there is low utilisation of hospital infrastructure and less number of medical professionals. In his introductory remarks, Dr Vivek Desai, Chairman, CII Western Region Healthcare Sub-Committee, said CII is the first to spot the very silent revolution on PPP that is happening in Gujarat. He categorically mentioned that the success of PPP model depends on the contract, which happens between three parties. Economic and financial sustainability of PPP is vital as most of the PPP projects in the healthcare sector have long gestation periods. The conference also had elite speakers from the academic front. Dr K V Ramani, Professor, Public Systems Group, Center for Management of Health Services, IIM Ahmedabad described how the combination of the expertise of private sector and facilities from the Government can deliver better services to the community as and when they need. He gave details of the Vasna Urban Health Centre in Ahmedabad as a model for the PPP. Overall, the conference received an overwhelming response. It did achieve the set objectives and the speakers showed hope for PPP policy adoption for meeting the unmet needs of the healthcare industry. (mmedit@infomedia18.in)

Product Update This section offers an overview of the latest medical/surgical equipment available in the worldwide market. If you wish to have your products featured in this section, send us the details at mmedit@infomedia18.in. Also gain added advantage through our ‘Product index’ and ‘Advertiser’s list’ to facilitate your business.

NATIONAL

0°C to 32°C. Forced air circulation system provided with this refrigerator ensures temperature uniformity.

Medical refrigerator Sigmatech Scientific Products offers Sigmazk medical refrigerator with glass door manufactured by Zhongke Meiling Cryogenics Limited Company, China. The medical refrigerator is specialised refrigerating equipment for cold storage of pharmaceuticals as well as biological products. It is suitable for hospitals, drugstore, pharmaceutical factories, biotech companies, research centres and many more. This medical refrigerator is provided with microprocessor-based temperature control system; combined with two sensors monitoring the chamber temperature and one sensor monitoring the ambient temperature. A stable and accurate chamber temperature can be maintained at ambient temperature ranging from

Sigmatech Scientific Products - Hyderabad Andhra Pradesh Tel: 040 - 6453 4491, 098496 32904, Fax: 040-4003 1896 Email: s_tech07@yahoo.com

Endocervical brush Global Surgimed Industries offers Endocervical brush. This is used for cervical papanicolaou (Pap) smear screening. Plastic spatula is also available. Wooden as well as plastic spatula have smooth edges. The pack consists of brush and wooden spatula. Each set is individually packed in medical paper pouch pack and is sterilized by Ethylene oxide (EO) gas. Stainless steel spatula with plastic handle is also available. Global Surgimed Industries - New Delhi Tel: 011-2748 0250 Email: gulshan1966@hotmail.com

April 2011 I

Product Update Lamp Saga Enviro offers lamps by DR Fischer. These lamps are used in the medical sector, for medical instruments and products. Operation Theatre (OT) lamps, lamps for the dental sector and analytical equipment make very high demands on precision and safety. Even the smallest amounts can be precisely tailored to the particular needs of the customer and handmade. The lamps are used in domestic appliances, refrigerator, microwave & ovens. The company also offers Industrial Infrared (IR) lamps for plastic blow moulding machines, textiles coating & laminating, printing, semiconductor & general heating.

cost on power consumption, cooling water consumption, hydraulic oil elimination, even housekeeping and maintenance cost. It will increase up time and decrease material wastage. Total annual saving of 100 ton electric IMM will be around R 6.5 lakh/year over 100 ton hydraulic IMM. Neejtech India - Ahmedabad - Gujarat Tel: 079-2656 1312, Mob: 09825040231 Email: sales@neejtech.com

Baby incubator

Global Surgimed Industries offers swab sticks. These are made of balsa wood, sanded and polished with finely rolled compacted cotton at one end. It has a smooth surface. It has no smell, no splints and no water lines. This is used daily for cleaning and wakeup in medical field. Swab stick is available in unsterile form in 100 pcs packing. This is also available in individually packed Ethylene oxide (EO) sterilised form.

V-Care offers model ‘V-150’ baby incubator, which comprises skin and air control system as well as digital display system to set the required temperature, and to measure canopy’s and infant temperature. To indicate the heater output, there is a bar graph LED system and these built-in features assure easy operation. In the model ‘V-180’ baby incubator a digital microprocessor is incorporated, whose function is to control and check all important functions. These incubators are used to measure infant temperature & air temperature and to set the required temperature. It is provided with a digital display system. These micro-computerised systems have large and brighter displays for easy monitoring and viewing from a distance. Fault indications are provided with alarm, for air probe failure, baby probe failure, 1° C temperature low and high, high temperature cut-off, power failure, etc.

Global Surgimed Industries - New Delhi Tel: 011-2748 0250 Email: gulshan1966@hotmail.com

V-Care - Bengaluru - Karnataka Tel: 80-2311 0651-52/2350 6047, Fax: 80-2311 0645 Email: sales@vcaremed.com

Electric injection moulding machine

Laser-based tool setting system

Neejtech India offers electrical horizontal injection moulding machines from Niigata in Japan. The machine ranges from 30 to 1000 ton & vertical IMM ranges from 30 to 150 ton. All electric machines are generally known as green machine because it saves more than 60 per cent power consumption than similar size hydraulic/toggle machine. The machine is absolutely free from oil and does not create pollution. Due to no oil use it reduces maintenance and repair cost of hydraulic system. It ensures enhanced accuracy, reliability, and also provides great cost savings and contributes to environmental preservation. The machine is ideally suitable for medical, automotive, pharmaceutical-healthcare and packaging molding segment of industry. It runs quietly & without vibrations. It is very precise due to no deviation through oil viscosity, compressibility, through drifting hydraulic valve action time. By switching over from hydraulic to electric injection moulding machines one can save greater

Blum Novotest Measuring & Testing Technology offers laser-based tool setting system for CNC machine tools. Blum laser control NT uses their patented NT Technology for the measurement, which provides positive and accurate measurement and breakage detection of tools. The measurement using NT technology does not get influenced by the falling coolant & chips. Blum lasers use focused beam instead of parallel beam using additional optics to facilitate precise measurement of even small tools. These are used in die & mould industry for accurate measurement of tool length, radius, controlling the form of the tool, etc.

Saga Enviro Pvt Ltd - Secunderabad - Andhra Pradesh Tel: 040 27713 368, Fax: 040 2771 1410 Email: drfischer@vedgroup.net/ vedintl@vedgroup.net

Swab stick

I April 2011

Blum Novotest Measuring & Testing Technology Pvt Ltd - Bengaluru - Karnataka Phone +91 93421 06498/ +91 93421 06499 Email: info@blum-novotest.com

Product Update IHC/ISH staining system Biogenex Life Sciences Pvt Ltd offers ‘Xmatrx Diagnostics’ fully automated IHC/ISH staining system with ready-to-use factory protocols and provision for user protocols. Its key technology includes 40 independently controlled thermo-cyclable slide stations with provision of individual slide loading and unloading. Here, temperature can be controlled from ambient temperature to 105°C in less than two minutes irrespective of laboratory conditions. It is designed to automate all the steps in molecular diagnostic technology and also has provision for any future technologies. The reaction micro-chambers on slide enable less reagent consumption with volumes as low as 30 µl. Disposable pipette tips used for reagent disposal eliminates cross contamination. Inventory management of the reagent is made easy due to RFID reagent vials and powerful software. Its report generation capability with bi-directional connectivity makes it ready for regulatory requirements like record keeping for number of assays, run log, reagent usage, etc. Biogenex Life Sciences Pvt Ltd - Hyderabad Andhra Pradesh Tel: 040-2718 5500, Fax: 040-27185511 Email: sales.support@biogenex.com

Oxygen concentrator Moditech offers oxygen concentrator with NASA-derived rapid pressure swing adsorption technology. It comes with oxygen purity indicators and in-built pulse oximeter for SPO2 monitoring. The features of this concentrator include purity of oxygen, which conforms to medical standard, requires only air, low power consumption with uninterrupted flow of oxygen, crush-proof tubing, etc. This oxygen concentrator is provided with adjustable flow meter with 0.5 lpm variation and has in-built devices for nebulising therapy. The builtin temperature control is provided for working at very low climate. It is used for respiratory diseases such as chronic bronchitis, bronchial asthma, emphysema, pulmonary heart disease and may more. It is also used in cardiocerebral vascular diseases, such as high blood pressure, arteriosclerosis, coronary heart disease, myocardial infarction, heart rate disorder, etc. Moditech International - Chandigarh Tel: 0172-271131, Telefax: 0172-508 5177 Email: info@medoxy.net

I April 2011

Product Update Resuscitation unit D4Surgicals India offers resuscitation unit. The double digital display system is provided to measure the infant temperature and to set the required temperature. The large bright displays are easy to monitor and can be viewed from a distance. The bar graph LED system is provided to indicate the heater output. It comes with single element imported CE marked ceramic heater placed in a parabolic reflector. The large baby tray is made of stainless steel frame with three side acrylic collapsible walls. This resuscitation unit comes with IV stand, observation lamp, self-test system, trendelenburg/fowler system, feather touch keys and monitor tray. It is available in servo and manual modes. D4Surgicals (India) Pvt Ltd - Mumbai - Maharashtra Tel: 022-6523 5614, Fax: 022-2878 17 83 Email: info@d4surgicals.com

Autoclave Narang Medical offers autoclave pressure steam steriliser. This portable vertical autoclaves are made out of thick high-quality (14 gauge) stainless steel sheet, deep drawn to cylindrical shape, without joints and welding. The seamless construction does not allow bacteria residue and is free from dirt accumulation. It is fitted with pressure gauge, safety valve (weight type), seam/pressure release cock and lid handle. The lid is similar to pressure cooker with locking over rubber gasket. The company also offers autoclaves made of 10 gauge aluminium. The drum is deep drawn & the ring on top is riveted. The lid is made by casting. The locking of lid is done by six nuts with rubber gasket seal in between. This autoclave consists of two safety valves, pressure gauge, flexible metal rubbing, outer stand, inner aluminium container, inner tripod stand, etc. Narang Medical Ltd - New Delhi Tel: 011-4555 4000 (100 Lines), Fax: 011-4555 4001 Email: NET@narang.com

April 2011 I

Product Update LED photo therapy unit nice Neotech Medical Systems offers the â&#x20AC;&#x2DC;Sapphire 4000â&#x20AC;&#x2122; LED-based photo therapy system. This is designed to meet both the NICU and Well Baby Nursery. This design eliminates a big & gauche box of the fluorescent and halogen lamp type of photo therapy. This unit is designed specifically to overcome the drawbacks including low irradiance levels, temperature rising and scattered, and unfocussed coverage. This photo therapy system follows the international standard. A microprocessor system is provided to control the irradiance of the LED, treatment time and lamp usage hours. The system delivers up to 94 MW of penetrating light directly to the babyâ&#x20AC;&#x2122;s skin for effective jaundice management. This unit does not emit UV rays, but only blue rays to reduce the potential risk of skin damage. It also does not emit IR rays, but only cold light rays to reduce the potential risk of fluid loss. The unit is light in weight, easy to handle and suitable for all types of incubators, radiant warmers and cradles. Alphanumeric display is provided to ensure simultaneous monitoring of lamp usage hours, treatment hours, lamp power output and real-time/date. nice Neotech Medical Systems Pvt Ltd Chennai - Tamil Nadu Tel: 044-2476 4608, Fax: 044-24762594 Email: marketing@niceneotech.com

Anaesthesia machine Ashwani Diagnostics offers anaesthesia machine with square tubular electrostatic powder-coated steel sections. The ring top tray is for monitor. The table top is made of stainless steel. It comes with one large storage drawer and gas-specific yokes for gauges with claming bars. The machine is provided with large-diameter antistatic castors with brakes for mobility. It contains two pressure gauges for oxygen and nitrous oxide. The non-return cum pressure release valve minimises risk of back flow of gases. It is provided with oxygen failure warning device and flowmeter. Space for three vapourisers is provided as standard. Emergency oxygen flush outlet button is provided at table level and a changeover unit is provided for open or close circuit. The standard accessories include one/two built-in oxygen outlets (422 kPa) for driving ventilators, extended rear platform for two 10-ltr water capacity cylinders and facemask for adult & paediatric use. Ashwani Diagnostics - New Delhi Tel: 011-2209 0997, 2027 9390, Fax: 011-2209 4144 Mob: 097170 98703 Email: ademco@vsnl.com

I April 2011

Product Update

INTERNATIONAL

Disposable probes

APC Cardiovascular offers ‘Model 4170’ single chamber temporary cardiac pacemaker. It is designed to operate in either demand or asynchronous modes. The Model 4170 includes continuously variable rate, output & sensing controls and also has the added feature of a separate high-rate control to provide rapid stimulation capability from 60 ppm to 800 ppm. The unit is housed in a durable metal case with a fixed attachment for bedrail mounting. The company also offers dual-chamber pacing analyser, in which all modes, parameters & test functions are directly accessible by key press and the test results are displayed continuously on the LCD, one channel at a time to avoid confusion. Its key feature include 12 sets of test results that can be held in memory, identified by patient ID, and may be printed via infrared connection to the optional model 4850 IR Link™ printer.

Keeler offers single-use disposable probes for its cryomatic cryogenic surgery unit. These disposable probes are used with a disposable adaptor for single surgery use or as a backup for high-performance reusable probes. Important features of these probes include the following: it does not require cleaning or sterilisation, single use eliminates the possibility of cross infection or tip blockages due to dust and debris, saves time and ensures surgical reliability. The company’s cryomatic is engineered to create a simple-to-use system with a reliable freeze. The intuitive console automatically configures itself according to the probe’s characteristics, removing the need for manual set up. To simplify the set up pre-surgery procedures, the gas pressure is automatically set by the console for carbon dioxide (CO2) or nitrous oxide (N2O). The control console provides clear, digital readouts of probe activity, temperature, time elapsed and gas pressure. Probe operation is controlled by a footswitch, leaving the user’s hands free at all times. The whole system is quick and easy to set up, a major advantage if experienced staff are not always available.

APC Cardiovascular Ltd - Cheshire - UK Tel: +44-0-1270 216 142, Fax: +44-0-1270 216 251 Email: info@apc-cardiovascular.co.uk

Keeler Ltd - Windsor - UK Tel: +44-1753 857 177, Fax: +44-1753 827 145 Email: info@keeler.co.uk

Nuclear magnetic resonance spectrometer

CPAP mask

Cole-Parmer offers picoSpin™ Benchtop Nuclear Magnetic Resonance (NMR) spectrometer. This is an innovative and disruptive technology that combines low price and a compact foot print, with true spectroscopic capability. This device is a complete liquidphase proton NMR system, including permanent magnet, transmitter, receiver, data acquisition, programmable pulse sequencer, Ethernet interface, and intuitive web-based control software. As a breakthrough technology, it has already garnered the attention of the scientific community. NMR is the most powerful analytical tool in chemistry. One can deploy multiple units within a factory to continuously monitor process fluids and control them all from a web browser anywhere in the world. The students can experience NMR hands-on in chemistry lab courses and in their research projects.

Besmed Health Business Corp offers CPAP mask, which is a flexible, onepiece silicone forehead pad. It conforms to the contour of the forehead to provide comfort and stability during use. Due to its unique and patented adjust forehead design, it increases the flexibility and comfort for different patients. Double-layer cushion optimises seal and minimises pressure on the nose. It is provided with quick-release clips, which allow for easy removal of the headgear and eliminate the need of adjustment. The swivel and 360° elbow rotation connector enables easy attachment and disconnection to air tube and provides flexibility of tubing position.

Cardiac pacemaker

Cole-Parmer - Vernon Hills - USA Tel: 847-327-5886, Fax: 847-327-2983 Email: bdumey@coleparmer.com

Besmed Health Business Corp - Taipei - Taiwan Tel: +886-2-2290 3959, Fax: +886-2-2299 9076 Email: info@besmed.com The information published in this section is as per the details furnished by the respective manufacturer/distributor. In any case, it does not represent the views of

April 2011 I

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April 2011 I

I April 2011

Product Index

To know more about the products in this magazine, refer to our â&#x20AC;&#x2DC;Product Indexâ&#x20AC;&#x2122; or write to us at mmedit@infomedia18.in or call us at +91-22-3003 4684 or fax us at +91-22-3003 4499 and we will send your enquiries to the advertisers directly to help you source better. Sl No Product

Pg No Sl No Product

Pg No

Adult/paediatric transport ventilator...... 15

Disinfectant product .................................... 25

Halogen light....................Back Inside Cover

Alcohol swab................................................. 75

Disposable plastic glove............................... 75

HIV aids kit................................................... 75

Anaesthesia machine..............................72, 76

Disposable probes......................................... 73

Hospital bed.................................................. 86

Anaesthesia system ........................Back Cover

Doppler.......................................................... 63

Hospital consultancy.................................... 71

Analyser ........................................................... 3

Dual surface phototherapy.......................... 74

Hospital curtain.............................................. 5

Aspirator ........................................................ 86

Dual syringe infusion pump....................... 15

Hospital furniture...................................23, 67

Audio/video mounting system ..................... 9

ECG .............................................................. 63

Hospital furniture & accessories................. 71

Audio-visual auscultation device................ 63

ECG accessories ............................................ 74

Hospital furniture/OT equipment ............. 35

Autoclave........................................................ 71

ECG machine................................................ 75

Hospital information sytem........................ 71

Baby incubator ........................................... 68

ECG paper roll.............................................. 74

ICU bed........................................................ 67

Barcode patient ID band ............................. 62

Electric injection moulding machine......... 68

IHC/ ISH staining system ........................... 70

Bed-side phototherapy................................. 74

Electrode gel.................................................. 74 66

Imported cardiac OT table.......................... 69

Biodegradable bag ........................................ 75

Electrolyte analyser....................................... 27 67

Imported general surgery OT table............ 69

Bipnasic defibrillator.................................... 15

Electronic patient recorderFront Inside Cover 68

Imported hospital furniture / equipment . 86

Blood glucometer ......................................... 45

EMR ...................................Front Inside Cover 69

Imported laparoscopy OT table ................. 69

Blood pressure monitor............................... 45

Endocervical brush....................................... 67 70

Imported LED light...................................... 69

Blood pressure recorder............................... 15

Engineered woodfloor ................................. 29

Caps non-woven ......................................... 75

Exhibition - Healthex 2011 ......................... 22

Imported neurosurgery OT table............... 69

Cardiac pacemaker ....................................... 73

Exhibition - Medicall 2011.......................... 50

Imported orthopaedics OT table................ 69

Central gas pipe line accessories................. 76

Exhibition - Meditec Clinika 2011............. 54

Imported OT light........................................ 69

Coagulometer................................................ 27

Face mask .................................................... 75

Intensive care ventilator............................... 15

Colour doppler ............................................. 75

Foetal monitor ........................................15, 63

Kaematology analyser................................ 27

Cord clamp.................................................... 75

Fixer................................................................ 74

Labels ........................................................... 62

CPAP mask.................................................... 73

Fogging machine .......................................... 74

Laminate floor .............................................. 29

Custom fabrication......................................... 9

Fully automatic biochemistry analyser...... 27

Lamp .............................................................. 68

Desktop pulse oximeter............................. 15

Fumigation .................................................... 74

Lancet steel/ plastic needle .......................... 75

Diagnostic equipment.................................. 27

Gynaec examination coach ....................... 67

Laser-based tool setting system................... 68

I April 2011

An invite that rewards as well...

Dear Reader, ‘Modern Medicare’ solicits original, well-written, application-oriented, unpublished articles that reflect your valuable experience and expertise in the pharmaceutical industry. You can send us Technical Articles, Case Studies and Product Write-ups. The length of the article should not exceed 2000 words, while that of a product write-up should not exceed 200 words. The articles should preferably reach us in soft copy (either E-mail or a CD). The text should be in MS Word format and images in 300 DPI resolution & JPG format. The final decision regarding the selection and publication of the articles shall rest solely with ‘Modern Medicare’. Authors whose articles are published will receive a complimentary copy of that particular issue and an honorarium cheque. Published by Infomedia 18 Ltd, ‘Modern Medicare’ is India’s leading magazine on healthcare, and related equipment & technologies. This monthly magazine was launched in December 2004 and provides the latest and most apt updates exclusively for the medical fraternity. Moreover, ‘Modern Medicare’ acts as a sourcebook that facilitates buying decisions for this key sector - hospitals, specialty clinics, pathology labs, nursing homes and doctors - and brings out highly useful business information on various healthcare facets such as surgeries, procedures, technologies, equipment et al. So get going and rush your articles, write-ups, etc… Thanking you, Yours sincerely,

Manas Bastia Editor Infomedia 18 Limited ‘A’ Wing, Ruby House, J K Sawant Marg, Dadar (W) Mumbai 400 028 India

D +91 22 3003 4669 T +91 22 3024 5000 F +91 22 3003 4499 E manas@infomedia18.in W www.modernmedicare.in

Product Index Sl No Product

Pg No Sl No Product

Pg No

107 Patient monitoring system........................ 63

134 Slid wood floor ............................................. 29

colour................................Back Inside Cover

108 Patient privacy system.................................... 9

135 SME finance .................................................. 33

LED photo therapy unit .............................. 72

109 Patient safety system .................................... 51

136 SME loan ....................................................... 57

LED tubelight................................................ 74

110 Patient transfer system................................. 69

137 Solar power.................................................... 74

Medical aprons/gown ................................ 75

111 Pedal suction ................................................. 39

138 Sphygmomanometer.................................... 86

Medical equipment ...................................... 31

112 Pendant.........................69, Back Inside Cover

139 Spot light ............................Back Inside Cover

Medical furniture.......................................... 41

113 Pergolas & outdoor cladding ...................... 29

140 Surgical / ICU pendant................................ 86

Medical refrigerator...................................... 67

114 Plain thermal paper roll............................... 74

141 Surgical diathermy........................................ 11

Medical/surgical & IR lamp ........................ 75

115 Portable colour doppler............................... 75

142 Surgical gloves-sterile................................... 75

Microscope bulb ........................................... 75

116 Portable ventilator ........................................ 75

143 Surgical instrument...................................... 86

Mobile light........................Back Inside Cover

117 Powder coated & stainless steel

144 Surgical light.................................................. 11

Multi parameter defibrillator...................... 15

furniture ...................................................... 81

145 Surgical pump............................................... 11

Multipera monitor........................................ 75

118 Prep razor ...................................................... 75

146 Swab stick ...................................................... 68

Nebuilser................................................ 63, 79

119 Printer ............................................................ 62

147 Tourniquet................................................... 55

Needle & syringe destroyer ......................... 75

120 Prosthetic and orthotic services.................. 17

148 Ultrasound gel ............................................ 74

Neonantal transport ventilator ................... 15

121 Pulse oximeter & NIBP monitor................ 75

149 Ultrasound scanner................................63, 75

Nuclear magnetic resonance

122 PW ultrasound scanner............................... 75

150 ULV fogging machine.................................. 74

spectrometer ............................................... 73

123 Rapid endotoxin detection system........... 75

151 UV medical therapy lamp........................... 75

Nuneb PRO nebuliser.................................. 79

124 Recovery bed ................................................. 67

152 Ventilator............................................... 72, 75

Online B2B marketplace ....................... 7, 83

125 Remote operated OT table.......................... 76

153 Vinyl floor...................................................... 29

Operation table ............................................ 67

126 Respiratory humidifier................................. 74

154 Vital signs monitor....................................... 75

100 OT / examination light................................ 86

127 Resuscitation unit......................................... 71

155 X imager C-arm memory.......................... 13

101 OT table................. 76, 86, Back Inside Cover

128 Scandoc DICOM workstation .................. 13

156 X-ray developer liquid ................................. 74

102 Outdoor wood floor..................................... 29

129 Scopy doc endoscopy IMS .......................... 13

157 X-ray developer powder .............................. 74

103 Over head phototherapy.............................. 74

130 Self-adhesive tape ......................................... 72

158 X-ray fixer liquid .......................................... 74

104 Oxygen concentrator.................................... 70

131 Sensor controlled suction sytem................. 11

159 X-ray fixer powder ....................................... 74

105 Oxygen flowmeter ........................................ 86

132 Shoe cover ..................................................... 75

160 X-ray machine.........................................63, 75

106 Oxygenator.................................................... 63

133 Skin blade ...................................................... 75

161 X-ray viewer .................................................. 86

LED lights with multi

April 2011 I

Advertisers’ List

To know more about the advertisers in this magazine, refer to our ‘Advertiser’s Index’ or write to us at mmedit@infomedia18.in or call us at +91-22-3003 4640 or fax us at +91-22-3003 4499 and we will send your enquiries to the advertisers directly to help you source better. Advertiser’s Name & Contact Details Aavanor Systems Pvt Ltd

Pg No .FIC

Advertiser’s Name & Contact Details Compamedic Instruments Pvt Ltd

Pg No 74

Advertiser’s Name & Contact Details Industrial Electronic & Allied Prod

T : +91-44-26208920

T : +91-11-43085193

T : +91-20-24222538

E : enquiry@aavanor.com

E : sales@compamedic.com

E : ieap@vsnl.com

W : www.aavanor.com

W : www.compamedic.com

W : www.diamondbp.com

Amkay Product Pvt Ltd

Endolite India Ltd

Krupa Electro Divice

T : +91-22-61317600

T : +91-11-45689955

T : +91-09879003188

E : info@amkayproducts.com

E : endolite@vsnl.com

E : krupaelectrodivice@gmail.com

W : www.amkayproducts.com

W : www.endoliteindia.com

W : www.krupaelectrodivice.com

Anand Medicaids Pvt Ltd

G S Health Care Products Pvt Ltd

Lonza India Pvt Ltd

T : +91-11-25225225

T : +91-33-24881574

T : +91-22-43424000

E : sales@anandind.com

E : hecapr@vsnl.net

E : prajakta.sonavane@lonza.com

W : www.anandind.com

W : www.gshealthcareproducts.com

W : www.lonza.com

Apollo Hospitals

Godrej Interio

MS Enterprises

T : +91-09866072433

T : +91-22-67962419

T : +91-866-2442786

E : patientsft@gmail.com

E : interiohospital@godrej.com

E : moinmsent@yahoo.co.in

W : www.apollohospitals.com

W : www.godrejinterio.com

W : www.accura-healthcare.org

Bangalore International Exhibition Centre

Great Eastern Impex Pvt Ltd

Magna Tek Enterprises

T : +91-80-65833234

T : +91-11-2347431/32

T : +91-40-66668036

E : suresh@bies.co.in

E : sales@geipl.com

E : sales@magnatekenterprises.com

W : www.healthex.co.in

W : www.geipl.com

W : www.magnatekenterprises.com

BPL Limited

Hospaccx India System

Medexpert Isha Homes

T : +91-80-22270134

T : +91-09845208778

T : +91-9840326020/9360707022

E : sales.healthcare@bpl.in

E : hospaccx.india@gmail.com

E : :info@medicall.in

W : www.bpl.in/healthcare

W : www.hospaccxindia.org

W : www.medicall.in

Charles River

India Mart Intermesh Ltd

7, 83

Meditech Engineers Pvt Ltd

T : +91-80-25588175

T : +1800-200-4444

T : +91-11-45545238

E : india.customercare@crl.com

E : pr@indiamart.com

E : marketinguk@meditech-india.com

W : www.charlsriverindia.com

W : www.indiamart.com

W : www.meditech-india.com

I April 2011

Pg No 55

69, BIC

Advertisers’ List

Advertiser’s Name & Contact Details Meditek Engineers

Pg No 67

Advertiser’s Name & Contact Details R D Plast Pvt Ltd

T : +91-09822092808

T : +91-11-25891219

E : meditekfur@hotmail.com

E : rdplast@bol.net.in

Pg No 9

Radiant Enterprise

E : sucheta@squarefoot.co.in 74

Sreelakshmi Traders

E : radiant_enterp@rediffmail.com W : www.medsynaptic.com 81

T : +91-20-24262562

Rational Health Care Systems

W : www.meelanhospicare.com 27

W : www.rationalhs.com

T : +91-22-22850877

Saga Enviro Pvt Ltd

E : contact@clindiagindia.com

E : drfischer@vedgroup.net

T : +1800 11 22 11/ 18004253800 45 E : contactcentre@sbi.co.in W : www.sbi.co.in

W : www.sanghvieurotech.com

W : www.mrkhealthcare.com

E : raahatmohammed@sc.com

State Bank Of India

T : +91-20-41242691

E : info@mrkhealthcare.com

W : www.standardchartered.co.in

W : www.vedgroup.net Sanghvi Eurotech Pvt Ltd

T : +91-22-23748371

Schiller Healthcare India Pvt Ltd Narula Udyog (India) Pvt Ltd

W : www.sreelakshmitraders.com Standard Chartered Bank

T : +91-40-27713368

E : sreelakshmitraders@gmail.com

E : rational_hcs@yahoo.com

T : +91-11-24378779

MRK Healthcare

T : +91-40-30727676

E : sales@meelanhospicare.com

T : +91-44-24343343

W : www.fogstarindia.com

Monash International Ltd

W : www.squarefoot.co.in

T : +91-79-26449120

E : sales@medsynaptic.com

Meelan Hospital Steel Furniture

T : +91-22-40476211

T : +91-20-25443349

Pg No

Square Foot (Classic Floorings & Interiors Pvt Ltd)

W : www.rdplast.in Medsynaptic Pvt Ltd

Advertiser’s Name & Contact Details

Transasia Bio-Medicalsp Ltd

35 T : +91-22-66920520

T : +91-22-40309000

E : rita@schillerindia.com

E : transasia@transasia.co.in

W : www.schillerindia.com

W : www.transasia.co.in

T : +91-11-42463777 E : ptn@medikraft.com W : www.medikraft.com Siemens Ltd Orbitz Exhibitions Pvt Ltd

United Surgical Industries

W : www.siemens.com/pharma T : +91-11-22149600

T : +91-22-39504586

Space Labs Health Care

E : info@meditec-clinika.com

.BC

E : info@unitedsurgical.co.in

T : +91-40-39803687 W : www.uniserg.com

W : www.meditec-clinika.com Photochem Labs Pvt Ltd

E : info@spacelabs.com 74

Window Techs

W : www.spacelabshealthcare.com

T : +91-11-29992146

T : +91-79-22732989

Spark Meditech Pvt Ltd

E : info@photochemlab.com

T : +91-484-2341335

E : window_techs@yahoo.co.in

W : www.photochemlab.com

E : sparkmeditech@gmail.com

W : www.hospitalcurtains.in

Our consistent advertisers

April 2011 I

RNI No: MAHENG 2007 / 21987 Postal Regd No:G2 / NMD 73 / 2011-13 Posted at Mumbai PatrikaChannel Sorting OfďŹ ce- GPO, Mumbai 400 001, On 11th & 12th of Every Month. WPP Licence No: MR / Tech / WPP-352 / Navi Mumbai 2011-12 Date Of Publication: 8th Of Every Month

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