Editorial
Bridging the divide
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t is that moment of the year again! With the Union Budget the sector and help India become a global leader over this new decade. 2011-12 barely a few weeks away, it is time to take a close The ‘Pre-Budget’ presents some expert views and expectations. look at the expectations vis-à-vis allocations for the Indian From the yester year’s X-rays to the latest non-ionising imaging healthcare eco-system. To start with, it will be prudent to methods, medical imaging has come a long way in providing anlayse how the rapid growth of the country in the recent years has cutting-edge diagnostics and detecting disorders at the molecular level. ushered in a significant transition in terms of health demographics, In fact, with recent advancements in technology, various pathologies socio-economic transformations and changes in disease pattern. Some can now be identified much earlier in a significant number of patients of the major growth drivers that have emerged in the healthcare sector before they become symptomatic. Besides, medical imaging provides alternative minimally invasive include growing and ageing population, expanding urbanisation, rising income levels, increasing occurrence of chronic diseases, image-guided treatment options, and thereby reduces the need for healthcare finacing options as well as medical tourism, among others. invasive surgeries. Moreover, by leveraging imaging technologies, To achieve the goal of inclusive growth across the nation, it is a surgery can be planned well in advance so that post-operative imperative for the government and policy makers to ensure that complications are minimised. Having said that, affordability and Indian healthcare is effective, available & affordable, both in rural global standards for imaging technologies remain some of the key and urban areas. However, considering the extensive shortfall in the challenges. For further insights, turn to the ‘Sector Watch’. Interested to know India’s fast emergence as an ideal destination for present health infrastructure and health human resources, there is an urgent need to have specific provisions in the forthcoming Budget medical tourism and the limiting factors that can derail the onward to boost investment in healthcare sector, especially in rural areas, journey? Take a look at the ‘Specialty Scope’. through public private partnership models. In short, a few popular expectations from this Budget are to address the rising cost of healthcare along with according infrastructure status to this sector. The latter can potentially result in better investment Manas R Bastia prospects needed to bridge the demand-supply divide in Indian Editor healthcare services. All these would hopefully accelerate the growth in manas@infomedia18.in
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Contents 24
37 Sector Watch
Pre-Budget Budget wishlist: Demand for a healthy India
Diagnostics: From detection towards intervention
26 Experts Speak Dr Devi Prasad Shetty Chairman and Managing Director, Narayana Hrudayalaya
42 Specialty Scope Medical tourism: Your health ticket to India
REGULAR SECTIONS 6 10 18 34
Editorial National News World News Hospital Monitor
30 Roundtable Surrogacy in India: A healthy controversy?
Lilavati Hospital & Research Centre: Aiming at benchmarking against the best
46
Interface
IT @ Healthcare
Rajnish Rohatgi Medical Director, BD India
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Spotlight Virtual manufacturing: A revolution in medical device development
Telemedicine: Transforming patient care Dr Aloke C Mullick, Director & CEO, Seed Healthcare Solutions Pvt Ltd
Group Capt (Dr) Sanjeev Sood, Hospital and Health Systems Administrator, Air Force Hospital, Jodhpur
56
Marketing Mantra
Meditech Tissue Plasminogen Activator : A novel treatment for stroke
58
NGO Corner Smile Foundation: Caring for the under-privileged
60
52 Business development strategy: Focussing on core competencies Vivek Shukla, Principal, Healthcare Business Consulting, Vivek Shukla and Associates
Curtain Raiser
Highlights of Next Issue
Medicall 2011, Kolkata: Showcasing the best in healthcare
62 68 76 84 86
Events Calendar Product Update Rx Product Index Advertiser’s List
Sector Watch: Emergency Healthcare Specialty Scope: Oncology
Details on page no. 89
Region Focus: North India
Note: ` stands for Indian rupee, $ stands for US dollar and ÂŁ stands for UK pound, unless mentioned otherwise Cover photo shoot: Dipti Desai
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National News
In Brief Manipal Hospital performs ‘Awake brain surgery’ Manipal Hospital, in a pathbreaking ‘Awake Brain Surgery’, has successfully removed brain tumour in a patient kept alert and conscious throughout the surgery. The surgery medically termed as ‘Awake Craniotomy’ was performed under sedation and local anesthesia. Dr Satish Rudrappa, Neurosurgeon, Manipal Hospital, said, “We wished to do this procedure since we had to monitor the patient’s motor activities during the surgery to prevent post-operative defects. The tumour involved some of the functionally important areas of the brain, which control important functions like movement and body sensation on the left side. The advantage of this surgery is that on instruction from the surgeon, the patient would be able to lift his hand and make facial movements corresponding to the area of surgery, and also talk during surgery.”
SleepCare facility launched in India by SleepCare Solutions SleepCare Solutions (SCS) has recently launched a state-of-the-art sleepcare facility in India. It will offer a comprehensive approach for diagnosis and treatment of adult sleep disorders by using the latest technology and therapeutic options. The facility was launched along the guidelines of the Joint Commission and the American Academy of Sleep Medicine to treat patients with sleep disorders. The first facility began its operations in Banjara Hills, Hyderabad. Dr Lavanya Gali, Medical Director, SCS, said, “We are excited to open our first independent sleep disorder testing facility in India in collaboration with Philips India.”
Mumbai college students pledge for organ donation Recently, in an organ donation awareness programme organised at colleges in Mumbai, students of Wilson College and R A Podar College of Commerce and Economics have pledged to donate their organs after death. More than 100 students rallied their support to donate organs during this campaign. Speaking on the occasion, Ronisha Chinoy, student, Wilson College, commented, “Deceased organ donations go beyond grants, handouts or cash.”
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BGS Global Hospitals gets Asia’s first microdialysis facility The Advanced Neurosciences Institute at BGS Global Hospitals, Bengaluru, is now equipped with Asia’s first microdialysis facility for the brain. This new facility was set up with the help of Karolinska Institutet of Sweden by a reputed team of leading neurologists. Dr N K Venkataramana, Chief Neurosurgeon and Vice Chairman, BGS Global Hospitals, said, “We are the first hospital in Asia and among the 20 hospitals in the world to be equipped with this facility. Microdialysis helps predict outcome in brain haemorrhage, brain injury and stroke.”
Narayana Nethralaya launches programme for early detection of childhood eye diseases Narayana Nethralaya Postgraduate Institute of Ophthalmology, Bengaluru, has recently announced the launch of its programme, ‘Find the Blind’. This was announced prior to the inauguration of the 2011 meeting of the International Society of Genetic Eye Diseases and Retinoblastoma. The L-R: Dr K Bhujan Shetty, Dr Ashwin programme was launched by Dr Elias Mallipatna, Paediatric Ophtalmology and Strabismus, Narayana Nethralaya & Traboulsi, Head of the Department, Dr Elias Traboulsi Paediatric Ophthalmology, and Director, Center for Genetic Eye Diseases, Cleveland Clinic’s Cole Eye Institute, USA. The programme combines several strategies for early detection of eye disorders that are a threat to the vision and life of children – eg, Red-Reflex Screening and Key-Informant Surveys. Dr K Bhujang Shetty, Chairman, Narayana Nethralaya, said, “RedReflex Screening is an effective way to detect serious childhood eye disorders such as cataract, corneal opacity, retinal problem and eye cancer. Narayana Nethralaya is looking at the possibility of the common man screening children with the help of a compact digital camera when used in a specific way.”
Dragon® Medical 11 launched by Nuance Communications Nuance Communications has recently introduced Dragon® Medical 11, the latest version of its medical desktop and real-time speech recognition software. This software has been developed to enable doctors to conveniently and efficiently generate clinical letters and navigate clinical systems. Commenting on the launch, Sunny Rao, Managing Director, India and South East Asia, Nuance Communications, said, “Dragon® Medical has a proven track record in reducing costs. This system will become a key component in increasing efficiency and assist in addressing the challenges faced by medical professionals to deliver tangible improvements in patient care and the bottom line.”
National News
In Brief UICC to initiate awareness on World Cancer Day The International Union Against Cancer (UICC) had initiated a plan to create awareness on the World Cancer Day observed on February 4. Dr Maheboob Basade, Senior Medical Oncologist, Jaslok Hospital, opined, “Currently, cancer falls under the lifestyle diseases category where most cases occur due to lifestyle modifications. Although opportunities for controlling and reducing the burden of cancer exist, these require a concerted effort by people. ”
KEM Hospital hosts gathering for Gaucher disease patients The Department of Paediatrics, Seth GS Medical College and KEM Hospital, recently hosted a gathering of patients suffering from a rare genetic disorder called Gaucher. This disorder is caused by absence or malfunctioning of a specific enzyme in the body. It belongs to a group of rare inherited metabolic disorders known as Lysosomal Storage Disorders (LSDs). Dr Mamta Muranjan, Assistant Professor, Department of Paediatrics, KEM Hospital, informed, “Many LSDs are extremely life-threatening. Unfortunately, it takes several years to make the right diagnosis because of low awareness in this field. Even when treatment is available, cost constraints may deter patients from seeking treatment. We have called for this programme to help address this concern and build awareness.”
Fortis strengthens its presence in Rajasthan Fortis Healthcare Ltd has recently added 100 beds at the Lifeline Hospital in Alwar, Rajasthan. With this move, Fortis has extended the benefit of high-quality medical care to increasing number of people in and around the district of Alwar. The addition to Lifeline Hospital takes the Fortis network to a total of 53 hospitals, with over 8,000 beds across 13 states in the country. The hospital will be named ‘Fortis-Lifeline Hospital’ that offers comprehensive services with a special focus on cardiology, neurosurgery, orthopaedics, dental and general surgery. It has three well-equipped operation theatres, 20 critical care beds, a cath lab, a CT scanner, an X-ray imaging and a full-fledged blood bank. Yogesh Sareen, CFO, Fortis Healthcare Ltd, said, “As part of our expansion strategy, Fortis is focussed on increasing penetration into smaller towns and cities in India.”
Trivitron and Apollo Hospitals form JV Trivitron Healthcare has recently formed a Joint Venture (JV) partnership with Apollo Hospitals Enterprise Ltd to set up Alliance Medicorp India Ltd (AMIL). The company will roll out a chain of dental clinics and dialysis centres across the country under the brand name of Apollo Dental Centres and Apollo Dialysis Centre. Dr GSK Velu, Director, Alliance Medicorp India Ltd, said, “The JV with Apollo Hospitals Enterprise Ltd re-affirms our commitment to continuously enhance our services in providing high-quality medical technology solutions and services for every healthcare facility in the country and emerging markets of the world.” AMIL in its first phase of operation will run 20 exclusive clinics and multiple networks of dental clinics. Vishal Sharma, COO, AMIL, said, “AMIL plans to increase the market reach by setting up 30 more dental clinics, with presence in a minimum of 20 cities by end of 2011. The company has aggressive growth plans and aims to set up more than 100 dental clinics by 2013-14.”
Karnataka gets Intel’s healthcare technology solution
Knee replacement system by Maxx Medical
Intel has introduced a new joint telemedicine initiative with the Government of Karnataka at the Anagodu Primary Health Center and Harihara Taluk Hospital, paving the way for extension of healthcare benefits to the rural population of Karnataka. Intel will provide the necessary technology support in terms of IT infrastructure & offsite technical resource, enable transmission of patient’s medical records including images and providing live two-way video & audio. It will also provide consultation of the best cardiac surgeons from Narayana Hrudayalaya Hospital, Bengaluru.
Maxx Medical has recently launched the first knee joint system to address size, fit, high flexion and bone conservation needs of Asian patients. Freedom Total Knee® system is a high-flexion knee replacement system engineered to address the unmet market need for small-sized and differently proportioned implants Prof Dr N S Laud, Director, to support the Indian lifestyle. This is Laud Clinic, Mumbai with Freedom Total Knee® System a USFDA approved system and will be available throughout the country. Ashesh Shah, President and CEO, Maxx Medical, said, “People suffering from osteoarthritis need to be made aware of a treatment option available for them that has been developed to suit their lifestyle and anatomy.”
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National News
In Brief Sixth anniversary of Hinduja Hospital’s patient education programme Hinduja Hospital in association with Colitis Association of India celebrated five successful years of creating awareness and educating patients and relatives about Inflammatory Bowel Disease on January 23, 2011. Colitis Association of India, a volunteerbased organisation was formed in 2005. The venture was started by Dr Devendra Desai and Nikhil Shah, who believed that patients having this disease did not have proper knowledge about ulcerative colitis resulting in a lifelong problem with relapses. Dr Desai said, “Various issues are addressed during the meetings where we educate the patients about the severity of this disease.”
Shalby Hospitals is Gujarat’s first DNB orthopaedics training centre Shalby Hospitals has recently announced that it has become one of the first institutions in Gujarat to be accredited as a centre for training in Diplomate of National Board (DNB) Orthopaedics for two seats per year. At present, about 65 teaching hospitals in India train a total of 72 DNB orthopaedic candidates every year. Shalby hospitals will train doctors to become orthopaedic surgeons. The orthopaedic surgeons trained here will be considered equivalent to those trained at other medical colleges across the country.
Forensic study to be made optional, says MCI The Medical Council of India (MCI) plans to make Forensic Medicine and Toxicology as an optional subject in the new MBBS curriculum. But, some doctors have said that disintegration of the subject will lead to more chaos in the law and order of the country. Dr Shailesh Mohite, Head Forensic Medicine Department, Nair Hospital, Mumbai, said, “Doctors at the undergraduate level should be introduced to the subject so that they can take it up during postgraduation. If the subject is made optional, few will take it up for PG. We will never be able to overcome the shortage of forensic experts.”
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Medfort Hospitals and LV Prasad Eye Institute ally with RAK Hospitals Medfort Hospitals and LV Prasad Eye Institute (LVPEI) have recently collaborated with Ras Al Khaimah (RAK) Hospital, UAE, for setting up a centre of excellence in Eye Care. On the occasion, Gaurav Malhotra, CEO, Medfort Hospitals, said, “This is Medfort’s first international venture in association with LVPEI. The centre aims to provide the cost-effective and comprehensive eye care facilities to the population of the UAE by creating its presence in all the Emirates of the UAE.” His Highness Sheikh Saud Bin Saqr Al Qassimi, Supreme Council Member and Ruler, RAK Hospital, said, “We focus on enhancing the healthcare provision capabilities of the Emirate to make it a destination for quality healthcare in the region.”
Apollo Hospitals forms PPP with Eisai and HelpAge Apollo Hospitals has recently signed a Public-Private Partnership (PPP) with Eisai Pharmaceuticals, Japan, and HelpAge India to improve access to medicines in the country for underprivileged elderly patients ailing with dementia and depression. The scope of the landmark PPP agreement is to explore collaboration followed by research between the parties for improving the rate of prevention, screening, diagnosis, treatment and support of dementia and depression among the elderly population. The Memorandum of Understanding (MoU) was signed by Dr Prathap C Reddy, Chairman, Apollo Hospitals Group; Haruo Naito, President and CEO, Eisai Co Ltd; and Amal Ganguli, President, HelpAge India. Elaborating on the PPP agreement, Dr Reddy, said, “At present, about 3.7 million elderly population is living with dementia in India. With the exponential increase in the population of the elderly in India, the disorder poses a challenge to public health systems.”
Biogen Idec introduces treatment for multiple sclerosis Biogen Idec has recently introduced Tysabri®, for the treatment of Multiple Sclerosis (MS) in India. Tysabri® is the first humanised, monoclonal antibody for the treatment of relapsing remitting MS in India. Alpna Seth, Managing Director, Biogen Idec India, said, “We believe Tysabri® will be an important option to help address the high unmet need of those living with MS in India. MS is a devastating disease that affects people adversely in their lives. We are pleased to bring this important therapy to the MS community.” Tysabri® inhibits adhesion molecules on the surface of the immune cells. Some researches conducted suggest that this drug works by preventing immune cells from migrating from the bloodstream into the brain.
World News
In Brief Thermally conductive silicones for healthcare applications from NuSil NuSil Technology LLC, one of the global leaders in silicone materials for healthcare and pharma industries, has recently introduced two thermally conductive healthcare silicone elastomers for use as a cure-in-place adhesive or potting compound between electrical/electric components and heat sinks. The low modulus feature of MED-2980 and MED-2955 ensures contact between uneven surfaces such that during the operational thermal cycling, the bond line will not break sensitive electronic components. These can also be cured at low temperatures or be heat accelerated and are non-cytotoxic. Brian Nash, Vice President, Sales and Marketing, NuSil Technology LLC, said, “By formulating adhesives we are applying our expertise in the regulatory environment, and designing advanced silicones for electronics, to fully support companies operating in this exciting, yet challenging, industry.”
Concierge practices setting in Reston-area residents are getting involved in a popular healthcare trend – primary care physicians changing their practices to ‘concierge’ practices. Concierge medical practices charge a membership fee for joining. Here, the doctors conduct more extensive annual testings, detailed laboratory results, health risk analysis and assessment of longterm wellness goals. Dr Kevin Kelleher with business partner, Dr Mark Vasiliadis, founded the Executive Healthcare Services in 2004, leaving their traditional practice – Generations Family Practice. Kelleher and Vasiliadis still own and operate Generations, but see only patients at Executive Healthcare. Kelleher’s patients have 24-hour access to their physicians through e-mail, cell phones, pagers, etc, and always have a doctor on call. The doctors also make house calls, if requested. Kelleher informs that the practice has established a relationship with specialists, offering them ‘the complete picture of a patient’s health’, and all related laboratory work and data.
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Invida conducts Asian Scar forum 2010 In order to increase awareness for evidenced-based scar management in Asia Pacific, Invida, a biopharmaceutical company focussing on commercialisation of healthcare products in Asia Pacific, recently organised the ‘Asian Scar Forum 2010’ in Shanghai, China. Over 80 leading physicians attended the event. Again, Invida also sponsored a pan-Asia speaking tour for leading plastic surgeon, Dr Thomas A Mustoe, Professor - Surgery and Chief - Division of Plastic and Reconstructive Surgery, Northwestern University Medical School, Chicago, Illinois, USA. Invida Group has developed this educational programme in support of Dermatix® and Dermatix® Ultra, two of its leading dermatology products. Post session, Dr Mustoe commented, “Dermatix® is an important scar management product that has demonstrated its efficacy in several human trials, and has a compelling rationale in terms of its mechanism of action. Invida had launched Dermatix® in the region in 2009 and 2010, and since then has seen the product become one of the flagships of its growing dermatology portfolio.
Medical tourism 2011 initiative by MTA Medical Tourism Association (MTA), an international non-profit trade association for the medical tourism, has announced its new Medical Tourism 2011 Strategic Initiatives and Campaign. ‘Patients in emerging markets, market research and intelligence’ was the theme for the 2011 campaign. The association claims to have effectively developed educational platforms for governments, investment organisations and insurance companies to understand the opportunities and challenges in the industry. With more regions developing their programmes for healthcare exchange and export, the MTA’s outreach will be greater than ever. Further, MTA will initiate its innovative programmes this year. There would also be continuum of care networks through several educational programmes and Continuing Medical Education (CME).
Wireless Health gaining popularity In order to keep pace with the country’s healthcare crisis, the nation is gearing up with technological advancements. With time, the new area of Wireless Health (WH) is developing rapidly. The aim here is to restructure, and thus revolutionise the healthcare system. Further, WH data streams can become an essential resource for considering electronic medical records with necessary information from patients located outside the hospital. Researchers at the Wireless Health Institute (WHI) of University of California, Los Angeles, have developed concepts for generic WH architectures and data-processing systems, as well as a number of practical applications. One example is a Personal-Activity Monitoring (PAM) system that provides a low-cost solution to capture human motion profiles and automated identification of activity and behavioural structures.
World News
In Brief Transasia Bio-Medicals Ltd registers high growth Transasia Bio-Medicals Ltd is now rated as one of the India Fast Growth Top 25 Companies. It is the only IVD company to be included in the elite list generated by the AllWorld Network, USA, in partnership with Entrepreneur magazine, PHD Chamber, the TiE Network, Nexus Ventures and Mumbai Angels network. These 25 companies offer novel economic values including more than 6,000 jobs since their inception. Since 2007, this group has generated 50 per cent of the revenue, and further expects to register tremendously high growth in the coming years. The recent acquisitions of IVAX Diagnostics & Pliva Lachema s.r.o. in the US and Europe, respectively, through the German subsidiary ERBA Diagnostics Mannheim GmbH, would allow Transasia to bring world-class technology in the fields of autoimmunity, infectious diseases, microbiology and cancer diagnosis to the Indian market.
URAC ensures quality healthcare facilities Utilization Review Accreditation Commission (URAC) is an independent non-profit organisation that provides quality healthcare through its accreditation, education and several measurement programmes. It releases revisions to three products of Pharmacy Quality Management Accreditation programmes. URAC has claimed that its accreditation offers the industry an independent resource for evaluating & monitoring the safety, effectiveness and service quality of organisation. The products in the programmes include Mail Service Pharmacy, version 2.0; Specialty Pharmacy, version 2.0; and Workers’ Compensation and Property and Casualty for Pharmacy Benefit Management, version 2.0. URAC gives the confidence to consumers and health plan sponsors that the companies taking care of their prescription service are dedicated to quality improvement. It also encourages organisations to ensure patient safety. Alan P Spielman, President & CEO, URAC, said that it is vital to maintain current URAC standards in this healthcare environment. By incorporating further measures into the pharmacy standards, URAC can facilitate quality improvement and innovation in the industry.
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EyeBrain develops eye-tracking device for Parkinson-plus diseases EyeBrain, developer of medical devices for the early diagnosis of neurological diseases, declared that its Mobile Eye Brain Tracker (Mobile EBT), an eye-tracking system, is now available on the market for the detection of Parkinson-plus diseases. The device has been used on about 100 patients to test for these syndromes. Results have revealed that eye movements provide a more accurate early diagnosis than traditional clinical examinations. This device offers early diagnosis for several neurological diseases based on eye movements of patients. It was developed in conjunction with La PitiéSalpêtrière neurology team in Paris. The Mobile EBT is available in France, Belgium and Luxembourg since June 2010, and will be launched soon in the UK, Ireland and European Nordic countries. Serge Kinkingnehun, Founder, CEO and Scientific Director, EyeBrain, “Our Mobile EBTs are fully integrated and normalised systems that can handle the entire clinical examination from stimuli display and eyemovement capture to data analysis and interpretation.”
Qatar aiming at universal healthcare Qatar hopes to have universal healthcare coverage for the country by 2012, according to Abdullah bin Khalid al-Qahtani, Minister of Public Health. Al-Qahtani said, “We have a new strategy of business as of June last year, according to which, universal healthcare will be made accessible across the country in two years’ time.” Universal healthcare indicates bringing all types of medical services closer to patients. Al Wakrah Hospital, one of the largest hospital complexes in Qatar and occupying 3,04,000 sq m of land, is reported to open in 2011. Dr Hanan al-Kuwari, MD, Hamad Medical Corporation (HMC), commented, “Al Wakrah is built as an integrated hospital and will be linked to Hamad General Hospital (HGH), Al Khor, and others via video conferencing. This will help in sharing the activities in the hospital.” Further, the Dukhan Hospital will open in April, with 79 beds, followed by a complete inauguration around December 2011.
Global hospital supplies market to exceed $ 37 billion by 2016, says GBI report ‘Hospital Supplies Market to 2016 – Disposable Hospital Supplies and Syringes and Needles to be the Fastest Growing Market Categories’, a recent report from GBI, provides market landscape, and market trends information on five hospital supplies market categories – disposable hospital supplies, patient examination devices, mobility aids & transportation equipment, sterilisation & disinfectant equipment & syringes and needles. According to the report, the global hospital supplies market is forecast to exceed $ 37 billion by 2016 at a Compounded Annual Growth Rate (CAGR) of 11 per cent during 2009-16. The market is thus expected to be driven by an increasing percentage of elderly people and an increased awareness about the importance of controlling Hospital Acquired Infections (HAIs).
World News
In Brief Funded four-year Integrated PhD in Biomedical Science University of Southampton’s School of Medicine, one of the top ten medical schools in the UK, has invited applications for its four-year Integrated PhD in Biomedical Science. This programme aims to help students who plan to pursue biomedical research and thus provides extensive training facilities. The programme is available in three pathways: The first is stem cell science pathway, in which students will gain a deep understanding of translational stem cell biology, and can improve their ability to communicate with biologists, clinicians, bioengineers and physical scientists. Secondly, the immunity and infection pathway helps to develop better diagnostic markers and discover more effective therapies for human infectious disease and diseases affecting human organs like the lungs, joints, skin, liver, pancreas, gut, and urogenital tract. Thirdly, the cell biology and immunology of cancer pathway research themes include basic and translational immunology, immunotherapy and DNA vaccines, as well as the molecular and genetic study of cancer for understanding the mechanisms of disease proliferation, invasion and cell death.
NMC to fund for further healthcare expansion New Medical Centre (NMC), a healthcare company based in Abu Dhabi, has raised more than $ 1 billion (Dh 3.67 billion) to fund its expansion by selling a 40 per cent stake to a local investment company. Dr B R Shetty, Chief Executive, declared that the $ 1.2 billion sale of a 40 per cent stake to Centurion Investment, also based in Abu Dhabi. Dr Shetty commented, “It will help to develop facilities in the country. We plan to have a 250bed hospital in Abu Dhabi, 100 beds in Dubai and 100 beds in Al Ain.” The cash raised will also allow the acquisition of hospitals in the region, including Egypt, Libya and Qatar, and expansion into India. Again, Simon Page, Divisional Director, Life Sciences Division, IIR Middle East, informed that preventive medicine, oncology and cardiac surgeries are in demand today. Thus continuous investment should be made in this regard.
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NIIT Technologies provides quality healthcare system NIIT Technologies Ltd, one of the leading IT solutions provider, has acquired an electronic health records & referral management platform – Patient Referral System (Preferr) – to ensure efficient and quality healthcare system in the US. The platform offers seamless collaboration between all healthcare providers like physicians, hospitals, diagnostic facilities and laboratories. Lalit Dhingra, President, NIIT Technologies, Inc, said, “The platform enables providers to meet federal guidelines for electronics health record meaningful use criteria, and will enable NIIT to pursue this space and mark its presence in the healthcare arena.” NIIT Technologies’ Healthcare Division set up in Orlando plans to create high-value jobs for managing and deploying its IT-based products & services. Preferr was pioneered in Clermont by Visions@Work, whose founder, Pranam Ben, is now Head of NIIT Technologies’ Healthcare Division. In Central Florida (US), Preferr is already in use by several healthcare providers.
Ingenix chosen for swift administrative operations of Bethesda Bethesda Healthcare System of South Palm Beach County, Florida, reported to have selected Ingenix for managing its administrative operations, especially financial performances. Ingenix will ensure that there is no delay in these administrative processes, thus solving most of the problems. Ingenix will use its electronic financial record platform to make immediate financial details accessible across departments within a hospital, and thus assist clients in taking the right actions in the revenue cycle. Joanne Aquilina, Vice-President, Bethesda Healthcare System, said that after an extensive evaluation process, they have determined that Ingenix could best provide them with the necessary support to enhance revenue cycle performance and enable them to meet the requirements of the community they serve.
PVCHC and TRE join for new healthcare facility A partnership between Peak Vista Community Health Centers (PVCHC) and The Research Exchange (TRE) has created a new healthcare facility – Developmental Disabilities Health Center. HealthSouth Rehabilitation Hospital of Colorado Springs and Aspen Pointe have also contributed to this centre’s birth. The services provided at the facility include both physical and psychological examinations, treatment of minor injuries, chronic disease management, and routine follow-up care. It will also serve as an alternative to hospital emergency rooms and urgent care centres.The centre features in-house equipment, which is a specialised ultrasound machine that can help pinpoint bladder problems. The lower examination tables helps people in wheelchairs to move on the table.
Pre-Budget
Budget wishlist
Demand for a healthy India Though the Union Budget last year brought some relief to the healthcare sector, the latter still demands an increased spending in healthcare, infrastruture status and tax SOPs. India is a country with a majority of the population living below poverty line, and where medical treatment is not within reach of most people. Therefore, the major expectation from this Budget is to arrest the ever-increasing cost of healthcare where possible. The upcoming Union Budget 201112 can have an impact on two major cost factors in healthcare, ie, the ever-increasing cost of medicines & medical consumables, and costly medical equipment with faster redundancy due to continuous technological advancements. The government must confer a ‘very special’ status to this industry, with major tax reliefs on all direct and indirect tax fronts in this budget to bring these two cost factors under control. The loss of revenue to government from these tax concessions will be only a fraction of the cost of providing affordable healthcare by government to all. Second, the government should substantially increase the mediclaim premium threshold under sec 80-D (from the current level of ` 15,000), as the increased cost of healthcare has sent the mediclaim premiums soaring. This move will marginalise the healthcare cost to some extent for policyholders.
The Indian economy is growing with the support of increasing domestic demand. It is therefore important to sustain this demand. In this context, while the rate of interest should be cut, it is being increased because of domestic compulsions, which is hampering the flow of funds into India. Fiscal parameters are expected to be rationalised and reset in 2012 when the new Direct Tax Code (DTC) is introduced and the Goods & Services Tax (GST) is expected to be in place. Preparing for these changes requires a lead time, which the forthcoming Union Budget 2011-12 can provide to the Indian healthcare industry, by maintaining the status quo and refraining from making too many changes on the fiscal front. Hospitals should be covered under infrastructure, as the sector needs serious addition of capacity in order to meet WHO standards. The need of the hour is that hospital projects be prioritised and treated as ‘Infrastructure Projects’ for the purpose of lending by financial institutions and banks. Also, under current regulations, FCCBs/ ECBs are subject to a ceiling of $ 100 million. Considering the prevailing business environment, the limit under automatic route can be increased to $ 250 million.
Deepak Samant
Manpreeet Sohal
Director Finance, Hinduja Hospital, Mumbai
Director, Fortis Hiranandani Hospital (Vashi), Navi Mumbai
Giving infrastructure status to the healthcare sector will help in attracting more investments necessary to narrow the demand-supply gap in hospital services. India is a signatory to the Millennium Development Goals (MDGs). Three of the eight MDGs pertain to healthcare. India’s ability to achieve healthcare-related MDGs depends on her ability to narrow the demand-supply gap. There should be an increase in the number of beds to about 200 per 100,000, which would mean creation of 1.3 million new beds
that would require fresh investments of $ 80 billion. Health is a state subject in India and cash-strapped state governments are not likely to be able to provide budgetary support for such an investment. Given these constraints, the private sector needs adequate incentives to enable it to make the huge investments needed to narrow the demand-supply gap. Healthcare projects in selected nonurban areas that commence operations during April 1, 2008, to March 31, 2013, will enjoy a five-year tax holiday under section 80IB as per budget 2008. Infrastructure status would enable them
to enjoy a 10-year tax holiday. The Budget must also address the areas of healthcare insurance and medical education, where further reforms are called for. This will make healthcare sector more attractive for investors. The Budget must also address the areas of healthcare insurance and medical education, where further reforms are called for. This will make healthcare sector more attractive for investors. The government spend in healthcare as percentage of Gross Domestic Product (GDP) is just about 0.99 per cent at present; this spend should be raised to at least 3 per cent of the GDP. Dr Rajeev Boudhankar Vice President, Kohinoor Hospital, Mumbai
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Pre-Budget
Union Budget 2010 brought about some relief to the healthcare. But, unfortunately, it had no meaningful impact due to the ineffectual nature of that fiscal initiative. The tax holiday envisaged under section 80IB is of little consequence for the healthcare industry, as it is applicable only to hospitals in non-metro locations and hospitals with less than 100 beds. The exemption is limited to five years, which totally ignores the fundamental reality of hospitals, ie, the long gestation projects. Therefore the tax holiday should be extended irrespective of location & size and for any block of five years during a 10-year period at the option of the assessee. Almost everyone in the bureaucracy and the government is aware of the importance of building a world-class nationwide medical ecosystem, from primary healthcare centres to diagnostics to high-end tertiary care. Also, much of the investment ought to come from the private sector. But it is baffling that no action has been taken despite years of filing petitions to grant ‘infrastructure’ status to this sector. Other areas that need rationalisation include the levy of service tax on hospital services, which increases the cost of healthcare delivery for common man. It is also suggested that healthcare sector should be kept outside the ambit of service tax. S L Narayan CFO, Max Healthcare, New Delhi
The government must accord ‘infrastructure’ status to the healthcare sector in order to facilitate access to affordable funds for the private sector. Health insurance should be made mandatory in the organised sector. Also, a creative and conducive atmosphere is needed to start paramedical institutions for addressing the shortage of skilled manpower. Government funded industry parks should be created to focus on manufacturing of medical equipment. This will help in reducing input costs. Tax sops for institutions involved in public private ventures will also help enthuse several players to venture into this segment. Tax benefits should be considered for hospitals as well as practitioners setting up hospitals in tier 2 and 3 cities. Allocation of more funds is required for prevention of chronic diseases like diabetes, hypertension and kidney diseases. As these diseases will increase the healthcare burden of the country, the government must undertake programmes for preventing these. Dr S Manivannan Joint Managing Director - Kavery Medical Centre & Hospital, Trichy, Tamil Nadu
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Experts Speak
‘There is a need for low-cost hospitals having multi-specialty facilities’ “Surgeons are ‘technicians’ – the more number of surgeries they perform, the more they improve on their skill,” says Dr Devi Prasad Shetty, Chairman and Managing Director, Narayana Hrudayalaya, Bengaluru. At India Healthcare Awards 2010, recently hosted by ICICI Lombard General Insurance and CNBC-TV18, Narayana Hrudayalaya won the Specialty Hospital award in the field of cardiology and Dr Shetty also received an award for ‘driving affordable and quality healthcare for all’. To top it all, this world renowned cardiologist has been awarded the Padma Shri for Medicine in 2004. Excerpts from the exclusive conversation with Modern Medicare. Shivani Mody While considering the world’s population, less than 10 per cent of patients requiring surgery can actually afford surgery. Therefore, the need is to provide surgery at an affordable cost and improve access to surgery for the poor as well. A radical change is needed in the mindset of healthcare professionals in the way they deliver such services. At present, the focus should not be on producing new medicines
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but on seeking cost-effective ways to deliver services to the majority. While bringing about innovation in medicines, the investment in Research and Development (R&D) drives up the cost of medicine. Seeing the recent trends, healthcare demands for process innovation rather than medicine innovation and healthcare solutions should be customised as per local needs.
Leading medical councils in any country protect and support the growth of the industry. This thought process needs to change and attention should be paid to patient issues. The number of patients in Asian and African countries is higher in comparison with that in developed nations. Globally, medical councils should work collaboratively and initiate training programmes for doctors and nurses in these regions to make healthcare effective, available and affordable.
Experts Speak An active role of citizens is an important factor in the availability of high-quality healthcare in the country. People need to drastically change their attitude, rather than just accepting the services, they should demand better quality.
Views on low-cost hospitals Presently, there is need for low-cost hospitals having multi-specialty facilities. Today, a full fledged hospital with the latest equipment and complete services can be built for ` 80-100 crore. But now these hospitals, having latest technology need to be constructed for ` 20 crore, which is also possible. Most of the technology and equipment used in hospitals are imported, which adds to the overall cost. There is a need to develop low-cost, high-quality equipment domestically. The volumes will help drive down the cost of producing these equipment. Some of the major requirements are low-cost magnetic resonance imaging (MRI) and electrocardiography (ECG) machines. Moreover, the maximum life of an imported machine is 5-7 years, after which it has to be replaced with a new machine. Since this is not feasible in the long run, the industry needs machinery that can work for a longer period, say 10 years, for example, Computed Tomography (CT) scan machines. Medical equipment need to become a commodity item for them to become affordable. While building a hospital, nearly 25 per cent tax is given to the government. Inviting a dramatic change, the policies need to be redrafted. If a hospital is catering to the middle class and poor population, then the tax adds to the financial burden. There is a definite need to have one million hospital beds in India. Added to this, developing a health city can also help in reducing costs. The health city can be a platform for developing medical colleges as well. There is a requirement for at least 1,000 medical colleges.
Government’s role Most hospitals are built in urban areas, and there is a strong need to develop tertiary healthcare. The government is now slowly focussing on quality healthcare for inclusion of rural population as well. Rather than developing hospitals in far-off locations, the government can set up hospitals having 1,000-2,000 beds in district headquarters. There can be smaller clinics in remote areas, which can be operated using telemedicine. People in remote areas can be referred to district hospitals in case of critical illness.
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One of our projects is to operate a lowcost hospital in Mysore. Starting this year, and built at a cost of ` 16 crore, the hospital will be equipped with the latest facility and will also act as a remote centre. The cost of a heart surgery in a city area can be as low as ` 50,000 instead of ` 2 lakh. This remote hospital concept initiated in Mysore will be followed by another in Siliguri (West Bengal) and Bhubaneswar (Orissa). With government support, our plan is to set up 50 such hospitals in two years.
Importance of technology adoption In the US, healthcare services is not a cost burden, as most of it is funded by the government. The procedures and infrastructure are well developed and even technology adoption is regularly updated. In India, the cost of healthcare services is huge and people cannot afford quality services. One of the ways to provide quality healthcare services in an effective manner will be through technology such as mobile healthcare or telemedicine. We are already on the path of a revolution in this area. In this case, India will take the lead much ahead of other nations. Most medical problems will be treated using mobile phones. Mobile phones will be used to transfer and record data and even help in video conferencing. Mobile phone devices have become even more intelligent and can be regularly used to monitor patients. These patients need not travel to the hospital and check-ups can also be remotely managed. The data is collected in real-time or as per the requirement and any change in the pattern is easily noted. In case of an emergency, the mobile device can raise an alarm and treatment can be ensured at the right time. Using telemedicine becomes an innovative way to deliver healthcare, as in India, only one-third of households are in urban areas, and two-thirds in rural areas. With this technology, we have been able to provide specialist services to patients in remote locations. It has also helped us set up virtual classrooms and impart medical education between two locations. Narayana Hrudayalaya runs the world’s largest telemedicine centres networked with over 800 centres globally. Telemedicine is also used for imparting training services for nurses in Africa and other international locations. The technology is capable of revolutionising healthcare delivery to under-developed nations around the world.
A glimpse of Dr Shetty’s personal life
Experts Speak
d exercising I believe in rising early an g the day rin du routinely. My work nts, doing tie pa ing revolves around see ions and tat sul con video conferencing al day, usu y an heart surgeries. On . My family I work for 15-16 hours adjusting to in e rol plays an important le. edu my hectic work sch sy bringing My wife has been bu a daughter. d an s up our three son to spend get I s day Fortunately, nowa ng my chi tea e some quality tim daughter.
Healthcare scenario in the next few years India has enormous talent in the medical profession. The number of trained doctors and nurses will increase in the coming years. With increased focus on medical tourism, India has the potential to become a hub in the coming 10 years. Already states such as Andhra Pradesh, Delhi, Karnataka and Gujarat have taken the lead in making most of this potential. In future, with the increasing volumes in the country, it is possible for pharma companies to reduce costs. We will see an increase in the number of medical colleges, as there is a need to train more doctors and add more number of beds. The government is considering insurance in healthcare to include the majority. All state governments will soon join the act. Most of the insurance schemes fund surgeries, as these are a major cost burden. It is surgery that kills the poor man. Along with appropriate insurance schemes for surgery, diagnostics services should be provided free of cost. Diagnostics centres being developed need to look at a proper model and collaborate with other services to reduce costs.
An advice to the budding surgeons Medical students should consider a career in surgery, as it has immense opportunity and also there is dire need for talent in this field. There is a huge gap between the number of trained surgeons and patients needing surgery. For example, considering heart surgery, there are 25 lakh patients in need of a surgery, but we have only 95,000 heart surgeons. Further, not only looking at operating procedures, surgeons should consider patient issues as well. One of the hindrances in opting for surgery is the cost factor and procedures, which need funding. Professionals should be willing to help poor patients and consider alternative methods to fund surgery. At Narayana Hrudayalaya, 40 per cent of patients pay regular market price, while 60 per cent pay reduced price. We also avail government sponsored surgery. Further, surgeons should note that there is no alternative to hard work. They should remember that we are ‘technicians’ – the more number of surgeries we perform, the more we improve on our skill. (mmedit@infomedia18.in) Photo shoot: Dipti Desai
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Roundtable
Surrogacy in India
A healthy controversy? The incidence of surrogacy is increasing in India, contributing to fertility tourism in the country. However, this still remains a contentious subject. Here are some expert opinions that clarify many of the questions about surrogacy in India. Dr Asma Mohd Yousuf
T
he term ‘surrogate’ was quite uncommon in the last decade, but this is not the case anymore. As a matter of fact, surrogacy was not uncommon in the past either, but was not much spoken about then. In India, commercial surrogacy was legalised in 2002 by the Supreme Court of India. Since then, India, besides tourism, has become a preferred destination for many to fulfill their parenthood dreams. However, the legal aspects surrounding surrogacy are complex. In some jurisdictions, the possibility of surrogacy has been allowed and intended parents are recognised as legal parents of the child since its birth. Yet, in many other countries, commercial surrogacy outside the country is considered illegal. Thus, children born through surrogacy to people belonging to these countries may land up ‘stateless’ due to divergent laws that may not grant them citizenship. Dr Alka Kumar Consultant Gynecologist, S L Raheja Hospital (A Fortis Associate), Mumbai Surrogacy is an arrangement in which a woman carries and delivers a child for another couple or individual. Intended parents may arrange for surrogacy in case of infertility or medical issues that make pregnancy risky in the female partner. Other clients could be single parents or gay couples. The parties that are usually involved in the entire surrogacy process include the biological parents, surrogates, infertility specialists, lawyers and surrogacy agencies. A meticulous and stringent criterion is followed while screening for a surrogate. Once finalised, the financial & legal agreement is then made between the surrogate and the commissioning couple. India is presently emerging as a leader in international surrogacy and fertility tourism. Clinics charge anywhere between ` 9 and 14 lakh ($ 22,00-35,000) for a complete package, which includes fertilisation, surrogate’s fee, delivery of infant at the hospital, medications, doctor’s fees and lawyer’s fees. Even after including the ticket fares, cost of the medical procedures and hotel tariffs, the surrogacy expenditure to the intended parents comes to a third of the amount that would have been spent on the same procedure in the UK.
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The birth certificate of the child would bear the names of the intended parents. In case of heterosexual couples with genetic contribution from both parents, their names go on the birth certificate. In case of same sex couple (or single father), the genetic father’s name alone goes on the birth certificate. If donor egg In Vitro Fertilisation (IVF) is performed, the names of both partners in the heterosexual couple go on the birth certificate. There is no mention of the egg donor or surrogate mother on birth certificate. Commercial surrogacy is legal in India and is recognised by the Supreme Court of India. The guidelines for surrogacy in India were laid down by the Indian Council for Medical Research (ICMR) in 2005. The success rate of surrogacy in India can be expressed at about 45 per cent of carryhome baby in procedures using fresh embryos and 25 per cent in those using frozen embryos. Hong Kong and Taiwan are the other countries known for fertility tourism and where surrogacy is popular. In fact, many Indian women go to these countries for sex selection (especially for male child), as gender determination is prohibited in India.
Roundtable Dr Aniruddha Malpani Medical Director, Malpani Infertility Clinic, Mumbai Surrogacy is an expensive and complex treatment option, which is best reserved for women without a uterus. India has now become the preferred destination for surrogacy, as several high-quality IVF clinics are available here that provide excellent medical care with high success rates at economical prices. Besides, there is a well-defined legal framework in India, with legal specialists to guide the intended parents throughout the process. At present, each IVF clinic is governed by the local medical authority (eg, local Municipal Corporation). The Assisted Reproductive Technology (ART) Bill has
still not been enacted but is expected to happen soon. This will give a major fillip to medical tourism, and will also provide more clarity on appointment of accredited authorities. It is important that a legal contract be signed by an expert legal consultant before the medical treatment starts. This ensures that everything is aboveboard, and that there are no legal hiccups later on. Taking shortcuts can give rise to the tragedy of the birth of ‘stateless babies’, who do not have the citizenship of any nation. This can cause irreparable harm to the surrogacy service industry in our country.
Dr Duru Shah Chairman – Gynaecworld - The Center for Women’s Reproductive Health, Mumbai Couples with health problems or general inability to conceive still have the option of experiencing parenthood with the help of surrogacy. It also gives a chance to single parents or couples with an alternate lifestyle to have a child of their own without going through the adoption process. In India, the costs involved in the surrogacy process are approximately five times less as compared those in some other countries. The approximate cost to the intended parent(s) is about ` 10-12 lakh, which includes screening of surrogate, IVF procedure, followed by antenatal check-up, monitoring and medications, hospitalisation & delivery of surrogate.
Moreover, the success rate of surrogacy in India is about 60-80 per cent. Besides, there are fewer legal hassles involved because surrogacy agreement is legal in India. Indian clinics have also become competitive not only in pricing but also in hiring and retention of Indian females as surrogates. Also, in India, poverty is the biggest and most important factor for women choosing to be surrogates. However, according to ICMR guidelines of ART Bill and Rules 2008; 34(5), no woman shall act as a surrogate for more than three successful live births in her life. The governing bodies in India for surrogacy and surrogacyrelated procedures are the ICMR, Ministry of Health and Family Welfare and the guidelines issued according to ART (regulation) Bill & Rules – 2008.
Dr Hrishikesh Pai Gynecologist & Infertility Specialist, Lilavati Hospital, Mumbai, and Fortis La Femme, New Delhi Indications for surrogacy include conditions when a patient is unable to become pregnant due to uterine problems like fibroids, adenoids, repeated surgeries, cancer therapies, hysterectomy or conditions of poor general health like in congenital heart, kidney and lung diseases. Surrogacy is also considered in dwarf patients or single parents. There are two types of surrogacy – natural and gestational. In India, natural surrogacy is not allowed, where the surrogate is also the biological mother of the child. In India, there are 450 IVF units, third in the world after Japan and the US with 600 and 500 units, respectively. The nationalities that usually travel to India for surrogacy are from
the UK, Canada, Australia, the US and Israel. There are about 40,000 IVF cycles done per year in India, of which surrogacy constitutes 5 per cent. Foreign patients form only 5-10 per cent of the infertility treatment, whereas the Indian population forms the bulk of patients with infertility problems. As per the ICMR draft, the surrogate is paid 25 per cent of the money before pregnancy, 50 per cent during pregnancy and 25 per cent after the child is born. However, arrangements can differ as per individual settlements. The compensation provided to the surrogates is in terms of the manpower involved and comes to about ` 2-2.5 lakh. This compensation is offered in the form of a token of gratitude, as one cannot commodify bearing a child.
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Roundtable Dr Indira Hinduja Obstetrician, Gynaecologist & IVF Specialist, Jaslok Hospital, Mumbai, and Breach Candy Hospital, Mumbai In the past, traditional surrogacy was carried out where, like a wife, a woman had intercourse with the man to bear a child biologically related to her. Later, the artificial insemination technique substituted the intercourse act. In recent years, gestation surrogacy has become more popular, wherein the surrogate mother practically only lends her womb for carrying the pregnancy to term. Here, conception takes place in the clinic through IVF and embryo is transferred to the surrogate mother. In this case, the commissioning couple is the genetic parents of the child. There are different kinds of surrogate depending on the system of recruitment, eg, in non-commercial surrogacy, the surrogate will usually be a family member or friend, whereas in a commercial system, the surrogate is unrelated and has to be paid compensation. In countries like Japan, Hong Kong, Hungary and Italy, commercial surrogacy is banned and condemned, which is also the case in Saudi Arabia. In India, the Supreme Court of India legalised the practice of surrogacy in 2002. As per the laws in India, a surrogate mother shall, in respect of all medical treatments or procedures in relation to the concerned child, register at the hospital or such medical facility in her own name and shall clearly declare herself to be a surrogate mother. The birth certificate issued in respect of a child born through surrogacy shall bear the
names of the genetic parents. The person(s) availing the services of a surrogate mother shall be legally bound to accept the custody of the child and a refusal to do so shall constitute an offence. All information about the surrogate shall be kept confidential and information about the surrogate shall not be disclosed anywhere other than the central database. ICMR and National Academy of Medical Science (NAMS) guidelines have suggested formation of a State Board and a National Board for regulating ART clinics. The State Board shall have the responsibility of laying down the policies and plans for assisted reproductive clinic in the state, taking into account the policies, recommendation and regulations of the National board. The Director General of ICMR will chair the National Board. These two authorities will monitor the functioning of the clinics, regularly inspect the premises and grant the licence. The licence will be renewed only after the authorities are satisfied with the working of clinics. Surrogacy stands as the pillar of hope for many infertile parents with the desire for a child. Taking up surrogacy as an option is quite a dilemma and, if not counselled properly, can come as an unexpected blow to the infertile couple. Other options like continuing treatment or adoption should also be put forward to the patient.
Dr Shivani Sachdeva Gour Gynecologist & Infertility Expert, Phoenix Hospital, New Delhi A major advantage of surrogacy is that it allows one or both parents to be genetically related to the child. As against adoption, surrogacy involves the intended parents at the time of conception as well as throughout the pregnancy. With a decline in the number of newborn infants available for adoption, surrogacy offers childless couples another alternative to have a child of their own. Individuals from foreign countries travel to India for medical care due to a number of reasons like lower prices, less wait times and infrastructure equipped with advanced technological facilities. Besides, there are plans that offer complete travel packages in India, including airfare, transfers and surgery costs, which are less than the costs in the US. All these make medical tourism more realistic for everyone, and not just for celebrities. In India, the approximate cost for a surrogacy procedure comes to $ 25,000 as compared to $ 1,25,000-$ 1,50,000 in the US. Also, as per
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the guidelines in India, surrogates have no legal rights on the child. Moreover, everybody wants a healthy surrogate for their child. Women in India are generally preferred as surrogates because they are healthy and do not drink, smoke or do drugs. A surrogate can be selected by contacting an agency that screens surrogates or an independent surrogate, who can provide her complete medical records. Tests results that rule out diseases like AIDS, hepatitis B & C, STDs and rubella are very important. According to Indian guidelines, a surrogate can deliver only three times in her lifetime. The governing body that rules the clinics and hospitals carrying out these processes is based on certain guidelines in ICMR in chapters 1-6. Another country that is attracting attention in fertility tourism is Thailand. But the facilities there are more expensive as compared to in India. Besides, in Thailand, people face language problems as English is not widely spoken there.
Hospital Monitor
Lilavati Hospital & Research Centre
Aiming at benchmarking against the best With unsurpassed commitment, Lilavati Hospital & Research Centre believes in adapting itself to the changing healthcare needs as well as providing quality treatment to patients from all rungs of the social ladder. With departments like radiology and nuclear medicine of national repute, the hospital believes in focussing on technologies now than building a chain of hospitals. An overview of what sets it apart. from general wards to executive rooms. It also houses a telemedicine facility. The hospital focusses on tertiary care around the multi-specialty arena of cardiology, neurology, orthopaedics and minimal access surgery. Dr Trivedi remarks, “We have become a benchmark among hospitals in the country for our specialised services.”
Academic success
Meghna Mukherjee
A
52-year-old patient, Shobha Rathi from Nashik was suffering from acute lower back pain for the last three years. She was unable to walk. A segment of her lumber or lower region had become loose, which caused a narrowing of the spinal canal, resulting in excessive pressure on the spinal cord. Dr P S Ramani, Consultant Neurospinal Surgeon, Lilavati Hospital, Mumbai, implanted a new high-tech device known as In-Space percutaneous interspinous distraction device, between two of Rathi’s spinous processes. This is just one of the many instances that Lilavati has performed giving a new lease of life to many patients. This highlights the commitment of the hospital in serving mankind. Standing tall as the beacon of light for health and prosperity in the city. The multi-specialty hospital is stretched over an area of 2,20,000 sq ft. It
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is an institution dedicated to deliver quality healthcare with a human touch.
Building up strength Aiming to improve healthcare for the common man, Late Kirtilal Mehta conceived this hospital in the name of his wife Lilavati, who died at an early age. For developing the hospital, Mehta had acquired a marshy stretch of land from the Government of Maharashtra in the mid-80s, but it was only in 1997 that the hospital became fully functional. Dr Narendra Trivedi, Chief Operating Officer (COO), Lilavati Hospital, states, “The hospital started with 10 beds and initially had only 22-30 doctors. But today, it boasts of 314 beds with one of the largest Intensive Care Units (ICUs) as well as 198 honorary consultants, 40 full time doctors and 92 resident doctors.” Since the hospital caters to people from all walks of life, rooms range
Nursing is one of the most crucial subject and to ensure that its patients are cared for, the hospital has various courses and programmes for training the nurses. Besides this, the hospital also has tie-ups with institutes to train students. He informs, “We have diploma courses in 14 subjects. These courses are recognised by the Diplomate National Board (DNB), New Delhi. We also have a good placement strategy in place. The most brilliant students are sent abroad or to the most recognised hospitals across the country. Several students are also working in our hospital.”
Gamut of services The hospital ensures that it has all the expert surgical and non-surgical procedures. Critical care: The hospital has a comprehensive and a holistic approach in the care of critically ill patients. The ICU here is one of the five training centres in critical care, which is to be recognised by the Indian Society of Critical Care. It is equipped with a 29-bed specialty unit, with the latest life support equipment such as ventilator and monitoring equipment, pulse oximeters, Electroencephalography (EEG) and Two-Dimensional (2D) echo machines. Almost 50 per cent of beds have
Hospital Monitor
We not only cater to the affluent section of the society but also to the poor. About 2 per cent of the revenue generated by the hospital goes for charity. - Dr Narendra Trivedi Chief Operating Officer (COO), Lilavati Hospital
bedside haemodialysis facility. The unit has two specialised isolation rooms for patients with infection. Imaging service: Department of Radiology and Nuclear Medicine is a department of national repute in radiology and imaging services. Outpatient imaging services are offered at the patient’s convenience. Inpatient imaging services and emergency services are available round the clock. Home service facility for ultrasound is also available for patients who cannot be admitted to the hospital. Further, the hospital has a well-equipped paediatric and intensive care, dental and pathology departments besides having 12 fully advanced OTs and a high-tech cardiology and cardiothoracic surgery unit. The hospital also houses a blood bank.
Healthcare 24x7 Lilavati Hospital has a round the clock emergency service. The hospital has ambulances spread all over the city and also quite a few helpline numbers. Talking about the emergency services, he cites a few instances, “After the 2006 Mumbai railway bomb blast accident, ours was the first hospital to offer specialised services to the injured. We had treated almost 49 cases. Doctors had been constantly attending the injured. I personally operated a case of spleen rupture. The patient’s condition was critical but we had successfully completed the operation.” He continues, “Again, during Mumbai floods in 2005, our hospital offered shelter to people in distress. The reception area as well as the second and third floors was made available for the people to stay.”
Serving the society Right from conducting free Outpatient Department (OPD), to sending their mobile vans to Adivasi areas for organising free
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health check-up camps, Lilavati has ensured that the citizens of the city and surrounding areas are not deprived of healthcare services. Apart from this, Lilavati has entered into a pilot project with Oil and Natural Gas Commission (ONGC) to launch a space telemedicine from its offshore rig and platforms (in the western region) through a satellite medical centre. Further, the social service department of Lilavati Hospital – SEWA – runs on the strong values of humanity. This department seeks to bridge the gap between the needy patients and the fast evolving medical technology of the third millennium. The hospital extends a helping hand for good health to all its patients. Dr Trivedi, reiterates, “We not only cater to the affluent section of the society but also to the poor. About 2 per cent of the revenue generated by the hospital goes for charity. We not only conduct free OPD’s for poor patients but also perform free operations on a yearly basis.” As part of their largest project, the hospital also runs an eye bank – Roshni Eye Bank – a well equipped, efficient, equitable and comprehensive centre for cornea removal, processing, storing, supplying and transplantation. The hospital has also organised corneal grafting diagnostic camps where free corneal transplants were performed. Also, SEWA has taken on numerous welfare projects.
Scrutinising strategies With a plethora of achievements down its line, Dr Trivedi explains, “This being a tertiary care hospital, not only gets patients from the city of Mumbai but also from all over the country. Nursing homes and relatively smaller hospitals, which are unable to perform high-risk surgeries on their patients, are operated in Lilavati Hospital. We have the latest and the best
CT scan machines and other biomedical equipment.” He further adds, “We also provide medical insurance to corporates.” Lilavati is constantly active in Research and Development (R&D). One of the foremost efforts made by Lilavati Hospital had been to establish a communitybased epidemiological research centre for cerebrovascular disease in stroke that functions under the Department of Science and Technology. It has been recognised and issued a special grant by the World Health Organization (WHO). This grant enables Lilavati to conduct the WHO stepwise approach for stroke surveillance.
Expansion plans Lilavati Hospitals has plans to expand in the near future. Dr Trivedi claims, “If we acquire land in the city or if we get an opportunity elsewhere in the country, then we shall surely work on expanding our hospitals into a chain. But, for now we are only looking at expanding the medical and technological services we render.” He further adds, “We are a non-profit organisation, and the profits we make are utilised for repairs, renovation and adding new technologies and devices for the betterment of our patients.”
Keeping patients at the forefront Dr Trivedi avers, “I consider healthcare as a service and not an industry. About 30 patients monthly from foreign shores are also treated in this hospital, but we are in the process of understanding medical tourism.” Apart from serving several notable personalities from the Bollywood industry, Lilavati Hospital has served some renowned names in the country as well as globally. His Holiness Dalai Lama is one of the wellknown treated at the hospital. Dr Trivedi recalls, “Junior Martin Luther had visited Lilavati Hospital as an observer to see the services we offer to not only the rich but also the poor section of the society.” Lilavati Hospital stands as a benchmark for other hospitals in the city. Providing excellent healthcare for almost 14 years, it still stands as a hope for the affluent as well as the poor within the city and across the country, though it has a long way to go. (meghna.mukherjee@infomedia18.in)
Sector Watch
Diagnostics
From detection towards intervention
rtesy: Siemens Healthcare, Siemens Ltd
Treatment of a disease is not possible without right diagnosis, which requires the use of high-end technologies. Advancements in imaging technologies have helped in early detection of several grave diseases like cancer. Here is an overview of the latest developments in medical imaging, its application in diagnostics & therapeutics and the likely future developments for further simplifying the diagnostic and treatment procedures. Dr Asma Mohd Yousuf
B
eginning with the discovery of X-rays in a laboratory, medical imaging today forms an indispensable part of treatment in a sterile and hi-tech environment. The technology has made significant advancements, from detecting disorders at the organ level to that at the molecular level. Advances in medical imaging assist in the early detection of cardiovascular diseases, cancers, stroke and many other disorders. Indeed, medical imaging is a boon to mankind.
Market scenario Medical imaging is the largest sub-segment of global medical equipment market. The ageing population, rapid urbanisation, growing chronic diseases, government plans and economic recovery in emerging markets are the key factors driving growth in this sector. This market is expected to grow further in the near future. Expressing views on the market growth for medical imaging, Dr Sanjeev
J Mudakavi, Consultant Radiologist, BGS Global Hospitals, Bengaluru, says, “The market for medical imaging is expected to grow significantly. With fast service and economical prices, the market for imaging can be tapped in a better way.� Medical imaging technologies, after their discovery, take a long time to reach the market. If the technology is proved to be safe, then it is granted permission for use by the US Food and Drug Administration (USFDA), which also regulates safety and efficacy of the imaging equipment.
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Sector Watch
The market for medical imaging is expected to grow significantly. With fast service and economical prices, the market for imaging can be tapped in a better way. - Dr Sanjeev J Mudakavi, Consultant Radiologist, BGS Global Hospitals, Bengaluru
Imaging diagnostics
Interventional imaging
“Over the years, imaging has undergone a sea change, from simple radiographs to highly sophisticated tools such as ultrasound, Computed Tomography (CT) and, more recently, Magnetic Resonance Imaging (MRI). The advent of ultrasound has vastly changed the present day obstetric management. It is heavily relied upon and is the backbone of infertility and Assisted Reproductive Technology (ART),” avers Dr Roma Lala, Consultant Radiologist, Metropolis Laboratories, Mumbai. With technological advances, various pathologies can now be identified much earlier in a significant number of patients before they become symptomatic. Dr Harsh Merchant, Consultant Radiologist & Coordinator of Radiology, Lilavati Hospital and Research Centre, Mumbai, informs, “Medical imaging has improved by leaps and bounds, especially in the last five years. Earlier, we concentrated on the structural capabilities, but now we are also considering the functional and physiological aspects and combine them with the anatomical information. Recent technological advances have been made in the fields of Positron Emission Tomography (PET)/CT, high-end multislice CT/ dual-source CT, digital mammography, digital radiographs, etc. These advances are expected to help in detecting the abnormalities earlier, besides being more sensitive and cost effective.”
Medical imaging reduces the need for invasive surgeries, as it provides alternative minimally invasive image-guided treatment options. Also, by using imaging technologies, it is now possible to plan a surgery well in advance, thereby reducing the post-operative complications. Elaborating on this, Dr Mudakavi says, “It is certainly possible to treat a few diseases by refined medical imaging techniques. For example, renal stones can be detected by ultrasonographic examination; the treatment includes breaking these stones into smaller fragments by using a concentrated beam of ultrasound – a process called lithotripsy. Interventional radiology is a form of radiology where many disorders such as aneurysms/tumours can be detected as well as treated using various types of coils or injecting a chemotherapeutic agent directly into the tumour. Another latest advancement, known as the Gamma knife, is a form of radiosurgery without incisions.” Prior to a major surgery, accurate localisation of the lesion is possible with imaging. It provides a ‘roadmap’ to the surgeon, according to Dr Sunila Jaggi, Consultant Radiologist, CT Scan and MRI Department, Bombay Hospital, Mumbai. “Sometimes, the same symptoms can be caused by different diseases, such as
Over the years, imaging has undergone a sea change, from simple radiographs to highly sophisticated tools such as ultrasound, Computed Tomography (CT) and, more recently, Magnetic Resonance Imaging (MRI). - Dr Roma Lala, Consultant Radiologist, Metropolis Laboratories, Mumbai
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pain in the right side lower abdomen is a symptom common to many conditions like appendicitis, uteric stone and right ovarian disease, making it difficult to diagnose the underlying pathological condition. By using imaging techniques such problems can be solved,” explains Dr Mudakavi. He further informs that abdominal CT scanning has shown to reduce unnecessary appendix surgeries by 88 per cent, and research demonstrates that evaluating cancer with PET scans saves unnecessary additional tests or procedures in 77 per cent of the cases.
Imaging in cancer Imaging is useful in screening, diagnosing and treatment of cancer. This helps in detecting cancers in early stages, making it possible to administer adequate treatment to patients at the right time. After treatment, imaging can be used for follow-up to monitor response to treatment as well as to rule out recurrence of cancer. “Routine screening digital mammographies, done annually or every two years after the age of 35 years in females, assist in identifying breast cancers in the initial stages. Also, in patients with a family history of colonic malignancy, virtual CT colonoscopy helps in polyp and cancer detection. Imaging can also help in better staging of cancers, eg, PET/CT can pick up metastases much better than CT in case of lung cancer. Also, contrast MRI mammography can pick up occult breast malignancy with metastatic axillary lymph nodes,” says Dr Merchant. Dr (Col) Dinesh Kapoor, Senior Consultant and Coordinator, Department of Radiology, Indraprastha Apollo Hospitals, New Delhi, adds, “Although radiation can kill all types of cancer, patients need to be informed that healthy organs in the vicinity of the cancer can also be affected. This becomes dangerous whereby radiation, while curing cancer, can also adversely affect the surrounding healthy parts of the body.”
Sector Watch He further explains, “Conventional radiation systems use fixed-shaped beams to treat tumours and lesions. Since most tumours are irregular in shape, a fixed-shaped beam cannot completely conform to this shape. Consequently, radiation could damage the surrounding healthy tissues. Here, Novalis Tx – one of the world’s most advanced, effective means of radiotherapy and radiosurgery – makes a vital difference. A new stateof-the-art radiotherapy machine, Novalis Tx, introduced by Indraprastha Apollo Hospitals, is at the forefront of world-class cancer care. It is one of the very few hospitals in India to offer this advanced imaging technology.” Providing details on this technology, Dr (Col) Kapoor says, “With the introduction of Novalis Tx, many cancer patients will benefit from the high precision and pinpoint accuracy of the treatment. This ensures that the best possible treatment dose is delivered while damage to healthy tissue is minimised.”
Contraindications and complications There are five major forms of medical diagnostic imaging, namely, X-rays, ultrasound, CT scanning, MRI and nuclear medicine, informs Dr Mudakavi. He further adds, “X-rays, CT and nuclear imaging utilise ionising radiations; thus, these are contraindicated in pregnant women, and need to be judiciously used in children. People with metallic implants like pacemakers, surgical clips in the body should not undergo MRI. However, ultrasound has no significant deleterious effects and can be used safely in most, if not all, patients.” Ionising radiations also have the potential to produce harmful side effects including cancers. Dr Mudakavi says, “Exposure to these radiations should be kept As Low As Reasonably Achievable (the ALARA principle). Further safety features employed include providing dosimeters to individuals working with these modalities, which measures the amount of exposure received. For patients, the vulnerable regions such as
The only way that these technologies can become affordable is when manufacturing of the entire equipment, such as CT/MRI, is started in the country. - Dr Harsh Merchant, Consultant Radiologist & Coordinator of Radiology, Lilavati Hospital and Research Centre, Mumbai
the eyes and gonads should be protected by lead shields where possible.”
Affordability quotient Medical imaging has proven to help in saving many lives. However, like all new advanced technologies, even this comes with a price that is affordable to some but expensive for many. Cost could be one of the major reasons why many patients do not opt for these tests, which results in either progress of the disease or increase in complications related to the disease. Dr Mudakavi says, “These techniques are certainly expensive and not available in all parts of the country as yet. There are many factors that go into the affordability of these investigations, such as non-availability of machines, high electricity requirement with continuous backup, well-trained dedicated personnel and so on. Interestingly, although imaging technologies are expensive, they actually save money in the long run, in addition to their life-saving impact. According to researchers at Harvard Medical School, every $ 385 spent on imaging decreased hospital stay by one day, saving about $ 3,000 per patient.” Discussing the possibilities of availability of these technologies at affordable prices, Dr Merchant says, “The only way that these technologies can become affordable is when manufacturing of the entire equipment, such as CT/MRI, is started in the country. Surprisingly, most of the core parts of these expensive equipment are manufactured in India, eg, CT scan tubes, generators, etc, which are then exported to the West, and later on imported back as a part of the whole machine. Using refurbished equipment
and adopting a film-less environment will substantially reduce the cost to the patient.” Further, Dr Lala opines, “Cost of imaging is high. Therefore, imaging should be recommended only when required. Every imaging test undertaken should be a step forward in the diagnosis of illness. Also, certain medical ailments may preclude some imaging modalities, eg, high serum creatinine may obviate the use of contrast medium in CT scans and angiographic studies.” However, Dr Jaggi believes that grant of government subsidies, availability of these techniques at subsidised rates in government-run hospitals as well as health insurance support could reduce the cost burden.
e-Imaging The global acceptance of digital imaging technologies has helped in seamless interaction. It is important to have global standards for imaging technologies, as the benefits of these are manifold. Dr Mudakavi elaborates, “Today, images can be stored in CDs or pen drives. These can also be transferred through Internet for analysis and reporting at a distant centre, also known as teleradiology. The images can be integrated into the operation theatre systems to guide surgeons during the surgery by precision mapping of body tissues and tracking the position of surgical instruments or navigating surgery through detailed intraoperative imaging.” He further elaborates, “Digital images can also be viewed on computers and eliminate the need for bulky expensive films. These can be accomplished without any degradation of the image quality while ensuring accuracy.”
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Sector Watch Medicine is now more clinicoradiological, the latter playing a dominant role. In the future, more compact systems with very high resolution may be available. - Dr Sunila Jaggi, Consultant Radiologist, CT Scan and MRI Department, Bombay Hospital, Mumbai
Molecular imaging Modern imaging approaches go beyond the anatomical or functional imaging of conventional radiological approaches and enable fundamentally new interrogations at the cellular, proteomic and genomic level. Biomedical imaging is increasingly becoming a keystone in biomedical studies by bridging the gap between research performed and its clinical application. Updating on the benefits of molecular imaging, Dr Mudakavi says, “Molecular imaging enables visualisation of the cellular function and follow-up of the molecular process in living organisms without perturbing them. Molecular imaging differs from traditional imaging, as chemical probes known as biomarkers are used to help visualise particular targets or pathways. Biomarkers interact chemically with their surroundings and, in turn, alter the image according to molecular changes occurring within the area of interest.” He continues, “The multiple and numerous potentialities of this field are applicable to the diagnosis of various neurological, cardiovascular and oncological diseases. Much research currently centres around detecting a pre-disease or molecular state that occurs before the onset of typical symptoms of a disease. The emerging field of molecular imaging is vital and forms cutting-edge research in the
medical field today. This research is expected to make personalised medicine a reality.”
Present and future Medical imaging has become the cornerstone of current medical practice and changed the way clinical medicine was practised in the last century. Agrees Dr Jaggi, “Medical imaging has evolved tremendously over the years, since the discovery of X-rays in 1895. Faster imaging speeds of CT scanners, flat panel digital X-ray imagers, excellent quality ultrasound systems, low-dose digital mammography systems, and imaging at higher field strengths on MRI have a big impact in today’s evidencebased practice, which supports and confirms clinical diagnoses. Medicine is now more clinicoradiological, the latter playing a dominant role. In the future, more compact systems with very high resolution may be available. Tissuespecific imaging is also possible. Imaging trends in India should now focus more on subject-based subspecialty rather than being modality specific.” Further, Dr Merchant informs that, today, a CT/MR perfusion scan of the brain can be done to detect not only the infarcted tissue but also the salvageable tissue within minutes of a stroke. This translates into better treatment for the patient and, ultimately, better quality of life. He adds, “Current
With the introduction of Novalis Tx, many cancer patients will benefit from the high precision and pinpoint accuracy of the treatment. - Dr (Col) Dinesh Kapoor, Senior Consultant and Coordinator, Department of Radiology, Indraprastha Apollo Hospitals, New Delhi
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developments in medical imaging are all directed towards reducing the ionising radiation to patients, thus improving accuracy and sensitivity. For instance, with the advent of new CT reconstruction and computing methodology, one can reduce the radiation dose by as much as 40-50 per cent. Also, direct detector-based digital X-rays as against computerised radiography systems can help reduce the radiation dose from X-rays by nearly 30-40 per cent. All these new developments in medical imaging will ultimately help us in providing better and safer ways to treat the patient.” Meanwhile, Dr Mudakavi points out, “The impact of medical imaging can be estimated by the fact that most of the inventors of imaging techniques have been awarded the Nobel Prize, eg, Wilhem Roentgen for discovering X-rays in 1901, Hounsfield and McCormack for CT in 1979, Mansfield and Lauterbur for MRI in 2003 and many more. The future for medical imaging research is vibrant and new technologies such as thermal imaging, microwave imaging and Terahertz rays (T-rays) are expected to further advance the imaging methodologies and improve the health of humans. Computed-aided diagnosis is another technology that is expected to reduce human error and improve accuracy of disease detection and characterisation.” Medical imaging plays a pivotal role in healthcare management. Currently, a gradual shift has been noticed towards non-ionising imaging methods like MRI and ultrasound. With the growing digital age, the future will see advanced compact imaging equipment with high image quality in lesser time and that can be accessed from anywhere – a convenient option for healthcare providers as well as seekers. There has also been an extension of medical imaging, from being used as a mere diagnostic tool to now being used as a therapeutic tool. Perhaps, in the future, medical imaging will aid in the bench-to-bedside development of many new remedies in a big way. (asma.yousuf@infomedia18.in)
Specialty Scope
Medical tourism
Your health ticket to India In the era of corporatisation, the healthcare sector is also experiencing a transformation. Today, people from all over the world travel to India to avail various medical treatments. Medical tourism is playing a significant role in not just helping Indian hospitals but also improving the country’s economy. An overview… Dr Asma Mohd Yousuf
I
ndia is a land of a rich and varied history. With its diverse culture and heritage, India has lots to offer to its visitors. Known as the land of timeless beauty, it has always been the ideal tourist destination for people across the globe. And today, the presence of excellent state-of-the-art healthcare facilities, together with highly qualified medical faculty, makes the country an ideal destination for medical tourism. Medical tourism, also known as medical travel or health tourism, describes the rapid development and the practice of travelling to different parts of the world to receive expert healthcare opinion. Although medical tourism has been known since long, it has recently become one of the most popular terms to refer to the countries that provide specialised yet costeffective medical services. India has now become the hub of medical tourism, with patients coming from various countries to reap the benefits of world-class healthcare services available here.
Corporate effect Corporatisation of hospitals in India has helped the country gain a foothold in the medical tourism industry. As Dr Nandakumar Jairam, Chairman and Group Medical Director, Columbia Asia Hospitals, India, says, “Prior to corporatisation, Indian healthcare was a service rather than industry. Today, hospitals in India offer value-added services with a customeroriented approach. And this is the basis of attraction for medical tourism in India.
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No perceptible effect is seen as yet because we are now looking at only the tip of the iceberg. The impact could be obvious and substantial only in the next decade.” Adds Dr Uma Nambiar, Zonal Director - Mumbai Fortis Healthcare Ltd, Mumbai & CEO - SL Raheja Hospital (A Fortis Associate), Mumbai, “Corporatisation has helped increase collective credibility of the hospitals by introducing standardisation of protocols, pricing and standards of care. This has also increased transparency by laying more emphasis on practice of evidence-based medicine.”
Why India? Treatment offered in developed countries is highly expensive. Besides, citizens there face several other problems like lack of personal attention, long waiting periods, etc. Also, people, due to lack of adequate healthcare facilities, travel from developing and underdeveloped nations to India for treatment purposes. Hari S Boolchandani, Head – International Patient Services, Max Healthcare Institute Ltd, New Delhi, says, “People visiting India to seek medical treatment prefer private healthcare providers for various reasons like less waiting time, cleanliness, low infection rates, personalised attention, etc. Besides, private healthcare providers,
unlike their government counterparts, consider medical travel to be a profitable source for patients and revenues, and thus make marketing efforts to attract medical travellers.” He further adds that India is a popular healthcare destination for treatment of medical conditions related to cardiology, neurology, orthopaedics, oncology, urology, cosmetology, gynaecology and organ transplantations.
Monetary benefits While discussing the contribution of medical tourism to the Indian economy, Boolchandani remarks, “The average spend of a foreign tourist to India is anywhere between $ 500 and $ 1,000. However, a medical traveller spends an average of $ 2,000-3,000 on medical treatment and an additional $ 500-1,000 on his/her pre- and post-treatment stay.” He further adds, “Looking at Delhi-NCR alone, by
Specialty Scope a very conservative estimate, we get at least 15,000 medical travellers every year, bringing about an approximate income of $ 45 million (over ` 200 crore) a year. If the medical travel incomes of other regions in the South, West and East regions of India are combined, then one can imagine the huge additions medical travel alone is making to the forex revenues and economy across the healthcare & hospitality sectors.”
Role of accreditation Accreditations act as benchmarks, and help hospitals in monitoring and improving their services & quality of care. Highlighting the role that accreditation plays in medical tourism, Dr Nambiar informs, “Accreditation of a hospital increases the confidence level of patients in accessing services from that hospital because a certain standard of care is guaranteed and patients or their relatives do not have to waste time in reference checking for a hospital or a doctor. This also helps a patient coming from another country since the accreditation criteria across countries are on comparable lines.” She continues to explain, “Hospitals opt for accreditations based on their philosophies. Most Indian hospitals opt for National Accreditation Board for Hospitals & Healthcare Providers (NABH) and some go for additional accreditation by the
Today, hospitals in India offer value-added services with a customer-oriented approach. And this is the basis of attraction for medical tourism in India. Dr Nandakumar Jairam Chairman and Group Medical Director, Columbia Asia Hospitals, India
Joint Commission International (JCI). A few have also opted for accreditation from Australian/Canadian agencies.” Elaborating on the advantages of accreditation, Dr Nambiar says, “Hospitals that undergo the accreditation process have to ensure that they follow an appropriate antibiotic policy and monitor the infections acquired in the hospital. This is the most effective method to check such infections.” She also adds that vaccination can help prevent most of the infective diseases. The bacterial infections commonly occurring in the post-operative period or hospitalacquired infections are kept in check by judicious use of antibiotics. However, in Boolchandani’s view, “Although accreditations are good for hospitals to maintain and monitor standards, in our experience, they do not play a major role in decision making for a majority of patients coming in from South Asia, Middle East and Africa, which contribute to over 90 per cent of
patients seeking healthcare in India. A small percentage of patients from the developed world – US and Europe – often ask whether the hospital is accredited by an international accreditation body. The most popular accreditation is that of JCI of the US. Max Healthcare is accredited by NABH, which is a national accreditation body for hospitals.”
Healing in leisure time Many health tourism packages are often combined with sightseeing and other vacation activities. But is it safe for a patient to indulge in such leisure activities after treatment? Answering this question, Boolchandani clarifies, “Not many people choose to go on excursions after the treatment, as most of the patients come for serious surgeries that require them to rest for about three days to three weeks post hospitalisation. However, people coming in for minor medical procedures like dental and eye treatments could go for
International price list (in thousands) Heart valve Heart replacement Countries bypass ($) with bypass ($) United States 70-133.0 75.0-140.0 India 7.0 9.5 Thailand 22.0 25.0 Singapore 16.3 22.0 Malaysia 12.0 13.4
33.0-57.0 10.2 12.7 12.0 7.5
30.0-53.0 9.2 11.5 9.6 12.0
10.5-16.0 4.8 5.0 7.5 6.4
35.0-52.0 9.3 13.0 16.5 12.7
10.0-16.0 3.6 4.4 5.3 4.6
Panama
10.5
13.5
5.5
7.0
2.5
8.5
3.2
South Korea
31.7
42.0
10.6
11.8
6.6
9.3
3.1
Taiwan
27.5
30.0
8.8
10.0
8.5
10.2
2.7
Mexico
27.0
28.0-30.0
8.0-13.9
7.0-14.9
5.8-11.3
11.0
11.8
Costa Rica
24.1
30.0
8.0-11.4
8.0-10.7
1.3-4.9
n/a
2.0-2.7
United Arab Emirates 37.0-40.9
50.6
46.0
40.2
n/a
n/a
n/a
Israel
25.0
25.0
18.0
11.0-18.5
7.8
n/a
5.0
New Zealand
37.0
40.0
25.0
22.0
n/a
n/a
11.0
Hip Knee Gastric Prostrate Face lift ($) replacement ($) replacement ($) bypass ($) removal ($)
Source: Hari S Boolchandani, Head – International Patient Services, Max Healthcare Institute Ltd, New Delhi
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Specialty Scope
Corporatisation has helped increase collective credibility of the hospitals by introducing standardisation of protocols, pricing and standards of care. - Dr Uma Nambiar Zonal Director -Fortis Healthcare Ltd, Mumbai & CEO - SL Raheja Hospital (A Fortis Associate), Mumbai
tours after ample rest. Appropriate advice is given to such patients to avoid any complication or injury.”
Post-treatment care Providing details on the methods employed in the follow-up of patients from other nations, Dr Nambiar says, “Patients have the option of communicating through email, telephone, teleconference or video conference. Also, if required, the treating doctor in the patient’s country of residence can communicate by any of these means to the doctors in India.” “We usually send the patients back after they have completely recovered so the probability of a complication is very low,” informs Boolchandani. He adds that the patient is given phone numbers and email IDs of doctors as well as international patient service executives to remain in touch for follow-up or assistance in future.
Medical insurance Medical insurance plays a vital role when it comes to paying the healthcare bills. It has not gained significant importance in India, but is a common practice in many other nations. Talking about insurance settlements of the patients visiting from other countries, Boolchandani informs, “Medical insurance practice is yet to pick up in India. The foreigners who seek treatment under any medical insurance
are either expatriates or business/leisure travellers, who require medical treatment usually in cases of emergency. They are dealt with the same way one would deal with a domestic client having an Indian mediclaim policy.”
Infrastructure, IT and language Although developing at a fast pace, the infrastructure of the cities in India still poses a challenge to many sector, which includes healthcare as well. Dr Nambiar points out, “Most people have problems with our non-medical infrastructure like transportation, road conditions, traffic snarls, accommodation, etc. There is ample scope for improvement in these areas.” In agreement, Boolchandani adds, “To an extent, the infrastructure of cities hinder India’s growth in medical tourism. Some destinations like Thailand, Singapore, Turkey, Costa Rica or Malta are preferred over India due to their general infrastructure, tourism and hospitality quotient. However, people looking for serious healthcare at a lower cost still consider India a favoured destination.” Information Technology (IT) plays a significant role in the digital world today. It helps in maintaining accuracy & transparency of medical and financial details. Boolchandani adds, “IT is an important
People visiting India to seek medical treatment prefer private healthcare providers for various reasons like less waiting time, cleanliness, low infection rates, personalised attention, etc. - Hari S Boolchandani Head – International Patient Services, Max Healthcare Institute Ltd, New Delhi
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communication tool for engaging with international target segment through web advertising, emails, web chats, telemedicine, etc.” Providing further details, Dr Jairam says, “IT system improves efficiency of healthcare delivery and enables instant communication with the host country and insurers.” Language is yet another factor that invites so many foreign tourists to visit India for medical tourism. India has a large populace of good English speaking doctors, guides and medical staff. This makes it easier for foreigners to relate well to Indian doctors. Agrees Dr Nambiar, “This is clearly a strong positive in favour of India, much like the popularity India has enjoyed in the Business Process Outsourcing (BPO) or Knowledge Process Outsourcing (KPO) sectors due to fluent English speaking skills. Also, in India, medicine is taught in English; hence, everyone in the healthcare field is quite comfortable using English terminologies.” Meanwhile, Boolchandani remarks, “The English speaking ability helps when it comes to dealing with English speaking patients. However, not more than 30-40 per cent of the patients come from countries where English is the primary language. We, therefore, have engaged full time staff for languages like Arabic and Farsi. We also seek the assistance of professional agencies for other languages.”
Health business of the future The advances in medical technology and creation of better healthcare facilities will continue to increase the demand for treatment of patients from countries other than India. The corporate hospitals in India with well-placed expansions plans are able to accommodate both Indian and international patients. The limiting factors, such as the non-medical infrastructure like transportation, documentation, security and stability as well as city logistics, are bound to improve with time, thus making the future of Indian medical tourism even brighter. (asma.yousuf@infomedia18.in)
Interface
‘The most effective way to control HAI is prevention’ The increasing occurrence of Hospital Acquired Infections is emerging as a global health concern. Most tertiary care hospitals in the country have noted the stark rise in such infections. Rajnish Rohatgi, Medical Director, BD India, explains various aspects of this increasing problem, and ways to tackle them. Meghna Mukherjee
What are the various factors that lead to Hospital Acquired Infections (HAIs)? Healthcare associated infections are acquired while receiving treatment for other conditions in a healthcare setting. Within hours of admission to a hospital, a patient’s flora begins to acquire characteristics of the surrounding bacterial pool. The infections that become clinically evident after 48 hours
Kindly list the symptoms of HAI. Have there been incidences of HAI in hospitals in India? HAIs include development of any infection in a patient while being treated at the hospital. Therefore, besides clinical symptoms of the contracted infection, HAI can impact a patient in more ways. The increased use and exposure of diagnostic & therapeutic procedures affect the patient’s health even further.
BD India has joined hands with All India Institute of Medical Sciences (AIIMS) as a knowledge partner for National Initiative for Patient Safety (NIPS). NIPS is an initiative set up with the objective to sensitise various healthcare institutions regarding the concepts of patient safety and healthcare-associated infections.
of hospitalisation are termed as Hospital Acquired Infections (HAIs). Infections occurring after the patient is discharged from the hospital can be considered to be associated with the healthcare setting if the bacterium was acquired during the patient’s stay at the hospital. However, a few factors that might lead to infection are irrational usage of antibiotics, improper hygiene (personal or environmental), improper use of invasive devices and usage of substandard products.
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HAI can add to functional disability, like emotional stress, of the patient and, in some cases, lead to disabling conditions. Some other factors that contribute to costs include the increased use and exposure of drugs, need for isolation and use of additional laboratory and other diagnostic studies. Conclusively, organisms causing nosocomial infections or HAI can be transmitted to the community through patients discharged from the hospital. If
organisms are multi-drug resistant, the disease might spread. However, due to lack of proper surveillance mechanism in the healthcare facilities, there is little or no data recorded. So the exact number is only an estimate. The unavailability of numbers and recorded data is an active issue in the country and efforts are being made to address it.
Which infections can be termed as ‘malignant’ in HAI? The most frequent HAIs include surgical wound infections, urinary tract infections and blood stream & lower respiratory tract infections. Studies by the World Health Organization (WHO) show that the prevalence of HAI is highest in Intensive Care Units (ICUs) and acute surgical & orthopaedic wards. However, an extremely fatal infection commonly occurring in the ICU is Catheter Related Blood Stream Infection (CRBSI), which is costly as well. When bacteria enters the bloodstream, serious problems called ‘bloodstream infections’ can result. The most serious bloodstream infections occur in sick, hospitalised patients or in people with complicated illnesses such as cancer or kidney failure undergoing dialysis. The use of infected tubes and catheters results in CRBSI, which is often difficult to diagnose. It is assumed that patients who have undergone a surgery are more susceptible to HAI. Is HAI only applicable to such patients or is it of any other kind? HAI can occur in any setting; Surgical Site Infection (SSI) is a type of HAI. It can occur during invasive procedures, which require additional and/or extended treatment. Despite the best efforts of
Interface healthcare facilities to maintain safe surgical environments, SSIs result in an increase of up to $ 10 billion in treatment costs every year in the US alone. Some common causes of SSI are complications from surgical hypothermia, contamination of the incision area by skin flora, bacterial cross-contamination and surgical instrument contamination.
According to a recent report, more than 72 people had died after receiving injections for diarrhoea and fever. How can HAI be prevented? The case of HAI being referred to here was from Modasa, a district in Gujarat, where more than 72 people succumbed to unsafe injection practices in 2009. Several international organisations and the WHO have compiled studies to promote methods to prevent HAIs. However, the answer lies in maintaining a safe environment, using safe procedures as per WHO guidelines, training and educating healthcare workers towards patient safety as well as installing a surveillance mechanism. Kindly elaborate on the epidemiology of HAI. The epidemiology of HAI depends on a number of factors like presence of host (patient), presence of an infectious agent (as is ubiquitous in nature), lowering of self-defense mechanisms (as in immunocompromised and debilitated patients) and further reduction in defense mechanisms as a result of compromised immune systems. What is nosocomial pneumonia? How does a patient survive such an infection? Hospital-acquired pneumonia, also called nosocomial pneumonia, is acquired during or after hospitalisation for another illness or procedure, with the onset of at least 72 hours after admission. Hospitalised patients may have various risk factors for pneumonia, including mechanical ventilation, prolonged malnutrition, underlying heart & lung diseases, decreased amounts of stomach acid and immune disturbances. Additionally, the microorganisms that a patient is exposed to in a hospital are
often different from those found at home. Hospital-acquired pneumonia usually has underlying illnesses and results from exposure to more dangerous bacteria, and tends to be more fatal than communityacquired pneumonia. VentilatorAssociated Pneumonia (VAP) is a subset of hospital-acquired pneumonia. VAP occurs after at least 48 hours of intubation and mechanical ventilation. A patient can survive such an infection if proper precautions are taken in terms of clean ventilator apparatus, proper physiotherapy, proper antibiotics and continuous monitoring.
How can HAI be diagnosed? The easiest way to determine HAIs is by surveillance and interpretation of records. National and regional programmes can educate healthcare workers. Internal hospital programmes can also increase awareness levels and reduce cases of HAIs. The diagnosis of an HAI is based on: Symptoms and signs of infection Examination of wounds and catheter entry sites Review of procedures that might have led to infection Laboratory test results A complete blood count can reveal cases of Urinary Tract Infection (UTI). If a patient has symptoms suggestive of pneumonia, a chest X-ray can confirm the infection. About 5-10 per cent of patients in the US are said to be diagnosed with HAI. Is there a way to control this infection and minimise the possibility for patients to succumb to it? What is the Indian scenario in this regard? Organisations like Centre for Disease Control and Prevention (CDCP) and International Nosocomial Infection Control Consortium (INICC) help in highlighting the magnitude of this issue. The systems are more in place in the US, and an effort to reduce HAI is continuous. However, India has recognised the urgency of this issue now and initiated nationallevel training programmes for healthcare workers. Also, certain hospitals have a complete HAI surveillance process, with
many more being encouraged to follow suit. On the other hand, individuals and patients too need to increase their levels of awareness for HAI, which, unfortunately, in India is still at a nascent stage.
It is believed that HAI sometimes cannot be treated, as the bacteria becomes resistant to antibiotics. The infection is usually the microorganism present in the blood vessel of the patient. How can a patient be treated in such a case? Any treatment of an HAI initiates a cycle of resistance by a microorganism. Therefore, a medication effective in the first round of treatment may cease to be so after repeated use, as the microorganism develops resistance to it. Conclusively, the most effective way to control HAI is prevention. How has BD India equipped itself to deal with HAI? BD India has been instrumental in aligning with and setting up effective and comprehensive surveillance systems in many healthcare facilities throughout the country. These systems are oriented to identify infections caused in hospitals. We also help in early detection of infections in patients. BD India trains healthcare workers, thus catering to this unmet need. We also dissuade irrational use of antibiotics, which are also a cause of HAI. Is BD India partnering with any medical organisation that is dealing with eradication of HAI in India? Recently, BD India has joined hands with All India Institute of Medical Sciences (AIIMS) as a knowledge partner for National Initiative for Patient Safety (NIPS). NIPS is an initiative set up with the objective to sensitise various healthcare institutions regarding the concepts of patient safety and healthcareassociated infections. It hopes to sensitise the healthcare delivery system on various issues of medication management, surgical safety and patient communication. BD would help NIPS in carrying out the baseline and end-line assessments of patient safety guidelines in hospitals that agree to undergo the assessments. (meghna.mukherjee@infomedia18.in)
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IT@Healthcare
Telemedicine
Transforming patient care Advanced technologies are transforming the tenets of healthcare delivery. Virtual reality, robotics and telemedicine have revolutionised the way care is delivered, creating new ways of visualising and transferring information. The future is here, in the information age. Emerging technologies are changing the basic approach of delivering healthcare services.
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ove the information, not the patient. This is the basic idea of telemedicine. Telemedicine is an umbrella term that encompasses any medical care activity involving distance between patient and the caregiver. Telemedicine enables patients to have expert opinions that they may not have otherwise had, by linking populations in remote geographical areas with the required level of clinical and diagnostic expertise. Telemedicine involves transfer of medical data across locations. The data may be high-resolution images,
Dr Aloke C Mullick Director & CEO, Seed Healthcare Solutions Pvt Ltd
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live video, sounds and text/numerical clinical data, which may be human or machine generated. It has become popular in oncology, ophthalmology, radiology, dermatology, surgery, cardiology, urology and psychiatry for providing care to patients in remote areas. It reflects the convergence of technological advances in the fields of medical devices, telecommunication, medical informatics, robotics, material sciences and artificial intelligence.
Shaping up of telemedicine Interestingly, telemedicine in some form has been around for a long time. Shortly after the invention of the telephone, attempts were made to transmit heart and lung sounds to a trained expert who could assess the condition of the organs. Poor transmission systems, however, made these attempts a failure. Later, radio was used to transmit information
from patients to doctors. It was used to assist ships at sea with medical emergencies. With time, telemedicine was made more sophisticated. Conventional telemedicine was ushered in 1964, when Nebraska Psychiatric Institute used a closedcircuit microwave-based television link to connect the Institute and Norfolk State Hospital, which was 112 miles away, for psychiatric consultation. In 1971, a successful pilot was demonstrated using an ATS-6 satellite-based video consultation, across 26 remote rural sites in Alaska. A 1984 pilot in the Australian North West used 20 two-way and 20 one-way earth stations. Following a massive earthquake in Soviet Armenia in 1988, telemedicine consultations with four medical centres in the US, with oneway voice, video and facsimile was organised using NASA satellites. The Indian telemedicine programme using Indian Space Research Organisation (ISRO) geostationary satellites and mobile Very Small Aperture Terminal (VSAT) matured and proliferated across the country after mid-90s. Early telemedicine adoption was affected by cost and technology limitations. As fibre optics, Integrated Services Digital Network (ISDN) leased lines, highspeed mobile networks and compressed high-resolution videos became available, costly low-bandwidth VSAT terminals started becoming obsolete. Telemedicine is on the fringe of mainstream adoption, with technology that has not only greatly improved but become affordable as well.
IT@Healthcare Usage Telemedicine generally provides facilities such as those mentioned here: Remote urgent evaluation of patients, triage decisions and making of pre-transfer arrangements Remote consultation in primary care encounters in locations where physicians are not available Remote specialist consultations and second opinions based on history, physical examination results and available diagnostics data Remote medical and surgical follow-up and medication checks Transmission of diagnostic images Remote management of chronic diseases by specialists not available locally Remote patient education A key feature of telemedicine is the property of supporting the interaction between the patient and caregiver. It also includes advisory information, education & training information and reassurance information, required for patient care.
Going tech-savvy Technology has provided enormous benefits to the healthcare industry, eg, faster patient throughput, faster diagnosis, etc. Most of the services are now within reach of consumers, as these are directly involved in the process of providing healthcare. A number of technologies are used for providing healthcare services. Communication: The oldest technology ‘bridge’ for telemedicine has been the telephone, which enabled a remote voice-only consultation. Telemedicine truly took off when video was added to the voice. This was done in the earliest days with microwave-based TV links and later through satellites. Thus, the ‘telemedicine video camera’ became an essential element of the whole setup, along with the VSAT, cabling, converters, etc. The evolution of communication algorithms has made it possible to transmit video and data through terrestrial ISDN copper lines, setting up the terrestrial telemedicine networks in the 90s. The high-end webcam has replaced the telemedicine camera too.
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The last decade saw interesting advances in high-resolution video compression and mobile broadband technologies. With similar application software advances, these developments have truly made mobile telemedicine possible for the first time in history. Medical devices: Earliest efforts at telemedicine involved transmitting heart and lung sounds, picked up through conventional stethoscopes, across telephone lines. It is no surprise that digitally enabled stethoscopes were the earliest mainstream telemedicine devices. The list has now grown to a wide range of clinical monitoring and diagnostic devices, including spirometers, glucometers, Electrocardiography (ECG) monitors, temperature, pulse & blood
Quick Picks The surgical console is the interface between the real and information world. From the console, the surgeon can perform open surgery, minimally invasive surgery, remote telesurgery, surgical pre-planning, surgical procedure rehearsal, intraoperative image-guided surgery and surgical simulation. pressure recorders and ophthalmoscopes. There is an equally impressive range of remote medical imaging equipment including clinical, radiographic and ultrasound imaging. With the advent of production grade medical robotics, telesurgery is the latest rage in several countries and institutions. As surgeons become used to operating from ‘operating consoles’ by using robotic hands, it was just a matter of time before the patient shifted from an adjoining operating room, to a facility in another city. Live programmes are in production in several surgical subspecialties across the world. This brave new world of medicine is poised to become mainstream in the future. The surgical console is the interface between the real and information world. From the console, the surgeon can perform open surgery, minimally
invasive surgery, remote telesurgery, surgical pre-planning, surgical procedure rehearsal, intra-operative image-guided surgery and surgical simulation. All these actions are possible from the single point of the surgical console. The first telesurgical procedure on a patient was performed by Prof Jacques Marescaux in September 1991. Sitting at his surgical console in New York City, he performed a laparoscopic cholecystectomy on his patient who was in Strasbourg, France, at a distance of more than 4,000 km. Dr Mehran Anvari of McMaster University, Toronto, Canada, routinely operates on patients in North Bay Canada, located 300 km away. Software: US Army medical practitioners are using hand-held computers with application software, which can download the information from a soldier’s ‘electronic dog tag’ into their laptops right on the battlefield. As the wounded soldier is placed on the Life Support for Trauma and Transport (LSTAT) – a portable intensive care unit – the surgeon back in the Mobile Advanced Support Hospital (MASH) can receive via telemedicine, the soldier’s vital signs, change the respirator settings and control the flow of the intravenous fluids & medications. The US Army has been using LSTAT since 2000. From the time of wounding to when the soldier is placed on the LSTAT, he is continuously monitored remotely and the medical record is automatically updated. This was of huge assistance in the Afghanistan and Iraq Wars, and when the LSTATs were proposed to be recalled for servicing, the medics strongly resisted sending them back due to their immense life-saving potential. Virtual reality, simulation and objective assessment has completely transformed the way medical education is imparted to students. Surgical simulator application and hardware packages are now replacing oral examinations and reports from the surgical mentors on how the resident surgeons perform in the operating room. These simulators have new levels of visual fidelity, and ‘organs’ that
IT@Healthcare
Earliest efforts at telemedicine involved transmitting heart and lung sounds, picked up through conventional stethoscopes, across telephone lines. It is no surprise that digitally enabled stethoscopes were the earliest mainstream telemedicine devices. look, react and ‘feel’ real. One of the most sophisticated systems, the Endoscopic Sinus Surgery Simulator (ES3) has multiple levels of training, from the abstract (eg, a video game) to the intermediate level. It shows the same objects overlaid on the realistic anatomy, to the expert level where a procedure must be performed realistically. The students’ performances are recorded and errors are counted; the students are then given an objective score of their performance. The simulator can be used to set criterion, which the students must meet before operating upon real patients. The expert/experienced surgeons perform on the simulator and their score is the benchmark, which the student must achieve before being allowed to operate.
Telemedicine – A game changer One of the biggest advances has taken place in medical informatics itself. Hitherto a telemedicine platform was the bridge between the patient and the clinician, with a two-way flow of information from and to wired medical devices. Clinical data is normally recorded, in face-to-face settings, in an Electronic Medical Record (EMR). However, there are only two options in a remote telemedicine environment: (1) The telemedicine platform itself serves as an EMR. This is difficult, given the complexities and costs involved in creating an EMR, evidenced by the fact that there are only about a dozen well-known EMR companies in the world, as opposed to hundreds of telemedicine companies. (2) The telemedicine platform gathers the data and passes it on to the hospital/ care providers chosen by the EMR via a data/transaction level integration. This is another challenge, given the steep effort/costs of such integration, and multiplicity of EMR applications. Vendors like iHASMD (www.ihasmd.com), besides having industry leading video compression algorithms for video teleconsultation across mobile broadband, have also created a unique solution for difficulties of the EMR by creating a live virtual window in which an EMR with full read-write capability can be pulled. This gives them the capability to support dozens of EMRs without costkilling hardwired interfaces. Truly mobile telemedicine straight from the physician’s laptop has finally arrived, with full clinical record keeping and imaging integration. The foreboding ‘telemedicine room’ along with its intimidating equipment stack can finally claim its place in history. (acmullick@gmail.com)
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Marketing Mantra
Business development strategy
Focussing on core competencies Developing a business today takes immense fortitude, as the success and failure of any venture depends on the choices made when facing a challenging situation. The smallest of an idea can help in the overall growth of any business, provided that it is supported with the right attitude.
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journey begins with an idea, which could be the thought of owning and running a hospital. This thought turns into a dream and then into passion. As the journey unfolds, the excitement grows. Some people succeed, while some succumb to mistakes. The nature of mistakes is different in each phase of the growth journey. In the planning stage, some people may make a mistake by being too impatient with the idea, while some may not act on the idea quickly enough. Sometimes, rationale takes a backseat amidst all the fervour of constructing a hospital.
Vivek Shukla Principal, Healthcare Business Consulting, Vivek Shukla and Associates
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Errors in inception stage During the inception stage, promoters can make mistakes that are irreversible. For example, while constructing a building, the design may not be suitable for further growth in subsequent phases. The initial idea may not include expansion possibilities or accreditation norms, which will then be reflected on the design. The capital structure of a business can have serious flaws as well. The money raised by loans may have to be repaid in short period, creating critical working capital issues. The equity participation may be too much or too less. Sometimes, over investment is done in the first phase without having any facts in hands. The entrepreneur, by nature, always overestimates the quantum of demand for his product. But, this is invariably based on assumptions, and hence is unrealistic. It is crucial to gauge the
depth of demand. Often, expert help is sought for this purpose. Most people underestimate the value of planning the equipment and manpower in advance. This leads to acquisition of expensive equipment, thus raising costs and accumulating inadequate or incapable manpower. In such a scenario, costbased pricing takes precedence over price-based costing, ignoring the laws of the market. Consumer preferences are ignored and the promoter plays into the hands of self-centric planning. Most promoters make the mistake of ignoring the importance of creating a unique brand right from the start. Differentiation is the basis for branding. The attributes that make a company unparalleled and relevant to the target audience must be articulated right from the beginning and then crafted carefully in the inception stage. A majority of people do not think of differentiation at all, while some start thinking after the hospital is commissioned.
Errors in post launch stage Some of the common mistakes made in this stage include the following: Lack of alignment among the staff can spell trouble for any company. In such a case, the vision and core values are barely articulated. Even if they do, people are not interested in those. This may thus result in disintegration of the aim of the organisation. People will push their individual agenda rather than working in cooperation towards a common goal. This lack of alignment can be attributed to lack of leadership. The leader is responsible for galvanising everyone
Marketing Mantra towards a common goal. Failure in leadership occurs when people lose faith in the ability of the leader. This can happen on many accounts. When the business starts to run and cash flow increases, the promoters face various possibilities of further growth. They need to make tradeoffs between various choices. For example, a hospital may be functioning well and the promoters and leadership may be debating on the subject of adding a new department. They may also be contemplating on the matter of adding new equipment. At this stage, any error in judgement will cost dearly to the organisation. Most decisions are usually made based on assumptions, which make the probability of errors high. Promoters while investing in the startup of a new department assume that because no other hospital has this department, theirs will do well. But, this basis is insufficient while investing in a new department. If the demand for a new service is not gauged, mere absence of that service elsewhere should not be the sole reason to make investments. It will be worthwhile to mention that adding new services may also dilute the existing brand equity. Ample researches have been conducted to prove that extending the brand dilutes the perception of the brand. For example, addition of a laparoscopic surgery department at an established mother and child hospital will dilute the brand. This is because people will be confused about the new identity.
Other common pitfalls If things go well, some players will move towards internal consolidation phase after the post launch growth. Common pitfalls in this phase are as follows: Not upgrading the systems with the changing workflow leads to redundancy and wastage. As people are inherently resistant to change, the new systems are either not created or not welcome even after they are created. Resting on previous achievements leads
to stagnancy. In business, a stagnant status quo is equivalent to death. So if an organisation does not reinvent itself continuously, it jeopardises its own existence. The products, brand identity, people and several other attributes need to be refined every now and then. This includes making occasional changes at all levels. Moreover, the strategy needs to be calibrated according to the changing times. The growth of the company must at least match the growth of the overall market in that area. This entails that the rate of growth of the hospital should be equal to or better than the industry growth rate. This is important because it deters new entrants to set up their base. If there is a lot of marketshare, a competitor or a new player may try to seize the opportunity, causing trouble for the established company in the long run.
Quick Bytes Differentiation is the basis for branding. The attributes that make a company unparalleled and relevant to the target audience must be articulated right from the beginning and then crafted carefully in the inception stage. Companies need to focus on their core competency. For this, they need to learn to say no and sacrifice seemingly interesting opportunities. Rapid growth is a function of focus. Companies that grow at a fast pace are like laser beams, which means that they pass through anything that comes in their way. Those trying to reach everywhere are unable to overcome the obstacles in their path.
Choosing the right options After a successful internal consolidation, the next step is external consolidation. But, this area is also fraught with risks. Thus, only the fittest can survive in this business jungle. Very few players reach the stage where they can start using external routes such as acquisitions,
mergers, franchising and setting up new centres. At this stage, problems arise if the growth route is not chosen correctly. A wrong choice may turn out to be expensive and make a dent in the existing business as well. Acquisitions can be complicated and if a hospital grows by that route, without having enough muscle to deal with the complexities brought about by this option, it can result in considerable loss of money and reputation. More often than not, funds are required for inorganic growth. A number of funding options are available in the market today. The right option catapults a company’s growth rate into the fast lane, while the wrong one leaves it disoriented. Funding options are broadly divided into debt and equity options. Each of these has various suboptions that have numerous pros and cons. Thus, the best bet is to choose the option that best suits a company’s need and strategy. The inability of a company to integrate the new entities with the vision and strategy of its existing business is another pitfall in external growth. Thus, a mismatch in the amalgamation results in complications, leading to difficulties for both parties. After the company reaches a considerable growth, the current promoters need to exit. Several options are available for this exit, including a sell out, Initial Public Offering (IPO), management buy-out, management buyin, succession, etc. Each of these options is unique and has its own set of limitations and opportunities. As in other scenarios described earlier, the success of the exit will depend on the tradeoff between the profits versus losses in each option.
Moving ahead with right attitude Despite the innumerable pitfalls there are ample examples of people who have overcome the challenges and created unprecedented growth for their hospitals. Often they seek help from neutral experts. A dispassionate rationale helps in making the right choices. Nevertheless, the attitude is important. (vivekshukla2006@gmail.com)
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Spotlight
Virtual manufacturing
A revolution in medical device development Virtual manufacturing is a technology that uses computer simulation of the design and processes involved in product manufacturing. Products can be visualised in a three-dimensional model in the manufacturing environment by using computers. This helps companies minimise expenditure on materials & production costs and improve product quality. analysis software to simulate a product’s performance and the processes involved in its fabrication. This is superior to Computer Aided Designing (CAD), as NFEA provides complete analysis of a product, which is then used for optimisation of factors such as manufacturability, final shape, residual stress and lifecycle estimations in a more realistic manner.
Finite Element Analysis
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edical device biomaterials manufacturing is a technology and capitalintensive industry that decides the treatment outcome, patient safety and quality of care. In case of prosthetic devices, such as knee joint, dental and ocular & heart valves, the device compatibility and durability depends on the design and manufacturing technology. Group Captain Dr Sanjeev Sood Senior Medical Officer and Hospital Administrator, Indian Air Force Station, Jodhpur
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Combined with simulation technology, appropriate software, design processes and operating systems, it can reduce costs and thereby increase company profitability. A recent development called ‘Virtual Manufacturing’ is being touted as ‘The Next Revolution in Global Manufacturing’. Virtual manufacturing involves simulation of a product and the processes involved in its fabrication.
Nonlinear Finite Element Analysis At the core of virtual manufacturing lies a technology called Nonlinear Finite Element Analysis (NFEA) that uses a powerful computer and modeling &
Finite Element Analysis (FEA) is a powerful engineering design tool that enables designers to simulate structural behaviour, make design changes and see the effects of those changes. The FEA method works by breaking the geometry of a real object down to a large number (1,000 or 100,000) of elements (eg, cubes). These elements form the mesh and the connecting points are the nodes. The behaviour of each minute element, which is regular in shape, is readily predicted by a set of mathematical equations. The summation of the individual element behaviour produces the expected behaviour of the actual object. The mesh contains the material and structural properties that define how the part reacts to certain load conditions & physical environment. In essence, FEA is a numerical method used to solve several engineering problems that involve stress analysis, heat transfer, electromagnetism and fluid flow. NFEA uses an incremental solution – a procedure to step through the analysis. In contrast to linear FEA,
Spotlight where a solution is achieved in one step, NFEA may require hundreds, or even thousands, of steps.
Advantages galore Simulation technology enables device manufacturers to optimise key factors like manufacturability, final shape, residual stress levels, product durability and obtain regulatory compliance, thus eliminating the need for multiple physical prototypes & reducing material waste. This allows everyone to ‘get it right the first time’, than taking the design-make-test route. It provides manufacturers with the assurance that they can deliver quality products to market on time and within budget. This directly affects profitability by reducing iteration, production cost, material usage and warranty liabilities. Some of the key advantages of virtual manufacturing include the following: Fewer prototypes Less material waste Reduced cost of tooling Improved quality, reduced time to market Lower overall manufacturing cost Confidence in manufacturing process
Improved stent design saves lives A stent is a cylindrical device used in arteries and veins to maintain patency of the vessel for acceptable levels of blood flow to specific organs. The stent geometry is uniquely defined using the several parameters. Their widespread use in cardiovascular surgical procedures is hindered by 20-30 per cent failure rates within the first year. Stent design profoundly influences the post-procedural haemodynamic and solid mechanical environment of the stented artery by introducing nonphysiologic flow patterns and elevated vessel strain. This alteration in the mechanical environment is known to be an important factor in the long-term performance of stented vessels. Due to their critical function, it is vital that the stent design be thoroughly validated by methods such as FEA. Finite element
Medical devices MSC solutions for the biomedical industry include the following: Stent analysis & deployment Dental implants & restorative procedures Biomechanics & stress analysis of joint replacements Contact lenses & intraocular implants Hospital beds & patient comfort studies Device–tissue contact Drug delivery devices Radiology & imaging equipment Pacing devices including pacemakers & defibrillators Blood flow analysis Medical packaging studies Simulation data & process management for FDA compliance Soft tissue modeling Understanding and foreseeing facial appearance before cosmetic and maxillofacial surgery
modeling highlights any design or process problems well in advance.
Modeling solutions The finite element models used rely upon simple linear elastic, isotropic beam and shell elements. Biomedical engineers are designing stents using MSC solutions (MSC.Software) for the pre-and post-processing and analysis code because of its capability to handle non-linear and large deformation material behaviour. Clinical evidence showed an abrupt compliance mismatch at the junction between the stent ends and the host arterial wall, disturbing both the vascular haemodynamics and the natural wall stress distribution. These alterations caused by the stent were greatly reduced by smoothening the compliance mismatch between the stent and host vessel. The stresses were found to be 5-10 times greater than the arterial wall stress under normal physiological pressure. A Compliance Matching Stent (CMS) was created using these findings and was manufactured & tested. It is expected that these results will improve stent designs that will prevent restenosis and, ultimately, improve quality of life for patients receiving them.
The downside
techniques are just tools, and clinical trials are still required to ensure their safety. The level of complexity and the appropriate tools needed are driven by the problem at hand instead of the tools. In spite of the great power of FEA, the disadvantages of computer solutions must be kept in mind when using this and other similar methods. These do not necessarily reveal how the stresses are influenced by important problem variables such as material properties & geometrical features, and errors in input data can produce wildly incorrect results that may be overlooked by the analyst. Perhaps, the most important function of theoretical modeling is that of sharpening the designer’s intuition. Users of finite element codes should plan their strategy towards this end, and supplement the computer simulation with as much closed-form and experimental analysis as possible.
Improving manufacturing Virtual manufacturing is a revolutionary medical device design and development technology that can improve treatment outcomes and manufacturing cost. Although in its infancy in India, this technology enables device manufacturers for delivering quality products at affordable cost and time.
At the end of the day, simulation
(mmedit@infomedia18.in)
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Meditech
Tissue Plasminogen Activator
A novel treatment for stroke Tissue Plasminogen Activator (tPA) can drastically reduce the long-term disability associated with stroke. However, it has been slow to garner acceptance as the standard care for acute stroke cases in hospitals across India. Let us find out why. disability or death – the usual outcome of a stroke attack.
Properties of tPA
Dr Asma Mohd Yousuf
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troke is the second leading cause of death worldwide. One in six people experiences a stroke during his/her lifetime. Stroke is the leading cause of serious, long-term disability, and it can occur at any age. Highlighting the factors responsible for high prevalence of stroke in India, Dr Sunanda Anand, Consultant Neurologist and Interventional Neuro Radiologist, Holy Family Hospital and Nanavati Hospital, Mumbai, informs, “Stroke is more commonly found in developing countries than developed countries. India has a huge population with diabetes, and this increases the
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incidence of stroke. Other causes that could lead to stroke are hypertension, dyslipidemia, sedentary lifestyle, smoking, etc. Usually, stroke is a disease of old age. But, it is not uncommon in the younger age group, ie, in people aged below 45 years. It can also affect younger children predisposed to genetic or congenital factors.” People must understand that it is possible to prevent stroke and also recover from it. At present, the only treatment approved for acute ischaemic stroke by guidelines and authorities worldwide is alteplase, which is also available in India. This drug can help save many patients from
The tPA is a serine protease found on endothelial cells and is involved in the breakdown of blood clots. Due to its thrombolytic action, tPA is used in clinical medicine to treat embolic or thrombotic stroke. Its use is contraindicated in haemorrhagic stroke and head trauma. Dr Anand adds, “In the treatment of stroke, it is important to prevent recurrence, which can be achieved by breaking the clot and revascularising the affected area. tPA is one such medicine, which is effective in the window period.” tPA is the only drug approved by the US Food and Drug Administration (USFDA) for treatment of acute ischaemic stroke. It is administered intravenously by the healthcare provider. tPA may be created using recombinant technology techniques and the resulting tPA is referred to as Recombinant Tissue Plasminogen Activator (rtPA). “tPA administration helps in saving many stroke patients from deformities. It is administered intravenously in the first 4-4.5 hours of stroke onset. After 4.5 hours, tPA is given endovascularly through angiography for six hours. It cannot be administered beyond six hours. Once the window period is crossed, then only sucking of the clot can prevent further damage to the brain,” informs Dr Anand.
Alteplase effect Alteplase is a man-made protein manufactured by recombinant DNA
Meditech technology. It was first approved in 1987 for use in heart attacks. In 1996, it was approved for treatment of acute ischaemic stroke. As per recent research reports, alteplase is effective up to 4.5 hours after the occurrence of the disease against the conventional three hours reported by the National Institute of Neurological Disorders and Stroke (NINDS) trials. However, there is a small increase in symptomatic Intracerebral Haemorrhage (ICH) and death, but not enough to prevent the use of this therapy. On this, Dr Anand elaborates, “tPA administration is based on Magnetic Resonance Imaging (MRI) scan results. It is administered if damage to the brain is less than one-third. tPA is first given as 10 per cent bolus, followed by 90 per cent infusion over the next one hour. The dose administered ranges from 0.9 mg/kg to 90 mg/kg. However, after administration, there is a chance of bleeding. So, the patient is kept under observation, and after 24 hours, Computed Tomography (CT) scans are repeated, based on which the subsequent line of treatment is decided.”
Need for awareness Without warning, stroke can paralyse or kill a person, who once must have been considered absolutely healthy. Some victims recover, but many do not and may even suffer lifelong disability. According to Dr Anand, “The current diagnostic methods like CT and MRI help identify a case of stroke as early as 15 minutes. However, there is limited awareness about the diagnostic and treatment procedures among the general population as well as general practitioners. Due to this lack of information, by the time patients approach a hospital for treatment,
In the treatment of stroke, it is important to prevent recurrence, which can be achieved by breaking the clot and revascularising the affected area. tPA is one such medicine, which is effective in the window period. - Dr Sunanda Anand Consultant Neurologist and Interventional Neuro Radiologist, Holy Family Hospital and Nanavati Hospital, Mumbai
the window period of 6 hours is already crossed and tPA cannot be administered.” Explaining further, Dr Anand says, “Stroke is painless, and symptoms may include numbness or motor weakness, which are usually ignored by patients. In patients with cardiac diseases, the symptoms are always accompanied with pain, which is not the case with neurological ailments. Therefore, patients
Quick Bytes Picks tPA is the only available medication that can prevent further damage in a stroke patient. Although treatment with tPA is expensive, it is the only opportunity to save a patient from the effects and complications arising after stroke. with stroke always contact a doctor when they have already exceeded 6 hours. It is important to administer the drug in the window period, as this is the time when the brain cells, though affected, can still be saved from apoptosis.” Besides medication, stroke patients can be treated by mechanical methods like sucking of the clot with the Penumbra Aspiration Device (PAD) or endovascular recanalisation, which can be done after four hours of the attack. In India, endovascular recanalisation was introduced in 2008, and since then it has
Face Arm Speech Test (FAST) requires an assessment of three specific symptoms of stroke Facial weakness: While smiling, is the person’s mouth or eye drooping? Arm weakness: When asked to raise arms, can the person raise both arms? Speech problems: Can the person speak clearly and understand what is said to him/her?
been successful in more than 100 cases, informs Dr Anand.
Prevention is better than cure Stroke is an emergency condition where every second counts. Once affected, tPA is the only available medication that can prevent further damage in a stroke patient. Although treatment with tPA is expensive, it is the only opportunity to save a patient from the effects and complications arising after stroke. For those falling in the high-risk group for stroke, preventing the occurrence of any such ailment is only possible by taking precautions. Dr Anand mentions, “It is important to control blood pressure and blood glucose & cholesterol levels. If an individual is overweight or obese, then measures must be taken to reduce and maintain the appropriate weight. Besides, quitting smoking and living a more active life will also reduce the chances of falling prey to a disease as dangerous as stroke. Women are less prone to stroke till menopause, but the risk increases afterwards. Therefore, annual check-ups will help in monitoring their health status. Also, people aged above 30-35 years, especially those with family history of stroke, should undergo annual health check-ups.” She concludes by informing, “As mentioned earlier, the awareness for stroke should be created among the masses as well as general practitioner so that the symptoms are noticed in the early stages when the chances of recovery are more. Simple tests like Face Arm Speech Test (FAST) can prevent many lives from disabilities and complications that an attack of stroke brings along.” (asma.yousuf @infomedia18.in)
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NGO Corner
Smile Foundation
Caring for the under-privileged Sustainability, social equality and the environment have now become business concerns. And corporate leaders cannot depend on governments to resolve these. With this thought, a Non-Government Organisation (NGO) – Smile Foundation – was established to provide education and health to under-privileged children. This NGO has transformed thousands of lives since its inception. of a referral service network. Education and counselling need to be imparted on health & hygiene, family planning promotion with emphasis on condom use for safe sex and methods for spacing between children. The programme would also involve organising regular health camps, including minor surgical interventions as well.
Smile on Wheels
Geetha Jayaraman
S
mile Foundation was founded in 2002 by a group of professionals who decided to finance, handhold and support genuine grassroots initiatives targeting at providing education and healthcare to under-privileged children. In the process, it grew to become the first ever NonGovernment Organisation (NGO) with a reach of millions. As a social venture philanthropist, Smile Foundation promotes and catalyses universal education among under-privileged children. It works to create the process to embrace these children into the mainstream in a sustained manner, and facilitates them to emerge as productive assets, thus setting the foundation for nation building. ‘‘Smile Foundation helps in facilitating affordable, accessible and
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accurate healthcare services to all sections of society,” avers Manju M, Head - Smile On Wheels Programme.
Healthcare initiative Smile Foundation provides best-inclass healthcare facility to the poor. The services provided include Outpatient Department (OPD), ante-natal/postnatal services, identification of difficult pregnancy and referral for institutional care, immunisation for mother & children, minor surgery, blood pressure examination, X-ray, Electrocardiography (ECG), first aid, distribution of iron folic tablets, vitamin A prophylaxis, treatment of children with malnutrition, etc. Children and women’s health is one of Smile’s prime concerns. Addressing these concerns requires development
Working for the under-privileged, Smile has launched a national mobile hospital programme called ‘Smile on Wheels’. It is a multi-centric project with an objective to provide a comprehensive range of healthcare services to under-privileged community in outreach, remote rural areas and slums through well-equipped mobile medical vans. The programme is based on an innovative concept of community-centric sustainable healthcare delivery model. Smile on Wheels operates by taking well-equipped medical van along with specialised doctors, nurses, medical staff, equipment and medicines to the identified villages/ slums in a systematic manner. Each unit covers the vicinity of up to 25 km from its centre and regularly visits 2-3 villages each day. The model envisages an efficient and cost-effective healthcare delivery system for the community. Durings its four years of operations, the programme has directly benefited more than 2,54,880 people and provided services to over 14,13,000 people. Currently, the programme provides services to over 7,86,667 people. Manju points out, “The healthcare van would enable
NGO Corner
Smile Foundation helps in facilitating affordable, accessible and accurate healthcare services to all sections of society. - Manju M Head - Smile On Wheels Programme
prevention, diagnosis and treatment services. The impact of this programme will be visible on the lives of more than 10 lakh people.” The first mobile van was launched in 2008 and is still operational in South Delhi, Gurgaon and Faridabad. Smile on Wheels mobile hospitals are equipped with latest technologies. This mobile hospital is fully air conditioned, with a dark room and X-ray machines.
Smile in Camps Smile in Camps is a special health initiative by Smile Foundation. Under this approach, customised health camps (multidisciplinary and general camps) are organised extensively across the country, and aims to reach out to at least 500 districts in two years. Manju highlights, “This approach is expected to meet the immediate healthcare needs of the marginalised community in remote rural areas/slums through standalone camps. Through more than 75 general camps till date, the programme has directly benefited more than 25,000 people, including children and women. The multidisciplinary health camps conducted annually at Bhilwara, Rajasthan, has benefited approximately 20,000 people every year.”
Response from India and abroad The healthcare initiatives of Smile have been encouraged by many national and international organisations such as Public Sector Undertaking (PSU) giants like Steel Authority of India Ltd (SAIL) and Gas Authority of India Ltd (GAIL). Other organisations that have supported Smile in Camps programme include Canara bank, Rotary Club of Delhi South (New Delhi), HINDALCO Industries Ltd, Lafarge India Pvt Ltd, AIIMS & Red Cross Society (New Delhi), Association of Obstetrics and Gynaecology of Delhi (New Delhi), Lifeline Hospital (Chennai), St Martha Hospital (Bengaluru), Vinayak Hospital [Delhi & National Capital Region (NCR)], Fullerton and Ajay Memorial Foundation (AMF) (Tamil Nadu).
More to go... Smile Foundation aims to run a fleet of 30 fully equipped mobile medical vans under Smile on Wheels programme, reaching out to approximately 35-40 lakh beneficiaries in the coming five years. (mmedit@infomedia18.in)
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Curtain Raiser
Medicall 2011, Kolkata
Showcasing the best in healthcare The sixth edition of Medicall 2011, Kolkata, with a focus on the US, Germany and Taiwan this year will open the gateway to the medical world. It aims to attract hospital professionals, manufacturers and distributors from the emerging Eastern and North-Eastern regions of the country. A base to expand, exchange and evolve.
Meghna Mukherjee
M
edicall 2011 will be held in Kolkata during February 11-13, 2011, at Netaji Indoor Stadium. Organised by Medexpert and co-sponsored by Shuter Enterprises India Pvt Ltd, it aims to bring the entire medical device fraternity under one roof to interact, share and exchange knowledge & ideas. The event will also showcase medical equipment. Doctors, hospitals, nursing homes, diagnostic centres, pathological laboratories and traders are expected to visit this exhibition.
Journey so far Medicall 2010 showcased various products on rehabilitation. The three-day event was segmented into three modules – International Conference on
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Molecular Diagnostics, Conference on Hospital Cost Control and the Australian Accreditation for hospitals and polyclinics. Also, a seminar on medical diagnostics was conducted. Over 60 representatives of various hospitals from attended this seminar. Rightly named as ‘Hospital Equipment Supermarket’, the event saw a huge visitor profile from 2,500 in 2006 increasing to 8,000 visitors in 2010.
Promising opportunities The sixth edition of Medicall 2011 promises to offer immense opportunities to visitors and healthcare professionals alike. Hospital partnerships, special B2B meetings for international visitors, a showcase of the latest advancements in the Indian healthcare industry and unmatched industry knowledge will be
the highlights of the event. Sharing the numbers, Dr Manivannan, CEO, Medicall, avers, “This time there are 120 exhibitors and we are expecting approximately 4000 visitors from India as well as the US, Germany and Taiwan.” He continues, “We are targeting the developing companies from North-East and East India as more hospitals are mushrooming there.” Besides there will be conferences and seminars concurrent to the event. This would focus on topics like organising a central sterile department, which will discuss about designing a Comprehensive Strategy for Services Sector Development (CSSSD) in a hospital, fundamentals of autoclaves, biological indicators, ideal packing materials, infection control, etc. Taking the discussion forward, the conference will give details on controlling cost in hospitals that will highlight on financial audit, efficient material management and role of IT in cost control, lean management in hospitals and business intelligence & resource optimisation. The topic on hospital construction will include preparing a project report for a new hospital, designing an operation theatre & intensive care unit, basics of medical gas in pipeline and lighting & flooring in hospitals. Medicall 2011 will provide an excellent platform for exhibitors to showcase their products & services to potential clients and give healthcare professionals a chance to get acquainted with the latest technological developments in the medical equipment sector. It will lend a unique opportunity to international visitors to discover India’s competence in the medical equipment arena. (meghna.mukherjee@infomedia18.in)
Events Calendar
NATIONAL Medical Fair India 2011
7th Medicall
An international exhibition and conference featuring diagnostic, medical equipment, devices and medical technology. Doctors, hospital administrators, hospital managers, directors, technicians and other healthcare professionals are expected to visit this exhibition.
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, hospital furniture, diagnostic/laboratory equipment, and dental & ophthalmologic equipment. The event expects participation from more than 400 exhibitors.
Date: March 25-27, 2011 Venue: Bombay Exhibition Centre, NSE Exhibition Complex, Mumbai Organiser: Messe Düsseldorf GmbH Tel: + 49 211 4560 900 Fax: + 49 211 4560 668 Email: info@messe-duesseldorf.de Website: www.medicalfair-india.com
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 om
Meditec Clinika 2011 Meditec Clinika is the 3rd international trade fair for medical equipment and technology showcasing innovative medical products & systems in India. The event aims to take a firm step forward in revolutionising and effectively contributing to the efficacy & quality of healthcare. 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
Healthex 2011 Healthex 2011 is an international
CHENNAI Tamil Nadu Mar 11-13, 2011 Chennai Trade Centre
Hospital Infrastructure India 2011 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. 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
PUNE Maharastra Oct 14-17, 2011 Auto Cluster Exhibition Centre
AHMEDABAD Gujarat Nov 2011 Gujarat University Exhibition Hall
INDORE Madhya Pradesh Jan 2012 Poddar Plaza, Nr Gandhi Hall
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
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Hospital Infrastructure India 2011 is an international exhibition on hospital infrastructure, planning, supplies and healthcare development sector. This exhibition will see investors, planners, builders, contractors, architects and designers. The wide range of products include building materials, flooring, roofing, cladding, walling, glazing, furniture, hospital supplies, etc. It is expected to be visited by senior managers, commissioners, medical centres, healthcare institutions, hospitals, CEOs, hospital administrators, medical superintendents, medical directors, executive directors, etc from the healthcare industry in the country as well as from overseas. Date: October 21-23, 2011 Venue: Bombay Exhibition Centre, Mumbai Organiser: IIR Exhibition India Tel: + 91 22 4020 3329 Fax: + 91 22 4020 3300 Email: guru.prasath@informa.in Website: www.hospitalinfra-india.com
Events Calendar
INTERNATIONAL Dental South China Dental South China International Expo, first held in 1995, has been in a leading position for the past 15 years. It will display a wide range of dental products including equipment, instruments, materials, denture, oral care products, dentistry furniture, dental management software, and dental teaching supplies.
Date: March 2-5, 2011 Venue: China Import & Export Fair Pazhou Complex, Guangzhou, China Organiser: Guangdong International Science & Technology Exhibition Company Tel: + 86 20 835 49125 Fax: + 86 20 835 49078 Email: dentalvisit@ste.cn Website: www.dentalsouthchina.com
Medtec 2011 A trade fair on medical equipment design and technology. Designers, engineers and decision makers from this field are expected to visit this exhibition. A concurrent conference would highlight and discuss various trends, quality and regulatory issues surrounding medical devices & equipment. A place to make new contacts and broaden one’s clientele. Date: March 22-24, 2011 Venue: Stuttgart Trade Fair and Convention Center, Germany Organiser: Canon Communications LLC Tel: +1 310 445 4200 Fax: +1 310 445 4299 Email: info@cancon.com Website: www.canontradeshows.com
MED-E-TEL 2011 An international educational and networking forum for e-health, telemedicine and health ICT. The conference will feature over 150 presentations and workshops that will highlight the current applications
and future trends in this field and their impact on the healthcare system. It will also provide a great platform for networking and establishing local as well as global contacts. Date: April 6-8, 2011 Venue: LUXEXPO Exhibition & Congress Center, Luxembourg, Belgium Organiser: International Society for Telemedicine & eHealth (ISfTeH) Tel: +32 2 269 84 56 Fax: +32 2 269 79 53 Email: info@medetel.eu education@medetel.eu Website: www.medetel.lu
MEDTEC UK 2011 A medical device & technology exhibition & conference showcasing technologies for design and manufacture of medical devices. Conferences will also be organised concurrent with the exhibition. It promises a good base for building new contacts and broadening one’s clientele. Date: April 6-7, 2011 Venue: National Exhibition Centre, Birmingham, UK Organiser: Canon Communications LLC Tel: +1 310 445 4200 Fax: +1 310 445 4299 Email: info@cancon.com Website: www.canontradeshows.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.
Date: April 11-14, 2011 Venue: Gaylord National Hotel and Convention Center, Washington DC, USA
Organiser: Terrapinn Pte Ltd Tel: +61 2 9005 0700 Fax: +61 2 9281 3950 Email: enquiry.au@terrapinn.com Website: terrapinn.com
14th ASEAN Paediatric Congress The 14th ASEAN Paediatric Congress and the 3rd ASIAN Paediatric Otolaryngology meeting will concentrate on topics like trends, issues, priorities in paediatrics and also translate & transmit new knowledge & information to doctors and allied health professionals. The meet will also hold 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/eng
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 66
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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.
water failure protection device by considering that the unit will not run in case of failed water supply and starts automatically the supply resumes at an extra cost.
NATIONAL RFID reader Honeywell Life Safety Systems offers RFID reader. The closerange RFID reader facilitates quick localisation of persons as well as devices via the existing and secure call system infrastructure. The reading device is configured with the ‘clino Card Manager’ so that personrelated rights and functions can be preliminarily defined. It can be used both at the bed databus as well as in the ward databus in existing clino System 99 installations. The reader can also be operated as a standalone solution with restricted functions. It functions as a contactless presence button which enhances the hygiene aspect. This is especially important in hospitals. The secure protection from manipulation is always ensured. This device expands the possible applications in connection with the ‘clino System 99 Zone Controller’ by a series of functions; among them are personalised presence control, rights management, device logistics, access control and time recording as well as data transfer to care documentation systems.
Sigmatech Scientific Products, Hyderabad - Andhra Pradesh Tel: 040 - 6453 4491, 098496 32904, Fax: 040-4003 1896 Email: s_tech07@yahoo.com
Ultrasound system Trivitron offers two new models of ultrasound systems, F 75 and I 4. ProSound F 75 has excellent refined image quality, comes with natural ergonomics, wide range of probes and preset functions. F 75 is user friendly for all clinical settings. ProSound I 4 give multitasking more meaning. It comes with pure harmonic detection, multi beam processing, dual dynamic display, quint frequency imaging and many more excellent and unique features. Trivitron Medical Systems Pvt Ltd - Chennai - Tamil Nadu Tel: 044-2498 5050, Mob: 099620 40668 Email: skraman@trivitron.in
Respirator Honeywell Life Safety Systems - Mumbai - Maharashtra Tel: 022-6765 0721, Fax: 022-6765 0730 Email: ackermanclino.hfssouthasia@honeywell.com
Ice flakers Sigmatech Scientific Products offers ice flakers manufactured by Pooja Lab Equipments. It produces clear, hard, slow melting uniform quality flake ice. By using environment friendly refrigerant, it offers utmost reliability and performance. Higher capacity industrial cooling system is provided with hermitically sealed super performance and trouble free compressor of Kirlosker Copeland (CE approved) coupled with air-cooled condenser and direct expansion. The machine offers self-contained ice producer with well-insulated ice storage bin and a variety of capacities. Ice flaker system MOC in non-GMP bin are corrosion resistant, SS-304 mirror finish and exterior is MS powder coated. In GMP bin is SS-316 and exterior is SS-304 mat finish. Guaranteed Ice production at 20ºC air and 15ºC DM water temperature. This is supplied with water filter and
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Thea-Tex Healthcare (India) Pvt Ltd offers Duck bill shaped N95 particulate respirator. Its automated production technology provides cost efficiencies that are passed on to the customer so ultimately the end-user benefits. Its ergonomic design permits perfect fit on any face shape. It is lightweight due to use of high performance raw materials and electro statically charged filter medium from a USA production line. Its greater respiration area allows easy breathing, so it can be worn for longer durations without discomfort & the user can perform better and has and has enhanced visibility for users wearing specs/goggles. There is no requirement of valve due to excellent inhalation and exhalation performance, thereby saving weight, cost and potentially dangerous valve leakage. Air leakage is prevented by soft and malleable nose clip. Medical grade non woven fabrics are made with German production technology. Thea-Tex Healthcare (India) Pvt Ltd, Thane - Maharashtra Tel: 0250-56218874, Fax: 0250-56480170 Email: theatex@hathway.com
Product Update Operation theatre lights Magnatek Enterprises offers a wide range of operation theatre lights both in LED and halogen with high-tech features.Magnapax shadowless halogen lights consists of multiple options of single dome/ double dome /ceiling mounted/ mobile with battery backup / with camera available with latest state of the art single bulb multi-reflector technology. Its brightness s up to 160000 lux on each dome and has cold lights; digital brightness control on dome handle is easy for use; excellent shadow with less effect & focused depth; bulb back-up system with auto switchover incase of failure; 3600C maneuverability with touch of a finger and laminar flow compatible. Magnaled multi colour, highly affordable LED OT lights features high brightness & luminance of 180000 lux on each dome. This has colour LED’s with 8 color settings; 3500-5000 Kelvin adjustment; high depth penetration; cold light with temperature increase of less than 10C; has uniform and powerful shadow-less lighting; long life of light upto 20000 hours; 3600C; maneuverability with touch of a finger and laminar flow compatible; superior result of improved contrast, less fatigue; optimum light output with multi-lens matrix and multiple options of single dome/double dome /ceiling mounted/ mobile with battery backup/mobile spot light. Magnatek Enterprises, Hyderabad - Andhra Pradesh Tel: 040-6666 8036/ 6550 1094, Fax: 040-6666 8037 Email: magnatek@gmail.com
IHC/ISH staining system BioGenex Life Sciences, India offers ‘Xmatrx Diagnostics’ fully automated IHC/ISH staining system with ready to use factory protocols and provision for user protocols. Its key technology includes forty independently controlled thermo cyclable slide stations with provision of individual slide loading and unloading where temperature can be controlled from ambient temperature to 105°C in less than 2 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 very 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
Patient monitor Schiller Healthcare India offers ‘Truscope’ modular patient monitor. It consists of a host monitor and an Emergency Mobile Server (EMS), which is connected to the host monitor. It comes with 17” colour TFT LCD display with 13 touch buttons, 3/5/7 lead ECG display, nine different screen configurations, ST and arrhythmia analysis, 96 hours graphical and tabular trends, drug dose calculation and OXY-CRG software, eternal video (VGA) output, built in battery with backup of one hour and connectivity to wired CN. The EMS provides fast and convenient monitoring during the patient’s transfer with display, battery alarm and storage capability. Through the EMS, patient data gets transferred automatically when connected to the base unit. The EMS is compact in design, convenient to carry and has 3.5” colour TFT LCD display. Schiller Healthcare India Pvt Ltd - Mumbai - Maharashtra Tel: 022-61523330, 09323799862, Fax: 022-2826 3525 Email: sameer@schillerindia.com
Alcohol swabs and lancet needle Amkay Products offers alcohol swabs and lancet needle. The alcohol swabs are saturated with isopropyl alcohol to provide maximum hygiene to the patients. This product is used in hospitals. The material used for packaging of the product helps keep the swabs moist by preventing the alcohol from drying. The premium alcohol swab is available with high quality swabs and best isopropyl alcohol. The company also offers lancet needle, that are sterilised steel needles packed individually. The sharpness of the point of these needles has been kept such, that they allow easy penetration in the body, thereby minimising patient trauma. The needle offers fine grip and can be easily disposed off. The company also offers plastic lancet with fine point 28 gauge needle. The point of needle is very sharp and allows easy penetration. The lancet fits into all glucometer pens. Amkay Products Pvt Ltd - Mumbai - Maharashtra Tel: 022-6131 7600, Mob: 093206 77998 Email: info@amkayproducts.com
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Product Update PoC products Trivitron Medical Systems offers new technology in the areas of In Vitron Diagnostics (IVD). These revolutionary PoC products are Fast check and Clover A1c. Fast check is a revolutionary new allergy test, which can rapidly test for over 24 different allergens in two simple tests. There are two versions of FastCheck PoC, one for testing airborne allergies and the other for testing food allergies.The test takes just 30 minutes to complete and requires only about 100 micro litre of venous EDTA-blood or heparin blood. It is risk free, very patient friendly and does not need any additional equipment or materials. It uses whole blood sample from finger tip and gives reliable visible results in 30 minutes. Trivitron’s diagnostic division’s onestep haemoglobin A1c measuring systems, Clover A1c, a point of care HbA1c analyzer. It is innovative with just one step Boron-Affinity technology which gives results in just 5 minutes with hands on time of 20 seconds. It is suitable for multiple clinical applications, convenient with no fasting and no refrigeration. It is fully automated and has facility like USB, printer, scanner connectivities. Trivitron Medical Systems Pvt Ltd - Chennai - Tamil Nadu Tel: 044-2498 5050, Mob: 099620 40668 Email: skraman@trivitron.in
Digital medical imaging system Chess Medicare offers digital medical imaging system. This system consists of DR detector, X-ray generator, X-ray tube & collimator, image workstation and universal U-arm & table. The DR detector consists of single 4k x 4k CCD detector, and the X-ray generator comes with 45, 65 & 80 kW ultra HF generator (240 kHz) with full anatomical programming, solid state inverter technology, self diagnostic capability, etc. The X-ray tube & collimator has 0.6/1.2 mm sharp focal spot, high heat capacity tube, multi leaf motorised remote controlled collimator with digital display of the X-Y axis of shuttle opening, etc. The image workstation comes with windows based pentium processor bundled with generator console and image acquisition on single software. Nucleo-DICOMSee is included with every patients images for viewing on any PC DICOM 3.0 compliant. It is provided with universal full motorised U-arm column, motorised tube travel, motorised detector angulation, intelligent anti-collision protection, etc. Chess Medicare Pvt Ltd - Mumbai - Maharashtra Tel: 098203 87087, 093226 76992, Fax: 022-2562 2773 Email: nitin@chessmedicare.com
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Product Update Handheld tele-ECG Chess Medicare offers ‘eKERNEL’, a handheld tele-ECG. It can be operated with a mobile phone via bluetooth. It records ECG of the subject and displays the same on the mobile screen. After recording, the ECG can be sent to the expert’s mobile through multimedia messaging service (MMS) for his opinion. In the event of impending heart problems, the tele-ECG does early detection and allows swift & appropriate action. Vital warning signs can be detected as and when it occurs, saving critical time. It can also be operated through laptop or desktop instead of a mobile phone in hospitals having local area network(LAN). This unit can also be used for personal monitoring in the urban population in established coronary artery disease. The other features of the tele-ECG include, portable & compact, mobile as well as LAN connectivity, acquisition, processing, storing & visualisation of ECG in real time and secure GPRS connection for transfer of ECG data. Chess Medicare Pvt Ltd - Mumbai - Maharashtra Mob: 098203 87087, 093226 76992 Fax: 022-2562 2773 Email: nitin@chessmedicare.com
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Product Update
INTERNATIONAL Chair scale Seca GmbH & Co KG offers ‘Seca 952’ chair scale for weighing, especially physically disabled or older people. Its fold-up armrests and footrests make sitting easy. Intuitive operating elements simplify the use. This chair scale is provided with brakes on wheels for secure stance. It is also equipped with ‘Seca 952’ with the ‘TARE’ function, which allows every newly added weight to be ascertained separately. The ‘HOLD’ function lets medical personnel take care of the patient first and read out the results later. The display elements are conveniently located in the handle and can be set to show kilograms, pounds or stones. The scale is easy to use because the batteries eliminate the need for connection to an electrical outlet and keep on working through up to 4,000 weighing. Seca GmbH & Co KG - Hamburg - Germany Tel: +49-40-2000 000, Fax: 49-40-2000 0050 Email: marketing.de@seca.com
Disposable vacuum cups Utah Medical Products offers ‘CMI® Tender Touch® and Tender Touch Ultra’ disposable silicone bell-shaped vacuum cups. Its smooth, soft silicone bell-shaped construction helps minimise maternal foetal trauma. The secure tractive capability provides consistent control in low and outlet foetal stations. The flexibility of cup promotes easier insertion and placement in OA position. Improved visibility through the cup aids in early detection of foetal scalp trauma and maternal tissue entrapment. These cups come with 65 ml fluid trap to reduce risk of pump contamination and are compatible with existing manual and electric vacuum pumps. The company also offers ‘Qwik Connect Plus’ foetal scalp electrode for foetal heart rate (FHR) monitoring. Its design is compliant with FDA standards for electrode lead wires. The specially designed leg plate attachment pads minimise patient discomfort while securing the electrode cables. The locking mechanism secures the electrode during attachment and stabilises the electrode wires until ‘unlocked’ by the clinician. The company also provides foetal monitor chart paper for keeping permanent records of foetal heart rate and intrauterine pressure during labour and delivery. Utah Medical Products Inc - Utah - USA Tel: +1-801 566 1200, 533-4984 Fax: +1-801-566 2062 Email: info@utahmed.com
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Product Update Dental suction unit RMS Medical Products offers ‘Dental-Evac’ hand held dental suction unit. This reusable suction unit consists of two canisters with a suction pump, filter, wide bore soft yankauer, saliva ejector, carry bag, etc. It is ideal for the use in emergency back-up suction, surgery, anaesthesia, retrieving a lost crown, and during lobby emergencies. The suction pump weighs 143 grams, and has a volume per stroke of 30 ml and the peak pump vacuum > 600 mmHg (>24” Hg). The peak air flow is 20 L (50 ms). The canister is available in 300 ml, L152.4 mm (6”) size. The filter blocks all known fluids and pathogens for total protection. It meets Osha 29 CFR1910.1030 Occupational Exposure to Bloodborne Pathogens and CDC guidelines for SARS. RMS Medical Products - New York - USA Tel: +1-845-469 2042, 800-624 9600 Fax: +1-845-469-5518 Email: info@rmsmedicalproducts.com
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Product Update Re-circulating chillers Thermo Fisher Scientific offers re-circulating chillers. These units are available with a deluxe controller and high-temperature range options for cooling capacities up to 10,000 watt. These chillers are able to operate from 5째C to 90째C with a hightemperature range option. These chillers are provided with a multiline LCD deluxe controller that offers users ease-of-use through graphical display and text. The deluxe controller includes a full alphanumeric display, temperature alarms, pressure alarms, fluid level readout and DI control & readout. It is ideal for users who want a more intuitive controller. Designed as a modular platform, these lines offers a wide variety of options and cooling capacities that can be configured for diverse applications in markets including optical, medical, laser, packaging, pharmaceutical and semiconductor processing. Thermo Fisher Scientific Inc - Massachusetts - USA Tel: +1 781-622-1000, Fax: +1 781-622-1207 Email: vaughn.harring@thermofisher.com
Binocular indirect ophthalmoscope Welch Allyn offers binocular indirect ophthalmoscope. It comes with video-aligned optical system, which ensures precise positioning of components for easy viewing. The wellpadded leather headband and swooped design combined with ergonomic controls provide comfort and simple operation. It can be adjusted to handle interpupillary distances of 49 mm to 74 mm. The SoftTilt park/rest feature allows optics to be moved to a stationary position out of the line of vision. The vital optics and mirror assemblies are sealed against dirt and dust for long-term clear viewing and durability. It is provided with diffuser filter, which broadens the illumination beam for enhanced viewing of the peripheral retina. Welch Allyn Inc - New York - USA Tel: +1-800-535-6663, Fax: +1-315-685-3361 Email: arnoldj@welchallyn.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
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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
To know more about the products in this magazine, refer to our ‘Product Index’ 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. Sr No Product
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56
84
Pg No Sr No Product
Adult/pediatric transport ventilator.............................Back Inside Cover Alcohol swabs.....................................................77 Alcohol swabs and lancet needle .....................69 Anaesthesia system.............................................78 Analyser.................................................................5 Aspirators............................................................90 Audio/video mounting system.........................11 Audio-visual auscultation device.............. 33, 62 Banking services ............................................. 29 Barcode patient ID bands.................................59 Bariatric/obesomatic OT table.........................75 Bed-side phototherapy......................................77 Binocular indirect ophthalmoscope................74 Biodegradable bags............................................77 Bipnasic defibrillator ............. Back Inside Cover Blood glucose monitoring system .....................9 Blood pressure recorder ........ Back Inside Cover Caps - non-woven........................................... 77 Cardiac OT table................................................75 Cardiothoracic surgery......................Back Cover Central gas pipe line accessories ......................78 Chair scale...........................................................72 Cleanroom design..............................................45 Clearroom equipment.......................................45 Coagulometer.....................................................27 Colour doppler...................................................76 Cord clamp.........................................................77 Custom fabrication............................................11 Dental suction unit......................................... 73 Desktop pulse oximeter ........ Back Inside Cover Diagnostic equipment.......................................27 Digital medical imaging system.......................70 Disinfectant products........................................23 Disposable plastic gloves...................................77 Disposable vacuum cups ..................................72 Dopplers....................................................... 33, 62 Dual surface phototherapy ...............................77 Dual syringe infusion pump.....Back Inside Cover ECG............................................................. 33, 62 ECG accessories..................................................76 ECG machine .............................................. 76, 77 ECG paper roll ...................................................76 Electrical & electronic components.................35 Electrical & manual needle & syringe destroyer ...........................................................61 Electrode gel .......................................................76 Electrolyte analyser ............................................27 Electronic patient recorder...Front Inside Cover EMR........................................Front Inside Cover Endocrinology....................................Back Cover Endoscope.................................................... 51, 76 ERCP/ endoscopy OT table..............................75 Exhibition - Engineering Expo ........................89 Face mask......................................................... 77 Financial services ...............................................29 Fixer .....................................................................76 Foetal monitor..... 33, 62, 77, Back Inside Cover
I February 2011
57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111
Pg No Sr No Product
Fogging machine................................................78 Fully automatic biochemistry analyser ...........27 Fumigation..........................................................78 Gastroenterology system ................Back Cover General surgery ..................................Back Cover General surgery OT table..................................75 Gynaec examination coach...............................71 Gynaecology system...........................Back Cover Halogen lights ................................................. 14 Hand-carried ultrasound system........................................Cover on Cover Handheld tele-ECG ...........................................71 Haematology analyser .......................................27 HIV aids kits.......................................................77 Hospital bed .......................................................90 Hospital curtains..................................................7 Hospital furniture ........................................ 71,73 Ice flakers ......................................................... 68 ICU bed...............................................................71 IHC/ISH staining system..................................69 Imported hospital furniture/equipment.........90 Infusion pump ...................................................77 Intensive care unit..............................Back Cover Intensive care ventilator ........ Back Inside Cover Labels................................................................ 59 Laboratory medicine .........................Back Cover Lancet needle steel / plastic ..............................77 Laparoscopy OT table .......................................75 LED lights ..............................................14, 75, 77 Medical aprons/gown............................... 76, 77 Medical equipment............................................87 Medical furniture...............................................67 Metal doors.........................................................45 Mobile lights.......................................................14 Modular cleanroom...........................................45 Monitor systems.................................................13 Multi-parameter defibrillator........................... Back Inside Cover Multipera monitor.............................................76 Nebuilsers ............................................ 33, 62, 79 Needle & syringe destroyer...............................77 Neonantal transport ventilator............................... Back Inside Cover Neonatology system...........................Back Cover Nephrology system ............................Back Cover Neurology operating room...............Back Cover Neurosurgery OT table .....................................75 Nuneb PRO nebuliser .......................................79 Online B2B marketplace.......................... 49, 84 Operation theatre lights.......................69, 75, 78 Ophthalmic products ........................................85 Opthamology system.........................Back Cover Orthopaedic system...........................Back Cover Orthopaedics OT table......................................75 OT / examination lights....................................90 OT table .................................................14, 71, 90 Over head phototherapy...................................77 Oximeter .............................................................77
112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169
Pg No
Oxygen concentrator.........................................77 Oxygen flowmeter .............................................90 Oxygenators................................................. 33, 62 Paediatric OT table......................................... 75 Paediatrics...........................................Back Cover Patient monitor..................................................69 Patient monitoring system...................33, 62, 77 Patient privacy system................................ 11, 75 Pedal suction ......................................................19 Pendants....................................................... 14, 75 Plain thermal paper roll....................................76 PoC products......................................................70 Portable colour doppler ....................................76 Powder coated & stainless steel furniture.......83 Prep razor............................................................77 Printer..................................................................59 Prosthetic and orthotic services.......................41 Pulse oximeter & NIBP monitor .....................76 PW ultra sound scanner ...................................76 Rapid endotoxin detection system ............... 77 Re-circulating chillers........................................74 Recovery bed ......................................................71 Refurbished goods ...................................... 51, 76 Remote operated OT table ...............................78 Respirator............................................................68 RFID reader........................................................68 Scandoc DICOM workstation....................... 17 Scopy doc endoscopy IMS................................17 Sensor controlled suction sytem......................15 Shoe cover...........................................................77 Shredding machine............................................61 Skin blade............................................................77 SME finance........................................................29 Sphygmomanometer .........................................90 Spot lights ...........................................................14 Surgical / ICU pendants....................................90 Surgical diathermy.............................................15 Surgical gloves-sterile ........................................77 Surgical instruments..........................................90 Surgical lights .....................................................15 Surgical pumps............................................ 15, 77 Tourniquet....................................................... 65 Ultrasound gel................................................. 76 Ultrasound scanner ...........................................76 Ultrasound scanner ..............................33, 62, 77 Ultrasound system.............................................68 ULV fogging machine .......................................78 Urology system...................................Back Cover Urology OT table ...............................................75 Ventilator ......................................................... 76 Vital signs monitor ............................................76 Wheelchairs and accessories ......................... 25 X imager C-arm memory .............................. 17 X-ray developer liquid.......................................76 X-ray developer powder....................................76 X-ray fixer liquid................................................76 X-ray machine....................................................76 X-ray viewers......................................................90
Advertisers’ List Advertiser’s Name & Contact Details
Pg No
Aavanor Systems Pvt Ltd
FIC
Advertiser’s Name & Contact Details Dispowear Sterite Company
Pg No 76
Advertiser’s Name & Contact Details Great Eastern Impex Pvt Ltd
T: +91-44-26208920
T: +91-11-28521839
T: +91-11-2347431
E: enquiry@aavanor.com
E: dispowear@rediffmail.com
E: sales@geipl.com
W: www.aavanor.com
W: www.dispowear.com
W: www.geipl.com
Amkay Product Pvt Ltd
77
Element 14 India Pvt Ltd
35
GTB Surgical Industries
T: +91-22-61317600
T: +180030003888
T: +91-11-22015913
E: info@amkayproducts.com
E: in-sales@element14.com
E: contact@gtbsurgicals.com
W: www.amkayproducts.com
W: in.element14.com/medical
W: www.gtbsurgicals.com
Anand Medicaids Pvt Ltd
19
Endolite India Ltd
41
India Mart Intermesh Ltd
T: +91-11-25225225
T: +91-11-45689955
T: +1800-200-4444
E: sales@anandind.com
E: endolite@vsnl.com
E: pr@indiamart.com
W: www.anandind.com
W: www.endoliteindia.com
W: www.indiamart.com
BPL Limited
33, 62
Engineering Expo
89
Industrial Electronic & Allied Prod
T: +91-80-22270134
T: +91-9920401226
T: +91-20-24222538
E: sales.healthcare@bpl.in
E: engexpo@infomedia18.on
E: ieap@vsnl.com
W: www..bpl.in/healthcare
W: www.engg-expo.com
W: www.diamondbp.com
Carewell Biotech Pvt Ltd
9
G S Health Care Products Pvt Ltd
78
International Trading Co
T: +91-11-41539602
T: +91-33-24881574
T: +91-33-22379476
E: carebio@gmail.com
E: hecapr@vsnl.net
E: info@lifeplusmedical.com
W: www.carewellindia.com
W: www.gshealthcareproducts.com
W: www.lifeplusmedical.com
Charles River
77
Genuine Medica Pvt Ltd.
51
Krupa Electro Divice
T: +91-80-25588175
T: +91-11-40513401
T: +91-9879003188
E: india.customercare@crl.com
E: genuine@ndf.vsnl.net.in
E: krupaelectrodivice@gmail.com
W: www.charlsriverindia.com
W: www.genuinemedica.com
W: www.krupaelectrodivice.com
Comfort Orthopedic Co.,Ltd.
25
GMP Technical Solutions Pvt Ltd
45
Lonza India Pvt Ltd
T: +886-5-289-2093
T: +91-22-66083700
T: +91-22-43424000
E: tina.lee@comfort.com.tw
E: projects@gmptech.net
E: prajakta.sonavane@lonza.com
W: www.comfort.com.tw
W: www.gmptech.net
W: www.lonza.com
Devine Medi Health Pvt Ltd
85
Godrej Interio
67
M.S.Enterprises
T: +91-11-26810195
T: +91-22-67962419
T: +91-866-2442786
E: sales@devinemedihealth.com
E: interiohospital@godrej.com
E: moinmsent@yahoo.co.in
W: www.devinemedihealt.com
W: www.godrejinterio.com
W: www.accura-healthcare.org
Pg No 59
76
49, 84
65
77
77
23
90
COMPLETE ENGINEERING UNDER ONE ROOF @ www.engg-expo.com
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Advertisers’ List Advertiser’s Name & Contact Details
Pg No
Advertiser’s Name & Contact Details
Magna Tek Enterprises
14, 75
R D Plast Pvt Ltd
T: +91-40-66668036
Pg No 11
Space Labs Health Care
T: +91-11-25891219
T: +91-40-39803687
E: rdplast@bol.net.in
E: info@spacelabs.com
E: sales@magnatekenterprises.com W: www.magnatekenterprises.com
Pg No 13
W: www.spacelabshealthcare.com
W: www.rdplast.in Meditech Engineers Pvt Ltd
Advertiser’s Name & Contact Details
87
T: +91-11-45545238
Radiant Enterprise
E: marketinguk@meditech-india.com
T: +91-79-26449120
78
Spark Meditech
15
T: +91-484-2341335 E: sparkmeditech@gmail.com
W: www.meditech-india.com
E: radiant_enterp@rediffmail.com
Meditek Engineers
71
Standard Chartered Bank
W: www.fogstarindia.com
29
T: +91-22-39401616
T: +91-09822092808 Rational Health Care Systems
E: meditekfur@hotmail.com
76 E: sme.custoercare@sc.com
Medsynaptic Pvt Ltd
17
T: +91-40-30727676
W: www.standardchartered.co.in
E: rational_hcs@yahoo.com
T: +91-20-25443349
Transasia Bio-Medicalsp Ltd
E: sales@medsynaptic.com
Saratech Equipments
61
5
T: +91-22-40309000
W: www.medsynaptic.com Meelan Hospital Steel Furniture
T: +91-2113-203049
E: transasia@transasia.co.in
E: rate@vsnl.com
W: www.transasia.co.in
W: www.saratech-india.com
Trivitron
83
T: +91-20-24262562 E: sales@meelanhospicare.com W: www.meelanhospicare.com
Schiller Healthcare India Pvt Ltd
Monash International Ltd
27
T: +91-11-24378779
BIC
W: www.trivitron.com
E: contact@clindiagindia.com
United Surgical Industries
W: www.schillerindia.com 79
73
T: +91-11-22149600 Siemens Ltd
T: +91-22-23748371
T: +91-44-24985050 E: skraman@trivitron.in
T: +91-22-66920520 E: rita@schillerindia.com
MRK Healthcare
BC
21 E: info@unitedsurgical.co.in
W: www.siemens.com/pharma
E: info@mrkhealthcare.com
W: www.uniserg.com W: www.mrkhealthcare.com
Sonosite Inc
Photochem Labs Pvt Ltd
76
Window Techs T: +91-124-2881100
T: +91-79-22732989 E: india@sonosite.com
E: info@photochemlab.com
W: www.sonosite.com
W: www.photochemlab.com
COC 7
T: +91-11-29992146 E: window_techs@yahoo.co.in W: www.hospitalcurtains.in Our consistent advertisers
FINALIZE SUPPLIERS @ 88
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Reg No: G2/NMD/73/2011–2013 RNI No: MAHENG/2007/21987 WPP Licence No: MR/Tech/WPP–352/Navi Mumbai/2011-2012 Date Of Posting: 11th & 12th Of Every Month/English & Monthly. Licence to Post at Mumbai Patrika Channel Sorting Office, Mumbai GPO., Mumbai 400 001 Date Of Publication: 8th Of Every Month
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