InnoHEALTH magazine volume 2 issue 3 - July to September 2017 by innohealthmagazine

EXECUTIVE OPINION

Where India is placed in Global Innovation Index

ndia moves from 81 to 60 ranking amongst nations in Global Innovation Index (GII) in two years as per latest report of June this year. The first 10 countries are same in last few years in index. We need to analyse our strength and weakness, even Vietnam is improving rapidly it was 76 in 2012 but is 47 now. The GII was developed 10 years back by business school INSEAD in Paris to benchmark countries in innovations and gives indication of future growth. Though lot is being done by present government in many ways to improve culture of innovations however impetus is required to get more grass root innovators on board by educating them of newer initiatives launched by government. The innovator does not have to be educated, experienced but person with idea which can be incubated and scaled up by hand holding and making resources available. The innovators are mostly young with passion to make their idea a success story and there are innumerable examples to prove the point. We should teach more case studies of failures than success stories to understand as to what has gone wrong. We are leap frogging many ways and showing diversity of bullock cart economy to landing on moon. Our innovators are yet to develop design thinking of desirable level to create disruptive innovations. We are master of frugal innovation which world is looking with keen interest to bring reverse innovations on our door step.

In my book “Innovations in Healthcare Management: Cost-Effective and Sustainable Solutions” by CRC, USA, have written “Innovation is an ancient concept. The capability to innovate is one of the most profound characteristics of human being. Still, certain periods and places in history have exhibited more innovations than others. Aryabhatta, an Indian mathematician, 3600 years back innovated a thing called Shunya (Zero)” and now we have been left behind in GII and it is time with present eco system to bounce back and achieve our rightful place amongst 10 nations in next 10 years which is very much feasible if we strive hard and continue buzz word of innovation as our national agenda. We would imbibe all your ideas and recommendations to make it happen and move forward. We are trying to connect all beads together by creative knowledge platform to include all innovators under one umbrella by organising international annual conference InnoHEALTH and bringing price sensitive technology from other parts of world, young innovators award, complimentary webinars from world renowned persons, InnoHEALTH magazine , IC InnovatorCLUB a unique concept to bring all stakeholders of healthcare innovation under one roof to brainstorm and bring innovative idea into reality with handholding of mentors, investors and other experts. It brings team of all people required next to each other. Also bringing training in new challenges of health sector like Cybersecurity, innovations in healthcare operations and many more. This body of knowledge and movement would optimise healthcare delivery cost and maintain quality. We would like all those who have interest in healthcare innovation participate to move faster to bring India in first 10 innovators nations in Global Innovation Index.

Dr. VK Singh Editor in Chief & MD, InnovatioCuris vksingh@innovatiocuris.com

Readers Feedback

A Brief Review on InnoHealth Healthcare is an ever-changing area. The disease patterns, the healthcare systems, patient expectations have undergone a major change in the last decade. With the changing trends, Innovations in Healthcare is the need of the hour. The subject is so vast that keeping up becomes a nearly impractical task. I was so impressed at the efforts put by the InnoHealth team to bring the innovations in healthcare right to your hands through their magazine. The articles on real life latest innovation bring hope to the reader to go out and make an innovative change in their own area of work, knowing fully well that the system has worked successfully. My best wishes to the team for bringing the world into our hands. Thank you! Dr. Sharmila Anand, Managing Director, SEHPL, India

The new design of the magazine is very impressive and easy to read. The Apr-Jun 2017 issue covered various aspects of healthcare from well being to technology. According to me, the best section of the magazine is Trends wherein it gives a snapshot of the latest innovations across the world and helps me keep abreast of new developments in healthcare. The article ‘IBM reveals five innovations’ was very informative. It gave insights about the advances being made in field of artificial intelligence (AI) and nanotechnology. Looking forward for next issue.

Riddhi Vasisth, USA

Hats off to you and your team at Innovatio Curis Dr. VK Singh for the new issue of Innohealth with a new look. It is an amazing effort, which equally impresses the medicos, and non-medicos like me. I specially liked the compilation by Dr. Avantika Batish of the latest healthcare innovations that prompted me to go deeper into these to get a wider view of the scenario. Kudos for the endeavor and best wishes to all of you. Looking forward for the next issue.

Working for US Healthcare as my domain and emerging trends in healthcare delivery in India keeps me hooked to Innohealth’s quarterly issue. Latest edition has covered sections under healthcare trends, policy and wellbeing. Articles under trends, which highlight emerging technology adaption by Yolo health with usage of Health ATM for a quick health, check and Bluestar’s Diabetic management app is need of hour of Indian healthcare. Also I was amazed to see launch of dental health insurance by OCARE providing a platform for empaneled dentist and insured patients solving dental out of pocket expenditure. Thanks for jotting all emerging technologies, good luck team. Gaurav Verma, US Healthcare Business Analyst, GalaxE.Solutions, Inc, USA

With so much to do in a day and with still a need to be updated on the latest in the industry, a well-structured and curated magazine like Innohealth is a great help. I would like to congratulate the team for a great new edition and wonderful leap from where they started. I like the way the magazine is now arranged into sections. My favourite was the Women’s section, something that absolutely hit the pulse of my current situation. Thanks for the great read and all the best for the future editions.

Molshree Pandey Head Innovation Centre Denmark Royal Danish Embassy, New Delhi

Having learnt about your programs in Innovatiocuris, and after reading the magazine Innohealth, I am very impressed with your vision to further healthcare innovation in our country. The magazine is very informative. The rapid strides that have been made to collaborate and extend the network globally, will lay a strong foundation for growth in this area. My compliments to the team under your leadership.

Usha R. Sharma IAS

Dr. Arati Verma Sr. Vice President – Medical Quality Max Healthcare Institite Ltd., India

InnoHealth is a unique magazine that I have come across which brings the readers interest on a different level. It not only provides the latest news, trends, policy in the health care world from across the country but, it also catches the attention of a regular reader concerned with improving and maintaining their health. It’s a beautiful platform where in all party to Health World gets together and shares valuable information. Each issue sheds light on recent innovative medical discoveries, articles on the latest health trends, the innovative medical procedures and preventative measures to help the reader know about how and where they could derive new information on the latest medical technology advancements, which could be beneficial for them. It’s a go-to guide for anyone who wants to learn more about heath, well-being and the way forward. My personal favorite being the women’s corner. Wish to see more information about women entrepreneurs, who are making a difference to the innovative healthcare fraternity. Radhieka Mitra Managing Director & Founder The Konnect India

“It is amazing how Dr VK Singh and his team are able to bring out an excellent magazine at this price. I must say well done Dr and his team for great work. Your panels of contributors are world class and the articles are so well written and easy to understand great editorial panel you have. Keep up the wonderful work. “.

When ideas are brought to management or finding methods, tools and techniques to deliver qualitative healthcare, those ideas don’t just sit on a shelf. They come to fruition and are brought to life. This organization truly values its members and their ideas. There is a feeling and culture of excellence and innovation that permeates throughout the organization. The leaders & members are not only expected to be efficient, creative, and hardworking—they want to be those things. They want to be the best at what they do. InnoHealth India’s First Magazine of Healthcare Innovations organization. For such a great & large organization, there truly is a family feeling and loyalty here. The thought of leaders & members of the InnoHealth are committed, engaged, and takes action on issues that need to be addressed. The organization is consistently seeking innovation to solve unique problems in Healthcare sector & transforming Healthcare through innovation. I am very proud to be a part of InnoHealth and grow professionally. The management team consistently recognizes the talents and efforts of everyone that works at Horizon. The culture is truly different and the management team works hard to continue to stand out from other organization to make Horizon the best of the best. The conference they conduct is excellent. The first conference of InnoHealth I have attended I walk out feeling like a million bucks and that I could accomplish anything.”

Prarthana Gandhi Partner, anAmaya Capital, LLP, India

Muthu Singaram CEO, IIT Madras HTIC Incubator, India

When I came across this magazine at a book stall,I thought it’s some Medical Journal,nothing to my interest. Being a retired Scientist ,at present I’m a home maker, I have keen interest in health articles. I was delighted to see your latest issue. Thanks Dr Singh for introducing a ladies corner in magazine. I will look forward to many more health informative articles. Wish you all the best.

Neerja Singh India

In India and also in rest of the world Healthcare sector has always been a vast area that can cater high end innovations in technology and products. InnoHEALTH magazine paves a remarkable way in keeping a track of new trends being incorporated in this booming sector. Wishing the team all the best and look forward to new volume of the InnoHEALTH magazine.

Parthvee Jain Market Research Analyst in Healthcare Sector India

Editor-In-Chief:

Dr V K Singh Executive Editor:

Sachin Gaur Editors:

Alok Chaudhary Dr Avantika Batish Nimisha Singh Verma Production Editor:

Vigyan Arya Assistant Editor

Kanika Chauhan Designers

Pankaj Singh Rawat Abdul Gaffar Advisors

Konda Vishweshwar Reddy, Member of Parliament, India Amir Dan Rubin, Executive Vice President, United Health Group, USA Thumbay Moideen, Founder President, THUMBAY Group, UAE Prof Prabhat Ranjan, Executive Director, Technology Information Forecasting and Assessment Council, India Global Editorial Board

Dr Shailja Dixit, Chief Medical Officer, Scientific Commercialization, Fellow of Health Innovation & Technology Lab, USA Ronald James Heslegrave, Chief of Research, William Osler Health System, Canada Dr Ogan Gurel, Chief Innovation Officer, Campus D, South Korea Dr Chandy Abraham, CEO and Head of Medical Services, the Health City, Cayman Islands Dr Sharon Vasuthevan, Group Nursing & Quality Executive at Life Healthcare Group, South Africa Dr Kate Lazarenko, Founder and Director, Health Industry Matters Pte. Ltd, Australia Major General (Retd) A K Singh, Advisor, Telemedicine and Health Informatics, Rajasthan, India Printed and Published by Sachin Gaur on behalf of InnovatioCuris Private Limited. Printed at Poonam Printers, C-145, Back side Naraina Ind. Area, Phase I, New Delhi. Published at E-2/9, First Floor, Malviya Nagar New Delhi 110017. Editor: Sachin Gaur. DCP Licensing number: F.2.(I-10) Press/2016 ÂŠ InnovatioCuris Private Limited. All rights reserved. Neither this publication nor any part of it maybe reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission from InnovatioCuris Private Limited. Editorial Design & Production: Indus Inc. #1 Ganga Apt., Alaknanda, New Delhi-19 Tel. : 011-41704107; e-mail: info@indusinc.co; www.indusinc.com Disclaimer: Readers are requested to verify and make appropriate enquires to satisfy themselves about the veracity of the advertisements before responding to any published in this magazine. Sachin Gaur, the Publisher, Printer and Editor of this magazine, does not vouch for the authenticity of any advertisement or advertiser or for any the advertiserâ&#x20AC;&#x2122;s products and/or services. In no event can the Publisher, Printer and Editor of this magazine/ company be held responsible/liable in any manner whatsoever for any claims and / or damage for advertisements in this magazine. Authors will be solely responsible for any issues arising due to copyright infringements and authenticity of the facts and figures mentioned in their articles. InnoHEALTH magazine is not liable for any damages/copyright infringements.

Online Healthcare LetsMD.com set for expansion

ew Delhi-based healthcare fintech start-up went live in January 2017. In Delhi NCR it has empaneled 300 hospitals and is now all set to expand its presence in five metro cities including Bengaluru, Mumbai, Chennai, Hyderabad and Pune by January 2018. Their vision is to bring entire healthcare ecosystem comprising hospitals, finance companies, and insurance and drug companies on its platform in long run. LetsMD helps users compare hospitals, look at doctor videos, compare pricing for their surgery and book an appointment at the hospital of their choice. It then gives the user an option of converting their surgery bill into an EMI at low interest. The healthcare fintech start-up will go live with 40 elective surgeries on its platform by the end of April 2017 including IVF, gynec procedures, cardiovascular surgery, pediatric, knee replacement, ophthalmology procedures, liver and kidney transplant etc. Currently it covers only IVF treatment. Around 1,000 super specialties doctors performing elective surgeries were expected to be live by the end of April. Patients undergoing surgeries at our empaneled hospitals are not required to pay interest rate. The hospitals treating them pay 6 to 9 per cent of total treatment cost to them as subvention fee. The amount of loan a patient can take depends on his credit profile, his bank statement, salary slips. LetsMD offers medical loan ranges from Rs. 30,000 to Rs. 5 lakh in an hour to 3 days, he said. Till date, the company disbursed Rs. 20 lakh as medical loan to 100 patients undergoing IVF treatment. Initially two years, our focus is on patient financing. They are planning to go live with financing other players in healthcare ecosystem including doctors to upgrade their facility by 2019.

Nivesh Khandelwal, founder

Indiaâ&#x20AC;&#x2122;s first fully automated lab in Mumbai

iemens Healthineers has installed Indiaâ&#x20AC;&#x2122;s first fully automated Aptio Automation track with multidiscipline modalities at the Aspira Pathlab and Diagnostic Limited in Mumbai. Siemens Healthineersâ&#x20AC;&#x2122; strategic goal is to help healthcare providers worldwide to meet their current challenges and to excel in their respective environments using products and solutions that increase efficiency and reduce costs. The new track will enable Aspira to perform all routine hematology, biochemistry and immunoassay tests with a comprehensive selection of pre- and post-analytical modules that automate sample loading, preparation and handling so as to free laboratory staff from time-consuming, low-value tasks.

The technology not only routes the samples automatically to all the instruments but also screens the test results intelligently in addition to the sample sorting and archiving. Aptio is an adaptable solution; its flexible track design option makes it easy to accommodate floor space allocations and fixtures. Integrated IT capabilities support multi-site connectivity in addition to the customized streamline workflows and result management. It delivers measureable gains in efficiency by driving the intelligent and coordinated operation of automation components, diagnostic analyzers, and high-performance assays. In addition to providing the capacity needed to satisfy peak volumes, this highly integrated approach effectively manages hour-to-hour fluctuations, reduces errors, balance instrument workloads, and achieve consistent and predictable turnaround times for both STAT and routine samples.

eVIN Project

Becomes global best practise in immunisation

epresentatives from Philippines, Indonesia, Bangladesh, Nepal and Thailand were on a visit to India to study the project on eVIN (electronic vaccine intelligence network) project of the Health Ministry to understand how it is being implemented and the ways in which it be replicated in their respective countries.

eVIN (Electronic Vaccine Intelligence Network) is an indigenously developed technology system in India that digitizes vaccine stocks and monitors the temperature of the cold chain through a smartphone application. The innovative eVIN is presently being implemented called across twelve states in India. eVIN aims to support the Government of India’s Universal Immunization Programme by providing real-time information on vaccine stocks and flows, and storage temperatures across all cold chain points in these states. The technological innovation is implemented by the United Nations Development Programme (UNDP).

eVIN aims to strengthen the evidence base for improved policy-making in vaccine delivery, procurement and planning for new antigens in India. eVIN provides an integrated solution to address widespread inequities in vaccine coverage by supporting state governments in overcoming constraints of infrastructure, monitoring and management information systems and human resources, often resulting in overstocking and stock-outs of vaccines in storage centres.

The integrated solution combines: • Technology: to facilitate evidence-based decision-making by making available online real-time information on vaccine stocks and storage temperature through the eVIN application software and temperature loggers. • Governance: to ensure efficient vaccine logistics management by systemizing record keeping through standardizing stock and distribution registers; identifying gaps and improving clarity on vaccine cold chain network; drawing attention to infrastructure upgrades; developing standard operating procedures; and encouraging good practices. • Human Resources: to empower the state cold chain network by building the capacities of government cold chain handlers; and deploying vaccine and cold chain managers in every district for constant support to estimate vaccine requirements, supervise cold chain handlers and coordinate with cold chain technicians across the district. eVIN empowers the cold chain handlers by building technical capacities and providing a robust decision-making tool for cold chain managers through a complete overview of vaccine replenishment times, supply and consumption patterns. By streamlining the vaccine flow network, eVIN is a powerful contribution to strengthening health systems and ensures equity through easy and timely availability of vaccines to all children.

Medela’s Unique Breast Pump Ad-

edela India, producer of breast pumps and nursing accessories announced the launch of their unique Breast Pump Advisor service, a first-of-its kind digital consultant of breast pumps, to ease out breastfeeding for new lactating mothers. The breast pump advisor is a personalized resource which recommends the ideal Medela breast pump basis one’s lifestyle, breastfeeding goal, baby birth, baby’s health, breast and nipple issues and breastfeeding challenges. Breast pumps are devices that enable mothers to provide mother’s milk for babies who cannot feed directly at the breast for a variety of reasons such as latch-on problems, cleft palate or premature babies. Breast pumps are also convenient, even necessary, for mothers to express and store their breast milk once they have returned to work, travelling or otherwise separated from their baby. Breast Pump Advisor serves as a one stop destination for every new mother to find and compare different Medela breast pumps and choose the one that best meets her needs. This multi-utility digital service refers a database of over 300 possible permutation and combination and displays the recommendation that best fits the mother’s unique journey. Not only does the mother get to know her ideal breast pump, she is also able to get a personalized list of articles to read which are based on her discreet lifestyle and breastfeeding challenges. Thus empowering her to make the right choice – for herself and her baby!

Nurturey An Intelligent Personal Assistant for Parents

urturey is conceived to operate as a skilled Personal Assistant and is the only comprehensive solution supporting parents from pregnancy to early years of parenting. The product was incepted in April 2014 and the company is headquartered in London.

The company has recently raised nearly $750,000 (approx. Rs 5 Cr) in Angel Investment, had launched an iPhone app in May ’16 along with an Android app in Aug ’16 (globally and in India). It also launched a desktop webapp version last year (globally and in India). As the one-stop companion for parents, Nurturey’s Personal Assistant offers a range of tools that will improve parents’ efficiency and effectiveness by managing the boring and tedious tasks – managing information, resources, activities, memories – basically their lives around kids- in one place. Parents can activate tools as per their multi-dimensional and ever-changing needs throughout their parental journey. Founder Tushar Srivastava

A3RMT and NEUROSYNAPTIC COMMUNICATIONS

o face the challenges of lack of bandwidth, awareness and healthcare workers and improper and adequate rural reach startups like A3RMT and Neurosynaptic Communications have entered the tele healthcare delivery arena. A3RMT is a World Bank funded start up which has a 3Kg equipment to connect patients with doctors and helps perform quick diagnostics with little medical training and has by far treated more than 60000 patients at over 450 locations in india. It has also saved about 2000 lives through emergency intervention. Neurosynaptic communications has helped treat about 2,50,000 patients in 2300 villages in India so far. Neurosynaptic communications and A3RMT trains local health workers and NGO voluneers to operate those devices which dont require intensive training. Their technology in India: Transmits high precision images and videos to doctors in limited and flickering data Bandwidth. The devices can conduct tests like blood pressure, heart beat, lipid test, urine test, haemoglobin, glucose cholestrol test and dozen more. More attachments can be added to this 3 kg machine for specialised tests like x-rays. A3RMT uses IBM and Neurosynaptic Communications uses Amazon Web Services for data storage, analysis and transmission of images and videos to doctors and specialists.

A3RMT Founders: Shrikant Parikh and Sunil Lakdawala Neurosynaptic Communications Founders: Sameer Sawarkar and Rajeev Kumar

NIRAMAI Bangalore-based healthcare start up Artificial Intelligence Niramai has raised seed funding led by Pi Ventures. Niramai uses machine learning and artificial intelligence, with cloud-based software, to make breast cancer screening more accessible and affordable. It uses a low-cost device that takes high-resolution thermal images which require no radiation. Artificial intelligence is applied to the images on the cloud to detect breast cancer.

SIG TUBLE Healthcare AI startup SigTuple can automate a pathologist’s job. It has secured the largest series A round of funding ever for an Indian healthcare AI startup – $5.8 million. The investment, led by Accel Partners, will go toward scaling up the startup and helping it go global. The startup has partnered with hospitals and labs to feed information to its AI. It is also running pilot programs in 17 medical institutions.  Founders: Rohit Kumar Pandey, Tathagato Rai Dastidar, and Apurv Anand

FLUTURA Bangalore-based Internet of things startup Flutura has raked in $7.5 million in angel funding. This Indian startup uses sensor data to monitor machines online. If there’s a problem with an oil rig part, for example, Flutura sensors can alert workers, saving time and resources from detecting the problem later – or waiting until the machine breaks down.

Founders: Krishnan Raman, Srikanth Muralidhara, and Derick Jose

MapmyIndia

VISIT launch Swastha Bharat m-health app

apmyIndia and VISIT Internet Services Pvt Ltd have come together to help the government launch Swastha Bharat m-health app for smart cities, tier-2 towns and villages powered by their mapping technologies and AI-enabled telemedicine platform, respectively. The app allows citizens to access emergency ambulance services find nearby hospitals, clinics, labs, pharmacy outlets and consult doctors and specialists over chat, phone and video. Mapmyindiaâ&#x20AC;&#x2122;s GPS technology and mapping data enables one tap ambulance requests helping governments build emergency response infrastructure for cities, towns and villages. Users can also lookup nearest health centres, fix doctor appointments and order medicines from nearby pharmacies. The app also solves health queries by providing instant health answers to the citizens through a chat based health assistant. The live chat service is developed by VISIT and backed by Indiaâ&#x20AC;&#x2122;s top doctors who keep reviewing the information provided to the citizens. The health assistant can also help users in diagnosing health issues; provide instant suggestions and home remedies. Users also get health recommendations about the most chatted issues by people based on the usersâ&#x20AC;&#x2122; demographic data and past history to help them avoid any possible health concerns. The chat assistant can also provide information on local epidemics and necessary preventive steps to be taken.

Cutting edge technologies in healthcare

1. Virtual reality Allows medical students virtual entry into operation theatres to understand complex procedures. Also helps support staff get required training without risk. It also acts as a therapy for patients with psychological problems such as vertigo.

3D printing

Allows for making customised body implants. It is used for manufacturing real-sized models for doctors to practice on before performing complex procedures. It can also engineer human tissues for pharma companies to test their new drugs.

Indo-Germany cooperation in alternative medicine

nion Cabinet chaired by the Prime Minister Narendra Modi has approved the Joint Declaration of Intent (JDI) between Germany and India regarding cooperation in the sector of alternative medicine.

The signing of the JDl will enhance bilateral cooperation between the two countries in the areas of traditional/alternative medicine. Initiation of collaborative research, training and scientific capacity building in the field of alternative medicine under the JDI between the two countries would contribute to the enhanced employment opportunities in the AYUSH sector. The Ministry of AYUSH as a part of its mandate to propagate Indian systems of Medicine globally has taken effective steps by entering into MoU with China, Malaysia, Trinidad & Tobago Hungary, Bangladesh, Nepal, Mauritius, Mongolia and Myanmar. The Ministry has taken many initiatives for promotion of Ayurveda in Germany with the recommendation and cooperation of the Indian Embassy in Berlin. One of the major initiatives is the collaborative research Project between the Central Council for Research in Ayurvedic Sciences (CCRAS) and Charite University, Berlin on Osteoarthritis of the knee. The results of the trial are encouraging and the clinical trial demonstrates significant improvement in patients. The study has been completed successfully and is under publication.

Apollo Sugar Clinics on expansion mode

pollo Sugar set up by Apollo Hospital group in collaboration with pharmaceutical company Sanofi, plans to set up 100 clinics by the end of 2018 and 300 clinics over the next three years. It currently operates 52 clinics across India. It aims at providing quality comprehensive diabetes care under one roof at cheaper rates. Apollo Sugar is focusing on tier-2 cities and rural areas for expansion. Right now, it is operating in metro cities like Chennai, Bengaluru and Hyderabad. According to estimates of Union Health Ministry, the total spending on diabetic care is about Rs 1.5 lakh cr per annum in India and every patient spends about Rs 30,000 a year on diabetic care.

ZOCTR

octr Health Network is a first-of-its kind pan-India Home & Telehealth Company that provides a comprehensive portfolio of home based medical services including long term Intensive Care, Chronic Care & Wellness, Corporate Wellness and Health Check-up programs and other subscription based value added services such as Teleconsulting, Home Laboratory Pick-ups, Home/Online Pharmacy and Emergency Management Support to its customers leveraging a proprietary, fully integrated and technology led business model. It also integrates several health services like doctor appointments, home health services, remote monitoring services, laboratory, pharmacy, medical equipment, telehealth, and ambulatory support. Zoctr raised a funding of $1 million from certain angel investors to improve and expand its presence in Pune, Mumbai, Bengaluru, Delhi, Ahmedabad and Kolkata.

Founder: Nidhi Saxena

VATSALYA

tatistics reveal that there is one dentist for every 10,000 people in urban areas in India. In rural areas, however, there is one dentist for 150,000 people. This is an indication of the challenge that exists in India when it comes to oral health. In an endeavour to contain this challenge “Vatsalya” was launched.

Vatsalya is a dental care firm for oral healthcare which provides end to end dental treatment at your doorstep. Recently the firm launched its 24/7 emergency home dental care services where it charges only the transportation cost as extra. The team had recently acquired a funding of Rs 11 crore from S-Squared Captial Investments, USA. The home healthcare company focuses on special needs dentistry and preventive dentistry. The team at Vatsalya also provides services like surgical removal of teeth, laser surgeries, complete or partial denture prosthesis, root canal therapy and fixed and bridge crown prosthesis.

Founder: Dr. Srivats Bhardwaj

Care24

he Mumbai-based home healthcare platform offers verified caregiver services across Mumbai. The startup raised a series A funding of $4 million led by SAIF Partners and seed investor India Quotient. As of February this year, the startup had clocked 600 transactions in a day. They have a network 24×7 nurses, attendants, and certified physiotherapists, who help individuals through the rehabilitation process.

Founders: Garima Tripathi, Vipin Pathak, Abhishek Tiwari and Pranshu Sharma

“FOOTPRINTS” SENSORS PREDICTING FALLS An Australian Innovation

ata reveals that currently Australian health care system pays $8.4 billion for injuries caused by falls. This led a team of Melbourne innovators to develop a sensor system that has the ability to predict falls in the elderly before they occur and also made them win the inaugural Janssen HaTCH challenge and was awarded a $100,000 grant.

The system which is known as “FOOTPRINTS” is attached to a walking frame that will continuously monitor a senior’s walking quality and inform doctors when interventions are required. This device can not only help to prevent falls but also reduce costly hospitalisations. Footprints can help reduce the healthcare costs by preventing falls. The device may also improve the quality of life of Australian seniors and could allow them to remain independent for longer.

ICESENCE3 IceCure Medical’s IceSence3 has been used by US doctors since 2011 to remove benign breast lumps in a 10-minute ultrasound-guided procedure that penetrates the tumor and engulfs it with ice. The system is being clinically tested over the next few years against small malignant breast tumors as well. The procedure is done in a doctor’s office, clinic or breast center, and the patient can get up and leave afterward with no recovery period or post-care.

TOTAL LIFT BED VitalGo Systems’ Total Lift bed is the world’s only hospital grade bed that can elevate a patient from a lying to a fully standing position and all points in between for treatment and transfer with no lifting required of the caregiver. Total Lift beds are used in the acute-care and home-care markets in the United States.

INTERNET OF THINGS IN HEALTHCARE

ccording to the Medical Council of India, the doctor-patient ratio in India is around 1:1,674 against the WHO norm of 1:1,000 . In such a scenario, IoT can actually be a great leveler.

As of now healthcare delivery in India happens when patients visit doctors for treatment. It is felt that IoT can bring the treatment to patients’ door step. Experts describe how the technology will benefit the sector. “The data of a patient can be captured via various wearables. A doctor can interface through a combination of consumer IoT (wearables) and other exponentials like Augmented Reality, which could change the way in which healthcare is delivered. Little wonder then that businesses are looking to explore this space. Here’s a look at a few startups in the healthcare IoT space in India

1. SPECTRAL INSIGHTS Pathologists in India donâ&#x20AC;&#x2122;t lead an easy professional life. And since senior-level pathologists in India are way short in numbers to serve the 120,000+ pathology labs across the country, the work pressure on them is unexceptionally high. There are also several occupational hazards due to the laborious manual process of operating and viewing through the lenses on a microscope for such long time. Startup firm Spectral Insights aims to come in rescue of pathologists by providing high quality digital copies of slides. The company insists that the technology they are using isnâ&#x20AC;&#x2122;t new as itâ&#x20AC;&#x2122;s available in the developed world but unaffordable by labs in India. So in this light the company has built an affordable automated microscope that makes digital images which are available to pathologists on a computer screen, either locally or over the Cloud. The company also builds various tools to help pathologists make rapid and informed diagnosis, thus increasing their productivity while raising the quality of the outcomes for the patient.

2. CARDIAC DESIGN LABS It is estimated that India has a ratio of 64 million cardiac patients to 4000 cardiologists. Cardiac Design Labs designs and deploys intelligent devices which help in bringing advanced diagnostics beyond large hospitals. The company has developed a wearable device called MIRCaM (Mobile Intelligent Remote Cardiac Monitor) which is capable of providing real time advanced cardiac diagnosis and monitoring in remote settings. The company believes MIRCaM will bridge the doctor patient gap. Resting ECG which is the prevalent method for diagnostics at small hospitals is only good at detecting patients whose heart problems are acute. However, often many cases with early symptoms go undetected. MIRCaM is designed to solve this problem.

Founder and CEO : Anand Madanagopal

3. FORUS HEALTH Forus Health is a medical technology startup founded by a group of engineers with the goal to eradicate avoidable blindness. According to data provided by the company, 80% of blindness in the world could be saved if screened and treated early. For this, Forus Health has built an imaging platform called 3nethra, a portable device for screening common eye problems. Here, IoT helps in conducting remote diagnosis. The images are screened in remote locations and doctors in towns and cities grade them and the patient gets the report back in their respective locations wherein all this happens over the Cloud. So far 3nethra has helped in more than 300,000 remote reading and reporting and has been able to touch around 150 locations. They aim to cover 3000 locations in coming years.

Compiled by: Dr. Avantika Batish is working as Director Strategy and Healthcare at International Health Emergency Learning and Preparedness. Also, guest faculty for MBA (HR) and MBA Healthcare Management at various B-Schools and is a soft skills trainer.

Glimpses from innovatiocuris team

Sachin Gaur from InnovatioCuris got the chance to be part of the Shodhyatra in Nagaland, scouting for grassroots innovators led by Prof Anil Gupta

Emergency Department at Sahlgrenska University Hospital, Sweden with Predicare Team

Sachin Gaur at the FibroTx office in Estonia, getting familiar with the skin test they have developed

Glimpse from the triage room of the university hospital in Gothenburg, Sweden

Dr V K Singh and Dr Girdhar Gyani with MoU copies on collaboration between the two organizations, IC and Association of Healthcare Providers (India)

MOHALLA CLINICS ARE HERE TO STAY ALISHA THAPA and SHREYA KUMAR visit the newlylaunched Mohalla Clinics and report how they contribute to a healthier neighbourhood.

ne of the initiatives of Delhi’s government is about innovations in the healthcare delivery model Mohalla Clinics meaning Neighbourhood Clinics. This is a format of care delivery targeting to improve the access to primary care.

With the launch of the first Mohalla clinic on a trial basis at West Delhi’s Peera Garhi in July 2015, the Delhi government initiated to give an access of basic health facilities to the people of Delhi within walking distance. The first clinic head Dr. Alka Choudhary as the main doctor, an auxiliary nurse midwife, a sister and a technician. The clinic received a positive response from the common people with a recorded visit of 102 patients in just three and-a-half hours. The government then proposed to maximise these clinics up to one thousand by 2016. However, there are less than 200 Mohalla Clinics operating at present. These clinics are set up with the aim to 1. Ease the burden on over-crowded hospitals. 2. Provide de-addiction counselling, family welfare counselling, lifestyle disease counselling and national programme counselling. 3.

Zero cost on check-ups, medicines and tests.

4. Cut down the expenses on travelling and avoid long distance travelling to reach the hospitals by the poor and old-aged people respectively. 5.

Immediate recovery from ailments.

At the beginning stage of this initiative, Delhi’s health minister Mr. Satyendra Jain had proposed that Mohalla Clinic could attend 80% of patients’ illnesses (20% with more serious illnesses to visit the hospitals). Mohalla Clinics have been more successful in attending patients than anticipated. the clinics were able to cater 95% of the patients’ illness. Mr. Jain also had spoken about more advancements and digitisation. Dr Pal while attending a patient at Todapur’s Mohalla Clinic said: The massive success of this project eventually gained the interests of other states in the country. A Mohalla clinic has been set up in the city of Mumbai in August 2016. Following the footsteps also includes the Karnataka government who announced on September 2016 to open two Mohalla clinics in Karnataka. The Gujarat Health Department decided to replicate the concept in four cities of Gujarat: Ahmedabad, Vadodara, Rajkot and Surat. The foreign media has equally lauded the initiative. The highly honoured press journals “The Lancet” and “The Washington Post” have mentioned the initiative as a lesson for America.

The second half of 2016 also marked another technological advancement in the Mohalla Clinics with an upgrade of a Mohalla Clinic in Todapur with a medicine vending machine, replacing the work of a pharmacist. According to the government reports, almost eight lakh patients were treated in five months in the Mohalla Clinics. A vending machine at Mohalla Clinic, Todapur, West Delhi The world leaders like Kofi Annan and Gro Harlem Brundtland were highly impressed and congratulated Delhi CM Mr. Arvind Kejriwal. Both the leaders perceived the model of Mohalla Clinic not only as a countryâ&#x20AC;&#x2122;s achievement but also a universal message to uplift the primary health care system. During the recent visit to a Mohalla Clinic at Todapur, West Delhi by InnoHEALTH (IH) Team, met with Dr Pal, who answered some of the questions of interest.

Q: What is a Mohalla Clinic project?

Dr Pal: It is a pilot project with a target of 1000 Mohalla Clinics in the entire city.

Q: How do you operate as a doctor of Mohalla Clinic?

Dr Pal: Considering data entry, consultation, examination and prescribing medicines, on an average I spend up to four minutes on a single patient and 60-70 patients during the working period of four hours in a day.

Q: How easy it is to access the facilities? Can someone just walk in or they need to show some evidence?

Dr Pal: (While practically demonstrating his procedure with the help of a tab) As you can see, the patient has come for the first time, I register her details like first name, sex, age, marital status, address, motherâ&#x20AC;&#x2122;s name along with a picture of her clicked and then the consultation part I fill up like symptoms, examination, type of tests, prescription in the tab and finally issue a slip of the prescription.

Q: What makes it stand out from other healthcare projects? Dr Pal: There are three major benefits of this project:

1. The hospitals can improve the quality of services as the load of the patients will be less because their load will be taken by Mohalla Clinics. 2. Only manifested and critical cases are going to the hospitals as patients at their early stages of illness are coming here (Mohalla Clinic) and we are giving all the possible treatments and advices within the clinic. 3. The quality of interaction between me as a doctor and the patient is more comprehensive and we are able to give a service with a personal touch to the community.

Q: Who is looking after the expenses of this project?

Dr Pal: It is a government project and the clinic has been set up as rented accommodation. The rent as well as medicines is provided at minimum costs. As a doctor I get INR 30 per patient, my assistant staff and multi-task worker get INR 8 per patient and INR 2 per patient respectively.

Q: From the time the project started till present, what is the level of success? And how do you measure the level of success?

Dr Pal: After the completion of one year, I can say the project has been successful. For instance, this area where I am operating consists of a population of approximately ten thousand comprising two thousand families. Surprisingly, almost each and every family has visited this clinic, be it for a minor or major purpose and that is exactly served our purpose. We want more and more people to visit Mohalla Clinics and get the required treatment. And not only the people of this local area but people from places like Noida, Rajasthan, Tamil Nadu, Andhra Pradesh have visited us to learn about this project, which is a proof that other states are also aware, happy and replicating the model.

Q: What are the criteria for the selection of doctors for this project?

Dr Pal: Doctors’ selection is done by Directorate of Health Services in the office through walk in interview. One can find the advertisements on newspapers. Doctors can appear along with the required documents and especially the retired doctors are preferred for this project.

Q: How often do you refer patients to the hospital for further treatment?

Dr Pal: I hardly refer 1 or 2 patients in a day and rest we take care of ourselves. Patients who are mostly at early stages of the illness come here. For instance, children are prone to disease such as pneumonia and we have been able to detect this disease at the early stage at least in this area and nobody has suffered from this illness. This is how burden of the hospitals is reduced.

Q: What are the changes you see in yourself?

Dr Pal: As I’m already a retired person, I’m getting professional satisfaction while working here and I’m able to keep myself fit by continuing to work.

An interaction between IH Team and patient named Pinky at the Mohalla Clinic IH: What health problems do you have? Pinky: Iâ&#x20AC;&#x2122;m having high blood pressure problem and Dr Pal has been taking care of me. IH: How often do you visit this clinic? For how long have you been treated here? Pinky: I visit this clinic on alternate days and my treatment is going on for last one and a half months here. IH: How do you find the treatment? Pinky: Sir is observing my problem really well. My blood pressure test is done very often and he advises me according to the blood pressure chart. IH: How far do you stay and earlier where were you going for your high blood pressure treatment? Pinky: My home is quite near. The hospital, where I was previously visiting for the treatment was one hour away from my home, due to which I used to leave from home early in the morning and at times it used to be difficult to manage with my small kid. But now everything has become convenient.

Alisha Thapa is working as a community manager in MixORG, New Delhi. She generates content and strategy for brands. Also, she runs campaigns for brandsâ&#x20AC;&#x2122; engagement and presence on online media channels.

Shreya is an engineering graduate who is working with team InnovatioCuris connecting European Healthcare innovation leaders with the Indian healthcare system and pioneers. She looks forward to pursue her masters in the field of data science. Her interest areas are Indian education, healthcare and transportation.

India paves the way for a healthier future The Government has formulated a new policy on medical devices that is expected to give the sector a leg-up and attract FDI. With an understanding that a robust medical devices policy is required to help realise the full benefit of the relaxation of the FDIâ&#x20AC;&#x2122;s this new policy has been finalized and approved by the government for implementation in 2018.

Vigyan Arya

he newly proposed National Medical Device Policy assumes significance given that India imports about 80 per cent of its medical device requirements. There is a need for FDI in the sector as the domestic medical devices industry is fragmented into small and medium enterprises and primarily manufactures products such as disposables.

The draft National Medical Device Policy, 2015, had proposed incentives for both new and existing medical devices firms. It had asked for interest subsidy to MSMEs, concessional power tariff, seed capital, viability gap funding, tax benefits to the sector, minimum or zero duty on raw materials. In fact, the draft policy had also suggested setting up of an autonomous body National Medical Device Authority and a single window clearance for the industry. The global market size for medical devices is about $220 billion and India has the potential to tap the opportunity. The sector in India is relatively small compared to the rest of the manufacturing industry though India is one of the top 20 markets for medical devices in the world and 4th in Asia. A task force under the chairmanship of the DoP secretary addressed issues concerning domestic production of high-end medical devices and pharma equipment manufacturing that have been elaborately incorporated in the new policy.

Medical devices include any instrument, apparatus, appliance, implant, material or other article, whether used alone or in combination, including the software intended by its manufacturer to be used specially for human beings or animals for one or more of the specific purposes. It also includes a device which is a reagent, calibrator, control material, kit, equipment or system whether used alone or in combination thereof intended to be used for examination and providing information for medical or diagnostic purposes.

Executive Summary The Indian medical device market is dominated by imported products, which comprise of around 75% of total sales. The domestic companies are largely involved in manufacturing low-end products for local and as well as international consumption. Lately, many multinational companies have established local presence by acquiring established domestic companies or starting a new business. There are few key factors about operating in India that every serious player should be aware of. Foreign Direct Investment in medical device manufacturing sector is now possible without any prior approval. The Indian Government has introduced various fiscal measures to promote research, development, manufacturing and import of medical devices. There is no import duty on certain medical equipment. Similarly, a number of lifesaving medical equipment are exempt from payment of excise duty.

The regulatory framework in India applicable to medical devices borrows heavily from the regulatory framework applicable to drugs. At present, only 15 types of medical devices are regulated (unfortunately, as “drugs”). The rest are unregulated. After a lot of efforts of various stake holders, the government has notified the Medical Device Rules, 2017, which are to come into effect from the 1st of January, 2018. These rules will regulate a much larger set of medical devices under a framework customized for medical devices. This should boost the confidence of all stakeholders, especially those who have been hesitant to enter into Indian market because of lack of regulation. The Indian medical device sector is Asia’s fourth largest market, and presents an exciting business landscape and opportunities for both multi-national and domestic players. Till the early 1990s, the medical device sector was significantly dominated by domestic players. But after India opened up its markets in 1991, tables have turned. The technological advancement and expertise that the global market leaders offered has proved to be an advantage. Today, India’s medical device sector is dominated by multi-national companies, which is evident from the fact that about 75% of the sales are generated by imported medical devices. The domestic players, on the other hand, were quick to adapt the winds of change and started to focus on low cost devices. It will come as a surprise to many that the domestic players in India export more than 60 percent of their output as Indian markets are dominated by such imported medical devices. Over the years, many multi-nationals have set up operations in India. However, the nature of majority of the operations is to only distribute imported devices and provide support function. Few multi-nationals have started domestic production too. Some multi-nationals have also entered India by acquiring domestic manufacturers.

A significant percentage of purchasers of medical devices are private medical institutions and hospitals. Due to increased competition in Tier I cities, private enterprises have started to focus on Tier II and Tier III cities, a market which is until now untapped in India. As private enterprises expand in lesser explored markets, the demand for medical devices will expand proportionally. Other reasons for strong growth prospects of the industry are:

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Economic growth leading to higher disposable incomes

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Increased Public Spending in Healthcare

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Increased Penetration of Health Insurance

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Improving Medical infrastructure

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Increasing affordability due to growing income

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Increasing number of ailments

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Increasing demand due to “Medical tourism”

The sector is also witnessing strong Foreign Direct Investments (“FDI”) inflows, which reflects the confidence of global players in the Indian market. As per official data, the medical and surgical equipment sector received a total of INR 8344 Crore (approx. USD 1452 Million) between 2000 and 20162. In 2013 alone, the FDI inflow was almost INR 920 Crore (approx. USD 138 Million). In 2015, this number jumped to a new high of INR 1019 Crore (approx. USD 153 Million).

India Entry Strategy Doing business in India is as big a challenge as it is an opportunity. The sensitive healthcare sector in India has long been conservative about foreign investment over concerns of foreign influence over health priorities of domestic manufacturers. However, in recent times, there is growing governmental and popular support for foreign investment in all sectors, including health. It is, therefore, significant to observe the political and economic environment of India. It is equally important to understand the business culture and consumer mindset prevalent in India. Companies that are quick to adapt to it turn out to be more profitable. To be aware of the legal framework is another must. Specifically, investors must keep an eye on the exchange control laws as they govern how profits made by the company can be realized out of India.

Investment climate in India By and large FDI is now permitted in almost all the sectors in India without obtaining prior regulatory approvals (i.e. under the “automatic route”) barring some exceptional cases like defense, housing and real estate, print media, etc. (referred to as the “negative list”). If the FDI is not in accordance with the prescribed guidelines or if the activity falls under the negative list, prior approval has to be obtained from the Foreign Investment Promotion Board (“FIPB”) (“approval route”). FDI in manufacturing of medical devices is permitted to the extent of 100% under the automatic route. For the limited purpose of FDI Policy, Medical device is defined as follows; Medical device means; i) any instrument, apparatus, appliance, implant, material or other article, whether used alone or in combination, including the software, intended by its manufacturer to be used specially for human beings or animals for one or more of the specific purposes of;

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Diagnosis, prevention, monitoring, treatment or alleviation of any disease or disorder;

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Diagnosis, monitoring, treatment, alleviation of, or assistance for, any injury or handicap;

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Investigation, replacement or modification or support of the anatomy or of a physiological process;

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Supporting or sustaining life;

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Disinfection of medical devices;

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Control of conception, and which does not achieve its primary intended action in or on the human body or animals by any pharmacological or immunological or metabolic means, but which may be assisted in its intended function by such means;

ii) An accessory to such an instrument, apparatus, appliance, material or other article; iii) A device which is reagent, reagent product, calibrator, control material, kit, instrument, apparatus, equipment or system whether used alone or in combination thereof intended to be used for examination and providing information for medical or diagnostic purposes by means of in vitro examination of specimens derived from the human body or animals. iv) However the definition above would be subject to the amendment in Drugs and Cosmetics Act. for manufacturing of medical devices.

Aspects of Legality As referred to in the introduction, the medical devices industry in India is currently largely unregulated because of the absence of a medical device specific legislation specifying standards of safety and quality for most of the medical devices. However, this is set to change with the introduction of the Medical Device Rules, 2017.

Presently, there are certain medical devices which have been regulated by creating a statutory fiction and deeming these medical devices as “drugs”. By virtue of this fiction, these few medical devices get regulated by the Drugs and Cosmetics Act, 1940 (“Act”) and the rules framed thereunder viz. Drugs and Cosmetics Rules, 1945 (“Rules”). The Act and Rules seek to:

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Regulate the import, manufacture, distribution and sale of Notified Medical Devices.

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Ensure the availability of standard quality Notified Medical Devices to the consumer.

Licensing Process The regulation of Notified Medical Devices is overseen by both, the central government and the state governments. Under the applicable regulatory framework, the functions of manufacture, import, distribution and sale of medical devices require licenses or permissions, as the case may be. In specific instances such as manufacture or import of new Notified Medical Devices (discussed later), both, a permission from the central drug licensing authority and a license from the state drug licensing authority is required. The required licenses and permissions are described more specifically in the table below. The Rules have prescribed the standard format of the application forms for relevant licenses for the benefit of the applicants. It has also prescribed the standard form (template) of the licenses that may be issued for the benefit of the regulatory authorities and the applicants.

Manufacturing process A separate license is required for each manufacturing location and for each Notified Medical Device at such manufacturing location. Under the Act, “manufacturing” includes any process (or part) for making, altering, ornamenting, finishing, packing, labeling, breaking up or otherwise treating or adopting any drug with a view to its sale or distribution. However, “manufacturing” does not include dispensing or packing at the retail sale level.

Importing Process The IEC Number would be required to be mentioned in the documents filed with Customs for clearance of imported goods. For obtaining the IEC Number, an application in the prescribed form has to be submitted to the office of the jurisdictional Joint Director of Foreign Trade, wherein details of Bank Account Number and Permanent Account Number have to be furnished Under the Act, the activity of import of Notified Medical Devices into India requires an import license from the office of the Drugs Controller General of India. In order to get an import license, there is a mandatory requirement of registration of the medical devices sought to be imported, the name of the manufacturer and its manufacturing premises with the office of the DCGI. The registration is certified by grant of a registration certificate. An application for grant of a registration certificate may be made by the foreign manufacturer itself if it has a valid wholesale license for sale or distribution of Notified Medical Devices under the Rules or its authorized agent in India, either having a valid license under the Rules to manufacture for sale of a Notified Medical Device or having a valid wholesale license for sale or distribution of Notified Medical Devices in India. Many a times, foreign manufacturers do not have an Indian subsidiary which has a wholesale license for sale or distribution of Notified Medical Devices. Hence, the manufacturers choose to appoint a third party as an authorized agent to make the application for grant of registration certificate. The authorization by a manufacturer to its agent in India must be documented by a power of attorney.

Clinical Trials The applicable regulatory framework for clinical trials is drug-trial specific. There is no medical device specific regulatory framework for clinical trials in India. The DCGI, who regulates clinical trials, is aware of this fact and has therefore, allowed for some tweaking in the drug-specific clinical trial regulatory framework to suit medical devices. For example, the DCGI has exempted Phase I clinical trials of medical devices. A number of manufacturers of Notified Medial Devices are interested in carrying out post-marketing observational study of medical devices. The core difference between an observational study and a clinical trial is the degree of interference of the manufacturer in both the scientific studies. In observational studies, the manufacturer does not interfere in the use of the device by the subject but in a clinical trial, the manufacturer sets out the way (design) in which the device would be used. There is no requirement to obtain any permission for an observational study, but permission would be required to carry out a post-marketing clinical trial.

Labeling Before a Notified Medical Device is sold or distributed in India, it must be labeled according to specifications outlined in the Rules. All medical devices sold in retail or wholesale package should are required to comply with the labeling requirements of The Legal Metrology (Packaged Commodities) Rules, 2011.

Penalties The penalties have been significantly enhanced through the amendment for manufacture, sale, distribution, stocking or exhibiting or offering for sale or distribution of spurious or counterfeit Notified Medical Devices to INR 1,000,000 or 3 times the value of the notified medical device confiscated, whichever is higher and imprisonment of not less than 10 years which may extend up to life, for spurious or counterfeit notified medical device leading to death or grievous hurt. The entire amount of fine that is realized from the person convicted for the offence is now paid by way of compensation, to the person who is the victim of spurious or counterfeit Notified Medical Devices. If the victim has died due the effect of the spurious or counterfeit Notified Medical Devices, the relative of the victim is entitled to receive the same amount by way of compensation. In case the spurious or counterfeit notified medical device does not lead to death or grievous hurt, then the penalty is a fine of up to INR 300,000 or 3 times the value of the notified medical device confiscated, whichever is higher and imprisonment of not less than 7 years which may extend up to life. The Ministry also has set up a â&#x20AC;&#x153;whistle blowerâ&#x20AC;? policy that aims to reward citizens, who provide information on the trade and source of spurious Notified Medical Devices.

Advertising and Sales Advertising medical devices is strictly regulated. The Rules prohibits labeling of Notified Medical Devices in a manner that may convey to the intending user that the enclosed device may be used for prevention or cure of certain ailments and diseases specified in Schedule J of the Rules. Some examples of such diseases and ailments are: Blindness, Bronchial Asthma, Cataract, Growth of New Hair, Deafness, Genetic Disorders, Improvement in vision, Myocardial Infarction etc. Please note that while the restriction on labeling applies only to Notified Medical Devices, some of the restriction on advertisement is general in nature and are applicable to all medical devices. These are dealt in detail under the sub-heading of Drugs and Magic Remedies (Objectionable Advertisement) Act, 1954.

Concluding the Benefits The Indian medical device industry continues its upward march of growth and is strongly supported by India’s robust legal framework. The Indian Government has identified the medical device industry as a focus industry for its flagship “Make in India” program. There is also a proposal to launch new medical device parks in which government will provide fiscal and monetary incentives. This should give lot of confidence to potential stakeholders to consider the Indian medical device industry seriously. With respect to the singular event of price fixation of Coronary Stents, The government had several interactions with the importers and manufacturers of Coronary Stent and took their feedback into account before fixing the price. Thus, it appears that the government sought to be restrained and transparent in its approach. Also, it is still possible for importers and manufacturers of Coronary Stents to increase their current margins by structuring their business model or by using the available relaxations as discussed in the body of this paper. Lastly, with the introduction of the Medical Device Rules, 2017, the medical device industry in India is certain to receive a fillip.

The Hospital Of Tomorrow Redefining Hospitals under the Affordable Care Hospitals have to think strategically and innovatively of how to make the experience better. It’s no longer just about the treatment. It’s about the healthcare experience.

he WHO quotes hospitals as “health care institutions that have an organized medical and other professional staff, and inpatient facilities, and deliver medical, nursing and related services 24 hours per day, 7 days per week.”

In the present day scenario hospitals extend beyond just inpatient facility. They extend into the community and offer accessible care. Hospitals are focusing on health promotion and protection. Hospitals are changing every day. The management of hospitals is also changing.

Need for change:

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Changes in healthcare

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Specialization on the rise

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Changed expectation of healthcare professionals

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Effectiveness of healthcare delivery

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More awareness toward quality of healthcare

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Increases awareness of safe practices in healthcare

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Influence of IT and other new regulation including Medical Tourism.

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More options to choose with freely available knowledge.

Patients are becoming more demanding than ever before and it will continue to increase. Hence hospitals have to think strategically and innovatively of how to make the experience better. It’s no longer just about the treatment. It’s about the healthcare experience. In order for hospitals to succeed it’s important to meet the needs of the customer and their families. Invariably it’s important the family is satisfied and more likely they are the word of mouth ambassadors keeping in mind they have a lot of time to be spent in the hospital when their loved ones are getting treated. Hence hospitals need to focus on both the experience of the patient as well as their families. Patients have different needs and in all likelihood they have done a lot of window shopping before they reach a particular hospital. Also word of mouth still is the single largest way patients come to hospitals. The expectations seem to be growing and hence the hospitals have to take a holistic view of providing the healthcare experience to the patients and their families. While infrastructure is important in hospitals, soft skills are equally important. At every step patients require hospitality in the hospital. Hence staff training and protocols are important. Staff needs to be better prepared to handle crisis situations, that too with a smile. Boutique hospitals have recently become a trend and surely would become a common concept tomorrow that would grow rapidly.

Effective Leadership: Lean Management Michael Porter, “Father of Modern Strategy Field” a Harvard Business School Professor said “We must make progress in dramatically improving the value that we deliver,” The key to an effective hospital is effective focused leadership making execution the key to success. Lean management was started by Toyota in 1950 and has found its way into making hospitals more effective. Lean management would increasingly be adopted by the hospitals of tomorrow to create the healthcare experience that the patient is looking to have. Lean hospitals focus on three areas: Firstly on the patients, secondly on the healthcare providers and finally on the hospital management.

Patient experience becomes the core of every activity in the hospital. Patient waiting time is greatly reduced that there is a seamless transition from appointment to treatment to billing and follow-up. The healthcare provider are the key in making this experience count hence keeping in mind their comfort also becomes vital to the success of the process. Hence usually hospitals conduct these workshops with the concerned staff to make them the process owners.

Technology for effective hospitals-mcloud Technology has redefined the way healthcare is being delivered today. It has greatly enhanced access to knowledge and reduced the waiting time. It’s been predicted by 2025 with introduction of technology there would be marked improvement in operational efficiency, reduction in medical errors, paper less hospitals and personalized care.

Fig 1: Prediction of hospitals of tomorrow using technology

Aruba Network believes that technology in healthcare would create a radical shift. The hospitals of tomorrow using technology would have 50% better Operational efficiency, 75% reduced patients misdiagnosis, 80% paperless and wireless & 100% personalized care.

Operational efficiency: Hospitals of tomorrow would be 50 percent more efficient as per the Aruba prediction through the birth of the â&#x20AC;&#x2DC;mCloudâ&#x20AC;&#x2122; and Smart Waiting Rooms. This would give patients the ability to have healthcare across the globe. These online data would be protected and hospitals could reduce the unwanted storage space by using the cloud computing. The doctor would have access to patient details more quickly and ensure lesser waiting time. Operation efficiency using technology.

(See Fig 2) Fig 2: Operation efficiency using technology

Reduced Misdiagnosis: Reduce misdiagnosis by 75 percent through the partnership of real-time data and mobile technology use of real-time data through the use of mobile software and devices, all allowing for more accurate diagnosis giving consultants greater visibility into a patients ailments and reducing misdiagnosis. (See Fig:3)

Wireless and Paperless: Fig 4: Wireless and Paperless hospital using technology

While an entirely paperless hospital would not be the ideal situation an 80% paperless hospital is a sure possibility in the hospitals of tomorrow with the wireless technology aiding it. Deliver a truly paperless and wireless world driving better confidentiality and collaboration using Telemedicine / electronic record (See Fig 4).

Personalized Experience: The patients of tomorrow would expect personlized care like they currently do in a hotel. Hospital industry would become more an hospital cum hospitality industry. Through the use of mobile apps and techonolically connected rooms a completely customized and personalized experience would be provided to the patients. Bring a customized and smart patient experience through remote consulting, hospital app, smart rooms, consult doc and nurses through customized hospital app (See Fig 5).

Fig 5: Personalized patient experience using technology

Benchside to Bedside to Population

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The hospital of tomorrow needs to be a large, integrated system providing extensive outpatient care beyond its primary facility, dedicated to keeping community members healthy

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The hospital of tomorrow should proactive, devoted to disease prevention

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It has a large network of medical professionals reaching into the community, working in outpatient clinics as well as urgent care centers

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This approach will result in a significant reduction in emergency room visits, an important step to lowering the cost of medical care

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Instead of measuring hospitals by the number of beds filled with patients being treated for illnesses, the hospital of tomorrow will be judged more by its ability to maintain a community’s health

Hospital without walls: Community care Health care is delivered both at hospitals and at home ( Fig 6). Hospitals of tomorrow would essentially spread beyond the borders of the four walls and extend into the community to provide home care. Using technology a perfect interphase can occur between the hospitals and the community care thereby ensuring continuity of care. Reduction of interphase is possible but interpersonal relationship is a must in healthcare. Key objective of the hospital of the future will be to keep more patients out of the hospital, an optimal outcome for improved communal medical and fiscal health

Collaboration for sustainability: Healthcare concept has shifted over the years from being hospital centric to patient centric. With the patientsâ&#x20AC;&#x2122; wellbeing in mind and with the concept of doing more from less we at Santosh believe that Collaboration would be the best way forward for sustainability. With so much need for healthcare and at the same time limited resource it becomes imperative that the resources are used effectively to ensure sustainability. To share our personal experience we took up a mission of providing healthcare to the people of Ghaziabadâ&#x20AC;&#x2122;s urban slum area in Uttar Pradesh. At first seemed like a huge task. We had access to a healthcare team, but that wasnâ&#x20AC;&#x2122;t sufficient we had to get to the interiors of Ghaziabad and spread the awareness that healthcare was available at an affordable cost. Hence we collaborated with the District administration, which in turn collaborated with the WHO, who wanted to provide immunization to the people but did not have access to the healthcare team. Thus the collaboration was a win-win and we succeeded in providing immunization and healthcare to 3 lakh people. The hospitals of tomorrow would also collaborate expand the pie and bring in synergies to provide better healthcare at a cost that would be affordable to the patients. The hospital of tomorrow is surely some years from becoming a reality. The good news is we are on the right path and with the use of technology, lean management principles, collaboration, preventive aspects of medicine and extending the hospital beyond boarders healthcare of tomorrow would be much better than what it is today.

Dr. Sharmila Anand,

MD (Pharmacology), M. Phil (HHSM), MBA (HA) USA | Managing Director, SEHPL Dr Sharmila Anand, a social entrepreneur with rich experience in medical education. She leads SEHPL focused on developing next generation of healthcare professionals / leaders who can transform the way healthcare is delivered in India. She is passionate about Affordable education and Healthcare. She left India to pursue her dream of education and returned to help others pursue theirs.

Re-shaping of healthcare through Innovations

he World economy is changing drastically from agriculture to manufacturing to services. Among all services, healthcare services are one of the significant contributors to the economic growth. Further, it has become easy to implement due to advances in information and communication technologies (ICT), Internet of Things (IoT), efficient network of organisations. IoT is a network of organisations based on their complementarity strengths / resources available. IoT is connecting homes, cars cities as never before to make life simple and more comfortable [1]. Innovations has become critical capability of many business organisations including healthcare organisations. New technologies such as Internet of Things (IoT), nano technology, semiconductor products, stem cells, genetic engineering are driving the healthcare across the world. Among all, medical sciences have advanced significantly in terms of adopting latest technologies throughout the process of care delivery. Innovations in healthcare industry primarily aimed at improving quality of life, life expectancy, treatment options and cost efficiency. Healthcare Innovation can be defined as the introduction of a new concept, idea, service, process, or product aimed at improving treatment, diagnosis, education, outreach, prevention and research and with the long term goals of improving quality of life, safety, outcomes, efficiency and costs [2]. There are several innovations happened in healthcare delivery. Some of these are given below (figure 1): •

Product innovation

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Process Innovation

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Service design Innovation

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Service delivery Innovation

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Business model Innovation

Innovations in healthcare improves adaptation and affordability.

Figure 1: Innovations in Healthcare Delivery

Product Innovation is concerned with introduction of new types of goods and services for the external markets. This includes significant improvements in technical specifications, components and materials, software, user friendliness or other functional characteristics. Examples include wearable devices, portable ECG of GE, Intra Ocular lens of Aravind Eye Hospital, Jaipur foot etc. These innovations help in generating incremental revenues [2]. Some of the main products include patient monitoring devices, home care and health and fitness. Wearable devices market is growing at the rate of 4.8% on year-on-year growth [3].

Figure 2: Product Innovation (Wearable Devices [3])

Process Innovation is mainly implementation of a new or significantly improved production or delivery method. This includes significant changes in techniques, equipment and/or software. These innovations help in improving internal capabilities and quality improvement [2]. Some of the examples include use of computerisation of medical records, improvement in the use of medical equipment like in Aravind Eye Hospital where surgical equipment is being used for two tables. Service Design Innovation mainly focus on design of man-machine system compatibility including customisation of devices and its functioning. For example, customising the pulse rate of pacemaker implanted to a patient. Examples include telemedicine, mobile healthcare units, small clinics in the vicinity of patients, collaboration with other stakeholders etc. Figure 3 shows

Service Delivery Innovation include the use of new methods in delivering the service and helps in cost reduction as well as turnaround time of care delivery. This include innovation in medication, surgical interventions, procedure etc. For example, use of iphone for taking picture of eye and checking for preliminary diagnosis in place of a computer or other equipment. MRI, CT Scan, Cataract surgery etc. Figure 4 shows arrangement of eye check-up equipment on a two wheeler which can reach to the location where four wheeler mobile unit cannot reach. Apart from these four innovations, one of the most important one is business model innovation. This is mainly focuses on number of alternatives and pricing of products and services. Examples include offering two or three options for surgical services along with other support services like room with air conditioner or without air conditioner etc. Providing enough number of winning alternatives refers to business model innovation.

Diffusion of innovations in healthcare requires acceptance of innovations by the different stakeholders mainly the care receivers (patients), care givers (doctors and others). This requires alignment of knowledge, technology and institutionalisation of practices. Innovations in healthcare helps government to provide conducive environment for innovation and collaboration opportunity between public and private organisations. Facilitate in implementing healthcare initiatives in large scale by optimising resources and their deployment. References:

1. Srivastava S C and Shainesh G (2015), Bridging the service divide through digitally enabled service innovations: Evidence from Indian Healthcare service providers, MIS Quarterly, Vol 39(1), pp: 245-267.

2. Omachonu V K and Einspruch N G (2010), Innovations in Healthcare delivery systems: A conceptual framework, The Innovation Journal: the public sector innovation journal, vol. 15(1), pp: 1-20.

3. http://www.todaysmedicaldevelopments.com/article/wearable-medical-devices-2016-market-72816/

https://www.innovation.cc/scholarly-style/omachonu_ healthcare _3innovate2.pdf

S Venkat is an Associate Professor in Operations Management at IIM Lucknow, India. His interests include healthcare operations management, affordable healthcare design for bottom of the pyramid consumers, Managing operations in religious organisations etc.

Ayurveda Mother of all Healings The fundamentals on which the Ayurvedic system is based are essentially true for all ages and so can be easily adopted time after time, century after century. By Indu S Arya

yurveda is generally understood as ‘Science of life’ translating ‘Ayuh (r)’as life and ‘Veda’ as science. Ayurveda is an ancient system of life and also the oldest surviving medical system in the world. Dating back almost 5000 years, it is also considered to be an ancient science of healing that enhances longevity. It has evolved from the quest to have a happy life, through a deep understanding of creation and its maintenance, perceived and conceived by the rishis or seers of ancient India. Ayurveda emphasizes upon life in general with bit more emphasis on human life. Its influence can be found in many ancient traditional methods of healing including Tibetan, Greek, and Chinese medicines thus making it the ‘mother of healing.’ The fundamentals on which the Ayurvedic system is based are essentially true for all ages and so can be easily adopted time after time, century after century. The philosophy of Ayurveda teaches a series of conceptual systems characterized by balance and disorder, health and disease. It teaches that a person’s mental, emotional and spiritual being are all interconnected and any kind of imbalance between them results in health disorder and diseases. Therefore, to be healthy, harmony must exist between the purpose for healing, thoughts, feelings and physical action. Health and disease are defined in a very special way in Ayurveda. Ayurveda’s central tenant is that life is a manifestation of mind, body, soul and spirit. Body and mind are prone to suffering while the spirit is free of any such trappings of life. Thus to remain healthy and happy, efforts are required to be made in the direction of maintaining harmony among all these elements and only then can one get closer to the goal of longevity and disease free life.

Science of Ayurveda Ayurvedic science is not merely a traditional Indian form of medicine but a perennial naturopathic system of healthcare that has survived the test of time as well as onslaught of modern science and methods of treatments. Based on wisdom acquired through the centuries, the main aim of Ayurvedic science is to achieve perfect health by creating an equilibrium of perfect harmony between human body and the environment it habitats. Ayurveda is also known as the science of living a healthy and disease free life. It is built on the premise that in olden days, man used to live close to nature and whenever he got exposed to some disease, he used to cure himself using resources and material provided by the Mother Nature. It therefore would not be wrong to say that Ayurveda charts out a health patter based on nature and its natural resources. The Vedic philosophy believes that human beings are all a part of nature. Just as animals and plants are interdependent on each other to create balance within their beings, there is a concurrent and inherent connection between the universe and human beings. The complex world that the human beings reside in, is perpetually exposed to environmental changes. Any amount of change in weather, lifestyle, diet, work, emotions and relationships can easily tip the balance and negatively influence an individualâ&#x20AC;&#x2122;s state of mind, body and soul. Ayurveda calls for a complete harmony of human body with the elements of nature and the surrounding environment for a stress free and healthy life. The Ayurvedic science does not merely deal with medical science but its scope goes much beyond the universe of the conventional science. It also includes factors like herbal medicine, body works, and surgery apart from social, psychological, ethical, spiritual and intellectual life of human beings.

Ayurvedic Body Types According to Ayurveda, each one of us has a unique mix of three body principals that constitutes our mental, physical and spiritual well-being. These three principals are known as doshas, which are further classified as Vatta (air-ether), Kapha (water-earth) and Pitta (water). But each individual has its own unique constitution that is usually governed by one or two of the doshas predominantly. It means that that our Ayurvedic constitution is mainly be either of these doshas or a mixed constitution of two doshas like Vatta & Kapa, Kapa & Pitta or Vatta & Pitta. Kapha: Kapha governs all structure and lubrication in the mind and body. It is the principle that holds the cells together and forms the muscle, fat, bone, and sinew. It controls weight, growth, lubrication for the joints and lungs, and formation of all the seven tissues â&#x20AC;&#x201D; nutritive fluids, blood, fat, muscles, bones, marrow and reproductive tissues. It helps build excellent stamina but when it goes out of balance it can also cause a person to become overweight, sleep excessively, and suffer from the problem of diabetes, asthma and depression. Pitta: The pitta dosha controls digestion, metabolism, and energy production. The primary function of Pitta is transformation. Those with a predominance of the Pitta principle have a fiery nature that manifests in both body and mind. Pittas have a lustrous complexion, perfect digestion, abundant energy, and a strong appetite. When out of balance, Pittas may suffer from skin rashes, burning sensations, peptic ulcers, excessive body heat, heartburn, and indigestion. Vatta: The vatta dosha is known to govern all the movements of mind and body. From controlling the blood flow to elimination of the waste and harmful toxins to breathing and the flow of thoughts in the mind; the vatta dosha is like a predominant force that minimizes stress and feeds the creativity within you. If the vatta dosha is in balance, you will feel energetic, enthusiastic and lively, but the moment it becomes imbalanced, it manifests in the body problems like constipation, hypertension, fatigue, digestive challenges and restlessness among others.

Ayurvedic Herbs Ayurveda understands health as a reflection of a man living in harmony with nature and disease arises when this harmony gets disturbed. In the ancient times, rishis and sages believed in Ayurvedic herbs as the solution to cure a number of health problems and diseases. The conducted thorough studies and experimented with these herbs before arriving at any conclusion regarding the accuracy of the medicinal values of these herbs and their effectiveness in treating various ailments and diseases. Due to their natural Ayurvedic herbs are considered to be free of any side effects and thus enjoy a global appeal. Ayurvedic medicines are mostly formulated using a mix of herbs and other plants, including oils and common spices. By combining several kinds of plants and herbs to get benefit of the drug or therapeutic value, Ayurveda has proven itself capable of overcoming various health problems that occurs in the human body. Today, Ayurveda is being widely used in modern medicine systems. This was triggered by a number of research-conducted by scientific research and has proved how effective and positive the role of plants or herbs can be on human health. Herbs play a vital role in the Ayurvedic system and a small herb is known to dissolve stones in the kidney, bladder and gall-bladder easily and effectively. Apart from timely cure, Ayurvedic herbs are also know to provide permanent relief from a disease by removing the metabolic toxins from the body. Know more about the various Medicinal Plants and Their Uses.

Ayurvedic Home Remedies Ayurvedic home remedies are considered safe as they are natural and herbal in nature, therefore, free from any side effects. They have an advantage over other methods of treatment as Ayurvedic remedies are known to cure the disease form the root, effectively. Treating an ailment or a disease using Ayurvedic remedies will not only help you get rid from it permanently but also aid you in leading a healthy life in the long run. Some of the major benefits of using homemade Ayurvedic remedies include: •

Ayurvedic remedies are preventive as well as protective and curative in nature.

• As the emphasis is on using herbal and natural ingredients or things that can be easily found in the kitchen, it does not pose any danger of being toxic. •

These remedies are free of any side-effect and provide long term or permanent cure from the disease.

• The remedies also emphasize on the need for a lifestyle change with modification required in one’s diet, sleep pattern and other basic everyday activity. Therefore, the holistic approach towards the overall well-being of a person is much effective as compared to other conventional forms of modern day science.

Ayurvedic Medicines Ayurvedic Medicines are fast gaining popularity across the world. One of the major reasons for it being that Ayurveda seeks to normalize body functions with varied techniques including advice on food and activity, internal herbal preparations, purification treatments (panchakarma), and surgical methods (shalya chikitsa). Ayurveda is based on the belief that the delicate balance of mind, body and spirit determines health and wellness of the body. The goal of Ayurveda is prevention as well as promotion of the body’s own capacity for maintenance and balance. Ayurvedic medicines are non-invasive and non-toxic in nature and therefore are free from any side effects. Using Ayurvedic medicines in your daily life enables you to re-establish balance and harmony in body’s system, aids in detoxification and cleansing of the body by removing accumulated toxins and normalize body’s functions. Products made using Ayurvedic plants have a stronger action on the body as they help in stabilizing the doshas. Tulsi, Guduchi, Ajwain, Brahmi, Shilajit and Ashwagandha etc., are some of the most commonly used herbs in Ayurvedic preparations. Each of these herbs or spices hold a multitude of benefits -- for the mind, body, and spirit and can be easily used internally or externally, depending on the need.

Ayurveda to the rescue The daily activities of life in the modern world systematically wear us down and speed up the aging process. Ayurveda maintains it is crucial to practice daily rejuvenative regimens to counteract the stressful wear and tear of everyday life. According to Ayurveda the most important rejuvenative routines for your life are: Going to bed by 10:00 PM. This simple habit is one of the most powerful techniques for health and longevity, according to Going to bed by 10:00 PM. This simple habit is one of the most powerful techniques for health and longevity, according to Maharishi Ayurveda. Meditate daily any meditation that does not involve concentration (which has been shown to increase anxiety) can be very helpful. I highly recommend the twice-daily deep rest and enlivenment of the Transcendental Meditation (TM) technique, whose benefits have been verified by over 700 published research studies. Eat organic, whole fresh food that is freshly prepared. There is an Ayurvedic saying: â&#x20AC;&#x153;Without proper diet. Medicine is of no use. With proper diet, medicine is of no need.â&#x20AC;? Be sure to avoid those leftovers, processed and microwaved foods for better nutrition and vitality.

Weird relaxation rituals Ten women, ten wacky ways to unwind and recharge. By Mary Moore

or most women, there is nothing strange or unusual about major stress – drowning in to-do’s has become a way of life. But sometimes the best strategies for countering stress are indeed strange, unusual and even downright kooky. Relieving stress is a creative process. There is no right or wrong when it comes to relaxation. You have to test out techniques that work with your schedule and lifestyle. In other words, whatever helps you unwind, do it! Here, 10 women offer up their screwball techniques for de-stressing in a pinch.

Paradise island “When I’m feeling frazzled, I set up a mini beach in my house. I mix up a tropical drink, play some reggae music and kick back in a lounge chair. Thirty minutes on my private island calms me every time.” -- Jennifer Colbert

Bubble om “I do what I call ‘bathtub yoga.’ I have a really big tub, so while I soak in essential oil-infused hot water for about an hour, I do easy stretches. The heat makes me that much more flexible, and afterward, I’m a happy puddle.” -- Sonja Case

Word play “I compete in online Scrabble tournaments. It’s a great way to settle myself down by getting away from it all. The thrill of beating a new player makes my worries melt away.” -- Christie Hiers

Puppy love “I let my puppy lick my toes. You cannot possibly feel tense while a dog licks your feet. It’s like having a personal reflexology session after a hard day at the office.” -- Buffy Schneit

Gone fishing “I go fishing. I have to get my husband to bait the hook, because that part grosses me out. Still, I love sitting quietly out on the water waiting for a bite. No one can make demands of you while you’re in the middle of a lake alone – it’s as serene as meditating.” -- Lori Couthran

Hot wheels “Anytime I need to relieve pressure, I just get into my car with my dogs and crank up the ‘80s music. Bon Jovi and Poison are some of our favorites. I roll down all the windows, and my pups stick their heads out while I sing at the top of my lungs. It’s like a getaway road trip for all of us.” -- Melissa Calvery

Joy pluck “When I’m feeling panicked about something going on in my life, I turn to my light-up mirror and trusty tweezers to take my mind off things. It’s not that I like to inflict pain on myself, but tweezing allows me to focus on the task at hand rather than fretting about paying my bills or finishing my homework.” -- Tara Donovan

Clean sweep “I power-vacuum. I cover every inch of the house. I don’t know whether it’s the calming hum of the machine or the fact that I believe I’m actually getting something accomplished, but afterward I feel completely at ease.” -- Suzanne Soriano

Virtual vacationing “I plan luxury vacations online, even though I have no intention of taking them. That’s the fun part — you can pick the most extravagant hotels and activities and live in a little fantasy world, even if just for an hour. Afterward I feel as chilled out as if I actually went!” -- Monica Maynard

Doodle date “I doodle with crayons. In fact, I keep Crayola boxes at my desk and around my house. Coloring makes you remember a time when things were simpler and not so demanding.” -- Carla Amerman

Calorie intake for your body type By Ian Leeps

or some people, the word “calories” brings about emotions of dread and fear. For others, it’s a place to call home, where they feel all warm and fuzzy. And yet for others, “calories” connotes a way to salvation and better health.

Well, for these 3 main types of people ([1] an ideal-weight person who fears getting fat, [2] an obese person who denies himself the freedom of getting thinner, and [3] a dangerously thin person who needs to put some meat on himself ), there’s hope. And guessing 99.9% of you out there, fall somewhere in these categories, I suggest you keep reading if you’d like to free yourself of that potentially vicious word forever.

Survival of the fittest No matter who you are or what kind of body type you have, there is one definite rule in this universe: you’ll come out on top only if you’re physically and mentally fit. From basics like getting that attention that you have always been seeking, or emanating a strong leadership presence during your presentation, it’s all about how you look and how you project yourself.

The skinny For the person who is extremely thin (i.e., your bones are protruding on some parts of your body), it’s more a problem of eating the basics for survival. These types need to carefully plan their daily meals in order to ingest the perfect ratio of fat:protein:carbs (30:40:30). 30% of the calories they ingest needs to be fat and carbohydrates, while 40% needs to be protein. This, coupled with moderate exercise, will help pack on some pounds gradually. People in this type of category need to change the way they view food. Food is not the enemy; it can be your friend. Actually, it can be your savior. Without basic sustenance from vitamins, minerals, fats, carbs, and proteins, the body will self-destruct.

The ideal weight person For the person who is already at his ideal weight, it’s more a problem of mental image and fear. They are usually so afraid of becoming fat that they deny themselves the smallest pleasures like a nice cold ice-cream cone on a hot summer’s day.

Fitness buffs who are in top shape burn themselves out by exercising too much and not letting their bodies recuperate. They harbor this fear (whether consciously or unconsciously) that they’ll go over their ideal 10% body fat limit, and become the next Guinness World Record holder for the heaviest guy alive. Since these types are already hitting the gym 6 times a week and eating sensibly, the only thing they should change is their mental reasoning. Pushing the body too much too fast is never a good thing.

The overweight Finally, for the person who is obese (i.e., you can’t see your own feet while standing straight and looking down at the floor), it’s a matter of eating too much and exercising very little -- if at all. This is when the calories start piling up and everything you eat gets stored as fat (yes, even protein and carbs). Following the aforementioned fat:protein:carbs ratio helps, but you also need to exercise at least 4 times a week for 45 minutes, doing a lot of cardio and aerobics in order to melt away those love handles and that large bottom.

How much is too much? Hereâ&#x20AC;&#x2122;s a simple table that summarizes how many calories one can ingest daily without gaining any weight, while continuing to lose weight if necessary. If you start eating more calories than the range listed below, and according to your body frame, then you will surely start gaining weight. Therefore, if you are the skinny type, by all means start eating slightly more than the ranges listed below. If you are the ideal-weight type, then eat exactly the amount of calories listed for your body frame and you wonâ&#x20AC;&#x2122;t gain or lose anything. However, if you are the obese type, then eat significantly less calories than what is listed in order to lose weight. Of course, for all types, never stop exercising. Height

Small Frame (Calories)

Medium Frame (Calories)

Large Frame (Calories)

5'5"

1518-1898

1620-2025

1744-2180

5'6"

1567-1959

1668-2085

1793-2242

5'7"

1618-2023

1718-2147

1845-2306

5'8"

1671-2089

1768-2210

1897-2372

5'9"

1726-2157

1820-2275

1952-2440

5'10"

1783-2228

1873-2341

2008-2510

5'11"

1842-2302

1927-2409

2065-2582

6'0"

1903-2378

1982-2478

2124-2655

How to decrease your calorie intake Eat a variety of foods that are low in calories but high in nutrients; check the Nutrition Facts Label on the foods you buy. Eat less fat and fewer high-fat foods. Eat smaller portions and limit second helpings of foods high in fat and calories. Eat more vegetables and fruits without fats and sugars added in preparation or at the table. Eat pasta, rice, breads, and cereals without fats and sugars added in preparation or at the table. Eat less sugar and fewer sweets like candy, cookies, cakes, and soda. Drink less or no alcohol.

How to increase your calorie intake Eat a variety of foods that have a lot of nutrients, but also a lot of protein and fat (always keeping in mind the 40:30 -- protein:fat -- ratio). Eat a bit more foods high in protein, such as egg whites and meats. Eat a lot of vegetables for regulating your digestion. Eat grains and beans. Eat sensible amounts of food at mealtimes. Do not deny yourself normal portions. Be careful about binge eating. Do not overdo it, then feel guilty and regurgitate everything later on. Not only is this unhealthy for your body, but also for your mind.

Exercise at home From the comfort of indoors - at home and in your favorite attire - a workout to keep you fit by Mary Le Merwinna

ake a look around your house. Does it look like a gym? No? Take another look. You might not see a pricey treadmill or a fancy set of free weights, but you’re probably looking at a number of everyday objects that can make terrific exercise aids. Got a gallon of milk and the yellow pages? Then you’ve got a workout!” Going to the gym isn’t the only way to stay fit,” says Cedric Bryant, Ph.D., chief exercise physiologist at the American Council on Exercise. You can stay home and still work up a sweat. Turning your humble abode into your workout spot makes fitting in physical fitness convenient, easy and, best of all, free! Denise Austin, your personal trainer and Lifetime’s exercise guru, says, “Make physical activity a part of your everyday life, whether you go out for a jog or work out with items available in your home! After you exercise, you’ll not only look great but you’ll feel wonderful too!” Roll over the objects in the virtual rooms below and get the prescription for your home gym workout, plus some inspiring words of encouragement from Denise herself. (No matter what shape your are in, you can do the moves described here. Experts recommend that beginners start with three sets of 10 repetitions, then work up to three sets of 15 and, finally, 25. Just pick the exercise you like, and remember to stop anytime you feel faint or out of breath.)

Living room Object: A Wall Exercise: Wall slides Target: Thighs Ready to feel the burn in your legs? Stand 12 to 18 inches from the wall, bend your knees and your upper body back until it’s touching the wall. Continue lowering your hips until your knees are bent at roughly a 90-degree angle (no lower), making sure your knees don’t extend beyond your toes. Hold for 10 seconds, then slowly stand up. Repeat.

Object: A coffee table Exercise: Seated dips Target: Triceps Get rid of that arm flap! Sit on a sturdy coffee table (or the set of an armchair), hands gripping the edge with fingers pointed toward your behind. Extend your legs out in front you, keeping your knees slightly bent, then point your toes and plant your feet flat on the floor. Straighten your arms and lift your backside off the table. Then bend your elbows and slowly lower your hips; stop as soon as you feel pressure in your shoulders. Push back up until your elbows are almost straight (don’t lock them). Repeat.

Object: A Chair Exercise: Semi-seated squats Target: Thighs and buttocks Bless that behind! Stand with your feet shoulder-width apart, your back toward a chair and your abdominal muscles tight. Squat! shifting your weight onto your heels as if you’re going to sit in the chair; keep your shoulders back and your chin up. Just before your backside reaches the seat, stop and hold the position for a second; then slowly straighten up again. Repeat.

Object: A couch Exercise: Crunches Target: Abdominal Flatten that tummy! Lie on the floor on your back, with your hips a few inches from the couch, knees bent and heels resting on the couch’s seat. Press your lower back into the floor. Inhale, tighten your abs and lift your shoulder blades up and forward. Don’t lead with your head; keep your chin a few inches away from your chest. Pause for a second, then exhale and lower yourself back down. Repeat.

Object: Your baby Exercise: Pelvic lifts Target: Hips and abs Strengthen your core! Lie on your back, knees bent, feet flat on the floor, with your wee one seated securely on your abdomen or lying across your hipbones (for safety, keep both hands firmly on her!). Straighten your right knee and extend your leg, keeping your thighs parallel and your knees together. Press your left heel into the ground and lift your pelvis a few inches. Hold for a few seconds, then lower. Repeat on the both sides.

Object: A fireplace mantel Exercise: Standing side leg lifts Target: Upper thigh Get Rockette-like legs! Face the fireplace with your feet hip-distance apart; hold onto the mantel for balance. Maintaining a slight bend in both knees, slowly lift one leg to the side and hold for a second or two. Lower it slowly, without relaxing the muscles. Repeat, alternating on both sides.

Object: A framed photo of your mother-in-law or another problem person Exercise: Karate-style kicks Target: Buttocks, thighs and pent-up aggression Give your rear a boost! Stand with your feet shoulder-width apart, knees bent slightly. Lift your knee so that its level with your hips, then kick your foot out toward the photo, contracting the muscles in your thighs and buttocks. Slowly lower your leg and return to the starting position. Repeat, alternating on both sides.

Object: A folded blanket Exercise: Push-ups Target: Arms and chest Improve your bust by getting on your hands and knees on your blanket, with your palms down and shoulder-width apart. Extend your knees back as far you can. Keeping your back straight and your abs tight, inhale and bend your elbows, lowering your chest until itâ&#x20AC;&#x2122;s a few inches from the floor. Hold for a second, then exhale and push back up to the starting position (do not lock your elbows). Repeat.

Object: A pillow Exercise: Lateral mule kicks Target: Buttocks and outer thighs Goodbye, saddlebags! Get down on your knees and place your elbows on the floor to prop up your upper body. Bend one leg behind you, holding a pillow between your foot and the back of your thigh. Lift that leg out of the side, squeezing the pillow and keeping your hips square. Hold, then lower. Repeat on both sides.

Object: A flight of stairs Exercise: Staircase drills Target: Cardiovascular fitness Get fit for speed-walking or jogging! Stand at the bottom of the stairs, imagine a starting gun firing and book it upstairs as fast as you can. Come down, then climb the stairs slowly, taking two steps at a time. Keep working up to more and more repetitions. (To motivate you to stick with this exercise, use it as an opportunity to take the laundry, your kidsâ&#x20AC;&#x2122; toys, etc. upstairs)

FOOD AS MEDICINE TO PREVENT STROKE DRINK TEA!

Prevent buildup of fatty deposits on artery walls with regular doses of tea. (actually, tea suppresses my appetite and keeps the pounds from invading....Green tea is great for our immune system)! ARTHRITIS? EAT FISH, TOO!!

Salmon, tuna, mackerel and sardines actually prevent arthritis. (fish has omega oils, good for our immune system)

COUGHING? USE RED PEPPERS!!

A substance similar to that found in the cough syrups is found in hot red pepper. Use red (cayenne) pepper with caution-it can irritate your tummy. DIARRHEA? EAT APPLES!

Grate an apple with its skin, let it turn brown and eat it to cure this condition. (Bananas are good for this ailment) HIGH BLOOD PRESSURE? EAT CELERY AND OLIVE OIL!!!

Olive oil has been shown to lower blood pressure. Celery contains a chemical that lowers pressure too.

Healthy intentions for a healthy world By: VIGYAN ARYA

Professor Jeffrey Braithwaite is a leading health services and systems researcher with an international reputation for his work investigating and contributing to systems improvement. He has particular expertise in the culture and structure of acute settings, leadership, management and change in health sector organisations, quality and safety in health care, accreditation and surveying processes in international context and the restructuring of health services. In an exclusive interview with VIGYAN ARYA of InnoHEALTH he responds to the growing global concerns of health and medicare.

What is the prime objective of the institute you are leading: Australian Institute of Health Innovations?

The Australian Institute of Health Innovation (AIHI) at Macquarie University conducts world-class research with national and international research communities, governments, policymakers, providers of health services, managers, clinicians, patients and the community. Our work underpins health reforms and systems improvement, providing new tools, perspectives and evidence to help stakeholders who are interested in making the health system more effective, efficient and productive. Our overarching aim is to produce new, high-quality research evidence to support change, prevention and improvement.in the Australian health system, and internationally.

Could you share some of the achievements of the institute in the recent past?

As highlights of 2016, we are currently running over 77 different funded projects valued at almost $40 million, and participating in another 17 grants administered by other institutions worth a similar amount. Overall, we attracted new funding in 2016 valued in excess of $15 million. One notable milestone is that we secured the largest grant ever awarded to the Institute and the largest to Macquarie University in 2016: the NHMRC Partnership Centre in Health System Sustainability, valued at $10.75 million. In that project we are trying to create more sustainable systems of care.

The contributions of the institute (and yours) limited to Australia or its implications are international? Can you elaborate on it with some examples?

In 2015 Professor Enrico Coiera won the highest international award for digital health—the IMIA Francois Gremy Award of Excellence. He is a highly influential commentator on national e-health strategies, advocating strongly for rational policymaking based on sound evidence. His work has translated into policy and practice changes for e-health safety, multiple patented inventions, as well as for a US-based consumer e-health start-up company. He is author of one of the earliest textbooks on health informatics, which is widely used internationally, translated into multiple languages and now in its 3rd edition. Professor Coiera is the lead researcher, along with colleague Dr Annie Lau, of healthy.me, a personal health management system. Professor Johanna Westbrook is an elected a Fellow of the American College of Medical Informatics (ACMI) - one of only four Australians. In 2014 she was named Australian ICT professional of the year by the Australian Information Industry Association for her research contributions. In 2015 she was appointed as an Associate Editor of the Journal of the American Medical Informatics Association (JAMIA). She was also appointed Chair of the Deeble Institute Advisory Board by the Australian Healthcare and Hospitals Association in 2015. The Institute has a major focus on driving evidence-based health policy. In 2016 Johanna was elected by members to the Sax Institute Board. In 2016, Professor Westbrook was appointed by the Federal Minister for Health to the Board of the Australian Digital Health Agency and chairs the national Digital Health Quality and Safety Governance Committee. Our landmark CareTrack Australia study revealed, in 2012, Australians receive “appropriate” healthcare in only 57 percent of consultations. A follow-up study to CareTrack Australia, “CareTrack Kids” will, for the first time, determine the percentage of healthcare encounters at which Australian children receive evidence- and consensus-based care for 16 paediatric conditions and examine the frequency and types of adverse events involving Australian children. We aim to deliver a range of important outcomes in this highly significant and overdue research. Led by Professor Jeffrey Braithwaite and Peter Hibbert, this research stream is building on CareTrack Australia’s findings to pilot new approaches to clinical standards and to explore digital platforms for their delivery. This stream aims to provide a new evidence base to reduce healthcare costs and improve care by helping clinicians deliver the right care at the right time to the right patients.

The Work Observation Method by Activity Timing (WOMBAT) developed by Institute staff led by Professor Westbrook, and now used by over 30 research teams around the world, has produced new opportunities to undertake international collaborative studies. This measures how care is delivered using a hand held device, looking at how clinical care actually takes place.

Are there any biological/medicinal differences in the needs and concerns of original Aborigines in Australia and its broadly expat population?

Everyone deserves good care. Australia has been trying very hard in recent years to provide high quality services to Aboriginal and Torres Strait Islands populations. Many live in remote areas, and it has been hard to narrow the gap between the health status of those populations and other members of Australian society. Governments in Australia are making investments in this situation.

What is your institute doing to address the needs and concerns of Australian Aborigines, who are genetically distant from the rest of the Australian expat population?

While this is not our area of expertise, we strongly support colleagues who do research on these populations. This is very important work. Most of our studies include a wide range of patient groups including those from Aboriginal and Torres Strait Islander populations.

Can you highlight some of the achievements of the institute in Emotional Health sector since it invests a lot in resources in this field?

We are very interested in doing research with clinicians who are want to deliver the best care that resources permit to patients. We are also interested in ensuring that patients are involved in decisions about their care. We have done a great deal of work with both groups.

What, according to you, are going to be the biggest challenges for Australia and the world for securing a healthy society and combat future medical challenges?

To my mind, three things are important. One is digital health: ensuring we get the greatest advantage from investments in future e-health and information systems. The second is patient safety and quality of care. It is critical that we make further inroads into keeping patients safe and improving the quality of their care. In particular, we need to understand when things go right as well as when things go wrong. Third, we need to build sustainable health systems: ones that are built to last, and flexible enough that they can cope with future changes and innovations.

On personal front, where do you draw the line between medical marvels and miracles?

I don’t personally believe in miracles. I am very much appreciative, as a scientist, of the benefits to be gained by the application of evidence, science and technology to improve the health system for the benefit of our patients. This is the real marvel.

What are your expectations from the global medical community and what direction would you see governments and people should invest in?

In my next edited book, involving care delivered to patients in 60 countries, I found four things that were success factors in improving care. One is to start with a pilot program, and then scale it up. A second is the importance of having good data on which to base decisions about systems and care. A third is to ensure that multiple stakeholders are involved in complex improvement initiatives. And a fourth is that the benchmark for improvement must be the patient, rather than other stakeholders’ views on the care we need to provide.

How do you see innovations of your country linked to Indian which is well known for frugal innovations, do you think some collaboration at working level to take it forward for benefit of both countries in view of two countries’ Prime Ministers have signed recently MoU of collaboration?

This is an excellent idea. India and Australia have many things to learn from each other, and have been friends for many years—not just because of our shared interest in cricket and because of our ties as members of the Commonwealth. We are natural partners in ensuring a better health system for our respective countries, and teaching each other about innovative things we have done.

Testing times for India By: KANIKA CHAUHAN

Brig (Hony) Arvind Lal is a pioneer in bringing laboratory services in India at par with the international world. He has modernized Indian medical diagnostics and initiated the first Public Private Partnership (PPP) in the field of laboratory testing in India. Under his guidance, Dr Lal PathLabs (LPL) has become one of the most reputed laboratories in Asia having to its credit quality accreditations from various national and international bodies. Currently they operate over 172 labs, including Asia’s biggest lab at Rohini, New Delhi with 1,500 collection centers and pick-up samples from another 7,000 medical establishments all over India. The lab tests over 50,000 patients every day or nearly 10 million patients in a year. He holds the honorary rank of a Brigadier in the Indian Army and the Government of India conferred him Padma Shri (Indian national award) in 2009, for his contributions to Medicine. In an interview with KANIKA CHAUHAN InnoHEALTH, he sheds light on the evergrowing demands of quality testing and test labs in the country and shares his vision of a healthier future for India and every Indian.

When the Lal Path Labs started 68 years back, what was the scenario of Indian healthcare industry? How do you see the market now? And how has been the journey?

My late father Dr. Major S.K Lal started this lab in April 1949. He was a displaced person from the partition and came to India from Rawalpindi in 1947. After coming to Delhi he worked in a government lab for one-and-a-half years and then started the first pathology lab in North India. At that point of time there were hardly any pathology tests as we know neither there were any routine tests like, HP, TLC, ESR, Urine Test, Blood sugar Test, Cholesterol test. So there was not any competition then.

What is your future business plans both at National and International level?

We are running 1700 laboratories in India and about 1600 collection centers. In addition we take another 5000 collections of blood samples from our pick up points. For example Medanta, Fortis, Moolchand and Apollo are some of the pick-up points we have.

Last year we tested about 1.35crore patients, so the average of the samples we can test is about 55000 in a day. We are the biggest Histopathology Biopsy Centre in the world. Histopathology Biopsy is a test basically to detect cancer. Suppose if a lady has a lump in her breast, so she feels something has to be done about the lump, a part of the lump is surgically taken out which is known as the biopsy, it is the biopsy we test and find out the results. There is a possibility of two things either the tumor is benign (Non-Cancerous) or malignant (Cancerous). If the lady has malignancy she under goes with further tests, chemotherapy and radioactive therapies as per clinical requirement. We are the largest Histopathology in the world. We test about 1000 biopsies in one day and we are the second largest kidney biopsy center in the world. We are the only laboratories in India which have their own electro-microscope for very high-end testing. We have our centers in all the major cities of India. Our next step would be to set up another comprehensive laboratory in Lucknow. We have such research center in Kolkata and next year we will make one in Lucknow. With this we will provide high end services for the people in the region for whom the services are not available.

With so many market players why people should opt for Dr. Lal? What additional value you bring to the table?

We have many reasons, first of all people know that we are not fly by night operators and also they have faith in us since last 70 years plus people come to us for their pathological tests because 70% of all the medical decisions are based upon the pathology test of a patient, hence if the pathological tests result aren’t in place 70% of the medical decision can’t be taken. Gone were the days when people used to visit the “vaids” and doctors and they felt the nerves and pulse gave medicines, now it is evidence based medication. If someone has fever the doctor would suggest the person to get a blood test because it could be malaria, chikungunya, dengue or it could be anything. And if the person is diagnosed with anything she or he will get the treatment for the same. Now the medicines are completely evidence based, there is no hit and trial. These are the reasons why people come to us

With Dr. Lal Path labs entering into the international market with operations in countries like Middle East, Malaysia, Bangladesh, Nepal and many more, where do you see the potential for growth of your organization?

The first reason is, India is not having the kind of quality labs that it should have. There is a demand and supply problem. That is because there are no large laboratories. There are lots of facilities that claim to do testing, but they are not testing laboratories but testing shops. This is what is to be changed and people give the example of our establishment and say that “they should be like Dr. Lal’s laboratory.” All these countries you have mentioned, we are getting their samples for testing but only one lab is set up in Nepal and next would be in Bangladesh and then we will go to other countries. The reason we are slow on this is because our own country is huge. I usually say to people that if we will take out Uttar Pradesh and put it in the Indian Ocean, India would be the 5th largest country in the world. So this is the reason that we want to look at our country first and then look at the outside market.

What kind of environment does your organisation provide to patients?

Our organisation provides a very sterile kind of an environment, it doesn’t smell, and blood is not spilled around, there are no flies buzzing around the surroundings. This is a kind of a place where anyone would like to go to.

Now days there so many machines available in the market for test like sugar, BP etc, which we can be used by the patients themselves. How good is that? What are your views?

These are known as point of care testing and people can test a few things but in India people can only test blood sugar. For which we suggest the patient to check his or her blood sugar on a regular basis of 15 or 20 days, so these are called Point of Care Testing (POCT) . The POCT in India is not established because firstly, it is very expensive and secondly the Indian people aren’t savvy. There are seven types of care testing which is emanated by a lady. A lady can go to the bathroom and test her pregnancy by a UPT (urinal pregnancy test) in which she gets to know whether she is pregnant or not then in this case there is no need of a pathological test. When I was young we never had cats and dogs as pets but we had rabbits , so I never couldn’t understand why my father killed those rabbits and I got my answer when I was studying medicine. The reason why rabbits were killed during that time i.e, in early 1950s people used to check the pregnancy through it. A pregnant woman’s urine was injected into a female rabbit and after killing them they use to dissect the abdomen area to find ovulating ovaries. This is how pregnancy test were conducted.

Now a days Dr. Lal Path labs is focusing on inorganic growth; how beneficial it is to patients?

The growth in any sphere or in any business is either organic or inorganic, organic means when a person is creating his own set up, say if a person is doing well in Delhi so he decides to open a set up in Uttar Pradesh and then in Uttarakhand, and inorganic growth is when other person is ready to give up her or his lab to somebody else irrespective of any reason the former will give some certain amount of money to the latter in position of the lab this is called inorganic growth. We have done 10 inorganic growths till now and yes we will buy some more from south of India and west of India.

What innovations you think can bring down cost, keep quality and improve efficiency on which researchers and start-ups concentrate?

There is no start-up in my line, if one is a qualified pathologist either he can work in a pathology lab or can start his own lab. The start-up in Delhi is difficult because Delhi has become a saturated city. there are many people who are running many pathology labs and they shouldn’t run these pathology labs and the reason they are running the labs is because it is very lucrative, which is very unethical and should not be done. So the government of India has also started the voice to our ways and they said that we are going to have a clinical establishment act which has been passed by the parliament in 2010. Since the healthcare is state subject so all the 29 states have not adopted it or implemented it. There are a chain of pathology labs which are not run by the pathologists they are run by the non-pathologists they are not even doctors they are quacks. So this brings out the quality and efficiency of the whole industry. They are many diseases which affect the mankind these days and these diseases are called the non-communicable diseases. The non-communicable diseases can’t communicate with others, whereas malaria, chikungunya and dengue are communicable diseases because it happens through a mosquito bite. TB is a communicable disease too and if a person’s lungs are infected by TB people around them will get infected. In India we lose two patients of TB in every three minutes, India has a burden of communicable diseases which includes Hepatitis A. But a bigger set of diseases have come out which are called NCDs (Non Communicable Diseases) and the NCDs are killing 65% of our people and if we will not control the NCDs it will also affect the two per cent of our GDP. The NCDs are headed by the high blood pressure, obesity, smoking, cardiac diseases, lung diseases, cancer, kidney diseases and stroke. Why it is becoming so important to us because it is also called the life style diseases, it changes the lifestyle of the person which has suddenly come up. India has large number of cancer patients and also large number of blood pressure patients. There is an element of genetic transfer of physical appearance of a person but some diseases are also transferred which only run in families. The problem with Indian people is they only come in illness, but they should know that they should get their self-check on a regular basis to keep a check on their health, my main point is to make people aware of the annual healthcare which is very important for one’s health which is in between the doctor and a patient and also make them aware of the testing in wellness not in illness.

Rising Star of Health If you’ve wanted to cook healthier meals, lose weight, or get some self-help advice, chances are you’ve looked to a brand or a person to help guide you on your journey. And there’s a very strong chance that person is on our annual list of the most influential people in health and fitness. This year’s list makes one thing clear: Body positivity is finally mainstream. You’ll also notice plenty of household names, another indication that wellness is increasingly becoming part of our everyday lives.

Adriene Mishler The YouTube Yogi The actress and yoga guru is the creator of Yoga With Adriene, a YouTube channel (and lifestyle) loved by yoga newbies and experts alike. Mishler’s channel has nearly 2 million followers, and it’s easy to see why: Her sequences are easy to follow and smooth, making them perfect for yogis of all levels. She kicked off 2017 with “Revolution,” 31 days of yoga videos that challenge her viewers to practice daily. We can’t wait to see what Mishler has planned for the rest of the year.

Upcoming cyber security threats in the health sector Cyber Security, Ransom Ware, Security Threats, Health Systems

Introduction

he famous Silicon Valley investor Marc Andreessen says, â&#x20AC;&#x153;software is eating the worldâ&#x20AC;?. By, which he means that increasingly we are bringing software into systems to increase efficiency, lower down the cost or time involved in the process. Interestingly, humans also do software writing and humans are prone to make mistakes. It is estimated by various experts that 1000 lines of code (KLoC) has approximately 15-50 bugs present. Bugs here mean mistakes made by the software programmer while writing the software code. Bugs often result in some kind of malfunction or wrong output. Some of these bugs can lead to exploit by a third party making the larger system vulnerable or as we call hackable. As long as humans will write software, bugs will be there. In a typical software company as bugs are discovered, new code is written to fix these bugs. The new code might further result into new bugs hence the cycle continues. At the consumer end, we keep receiving software updates over the air, as we use our phone / laptops or other devices, which are many times an attempt of the software company to overcome the past mistakes. A lone computer hacker or an organized crime group looks at these software updates (sometimes called patches) very curiously as for them this could be a chance of hitting the jackpot! They reverse engineer it and try to understand the bug, that the patch is trying to cover. Very often systems are not updated with latest updates. Leading to most system having a known vulnerability, which the hacker can take advantage after understanding it well. Hackers further can create a simple script (programming code snippet) to some sophisticated software, which can then take advantage of the vulnerable system. We often call such a program as malware, as it is built with bad intention. Today, as we talk it has become from a hobby crime to organized crime! Software companies regularly receive communication from bounty hunters about exposing their critical software bugs and in exchange not to do so, hackers want to charge them bounty money. Some software companies have gone further and engaged these bounty hunters to reduce security risks in their software. In some cases the hacker is not interested in the bounty money (hence they do not inform the software maker) but rather interested in exploiting the bug. Sometimes, the bug is not known to the software maker or anyone else in the world and can be converted into a lethal attack. Such attacks are known as a zero day attack! As prior knowledge of such a vulnerability does not exist. Hence, most software security solutions, like anti virus software do not work on them. Further selling the knowledge of exploit as lethal software is now called as a cyber weapon . Nation states are now engaged in buying or building such software to infect systems of enemy states. Hence, we have come very far in the business of software bugs, where the enemy could be a lone developer, an organized crime group or a Nation state.

How is software eating the health sector and the threats linked to it? In the above section we discussed in general, how the exploitation of software is increasingly becoming a serious business. While, we have seen many examples in last 30 years from a hobby software programmer to Nation states taking advantage of the software driven vulnerabilities. We would like to share some examples closer to the health sector. 1. Malware affecting data systems Hospital information systems and similar information systems as part of the healthcare delivery have become very commonplace and one of the core component of the system. As pointed out in the introductory section, organized crime groups are now looking to exploit software bugs for commercial purposes. One of the ingenious way that they have developed is a malware known as ransomware . Ransomware is a malicious computer program which when executed on a system encrypts the data with very strong encryption making it unusable for hospitals or any other care provider to access patient records or other vital information. It then demands a ransom inform of bitcoins (a crypto currency) in order for the victim to have the key to decrypt the vital information. In recent incidents of ransomware infection, some hospitals in USA have even demanded millions of dollars as ransom and some have even paid. The mitigation strategy for countering ransomware for any organization would be a strong backup of data. Also, creating awareness among the employees on sources of malware and reducing the chances of accidental infection of the workplace systems. The long-term solution of tackling such organized crime is a better international legal framework, which allows international prosecution and cooperation among law enforcement agencies. 2. Denial of service attacks on ehealth services In 2007 there was a distributed denial of service attack that took place in Estonia. A statue of the Russian soldier was removed from the Tallinn Square, capital of the country. Which sparked a response from sympathizers from Russia and it brought down the Estonian economy for three days. Estonia being one of the most advance countries when it comes to take up of e-governance services, ehealth being one of them. The entire attack costed less than 50,000 US dollars. That was the first Denial of service attack the world saw at the level of a nation state. The basic premise behind such an attack is that you have a service (e-service) to be provided to citizens over Internet like their own health records for example. The provider would have some finite amount of bandwidth and computing power at the backend of the service correlating to the average load on the service. In a distributed denial of service attack, the attacker uses compromised computing devices (commonly known as a bot) to access the Internet service. The botnet, which is a collection of such bots could be having thousands or millions of such devices that simultaneously access the service. The service provider is not able to distinguish the normal traffic from the bot traffic and often the server crashes under the heavy load. For a normal user trying to access the service, the service is unavailable because of the finite resources of the server being exhausted by the bot traffic. Hence, it is called a denial of service attack. Hence, when a city, state or a nation is considering providing an eservice to citizens it could witness such attacks. One strategy to mitigate such attacks is to have tracking of the server traffic for any anomalies and having redundancy available in the system. This is achieved many times by putting the service on a cloud, which can tolerate such traffic fluctuations. 3. Data leak and breaches Many health systems or systems require some kind of authentication mechanism to log in to the system in order to access the service. Many a times these are text password based systems behind which, important patient profile or health records information is stored. The largest of the companies like that of Google, Microsoft etc have seen attacks where the attacker is able to leak the passwords of millions of their customers. Such scenarios result in massive breach of data privacy and compromise for customers. Good security practices, proper encryption of data and regular updates of the system are some of the key considerations for avoiding such instances. Nowadays, two-factor authentication has become a standard practice for making the authentication systems more robust. However, still some user awareness is needed to opt for better security practices whenever possible.

4. Hacking medical devices and health system If we look at the building blocks of the health systems, where information technology is deeply integrated. We have already covered the health information systems, eservices and patient interface of authentication into the services. However, increasingly we hear about Internet of Things (IoT) devices in the health sector domain. Which means the integration of Internet services into traditional medical devices or new age devices, which have also connectivity. For example, a thermometer which can send the temperature data to your phone or a stethoscope which can record the patient breathing sound and upload in a server for finding patterns of lung diseases. These are powerful use cases and provide great opportunity to clinicians and care providers, where they have greater computation power available to them and they are able to do more with less. However, these IoT devices are prone to the same kind of attacks as any other communication device or a software program. They can be compromised to show wrong values and totally messing up the diagnosis. There are already such instances. One such instance not related to health sector but important is of the Stuxnet. Stuxnet was designed for the SCADA systems of Iranian nuclear program by USA and Israel in order to delay their nuclear program. 5. Stealing identity information As mentioned in the point 3, about data leaks and breaches at the system level. One problem, which can arise from such an attack, is a further more damaging attack that is stealing of identity information. In India, mobile phones to receive an sms message containing one time password is increasingly becoming a standard practise because of being cost effective, simple and secure. Any such application, which you may install on your phone, can also get access to the sms and other features of your phone. Meaning the incoming sms or calls can also be stolen by this application to complete the transaction on your behalf. As increasingly we have to prove ourselves using biometrics or passwords to online systems. It is possible for the attackers to steal these credentials and access our records without our knowledge. Hence, any third party applications that we install on our devices (especially phone) , we need to be very careful about the type of access control they have on our devices. 6. Implantable medical devices with communication interfaces: In 2007, the former US Vice President, Dick Cheneyâ&#x20AC;&#x2122;s implanted pacemakerâ&#x20AC;&#x2122;s wireless communication was disabled fearing a terrorist attack. This sounds like science fiction to many but incident has already happened ten years back! Many of the medical devices are built with a communication interface and it is quite normal for a typical pacemaker or other such devices to have a Bluetooth or a similar communication technology based interface for remote diagnosis and other purposes. While, the communication ability of such a device was planned for looking at the state of the pacemaker it was not designed with keeping security in mind. Hence, it is possible that someone can connect to a critical device like pacemaker and shuts it down remotely. One more reason that such exploits are possible increasingly as computing is becoming cheaper. What seems strong security today might not be strong tomorrow. However, an implantable device might stay in the patientâ&#x20AC;&#x2122;s body for tens of years. Hence, we need to have a long-term view on the communication interfaces and their capabilities on such devices. We need to make considerations on control and information capabilities of these interfaces. Misuse of control capabilities can lead to even death and misuse of information capabilities can lead to breach of patient privacy.

Way forward: why Internet is the new breeding ground for crime? The law of the land governs the Internet in every country and hence the legal regime globally is very fragmented. However, a user of Internet does not see any borders or walls and so is the criminal. They build their criminal businesses where they do not fear strict government action and often for paltry sums the user or the national law enforcement agencies do not pursue the criminal cases cross border. On top of it newer crypto currencies like Bitcoins, makes it easy to make such transaction in an anonymous manner. Dark net marketplaces provide a breeding ground for criminals to conduct illegal transactions of billions of dollars without getting caught. So, the three important components, weak legal enforcement, anonymous currency and secret marketplaces are enabling the cyber crime to flourish. If we want to slow it down, we will need greater international collaboration among lawmakers and user awareness at all levels. Reference: (i) https://www.wsj.com/articles/SB10001424053111903480904576512250915629460 (ii)http://labs.sogeti.com/how-many-defects-are-too-many/ (iii)https://www.ted.com/talks/mikko_hypponen_fighting_viruses_defending_the_net/transcript?language=en (iv) https://hackerone.com (v)https://en.wikipedia.org/wiki/Zero-day_(computing) (vi)https://en.wikipedia.org/wiki/Cyberweapon (vii)https://en.wikipedia.org/wiki/Ransomware (viii)https://en.wikipedia.org/wiki/Bitcoin (ix)http://www.csoonline.com/article/3033160/security/ransomware-takes-hollywood-hospital-offline-36m-demanded-by-attackers.html (x)https://www.theguardian.com/technology/2016/feb/17/los-angeles-hospital-hacked-ransom-bitcoin-hollywood-presbyterian-medical-center (xi)http://innovatiocuris.com/looming-danger-of-ransomware/ (xii)http://www.bbc.com/news/technology-24608435

Sachin Gaur is director operations at InnovatioCuris. He is interested in topics of mHealth and Cyber Security. Abstract: We are seeing phenomenal technology shifts and human life is greatly impacted by them. Health sector is not untouched as the health systems now have deep IT integration and care givers increasingly rely on the information shown by digital systems. Hence, any compromise to the integrity of such systems would lead to wrong diagnosis or treatment. This paper investigates some of the early signals about the kind of threats out there relevant to the health systems.

Time to take some intelligent decisions A new paradigm for use of machine intelligence in healthcare

any national economies are on the brink of collapse under the burden of state-supported health insurance programs. For example in the US, a country that does not provide universal healthcare, the national debt is expected to double as a result of healthcare related liabilities over the next three decades. There is an even greater price to pay for the inefficiencies found in healthcare systems. When already overburdened systems are pushed to their limits, healthcare professionals are forced to make bad decisions. In a startling example, during Hurricane Katrina, doctors and nurses at New Orleansâ&#x20AC;&#x2122; Memorial Hospital found themselves incapable of making even simple decisions. In her Pulitzer Prize-winning coverage, Sheri Fink reported how patients deemed the least likely to survive, were injected with a lethal combination of drugs â&#x20AC;&#x201D; even as the evacuation was already on its way. This chilling anecdote sheds light on a greater problem underpinning many of the biggest threats hurting human society and the eco-system of our planet. We humans are not equipped for making good decisions under stress. Positive outcomes across a multitude of fields, including healthcare, largely depend on the ability to make good decisions under unpredictable and stress inducing conditions. We, humans, are not only bad at making decisions under pressure but are poorly equipped for making any rational decisions at all.

Daniel Kahneman, in his Nobel Prize winning work on decision making, explains how after years of deliberation leading to a single decision, the person making the decision might still completely ignore the entire process of deliberation and instead make a decision driven by emotions in a whim of the moment.

An Age of Automated Decision Making As the information age is about the focus on automating processes related to access to information, the next age, the age of “decisioning”, will focus on automation of processes related to decision making. Whereas humans are excellent in pattern detection and pattern making, an essential requirement for creating intelligent computer systems, computers are strong in making decisions where processing of facts is of vital importance. This almost magical ability of computing systems to process information includes the capability to identify and utilize extremely subtle connections between otherwise seemingly disconnected pieces of information, a feat us humans could never do on our own with the kind of precision and scale even a simple computer system can. In no other field, rational decisions are of such vital importance as in healthcare. Not only healthcare is the most significant economic liability for many nations, but it is also the only field of practice affecting people’s everyday lives that can be considered truly as “life and death” matter. It is, therefore, the area where the human society most desperately needs help.

Analytical Approach Stage 1 Stage 2 Stage 2

Surprising Result

Descriptive Not Likely Predicive Sometimes PrescripLikely tive

DebendExample ence on Method Human High Excel Moderate Basic Statistics Low to none Deep Learning

Computer-aided decision systems can be categorized into three evolutionary stages, each with a corresponding quality of results, and the requirement for a level of human involvement. Whereas up until a few years ago, most systems were still ‘descriptive’ with some examples of ‘predictive’ decision-making support systems, in the last two years the developments in the field of machine intelligence have for the first time made the dream of prescriptive expert systems realistic. Recent advancements in both open source software and commercial hardware have paved the way for rapid prototyping of ideas that promise to revolutionize the way decisions are made across a multitude of fields, including healthcare. Examples of these advancements include deep learning platforms such as Google’s TensorFlow and Keras, unstructured data processing innovations such as word vectorization, and Nvidia’s data processing focused GPU product-line. Regardless of the tremendous promise and the recent hype surrounding machine intelligence, some significant concerns remain without any serious attention. While machine intelligence innovators would like to focus on showcasing “what’s possible,” before introducing new ideas and processes into the healthcare apparatus, it is far more important to ask “what could go wrong.”

Morality and Healthcare Algorithms

Every machine intelligence solution can be reduced into two aspects; the data inputs available for the solution, and the means by which the solution process those inputs. These two act as the causes for the result the system provides. Algorithms underpin every decision a computer system makes, regardless of the kind of system it is. The unique feature in this regard, of modern machine intelligence systems, such as those based on neural networks and the deep learning method, is that humans cannot audit them. It is for this reason that we can get surprising results us humans could not arrive at without working with machine intelligence, and it is important to understand that surprising results may also be negative results. In many cases, adverse results in the healthcare context arise from causes that were set years or even decades before, and as of today, it is virtually impossible to establish true causality in such cases. This means that it would be almost impossible to know if a given machine intelligence solution is contributing positively in the long term or just driving shortterm efficiency. This will hold true at least for the next 100 years, or as long as it takes to understand causality in results that take decades to mature. When in the 1980â&#x20AC;&#x2122;s game theory-based principles were widely introduced in the western healthcare context, nobody predicted the consequences. For example, while nurses and doctors were incentivized to meet certain productivity quotas such as the number of days spent in the ICU, mortality rates of patients skyrocketed as a result of ICU beds being more available. In effect, a quota scheme is an example of a simple algorithm and can be used to highlight the danger that comes with introducing machine intelligence into healthcare. This applies in particular in countries with universal healthcare and poorly performing national economy. Under such conditions, humans that make the decisions about the use of machine intelligence in the national healthcare system, are under tremendous stress. Not only their decisions affect individual patientsâ&#x20AC;&#x2122; lives but also have the potential for changing the destiny of an entire nation. It is very hard to see how under such conditions, non-experts, being bombarded with endless hype by self-proclaimed machine intelligence experts, would be able to make the right decisions. In fact, government officials, healthcare professionals, nor computer and data scientists, are formally trained in morality and often lack even the most basic understanding of ontology, epistemology, and formal logic. The three legs of the stool on which rational decisions sit. As a result, as we have seen through examples in financial markets, online advertising, and other early embracers of algorithmic decision making, we end up with so-called greedy algorithms that optimize towards a given end ruthlessly without caring about anything else. Unlike healthcare professionals, these algorithms are not afraid of losing their livelihood and reputation as a result of making the wrong decision that ends up hurting people. While a healthcare facility or a professional working in one, could be sued for damages, in the case of machine intelligence systems, liabilities in the healthcare context have so far not been defined.

Security in Healthcare Systems

In the light of the recent events regarding ransomware, and the rapid growth in its popularity as a cybercrime tool, it does not seem too far-fetched that in the near-future entire hospitals will be targeted and held for ransom. Indeed many hospitals had already become victims of ransomware as a consequence of passive global or national attacks. In the recent WannaCrypt ransomware attack individual medical devices were rendered temporarily useless after being infected. Siemens released multiple warnings about its healthcare devices being possibly vulnerable to WannaCrypt. Beau Woods, deputy director of Cyber Statecraft Initiative at the Atlantic Council said that it was likely that many important medical devices such as MRIs and other crucial computer-aided systems were rendered temporarily useless by the attack. These examples show how healthcare organizations and their technology partners are currently incapable of securing important systems. Whereas in the human operated healthcare apparatus, the devastation is so easy to create, in a highly automated machine intelligence based healthcare apparatus, the problem would be significantly amplified. Here too, regarding security and healthcare systems, we have to seriously consider the implications of the machine intelligence ideas that are adopted today, regarding the threat landscape over the next few decades. For example, current cryptographic methods are all based on so-called key exchange cryptography. Any sudden improvement in computation power, for instance in the form of quantum computing becoming practical, will lead to an immediate collapse of the key exchange based security paradigm. In a machine intelligence dominated healthcare apparatus, collapse of the key exchange based security paradigm has the potential for leading to the greatest human travesty in the history of the world. In the absence of serious discussion about such longer-term threats, it will not be possible to make the right decisions regarding decision-making automation and wider adoption of machine intelligence based expert systems in healthcare.

The Importance of Human Touch

Sometime in the distant future, we may be able to completely automate certain key aspects of healthcare, such as triage management. Even then it is of significant importance to not lose sight of the essence of healthcare; taking care of people. Taking care of people is one part taking care of their physical body, and one part taking care of their feelings. In a completely machine intelligence and robotics based triage management approach it would be hard for patients to feel that they are being taken care of in the way they feel when an actual doctor is treating them. On the other hand, in a very short period of time, the doctors would lose their ability to deal with the basic day-to-day taking care of patients that still today keep them overworked. Because algorithms donâ&#x20AC;&#x2122;t feel anything, for example, empathy, it is also likely that as specialist doctors increasingly get their inputs from those algorithms, they become further distanced from the human aspect that some argue is necessary for healing practice. In this light, perhaps itâ&#x20AC;&#x2122;s more reasonable for the allopathic medicine to seek intelligence from its eastern counterparts such as TCM, TTM, and Ayurveda, as opposed to seeking it from machines. Machines that ultimate base their decisions on the combination of the information they are receiving and the algorithms that process the information. Both the information and the algorithms being a product of, and therefore limited by, the people who produce them. Combining the instruments and other marvels of the western symptomatic healthcare approach with the more holistic but in some cases inferior Eastern practices, have the potential for driving significant change within the healthcare system as we know it today. In terms of specific machine intelligence implementations, as the point-of-view presented in this article clearly shows, the focus should be on long-term macro effects of such implementations, as opposed to focusing on short-term and micro context. Perhaps in a future world where the western and eastern medicinal practices are better integrated and institutionalized into a new era of taking care of patients, we will be better equipped to handle the challenges that come with machine intelligence focused healthcare.

Mikko Kotila The author Mikko Kotila has 12 years of continuous research and development in machine intelligence, and is the core developer of Autonomio, the first rapid machine intelligence prototyping platform for non-programmers. Mikko is the principal of Botlab, a nonprofit foundation focused on long-term thinking on machine intelligence, and decentralization, and a co-founder of Autom8, one of the worldâ&#x20AC;&#x2122;s first deep learning focused startup foundries.

Ransomware Epidemic – Who is next? Ransomware epidemic is spreading in healthcare like wildfire due to its increasing digitalization which is and will attract more attention of hackers.

he healthcare industry has been a victim of various cyber attacks in the last few years. According to recent studies, healthcare has outnumbered financial services and become the most cyber attacked industry. The latest in cyber-attack is ransomware wherein the hacker encrypts the data and threatens to publish it until the ransom is paid in form of bitcoins. In US alone, healthcare industry was the victim of 88 per cent of all ransomware attacks across industries last year. The recent case of WannaCry ransomware crippled the IT systems of NHS, UK. And after hitting NHS, it spread globally targeting more than 99 nations. The hackers demanded payment of £300 - £600 to unlock systems and have earned about £55,000 in ransom. Ransomware has indeed become a lucrative revenue source for hackers due to which the number of attacks is predicted to quadruple by 2020. Medical records have 10-20 times more value than the credit card data in the internet black market. Ransomware epidemic is spreading in healthcare like wildfire due to its increasing digitalization which is and will attract more attention of hackers. Also, the vulnerability of the health data tends the organizations to pay the ransom to get the data back to maintain privacy and confidentiality of patient data. Even after so many cases of cyber attacks compromising millions of electronic health records each year, the healthcare industry is inadequately prepared to prevent and resolve these attacks. Whether it is India or US, cybersecurity is always discussed in forums and budget is allocated for the same but is not put to proper use. Cyber attacks happen due to outdated security infrastructure or employee negligence. Hospitals and insurance companies have been the main targets of hackers. But, a new vulnerability is catching everyone’s attention i.e. medical devices. The next nightmare in ransomware attacks could be hacking of medical devices such as insulin pumps, pacemakers, defibrillators, implants etc. Disfunctioning of medical devices can be catastrophic. Just imagine, hackers take control of one’s pacemaker and ask for ransom or else they would manipulate the device which could be fatal. This kind of attack has been showcased in the very famous TV show Homeland wherein the Vice President dies due to hackers remotely disable his pacemaker.

Just like the serial, the former US Vice President Dick Cheney’s doctors disabled his pacemaker’s wireless functionality due to fear of possible assassination attempts as revealed by him during an interview in 2013. This clearly showcases that medical devices can be the next target for hackers. Regulators such as FDA are increasingly getting concerned about medical device security and have issued warning. In 2015, for the first time FDA issued safety notice to hospitals which strongly discouraged hospitals to use an infusion pump which was found to be vulnerable to cyber attacks. But it has been observed that FDA did not force the company to fix the devices being used in the hospitals and didn’t investigate other insulin pump models. This shows that FDA needs to be more stringent towards medical device security. The vulnerability of infusion pump was pointed out by a white hat hacker Billy Rios during his hospital stay. Few of the medical device companies/providers have been proactive in strengthening their device security such as Johnson & Johnson in Oct 2016 warned 114,000 diabetic patients about a security lax that a hacker could exploit in one of its insulin pumps (J&J Animas OneTouch Ping). The hackers can disable or alter the dosage which could be fatal. J&J suggested ways to the patients for mitigating risk. There have been no documented cases of medical device hacking till date but demonstrations have been conducted in research environment. One such example is of Barnaby Jack who succeeded in hacking an insulin pump and demonstrated giving off lethal dose of insulin without the pump alerting the user. Another example is that of St Jude Medical’s implantable devices such as pacemakers, defibrillators, and resynchronization devices. The radio frequency (RF) enabled St. Jude medical implantable cardiac device and corresponding Merlin@home Transmitter enables transmitting and receiving patient data stored on the device to the physician to monitor his health. But FDA reviewed the device and confirmed about cybersecurity vulnerabilities, if exploited, could be fatal. Also, researchers at TrapX Security analysed three hospitals for medical device hacking. The deception technology was installed which utilized emulated medical devices in the hospitals. These emulated devices attract and trap hackers so that TrapX could trace the hackers activity. These fake medical devices such as Radiation Oncology system, LINAC, Fluoroscopy, PACS and Xray system appeared real to the hackers and TrapX could monitor hacker’s activity. According to TrapX, these hospitals utilized older version of Windows that made it vulnerable and most medical devices did not have additional endpoint security software which made the attack undetectable. It was also noticed that the main goal of hackers was to steal medical records not to manipulate the device. Another research at University of South Alabama showcased how they hacked pacemaker and killed a medical simulator called iStan. The $100,000 medical dummy comes equipped with robotics that mimic the human cardiovascular, respiratory, and neurological systems. The researchers could speed the heart rate up or could slow it down. Not only pacemaker, researchers could manipulate an insulin pump or a number of things that would cause life-threatening injuries or death. This clearly illustrates why medical device security is important. With the advent of IoT, where devices are connected via internet should focus on cybersecurity. Industrial experts are realizing that cybersecurity is prime priority for all the devices connected to the internet. Devices such as wearables, smart bed, smart emergency system, etc. are all lagging behind in cybersecurity. Apart from medical devices, surgical robots are not being scrutinized for cybersecurity. Just imagine, surgical robots been hacked which could lead to life threatening situation of the patient. One such demonstration has been showcased by researchers at University of Washington in 2015. They hacked a teleoperated surgical robot, Raven II. The experiment demonstrated three types of attacks that made telesurgery vulnerable with this robot. The researchers demonstrated how they took complete control over the robot and disrupted the operation.

All of this sounds scary but it can be prevented if we are well prepared. It is important to understand that not only regulators like FDA need not address the challenge of cybersecurity but also the medical device vendors and providers should take shared responsibility. It has been observed that providers point the device manufacturers to be accountable for cybersecurity for responding to vulnerabilities and providing fixes for the same. On the other hand, the device vendors hold providers responsible for their negligence and having outdated network protection. To be safe from such attacks, organisations should review their cyber defence strategies and budget. Also, employee training and awareness needs to be tackled to avoid falling for opening phishing mails and change passwords regularly. It has also been observed that providers such as middle scale hospitals, clinics or laboratories have often overlooked cybersecurity as priority as they believe not much data is present with them and only the big organisations are in trouble. Which is not true, as hackers are aware of the precious financial and patient data these clinics hold and are aiming at clinics or small hospitals also to get the data. So, they should also focus on medical device security. The next big thing in helping fight against cybersecurity is artificial intelligence (AI). According to some analysts, the advantage of using AI is it can help predict cyber attack before it happens with the use of behaviour analysis. It alerts security team on any behaviour deviation or authentication failures while accessing records. AI not only helps in detecting threats quickly but it is also cost efficient compared to the money paid by companies in ransom. It does not replace security tools but acts as an additional layer of security. AI can also help in analysing employee behaviour for avoiding any internal security breach. AI can help in bridging the shortage of skilled cyber security professionals also. According to Centre for Cyber Safety and Education, there is a shortfall of 1.8 million cyber security professionals by 2022 worldwide. Companies such as IBM are already investing in AI system Watson for cybersecurity. Also start-ups such as Cognetyx are providing cognitive cyber surveillance solution to healthcare organizations. Use of AI for cybersecurity in other areas has been showcased, for example, the Las Vegas city officials and UK government to monitor their Public Services Network and protect their records from security threats. Whereas, the successful implementation of AI in healthcare cybersecurity is yet to happen. The next wave of medical device cyber attacks can be prevented by collaborative approach and commitment from all the stakeholders. Not only the healthcare organizations should make sure their security practices and strategies are updated but the government should also help in skill development of cybersecurity professionals and encourage more research on medical device security by providing medical device at low cost. Since medical devices are expensive and require license, it makes it difficult for researchers to explore this area. At the end, we should not forget that we have to stay a step ahead of hackers to be a hard target for them.

Nimisha Singh Verma is Healthcare IT consultant. She brings with her experience of various esteemed healthcare organizations Optum, Religare Technologies and tertiary care hospitals. Authored chapter on Indovation in Innovations in Healthcare Management: Cost Effective and Sustainable Solutions book published in US.

Technology to the rescue Innovations in program and technology offers an opportunity to accelerate improvement in health in India.

dia has made substantial progress in health. This is also reflected in some of the millennium development goal MDG targets that have been achieved and for others substantial progress has been made. Under-five mortality rate has declined from 126 (1990) to 48 (2015) and maternal mortality ratio from 560 to 174 during the same period. Though India missed MDG target of 42 and 140 respectively for these two indicators but the progress is remarkable. The estimated number of child deaths have come down from 3.2 million in 1990 to 1.1 million in 2015 which means 3,300 child lives saved every day!

However this progress does not commensurate with the economic and technology progress India has made. Our neighbouring countries with lesser development have made better progress. For example, the under-five mortality rate in the neighbouring counties of Sri Lanka, Nepal and Bangladesh is 9, 36 and 38 respectively, against 48 in India (Kumar S, Bothra V, Mairembam DS, 2016). Innovations in program and technology offers an opportunity to accelerate improvement in health in India. The ministry of health and family welfare has actively encouraged the state governments to innovate, identify innovations that address the burden of diseases, are cost effective and replicable. The government provides technical and financial support to scale them up. We look at how technology innovations in public health system in India can help accelerate its progress in improving health.

Opportunities There are many opportunities available in India today for innovations. Indians have provided substantial inputs to digital revolution across the world. However within India we have only recently started efforts to harvest the benefits for the Indian population. The recently launched ‘Digital India’ strategy in 2014, has made many government services available online cutting down delays, red tapism and corruptions. A common man is making payment for day today necessities online or through mobile telephones saving time and money. A related initiatives to accelerate innovations in the ‘Start-up India’ campaign facilitates bank financing and creates a favourable business environment for start-up ventures including technology innovations. Similarly, the ‘Make in India’ launched in 2014, encourages Indian and multinational companies to manufacture technology and medical devices in India. The global statistics shows that the 4.61 billion mobile users in 2015 from 4.01 billion in 2013. In 2017 the number of mobile phone users is forecast to reach 4.77 billion. Considering the challenge in grabbing this opportunity, there is a need to respond with service innovation. Overall, consumers and society will reap the fruits of thistechnological and socio-economic development. Data consumption is growing 65 percent annually for accessing services such as e-commerce and e-learning. Bharat Net’s aim is to connect India’s 250,000 Panchayats at an estimated cost of $18 billion. Health and education have been identified as priority areas to benefit from this connectivity. There are alternative approaches to connect India, including cable TV pipes and White spaces (refers to the unused TV channels between the active ones). These and many other opportunities are available in abundance today. The Digital India, National Skill Development Corporation,Swachh Bharat Abhiyan and Kayakalp Awards, creating ‘Smart Cities’ are some more opportunities to mention.

Ministry of Health & family Welfare promotes innovation in public health Considering the tremendous potential in technology to compliment, accelerate effective implementation of health care, all the states have been encouraged to include innovations in the state programme implementation plans under National Health Mission (NHM). Annual national summits are held to recognize share successful efforts by the states. To facilitate this entire process including identification and review of such innovations a platform of ‘www.nhinp.org’ portal has been created. This allows uploading of innovations. There are two categories of innovations program innovation and product innovation. Program innovation includes service delivery including referral, governance, treatment compliance, reduce cost of care or out of pocket expenditure etc. the product innovations include medical devices, innovative technologies including healthcare IT, m-health, and Tele-health/ E-health. There are norms set for inclusion and exclusion of innovations. The inclusion criteria are –relevance to health needs, address endemic health problems and or diseases, facilitates accessibility, affordability, reduce cost of care, ensure quality and safety of healthcare product and process, and bridge skill gap required in service delivery. Similarly, the exclusion criteria are - Specific drugs, surgical or medical procedures or practices that need evaluation through one or more of the processes such as- Randomized controlled trials, Systematic Reviews, Meta-analysis etc, and Incomplete Documentation. The screening processis well laid out. This involves a six member screening group at NHSRC and an in depth reviews held by product and program committee. In health, states are encouraged to propose innovation in program implementation plans for approval. In addition, to encourage and recognize the successful efforts, National Summits on Good and Innovative practices were initiated. In continuation, National Health Innovation Portal was launched by Shri. J. P. Nadda, Hon’ble Health Ministerof India, in the year 2015. To strengthen and sustain the efforts further, Health Technology Assessment Workshops were held. In all, six such workshops with 325 participants were trained. To strengthen the whole effort, there has been health technology assessment trainings being conducted for non-invasive Haemoglobinometer and Glucometer, urine strip analyzer, SMS enabled patient monitor etc.

Table 1: Technology can help India leapfrog to improve health by addressing challenges, some examples: Challenges

How Technology can help: Examples

Preventive care Health Promotion

Family Health including MCH

Lack of physical activity, dietary intake, stress level

Mobile Apps to monitor physical activity, stress level, food intake etc

Lack of awareness of wellness, healthy lifestyle, mental illness, awareness on domestic violence

Films on youtube and smatphone, mobile apps, SMS, Cloud based screening and monitoring of mental health

Lack of health record

Electronic Family Health Record for all family members including those with NCDs linking it to UID, ANM Online

Record of child and maternal care

Electronic Health record

Lack of awareness

Mother and Child Tracking System Sending SMS to beneficiaries to alert them regarding services due to them, or services which have become overdue using M-health

Lack of clinical and personal health data

Machine Learing based Predictive Analytics for providing hyper-personal, actionable insights.

Lack of awareness and counselling (HIV/AIDS)

Mobile Apps for counselling, awareness, mobile apps for nurse, doctor for monitoring

Lack of real time monitoring (Lymphatic Filariasis Mass Drug Administration)

SMS Reporting Program for ASHA

Shortage of Doctors

E consultations, Any Time Medicine

Shortage of specialists

Telemedicine, teleradiology, teleophthalmology

Delay in fund flow and poor monitoring

Automation in Fund flow: PFMS

Stock outs of drugs and other consummables

online tendering and monitoring linked to supply chain management such as E aushadhi in rajasthan and similar initiatives in other states

Unsatisfied beneficiaries and in extreme cases become violent against health care providers

Patient feedback and grievance redressal system using telephone, internet etc

long term patient records are not available

Interoperable Electronic Health Records connected electric family health record

Delay in getting reports

Realtime online dash boards

Problems with Record keeping, symptom monitoring, Psychiatric Patient localization, inventory management, supply chain management, lack of real time monitoring of hospital activities and data, medical device tracking and management, dialogue between patients, or between patients and health professionals, health promotion

Linking Family Health records with Electronic Health Record, Radio Frequency Identifier Devices, Smart cards, Kiosk, dashboard for realtime hospital monitoring, Data Analytics, Social Media, Internet of Thing

Curative care Disease outbreak

Access andc Quality Access to health care

Quality Monitoring Performance

Hospital care

Whole of population approach for addressing population health: The world is moving towards promoting health among those who are healthy. Technology can help us in achieving this as traditionally people approach healthcare providers only after falling sick. Technology can help us in providing health related inputs to the whole population. The conceptual framework (Kumar S, Preetha GS 2012) is useful while addressing and ensuring health in a population. This framework broadly categorises the whole population in four sections (Fig. 2): a. Healthy Population (with no risk factors and no disease) b. Population with Risk Factors c. Population with Disease but not aware d. Population known to have Disease With the above categorization, the health efforts can be strategized and concentrated, for example - provision of preventive and promotive health services to the population categorised as (a) Healthy population; screening and promotive health services, (b) building resilience for population categorised as Population with risk factors; early detection, treatment and care including limiting disability and rehabilitation along with healthy lifestyle for category (c); and compliance to treatment and care along with healthy lifestyle for category (d) which is known to have disease.

Fig. 2 Conceptual framework to address health needs of the whole population Is technology innovation addressing major killers? At this stage, it is very essential that we look at what are the major causes of death in India and address these. The seven major causes of deaths in India were prominently evident from WHOâ&#x20AC;&#x2122;s India Country Profile of Burden of Disease, NCD 2014. Accordingly, in all 98, 16,000 lakhs estimated deaths took place in India. An estimated 27,48,480 (28%) deaths can be attributed to communicable, maternal, perinatal and nutritional conditions put together, 25, 52,160 (26%) to cardiovascular diseases, 12,76,080 (13%) to chronic respiratory diseases, injuries taking toll of 11,77,920 (12%), cancers causing 6,871,20 (7%), diabetes 1,96,320 (2%) and other NCDs being 11,77,920 (12%). Above understanding regarding causes of deaths in India shall not only inform the overall planning towards actions required for addressal but could be complemented by technological

Some Innovations that can revolutionise healthcare in India: Family health folders: This has been another initiative which looks at family as a unit and tries to maintain health record for each and every member which could be linked and segregated for individual service like immunization, antenatal care, postnatal care, spacing methods, next monthâ&#x20AC;&#x2122;s medicines, BP records etc. this initiative has been piloted in AIIMS and INCLEN projects in some of the states like Rajasthan called Jan Swasthya, Madhya Pradesh and in Himachal Pradesh by the name of ANMOL. There is a provision of print work plan for next day/ week/ fortnight/ month. Also, it can be linked with the Electronic Medical Record (EMR). Electronic Health Records (EHR): Government is working on EHR to ensure continuity and quality of care. EHR will help in recording disease episodes and core plans and would al low data portability between different providers. Also, the metadata and data standards have been developed for it. Not only between clinical systems but also between support systems such as HR, Finance, Logistics, Lab, Emergency Transport FHR etc.There is also a possibility of establishing linkage to UID (Aadhar card). Access: Free essential drugs: To widen the accessibility of free drug services, there is a web based supply chain management system (e-Aushadhi) has been created. This system allows online tracking of drug inventory. It enables steamlining of inter-drug warehouse transfer and efficient control of inventory. Also, it enables multi-users and multi-location for storage. This initiative has been implemented by various states like Rajasthan, Tamil Nadu, Andhra Pradesh, Odisha, Jammu& Kashmir and at various stage in other states. Access: Healthcare Any Time Medicine (ATM): Presently, there are about 25 percent PHCs without a doctor, in India. This calls for innovative approach to address the challenges and originated an innovation called ATM. ATM, piloted by National Health Systems Resource Centre, New Delhi, provides Tele-consultation supported with mobile phone and the generic drug vending machine. The pilots have been conducted in five states [HP, Odisha, MP (3-4 each), UP (100) and AP (100). Total cost of this initiative per facility has been only 3 lakhs. See photograph below:

Access: Telemedicine: Yet another example for use of technology is ‘Telemedicine’ which is very successfully piloted in states like Tripura, Andhra Pradesh, Bihar, Maharashtra and Assam. With this technology, images and scans can be easily sent across the specialists for diagnosis and consultation for treatment; especially when specialized treatment is required and is not easily available nearby.

Automation of fund flow: It has been the experience so far that programme activities suffer due to delay in fund transfer and in this context establishing public fund management system with the use of technology is a bliss. With this, automation of recording, verification and calculation of payments are done a smoother and faster way and electronic fund transfer (EFT) towards payments into recipient’s bank account becomes easy. This technology has been utilized in states like Rajasthan- with ASHA Soft, in Bihar- namely HOPE and Delhi. To simply sum up, it is obvious that the technology can address access to and quality of health care in India. Many initiatives across the country exist and therefore there is a need to identify cost effective, scalable innovations which address bottlenecks and the burden of diseases. To enable this, there is a platform provisioned called National Health Innovation Portal, in India. This is an effort of Ministry of Health & Family Welfare commitment to support scale up of good and replicable practices in public health in India. There is a need to encourage innovations and the government must make resources available to scale up the promising innovations to reach the last beneficiary.

Dr. Sanjiv Kumar is MBBS and MD from AIIMS, New Delhi, DNB in MCH and MBA in Strategic Management. He has 41 years of experience in public health across 29 countries. He started as Medical Officer in Indian Army. He taught Preventive and Social Medicine at University College of Medical Sciences, New Delhi. He then joined UNICEF and worked for 22 years at various levels in 29 countries. He worked as Executive Director at National Health Systems Resource Centre, New Delhi. Dr Sanjiv Kumar is back to teaching as Director, International Institute of Health Management and Research in New Delhi.

Dr. Nishikant Bele received his Doctorate in Computer Science from Utkal University, Bhubaneswar, Orissa and MCA from Amravati University Amravati, Maharashtra. Dr. Nishikant has over 16+ years of experience in teaching, training, administration and research with prominent organizations. He is a SAP certified ERP Solution consultant. He had published research papers in various journals of international repute and has attended and presented papers in many international and national conferences. His areas of interest are: Health Informatics, Business Analytics, ERP, Data Modeling &amp; Database Designing, Web and Text Mining.

Healthy Diet for Moms-to-be Eat well, be well during pregnancy By Samya Athamneh, International Dietician

ongratulations, you are pregnant. However, if you are like most women, who have concerns running through your mind, how can I eat healthy for both my baby and my self? In addition, how can I gain the right amount of weight so that it does not take me until my child is in preschool to fit back into my jeans again?

Between cravings and morning sickness, eating well during pregnancy may not always be a piece of cake. However, prenatal nutrition is a serious business. It is necessary for you and your babyâ&#x20AC;&#x2122;s growth, brain development, reduced risk of birth defects and a strong immune system. Since it is not how much, but what you eat that makes the difference, here is how the healthy pregnancy diet can help. During pregnancy, the body requires extra calorie, protein, vitamins, mineral in order to support the babyâ&#x20AC;&#x2122;s growth and to allow for changes in mothers body. Important considerations in pregnancy The extra food you eat should not be just empty calories, it should provide the nutrients your growing baby needs. For example, calcium help makes bones and teeth strong, while you are pregnant; you still need calcium for your body plus extra calcium for the developing baby. Similarity, you require the all-essential nutrients than you did before become pregnant. Here are some of the most common nutrients you need and the foods that contain it:

Nutrient

Needed for

Best sources

Protein

Cell growth and development

Lean meat, fish, poultry, egg white, beans, peanut butter, tofu

Carbohydrate

Daily energy production

Breads, cereals, rice, potatoes, pasta

Calcium

Strong bones and teeth, muscle contraction/nerves function

Milk, cheese, yogurt, sardines with edible bone, spinach, okra

Iron

Red blood cell production / needed Lean red meat, spinach, iron fortified to prevent anaemia cereals, nuts, dried fruits

Vitamin A

Healthy skin, good eye sight, growing bones

Carrot, dark green leafy vegetable, potatoes

Vitamin C

Healthy gums, teeth and bones, assistance iron absorption

Citrus fruit, broccoli, tomato, fruit juices

Vitamin B6

Red blood cell formation effective Whole grain cereals, banana use of protein, fat and carbohydrate

Vitamin B12

Formation of red blood cell, maintain nervous system health

Vitamin D

Healthy bones and teeth, aid in calci- Fortified milk, dairy product, cereals, um absorption fish, sardines

Folic acid

Blood and protein production/effective enzyme function

Meat, fish, poultry, milk

Green leafy vegetables, dark yellow fruits and vegetables, beans, nuts, peas

Food craving during pregnancy Food craving during pregnancy is normal. Although there is no widely accepted explanation for food cravings, almost two thirds of all pregnant women have it. If you develop sudden urge for a certain food, go and indulge your craving, it provides energy or an essential nutrient. However, if your craving persists and prevents you form getting other essential nutrients in your diet; try to create more of a balance in your daily diet. During pregnancy your tastes for certain foods may change, you may suddenly dislike foods you were fond of before your pregnancy. In addition, during pregnancy, some women feel strong urges to eat non-food items such as ice, laundry starch, dirt, chalks, ashes, paint chips, clay. This is called pica and may be associated with a mineral deficiency like anaemia. Do not give in to theses non-food cravings; they can be harmful to both you and your baby.

Foods to avoid Some foods make you and your baby sick, avoid these foods as they can cause food poisoning or certain harmful diseases.

•

Raw fish, especially shellfish

•

Soft scrambled egg and food made from raw or lightly cooked eggs

•

Un-pasteurized juices

•

Un-pasteurized milk and foods made from it

•

Herbal supplements and teas

•

Raw or uncooked meat, poultry, seafood and hotdog

•

Never eat non-food items like clay , starch, coffee grounds

•

Avoid alcohol during pregnancy; alcohol has been linked to premature delivery, mental retardation, birth defects and low birth weight babies

•

Do not eat shark, swordfish, king mackerel, or tilefish (also called white snapper), because they contain high levels of mercury.

What to eat and when During pregnancy, you may have morning sickness, diarrhoea or constipation, you may find it hard to keep foods down or you may feel too sick to eat at all. Here are some suggestions: Morning sickness: Eat crackers, cereal or pretzel before getting out of bed, eat small frequent meals throughout the day and avoid fatty, fried, and grassy foods. Constipation: Eat more fresh fruit and vegetables, drink six glasses of water. Diarrhoea: Eat more foods that contain pectin and gums to help absorb excess water such as apple, applesauce, banana, white rice, oatmeal, boiled potatoes. Heartburn: Eat small frequent meals throughout the day. Try drinking milk before eating and limit caffeinated foods and beverages like tea, coffee, chocolate, soft drinks.

Unveiling myths with reality Pregnancy produces a host of physiological and emotional changes in women. Advice seems to pour in from all sources, well-meaning friends, family member, and colleague at work and even perfect strangers tend to comment on a pregnant womanâ&#x20AC;&#x2122;s health. In the face of often-contradictory advice, especially concerning ones diet, it may be hard for a mum to achieve a comfortable and healthy balance. Eating a healthy diet is one of the most important things any pregnant women can do to enhance her health as well as the health of her baby. Here are some nutrition myths followed by information to get you and your baby off to a good start.

Myth#1: You are eating for two In reality, you are eating for one plus one very small being. Most women only need to consume an extra 300 calories per day. Far from being a tome to overindulge, pregnancy is a time to eat sensibly and healthily. The suggested weight gain during the pregnancy is approximately 2435 pounds (10-15 kg). However, this weight may vary depending upon each mother-to-be, pregnancy weight and the number of babies she is carrying. An under weight woman may gain up to 40 pounds, while an overweight woman may be asked to gain just 15 pounds, your doctor will specify an appropriate weight gain for your height and body build.

Myth#2: Eat low carbohydrate, high protein diet In reality, weight loss diet, high protein - low carbohydrate, is not recommended during pregnancy. According to the daily food guide pyramid, grains, fruits and vegetables should compromise more of your diet than the meat groups. In fact, 2-3 servings of protein are required each day for pregnant women. This is easily achieved by consuming an egg/ 2-3 oz of poultry or meat/ Â˝ cup of dried beans or peas in the course of one day. Extra calories consumed during pregnancy should be evenly distributed among five major food groups.

Myth#3: Pregnancy induced high blood pressure caused by too much salt In reality, pregnancy induced high blood pressure is due to a variety of physiological changes in the body during pregnancy and is therefore not treated the same way as hypertension in non pregnant adults. Moderation is the key. While overindulging in processed foods, typically containing too much salt would be unhealthy, eliminating salt and consuming no salt or low sodium specific food will be inappropriate. Aim to get 6 grams of sodium as a table salt in your foods every day.

Myth#4: Now that you are pregnant, it is a good time to start thinking about folic acid and B complex vitamins In reality, Folic acid is particularly important in the first days and weeks of fatal formation, for this reason it is recommended that women take multivitamin before becoming pregnant to ensure they have adequate folic acid during the early development of the baby’s brain and spina bifida. Optimal folic acid consumption should continue through out pregnancy and in every woman’s diet during the childbearing years. Beside vitamins, excellent sources of B complex vitamin include orange juice, beans, citrus fruit, dark green leafy vegetables, nuts and whole grains.

Myth#5: It is better to rely on vitamins rather than ones diet during pregnancy In reality, Vitamin should never be a substitute for a healthy diet, while most obstetrician and midwives will prescribe a multivitamin for their patients, these vitamins are intended to supplement and not replace a sensible diet. The best sources of vitamin and minerals may be found in their naturally state as they are better absorbed and are accompanied by their other nutrients such as protein or fiber.

Dietary guide In order to achieve a well balanced healthy adequate nutrition during pregnancy, you should cover the daily allowances from the different criteria of food on a daily basis as following: Nutrient

Food allowances per day

Milk

2-3 cup

Meat/fish/poultry(liver once a week) cooked weight

4 oz

Vegetables including: Dark green leafy or deep yellow Potato Other vegetables

½ cup 1 medium ½ to 1 cup

Fruits including: Citrus Apples or other fruit

1 serving = 1 fruit 1 serving = 1 fruit

Cereals enriched or whole grain As pasta/rice/macaroni

3 serving ( 1 serving = to ½ cup)

Bread, enriched or whole grain

4 slices (2 in the morning as breakfast / 2 for dinner and keep 1 slice as a snack in between )

Vegetables oil

4-5 teaspoons

Vitamin D supplement or use fortified milk Iodized salt

400 IU ( consult your doctor) 5-7 grams per day

Eggs

3 eggs per week

Repeatedly, it has been emphasized that reduced nutritional intake has a depressing effect on physical development. Malnutrition during the period of rapid brain growth will lead to some neurology impairment. Past studies of nutrition in women during pregnancy have shown a definite relationship of the diet of the mother and the condition of baby at birth. To protect your self and your precious baby from any possible complications review your lifestyle and try to change any unpreferable behaviour related to your diet toward the better.

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