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Aligning business and healthcare in India

Total number of pages 48

March 2018 Vol 6 • Issue 6 • `50

DIAGNOSTICS

MOLECULAR PATHOLOGY

TREND

WEARABLE DEVICES

DYNAMIC DISRUPTOR

DR GIRDHAR J GYANI, DIRECTOR GENERAL, ASSOCIATION OF HEALTHCARE PROVIDERS (INDIA), ON POLICY FORMATION THAT IS GIVING A NEW THRUST TO THE INDUSTRY

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Contents 14

30

09 21 34 COVER STORY Dr Girdhar J Gyani, Director General, AHPI, on working with the government and other stake holders.

BULLETIN 10 This month's important

DIAGNOSTICS 30 Molecular pathology

news updates.

MANAGEMENT 21 Arthritis stem cell procedure

combines principles or techniques of molecular biology with diagnostics technology of pathology practice.

also involves PRP injections which are found in the platelets.

OPINION 34 Experts hail budget allocation for healthcare for 2018-19

INFRASTRUCTURE 24 Project management helps to plan and finish complex projects on time.

QUALITY 28 Avoiding use of misleading abbreviations helps preventing medication prescription errors.

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MARCH 2018 | HEALTHCARE RADIUS

TREND 38 Many track their fitness regime and food habits through wearable devices and applications.

ANALYSIS 40 The NHPS positions the Govt in the leadership role.

EDITOR'S NOTE

Policy enabler

MARCH 2018 • VOL 6 • ISSUE 6

ITP MEDIA (INDIA) PVT. LTD

It has been only five years that the Association of Healthcare Providers (India) or AHPI has been formed, and today it is revered as the most crucial body working with the Government and other stakeholders on healthcare policy making and execution. Whether it’s taking the initiative to draft policies addressing a market need (like utilising the CPS course to address shortage of PG doctors or convincing the IRDA to make NABH mandatory for all TPA empanneled hospitals) or engaging with the Government to make modifications in its stringent regulations that could stifle growth, AHPI has been significantly contributing towards the growth of the industry.

The credit to make AHPI accomplish so much could be attributed to the humongous efforts by its Director General, Dr Girdhar J Gyani. One of the most dynamic leaders of the industry, Dr Gyani has also been the most successful CEO that NABH had ever had. Read how he is steering AHPI and paving the way forward for the healthcare industry in our cover story.

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C

M

Y

CM

MY

CY

CMY

K

BULLETIN

CDC Group plc invests Rs 138 cr in AIMS Asian Institute of Medical Sciences (Asian), a 725-bed tertiary care service provider with facilities spread across Delhi NCR, Haryana, UP, Bihar and Jharkhand, has announced an investment from CDC, the UK's development finance institution and an investor operating in growth markets.

Established in 2010, Asian commenced operations with a 350-bed facility at Faridabad with centres of excellence across key tertiary care specialties including cardiology, oncology, nephrology, critical care and orthopaedics. Over the last three years, the company has further expanded the business with four more Dr NK Pandey hospitals at Dhanbad, Moradabad, Sambhal, Yamuna Vihar and three primary healthcare clinics in and around Faridabad. As part of the next phase of expansion, the Group intends to add 1,000 more beds over the next three years with new hospitals being planned across states of Delhi NCR, Haryana, UP, Bihar

and Jharkhand.

Said Dr NK Pandey, Chairman and Managing Director, Asian, "This investment lets us expand and develop high-quality medical facilities, allowing us to replicate our success at Faridabad across the other major towns in UP, Bihar and Jharkhand.

The new investment gives us the capacity to expand the number of beds available to patients from the current level of over 700 to close to a 1,750 by 2021."

Dr Pandey added, “At Asian we firmly believe quality healthcare is a basic need and needs to be delivered closer to where the need is and not only in big metros. The development focused investment approach taken by CDC, and their ability to stay invested for a longer tenure help us achieve our vision of reaching out to those tier 2 and tier 3 towns of north and east India that have huge unmet demand for quality healthcare services."

Apollo Spectra Hospitals & Regrow performs painless bone cell therapy

Future Generali launches new health insurance plan

Apollo Spectra Hospitals, the leading surgery specialists in the country, along with Regenerative Medical Services Pvt. Ltd., (Regrow) the first Indian biotech company, marked another milestone in the country’s medical history by performing a revolutionary bone cell therapy- OSSGROW on a 44-year-old accident survivor from Bengaluru. A team of doctors led by Dr Gautam Kodikal from Apollo Spectra Hospitals successfully performed the new generation regenerative medical treatment on Rajkumar, who was suffering from the condition called avascular necrosis, which had progressed post meeting with an accident. The surgery was done at Apollo Spectra Hospitals and Regrow’s center at Koramangala, Bengaluru.

OSSGROW is a patient specific natural and biological regenerative medical treatment that allows the formation of new bone in the area of bone loss, naturally providing restored mobility without any side effects. Conditions like avascular necrosis of hip joint, non-healing fractures and bone defects of oral cavity and maxillofacial region could be successfully healed through the therapy.

Future Generali India Life Insurance (FGILI) has announced the launch of a new heart and health insurance plan, further strengthening its health portfolio.

The plan will provide financial protection to insured against 59 heart related, cancer related and other illnesses.

FGILI’s heart and health plan will be the first insurance product to introduce customers to a modular combination of four distinct types of coverage options, allowing them to choose from an exclusive heart cover, a heart cover with return of premium, a critical illness cover (related to heart, cancer and other illnesses) and a critical illness cover with return of premium.

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MARCH 2018 | HEALTHCARE RADIUS

BULLETIN

Biomineral in bones helps to kill cancer cells In a major medical breakthrough, scientists of Centre for Nanosciences and Molecular Medicine at Kochi’s Amrita Institute of Medical Sciences have succeeded in turning nanoparticles of calcium phosphate – a biomineral naturally found in human bones – into fully biodegradable radio frequency (RF) Dr Shanti Nair agents and made them imageable by MRI and CT scans. This has paved the way for safer, cheaper diagnosis and treatment of cancer. The project has been funded by the Department of Biotechnology of Government of India.

Said Dr Shanti Nair, Director, Centre for Nanosciences and Molecular Medicine, Amrita Institute of Medical Sciences, “The development of calcium phosphate nanoparticles with imageable properties for drug delivery applications is a major innovation in the quest to develop biodegradable contrast agents for imaging (diagnostic) purposes. Calcium phosphate is

naturally found in human bones and is non-toxic and fully biodegradable. Now that its nanoparticles have been made imageable by MRI and CT scans, their accumulation in tumours can be verified and the MR contrast used for imageguided surgical treatment of cancer.”

Currently, the most common treatment for cancer involves radiation and use of gamma rays to kill cancer cells. However, this inflicts collateral damage – healthy cells also get destroyed along with cancer cells. Radiation treatment with Cyber-Knife is much more precise, but very expensive.

In this situation, the most easily accessible and cheapest cancer treatment available uses radio frequency (RF) microwaves.

But for this method to work, the RF agent should be non-toxic to human body and preferentially accumulated in the tumour.

This is where the development of calcium phosphate nanoparticles as a biodegradable RF agent becomes significant.”

Tejnaksh Healthcare to manage Tarachand Bapa Hospital Tejnaksh Healthcare has taken over Tarachand Bapa Hospital in Sion, Mumbai. The acquired hospital is a 65-bed multispecialty hospital with more than four decades of presence at prime location in Mumbai. Tejnaksh is taking its bed count from current 140 to 300 in the next two years. The company has added 65 beds to its current bed count of 140 which takes its bed count to 200 and will add another 100 beds in the next two years.

The company has recently increased

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MARCH 2018 | HEALTHCARE RADIUS

its stake in Navi Mumbai based hospital Tejvedaant to 75%, Tejnaksh has installed a Laser and has also started full-fledged ICU facility at their Navi Mumbai centre.

Dr Ashish Rawandale- Patil, director, Tejnaksh Healthcare, said, “With this we have 100 beds spread across two hospitals in Mumbai, one in Sion and another one in Navi Mumbai and another 110 beds in Dhule. We are very positive on adding more beds in Mumbai, as there is a tremendous scope in growing our network of hospitals in the city.”

idsMED and We Doctor sign MoU IDS Medical Systems Group Limited (idsMED Group), supported by the Fung Group, and Tencent-backed We Doctor Holdings Limited (WeDoctor) announced the signing of an MoU that will see the two companies form an intelligent medical supply chain and procurement company in China.

The idsMED Group is an integrated medical supply chain solutions company supplying medical equipment, consumables and value-added services to thousands of hospitals and care institutions across the Asia Pacific.

WeDoctor, a technology-enabled healthcare solution platform in China, has a network of 2,700 hospitals, 220,000 doctors and over 110 million platform users in China. It uses AI and technology to deliver healthcare services and is the leader and pioneer of internet hospitals in China.

BULLETIN

Launch of personalised care in Bengaluru

MS Ramaiah Memorial Hospitals is the first client of Eldricare in Bengaluru to use Jiva to improve care management.

ZeOmega, an industry leader in population health management solutions servicing healthcare organisations, has announced the opening of its new sister company— EldriCare. Based in Bengaluru and servicing all of India, EldriCare creates and coordinates personalised care plans that help improve outcomes and lower costs for the most complex populations suffering from high burden of disease. Eldricare will facilitate follow-up care programmes using multi-channel engagement campaigns that connect

with patients via telephone, mail, text, web chat, and/or interactive voice recognition outreach.

Eldricare will support patients suffering from both chronic and acute conditions by leveraging Jiva, the endto-end PHM platform created by its parent company, ZeOmega. The interoperability-enabled, innovative technology within Jiva allows doctors, nurses, pharmacists, other healthcare providers and patients to appropriately access and securely share a patient’s vital medical information electronically.

MS Ramaiah Memorial Hospitals is the first client of Eldricare in Bengaluru to use Jiva to improve care management. For now, Eldricare will be supporting the hospital’s diabetes clinic. But with time, Eldricare will expand its services to other specialty areas of the hospital. “In India, there is a rise in number of patients suffering from chronic illness—diabetes being the most common of all,” said Dr Naresh Shetty, President, MS Ramaiah Hospitals. “Patients suffering from chronic illnesses need dedicated follow-up care and lifestyle management, but to make that happen doctors and hospitals must take on extra tasks. With our ratio of only one doctor per 1,800 people, that simply is not possible without help. Eldricare offers the crucial support we need.”

New monogenic form of diabetes in India A breakthrough study on Maturity Onset Diabetes of the Young (MODY) was published in ‘BMC Medical Genetics’ journal by Dr V Mohan and Dr Radha Venkatesan from Madras Diabetes Research Foundation (MDRF), Chennai.

The usual forms of diabetes are type 1 diabetes, (which comprises 90 - 95% of all forms of diabetes) and type 1 diabetes.

There is a genetic form of diabetes due to a single gene defect and hence these are called as ‘Monogenic Diabetes’. The commonest form of monogenic diabetes is 'Maturity Onset Diabetes of the Young (MODY)' which like type 1 diabetes also affects young people or children. Patients with MODY are usually lean and because of their young age, they are often wrongly labeled as having type 1 diabetes and advised to have life-long insulin injections.

The study was carried out was based on a comprehensive genomic analysis of 289 individuals from India which included 152 clinically diagnosed MODY cases and 137 normal glucose tolerance subjects

KMCH and MedGenome launch genomics centre Multi-speciality hospital, Kovai Medical Center and Hospital (KMCH), and MedGenome, a global leader in genomics based research and diagnostics, announced the launch of a genomics centre at the KMCH premises in Coimbatore.

The new facility will enable researchers to find novel insights into the biology of diseases. The genomics centre will also empower clinicians with validated and actionable clinical information to make effective treatment decisions for their patients. Additionally, genetic counselling will be provided to patients on hereditary cancers, genetic disorders, pregnancy related issues and neurological disorders.

HEALTHCARE RADIUS | MARCH 2018

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COVER STORY

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COVER STORY

Dynamic Disruptor Dr Girdhar J Gyani, Director General, Association of Healthcare Providers (India), on health policy formation along with the Government and other stakeholders

BY RITA DUTTA How has the functioning of Association of Healthcare Providers (India) or AHPI evolved over the years?

AHPI was formally started in October 2012 as a voice of the healthcare industry with the primary focus on the well-being of the common man. Till AHPI was formed, there was no pan India association for healthcare providers. Right from the beginning, we have been functioning as a 'not for profit’ organisation that wanted to engage with the Government and other stakeholders to participate in health policy formulation and execution. We chose the motto of AHPI as ‘Educating and Advocating for Well Being of Common Man’.

We are unique in a way that we do not charge any membership fee. Some of our patrons like Dr Devi Shetty and a few others generously donated money for our operations for the first couple of years. In the past three years, we have not drawn any major donation as we generate sufficient revenue through our activities including organising events and training programmes.

I am happy to say that AHPI today is a selfsustainable organisation.

What were challenges that you faced to make AHPI a pan India body? And how did you overcome them?

AHPI, as I mentioned earlier, is registered as society. It is governed by an executive committee, which comprise eight founding members drawn from seven states. It was

proving to be difficult to engage hospitals from other states through personal contacts. So, we decided to form 14 state or regional chapters with each chapter having its president, secretary and members as a part of state executive committee. The committee has three sub-committees, each working on advocacy, education and training and public engagement. The state committees regularly hold meetings in different subregions/districts of state. The President of each chapter gets nominated as a member in central executive (governing) committee.

AHPI: AT A GLANCE Founded in: 2012 Headquartered in: New Delhi No of designation courses: 10 No of people trained: Over 2,500 No of regional chapters: 14

FOUNDER MEMBERS OF AHPI S. No

Name

Office

1

Dr Alexander Thomas

President

2

Dr Girdhar Gyani

Member Secretary

3

Dr R Rajasekaran

Treasurer

4

Dr Prem K Nair

Member

5

Dr N Trivedi

Member

6

Dr Devi Shetty

Member

7

Dr. Somaraju

Member

8

Dr Bhabatosh Biswas

Member

HEALTHCARE RADIUS | MARCH 2018

15

COVER STORY

This changed the entire scenario and AHPI has today become a truly pan India body.

1. The association is self sustainable due to its various conference and training programmes

Please elaborate more on the functioning of AHPI in different regions.

We encourage regional chapters to do advocacy with respective Governments in consultation with the central office. We have instituted 'the best chapter award' to motivate chapters. For instance, for the second consecutive time, Tamil Nadu (TN) was awarded 'the best chapter award' during our recently held conclave at Kochi on 16-17th February 2018.

To cite some of the work done by AHPI in TN, the Government of TN had passed a stringent regulation to penalise hospitals that did not have fire ramps. Now many hospitals, housed in old buildings, would have been shut down due to this norm.

AHPI engaged with the Government as well as sought judicial intervention. The TN-HC has now constituted a committee of experts, in which AHPI is a member, which will examine all hospitals and suggest remedial measures on case-to-case basis to mitigate the risk arising out of fire.

In another case, the Government has appointed a single vendor to undertake laundry work. This was objected with TN PCB, which

1

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MARCH 2018 | HEALTHCARE RADIUS

has agreed to have more such vendors. The AHPI-TN chapter is pursuing a series of value adding training courses in small towns which have been widely appreciated.

What are some of the major achievements of AHPI in policy making?

In terms of significance, it would be convincing the IRDA to make NABH accreditation mandatory by July 2018 for all hospitals wanting to get TPA empanelled. This will generate a big push towards quality and patient safety in the country.

At the time of my superannuation from position of Secretary General, Quality Council of India and CEO-NABH, I mooted the idea of formation of Consortium of Accredited Healthcare Organisations (CAHO) to act as customer voice for NABH and, at the same time, promote collaboration among accredited hospitals and laboratories to share best practices so as to improve quality.

At present, President of AHPI, Dr Alexander Thomas, acts as founder President of CAHO. AHPI continues to support activities of CAHO, which has trained over 400 healthcare professionals including 130 with advanced level training in implementation of quality accreditation in the hospitals.

COVER STORY

DIPLOMAS CAN SAVE LIVES IN RURAL INDIA Specialty

Practicing specialists

Specialists Required in India

PG seats in India

PG Seats Required in India

India

USA

Cardiology

4,000

22,000

88,000

315

3375

Nephrology

1,200

10,000

40,000

120

2,160

Oncology

1,000

14,476

58,000

89

2,160

Pulmonology

1,200

5,750

23,000

31

2,260

650

6,975

27,900

78

1,100

20,000

41,351

200,000

1,695

6,400

1,400

13,000

52,000

219

2000

Endocrinology Anaesthesiology Neurologist

We worked with the Government to reduce electricity tariff for healthcare institutes to make healthcare more affordable.

The electricity cost is Rs 700 to Rs 800 per day per bed for a tertiary care healthcare institute. The Karnataka Government was the first to act and reduce tariff by 15%.

Now the Governments of Haryana, MP and Gujarat have taken similar steps. In yet another major step, when the Government of Karnataka wanted to bring in the Clinical Establishment Act with the provision of fixing rates of various medical procedures, AHPI successfully persuaded the Government not to include this clause.

The Government has been enacting policies to make healthcare more affordable.

What are your views on the efforts, including the methods used to achieve the goal?

Till date, no agency has worked out the costing of medical procedures and therefore fixing of rates without any scientific basis would have proven to be a disaster and make hospitals unsustainable as well as compromise on patient safety.

The Government for its schemes like CGHS/ECHS has fixed the rates on the basis of inviting open tenders, in which nursing beds with 50 beds and tertiary care

DISPROPORTIONATE UG AND PG SEATS Undergraduate seats

Post graduate seats*

India

63,835

14,500

USA

21,000

40,070

Country

Source: India – MCI accessed 2nd Dec 2016; USA – National Resident Matching Program 2016 and American Association of Medical Colleges 2016

super-specialist hospitals are made to bid.

The lowest bid is adopted as the industry standard for all categories of hospitals.

Most of the rates are irrational and illogical. Tertiary care hospitals cannot sustain if they treat all patients at such illogical rates.

For example, Delhi-NCR has more than 50% of CGHS patient load, and treating these patients at the CGHS rates is proving to be extremely challenging for them.

To prove our point, we initiated a unique costing study under the aegis of Government of Karnataka with key members like IIM (B), NABH, CMC Vellore, Medical Department of ISRO, and others. This study was based on clinical pathway methodologies to arrive at the actual cost incurred for 20 selected procedures. The study showed that reimbursement under various Government health insurance schemes such as CGHS, Yashasvini and Vajpayee Arogya Shree fall short of actual cost of medical procedures by a huge margin. It also revealed that different Government schemes have different rates for the same procedure. It found out that private hospitals are providing treatment at a highly subsidised rates for most scheme patients. AHPI has shared the study with MOHFW (Government of India) with the demand that new rates for Government

HEALTHCARE RADIUS | MARCH 2018

17

COVER STORY

3 2 health insurance schemes including CGHS be revised and brought at par with actual cost being incurred by hospitals.

2. The AHPI-TN chapter is pursuing series of value adding training courses in small towns, which have been widely appreciated.

18

Please tell us about efforts by AHPI to address shortage of specialists.

India is producing 63,835 MBBS graduates every year but have less than 25000 PG seats. Countries like the US, on the other hand, has 40,000 PG seats as compared to 20,000 UG seats. The Government alone employs 65,697 MBBS doctors, whereas specialists’ vacancies are reported to be more than 80% in community health centres (CHCs) alone. Faced with the dearth of availability of medical talent, we cannot improve on health indicators including IMR/MMR. AHPI, right at the time of its inception, launched a movement; ‘Equal PG-UG seats’ to draw the attention of the Government to increase PG seats. The MOHFW has increased some seats, but these were not going to be sufficient. With efforts from AHPI, the Government has now recognised diploma courses of CPS and this will meet the shortage of specialists in the next three to five years.

AHPI has set up of legal cell. What was the need for that?

Today having a legal cell is a requirement

MARCH 2018 | HEALTHCARE RADIUS

for most healthcare institutes but much mid-sized and small sized hospital cannot afford to have one. AHPI has initiated a dialogue with the National Law School University to establish a legal cell. The cell will be of immense help and support AHPI member hospitals in mitigating threats coming from unforeseen medico-legal cases.

It may not be out of context that with efforts coming from AHPI that the National Law School University has also agreed to institute a 'Healthcare Think Tank', which is going to be the first of its kind 'Think Tank' and will provide policy level inputs to the Government. AHPI will be one of the key members of the 'Think Tank'.

How is AHPI working with the Government on improving the medical tourism sector?

There have been many complaints about medical tourism patients being cheated on by facilitators. This was adversely affecting the image of Indian hospitals, without their involvement. AHPI initiated the subject with Ministry of Commerce to have an empanelment scheme to accredit Medical Value Travel Facilitator.

I am happy to say that so far, six facilitators have been accredited under the scheme

by NABH. Their names are available on the NABH website. The Ministry of Commerce is actively promoting the concept through

COVER STORY

diplomatic channels. AHPI and its associate CAHO is also engaging the member hospitals to promote the concept.

The Ministry of Commerce is also working on an ambitious project involving export of trained allied health workforce. AHPI, in association with MOHFW and IGNOU, are working on training of various categories of allied healthcare workforce to meet the demand within the country as well as in export of such services. Overall, our aim is to give a boost to skill-based employment.

Earlier nurses were known to have been employed overseas but that was more of unorganised activity, while the Ministry of Commerce would be aiming to do this as an organised task.

If Cuba can supply doctors to the US, India which has a vast number of educated but unemployed youth can supply its trained healthcare workforce to BRIC, ASEAN, USA and other countries. AHPI will make their member hospitals available in training of this workforce.

What are your thoughts on the National Health Protection Scheme (NHPS)?

NHPS sets the path towards achieving universal health coverage (UHC). The NDA Government had announced to accord priority to health. Our Prime Minister on 15th August 2016 announced a Government health insurance scheme with cover of 1 lakh for BPL families. This was later enhanced to a whooping Rs 5 lakh in the budget presented on 1st February 2018.

This is going to be the biggest health insurance scheme anywhere in the world, as it would target nearly 40% of 1.25 billion populations. The scheme, named as ‘Ayushman Bharat Scheme’, will provide a huge relief to poor people who can think of seeking tertiary care in the best of hospitals. As our public health system is not adequate, the scheme will lead to the opening of new hospitals in tier-II and III cities. Coupled with CGHS, ECHS, and ESI, India can claim to have achieved the goal of UHC.

What should the Government do to make healthcare more affordable?

Like any other commodity, if the healthcare is in short supply, it will not be competitive and therefore expensive in that sense.

Therefore, the Government should incentivise private sector to establish new hospitals in deficit tier-II and III regions by giving tax benefits.

It is equally important to make the specialist doctors available by increasing PG seats in medical colleges and through National Board Of Examination (NBE) hospitals. We also need to apply quality management tools like LEAN to improve efficiency in healthcare operations.

Can you give us a few examples of capacity building?

Healthcare industry has two challenges; one is ensuring patient safety and second is making healthcare affordable. AHPI is constantly working on enabling members to meet these twin challenges. AHPI Institute of Healthcare Quality has launched a series of short-term training programmes.

Four of these programmes have been endorsed by the West Bengal University of Health Sciences. These include certified infection prevention and control nurse course, which for the first time introduces the concept of deploying Link ICN for each

3. AHPI Institute of Healthcare Quality has launched a series of shortterm training programmes.

3

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COVER STORY

programme, aimed at protecting the vast population from a variety of diseases and epidemics.

4

4. Dr Gyani has mooted the idea of formation of CAHO to act as a customer voice for NABH.

20

nursing station. AHPI has developed a standard for Green & Clean Hospitals which has been endorsed by the Ministers for Health and Environment. The standard has now been adopted as a certifiable standard by the USA based management system accreditation body, under which 15 hospitals have been certified in the UAE. It has also been adopted in modified form

by Bureau Veritas India (BVCI) for the Indian market. AHPI has also facilitated BVCI in developing unique standard for certifying ICUs. Considering that most ICU patients get infected via ventilators and other means, this is going to be of big help in containing hospital acquired infection.

The standard has also been endorsed by the Indian Society for Critical Care Medicine.

In a very significant initiative, AHPI collaborated with Indian Space Research Organisation (ISRO) to adopt their best practices in terms of quality in the health sector. Two pilot projects for critical care medicine and emergency medicine have been successfully completed.

AHPI has prepared an ambitious project on promoting adult vaccination. There are 11 vaccinations, which are recommended by CDC but are hardly known in our country. We are shortly going to launch this

MARCH 2018 | HEALTHCARE RADIUS

How do you see AHPI, five years from now?

The basic premises on which AHPI came in to existence will remain the same- which is to educate its members to build capacity and engage with the Government, regulatory bodies and other stakeholders on issues which have a bearing on enabling its member organisations in delivering of UHC to the community at large.

Five years down the line, I would like to see AHPI representing entire community of healthcare providers including allied health organisations representing IT, equipment and pharma sector. AHPI should be able to establish a collaborative approach between hospitals and the allied health industry which only will take India to realise UHC. AHPI would be a powerful and consolidated voice for dialogue with the Government and regulatory bodies in framing policies related to healthcare delivery and research. AHPI would be connected with the global hospital community. It is already a member of the Asian Hospital Federation and through that it has access to International Hospital Federation. AHPI is a permanent partner with Hospital Management Asia. These initiatives will help in bringing the global best practices in Indian hospitals.

Ideally, AHPI shall adopt the American Hospital Association model, by which AHPI will have separate verticals promoting healthy community in general and longterm care and rehabilitation in particular, having its data centre, establishing a hub and spoke model to develop small and rural hospitals and an education and events centre. AHPI will have dedicated forums including one for nurses, hospital administrators, healthcare quality professionals and others. AHPI will be a vibrant organisation to which all stakeholders will look forward to derive value proposition.

MANAGEMENT

1

Stem cell therapy for arthritis Arthritis stem cell procedure also involves PRP injections which are found in the platelets

BY VIPUL JAIN

A

rthritis is a serious medical condition which affects the joints causing pain and inflammation.

Joints are the points in the body where two bones meet and allow the movement to occur. Arthritis comprises a number of diseases which not only cause swelling in the joints but also degenerates the joint surfaces and the cartilages surrounding the joints. The most common type of arthritis includes osteoarthritis, rheumatoid arthritis, gout, etc. Various body parts suffering from arthritis can be the hips, knees, neck, lower back or small joints of the hands. Some of the reasons as to why there have been continuous cases of arthritis can be due to

job limitations, changing lifestyle, stress, over usage due to increasing physical pressure, any injury, aging, overweight, etc.

Stem cells are widely being researched and investigated for treating various diseases as they have the capacity to multiply and divide themselves and differentiate into multiple types of cells. Stem cell therapy for arthritis can be of profound use as it can prevent the patient from undergoing surgical operations and can also minimise the pain and severity of the condition in less time as compared to other medical treatments available. Moreover, less complication are involved in stem cell treatment for arthritis as the patient's own cells are used in the treatment.

1. Stem cells are widely being researched and investigated for treating various diseases.

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MANAGEMENT

2

3

2. Normal joint Vs arthritic joint.

3. A joint with

rheumatic arthritis.

22

Arthritis stem cell therapy involves harvesting of the stem cells from the patient's body itself which can be obtained from the mesenchymal cells, adipose tissues or from the bone marrow. Arthritis stem cell treatment usually takes place in a single day which includes the harvesting of stem cells using syringes and then injections are used to re-injecting theses cells into the patient and precisely delivering the stem cells at the damaged area. Since arthritis stem cell treatment is a non surgical treatment, the patient is able to return to normal activities soon and the process is devoid of any pain and the rehabilitation periods are not required usually.

MARCH 2018 | HEALTHCARE RADIUS

Moreover, patient gains mobility in comparatively lesser time. Once the stem cells are reinjected, they multiple and differentiate into specialised cell types, help in repairing the damaged tissues and cartilages and produce certain cells and proteins which prevent the inflammation to occur.

Arthritis stem cell procedure also involves PRP injections (Platelet Rich Plasma) which are found in the platelets. These secrete specific growth factors and enzymes which assist in healing the joint inflammation and promote tissue regeneration. PRP injections along with the stem cell therapy for arthritis maximise the healing results.

A stem cell treatment in India is performed by arthritis stem cell therapy expert who harvests stem cells from the patient's body and uses them for treatment of arthritis. It is mandatory that the stem cell procedure for arthritis is given by an arthritis stem cell expert only, as it requires specialised techniques and the sophistication involved in the therapy helps in acquiring the maximum benefit from the stem cell therapy.

India has been recognised as the new medical destination for stem cell therapies for arthritis because of the cost effectiveness and extensive diagnostic and imaging facilities such as MRI and CT scans. India provides services of the most leading doctors and stem cell therapy professionals at reasonable cost budget.

It has been widely reported that patients who have undergone stem cell therapy for arthritis in India got satisfying results and now they can be assured with hassle free, painless life ahead. It is believed by most scientists that stem cell research has great life-saving potential and will change the course of the treatment for many injuries and diseases.

Vipul Jain is CEO of Advancells.

29 Years of committed service to Healthcare Industry.

More than 10,000 global and local installations & still counting

INFRASTRUCTURE

1

Faster delivery Project management helps to plan and complete complex projects, meeting time, quality and budget requirements

BY MOHD KHALID

T 1. In execution phase, all vendors should be managed in such a way that all the parallel activities executed as per the plan.

24

he bed to population ratio in India is poor and lagging behind many western and the developed countries. According to The World Health Statistics, there is only one bed available for every 1,000 people in India, whereas in Western countries- one bed is available for each 250 people and for every 80 people in Japan.

It is therefore observed that the bed capacity should be improved upon significantly in India to extend proper healthcare to all.

To meet the exponential demand of beds, the Government is paying attention to provide infrastructure at a greater pace and by allocating more funds. Meanwhile, corporate players are also focusing on this industry to bridge the huge gap between demand and supply.

Hospital projects and healthcare facilities projects are typically complex in nature. It

MARCH 2018 | HEALTHCARE RADIUS

is due to the large number of stakeholders involved in the briefing, planning, design and construction of the project and the relationship between the project and its medical context or medical operating group, and the relationship between the various internal parts of the project. The involvement of enormous engineering services makes it more complex when it comes to execution.

Therefore, Project Management (PM) has become the need of the hour to plan and finish huge and complex healthcare construction projects, meeting time, quality, safety and budget requirements.

PROJECT MANAGEMENT & LIFE CYCLE OF PROJECT Project Management is the application of knowledge, skills, tools, and techniques to

project activities to meet the project requirements. PM methodology includes: • A set of skills, specialised knowledge, skills and experience that help to reduce a project’s level of risk and thereby increases its likelihood of success.

• Project managers use various types of tools to improve the projects success rate.

Examples include templates, forms, reports, registers, software and checklists.

• A series of processes, and processes that are needed to monitor and control the project, like time management, cost management, quality management, change management, risk management and sustainability management.

The Project Management Life Cycle has four phases mentioned below, whereas PM plays a cardinal role in every stage of project life cycle in identifying associated risks and mitigating them beforehand by co-ordinating with the stakeholders.

1. Project Initiation 2. Project Planning 3. Project Execution 4. Project Closure 1. Project Initiation: It is important to get project initiation right, as this establishes the foundation for the project and can make the difference between a successful and an unsuccessful project.

2 In this stage, project manager ensures the following parameters are implemented for a successful project; • Business case developed and feasibility study are conducted.

• Roles and responsibilities of relevant stakeholders defined and inked.

• Scope of the project is defined.

• Approval of concept to be ascertained with the concurrence of all stakeholders.

• Broad level budget is developed in this stage.

• Medical operation team involved and signoffs taken on plans/ layouts.

• Key deliverables are defined and responsibility is assigned.

2. Project Planning/ Design Management: A project plan is a formal document designed to guide the control and execution of a project.

• Project planning is the process of establishing the scope, defining the objectives and steps to obtain them.

• Resources are planned and allocated activity wise.

• Start and end date established and highlighted to the stakeholders.

• Milestones are established and a Gantt Chart Master Schedule is developed.

2. Hospital projects and healthcare facilities projects are typically complex in nature.

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INFRASTRUCTURE

3

3. It is important

to get project initiation right

26

• Schedule is tracked on regular intervals and activities falling in critical path are traced minutely by project manager to avoid delays.

• Procurement schedule is created to monitor the procurement phase.

• Cost report or financial plan is developed matching the assigned budget.

• Design management is the process of monitoring and closure of the detailed design and sign off from client/ stakeholders.

• Design review meetings are conducted and make architect/ consultants / stakeholders accountable for timely revert/ closure of design.

• Design inputs from the functionality and constructability point of view are provided, in turn saving time and cost.

• Alternate options suggested to meet the time lines, keeping the deign intent intact eventually.

• Ensures that the design parameters associated to the hygienic standards / protocol, set up by international regularity or research institutions, are to be implemented.

• Life-saving protocols set up AIA/ ISCCM need to be considered while designing the facility.

MARCH 2018 | HEALTHCARE RADIUS

• 80% value engineering/ savings in time and cost can be achieved in this phase only by reviewing the design in detail and suggesting alternate solutions.

• Contract management is the process to take the most suitable vendor/ parties on board through the laid down and agreed upon procedures. Procurement strategy like GC model, D&B or Split Contract is suggested, based on the project size and constraints to get the maximum benefits it in terms of cost and time.

• Pre-qualification (PQ) process having various parameters like financial and technical capabilities, relevant work experience, solvency etc are run to shortlist vendors to share the contract documents.

• Contract/Tender document is prepared which consists of: a) Tender Drawings b) Bill of Quantity (BOQ) c) General Conditions of Contract (GCC) d) Special Conditions of Contract (SCC) • BOQ line item wise reviewed, value add inputs are suggested and incorporated to avoid the extra items claims which may arise at the time of execution.

• Safety and quality clauses are ensured part of GCC, so that violations can be avoided and dealt with penalty at worst cases or repetitive occurrences.

• A design workshop/pre-bid meeting is arranged with all the stakeholders and vendors, so that a design intent could be explained to everyone to remain on same page or mitigating ambiguity.

• Line item wise comparative is prepared for neck and neck bench marking.

3. Execution Phase: In execution phase, all vendors should be managed in such a way that all the parallel activities executed are as per the plan. A master construction schedule is prepared and tracked rigorously. A weekly coordinated meeting with all vendors is arranged to ensure that work goes on smoothly and seamlessly or as per agreed plan.

INFRASTRUCTURE

Following measures are taken into consideration while execution phase to meet the quality and progress.

• Design workshop is arranged with architect/ consultant and vendors, so that design understanding is made clear and to avoid any ambiguity in the execution phase.

• Alternate options are suggested for quick execution.

• Measurement of quantities is ensured to meet the BOQ. • Quality checklists are implemented to check the incoming material conforming to list of makes.

• Execution Quality Checklist- Various quality checklists for each activity is implemented to maintain the desired quality.

• Relevant tests are conducted conforming to relevant Indian Standard codes.

• MEP Checklist- All facility test of the capital equipment’s ensured to be conducted.

• Medical services are laid out and coordinated with other services so that rework could be avoided.

• OT- Seamless joints of floor is maintained from the hygienic point of view, guidelines for maintaining laminar flow is implemented and HEPA fitness to be ensured.

4. Project Closure and Trial Run: A strategy is penned down and informed to vendors for timely closure. Following measures must be taken to ensure the success of this phase: • Trail run and training is arranged to FM team for seamless transition.

• As built drawings and warranty certificates are a part of handing over documents.

• Commercial closure.

Apart from the above, following trackers are implemented throughout the project cycles to ensure seamless delivery of the project. u Budget Tracker- Regular budget tracker is maintained. u Project Management tools – following are the prominent tools: • Schedule tracker - MSP

IDENTIFIED RISKS, CHALLENGES AND MITIGATION SR. NO

RISK/CHALLENGES

MITIGATION

1

Statutory Approvals

Suggesting and helping client with the required no of approvals.

2

Medical Equipment Coordination, Finalisation and Procurement

Plan in advance to meet the schedule, services inputs and consideration to avoid later reworks and cost over run

3

Design ManagementCoordination

Coordination with all stakeholders to meet the design intent.

4

Budget/ Cost Escalation

Regular budget tracking, accurate site measurement to avoid inflated claims of the vendors and extra items if comes to be negotiated per market rates.

5

Ambiguity in Technical Specs/ Drawings/ BOQ

Giving inputs at the design stage to avoid extra claims by vendor and delaying.

6

ProcurementVendor & Capital Items

At par comparison and line item wise discussion with the vendors, rate analysis on market rates and capital equipment purchase at competitive rates.

7

Delay in delivery of long lead items

Rigorous follow up for timely delivery

8

Quality & Safety Issues

Checklists are followed for each and every activity, safety process too implemented.

9

Schedule over run

Regular schedule tracking with schedule.

10

Change Management

Record of change management to ascertain the delays and impact because of the changes.

11

JCI & NABH Accreditations Standard Implementation

Follow up with consultants and get the necessary implementations.

• Weekly/ Monthly progress report • Risk Register • Material Tracker- Long lead items • Manpower Tracker u LEED Tracker - Coordination with LEED consultant, recommended measures implementation, so that target LEED rating could be achieved.

Mohd Khalid is Deputy General Manager with CBRE South Asia Pvt. Ltd.

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QUALITY

Stop medical abbreviations

1

Avoiding the use of unclear abbreviations is a key step in preventing medication prescription errors

BY ANUP KUMAR MISHRA

W

1. Patient safety is an important element of an effective and efficient healthcare system where quality prevails.

28

hen we talk about patient safety, we are actually talking about how hospitals and other healthcare organisations protect their patients from errors, injuries, accidents, and infections. In some hospitals, patient safety is a top priority. Strong healthcare teams reduce infection rates, put checks in place to prevent mistakes, and ensure strong lines of communication between hospital staff, patients and families.

Patient safety is an important element of an effective and efficient healthcare system where quality prevails. This is how both the core elements are related:  Safety has to do with lack of harm. Quality has to do with efficient, effective and purposeful care that gets the job done at the right time.  Safety focuses on avoiding adverse events.

Quality focuses on doing things in the right way.  Safety makes it less likely for mistakes to happen.

The World Health Organisation (WHO)

MARCH 2018 | HEALTHCARE RADIUS

as part of the initiative to develop Patient Safety Goals had assigned the Joint Commission and Joint Commission International (JCI) as a WHO Collaborating Centre on ‘Patient Safety Solutions’. In the context, the JCI has developed the ‘National Patient Safety Goals’. Currently, the National Patient Safety Goals (NPSG) 2017 is in practice, effective since January 2017.

Abbreviations are commonly used in the medical world to save time and space while writing the patients' medical records.

As various specialties have evolved, each has developed a collection of commonly used abbreviations which may not be recognisable to those not working within the same field.

In the past decade, medication errors have emerged as a significant patient safety concern. One intervention aimed at reducing the incidence of medication errors is improving written or electronic communications, particularly in patient medical charts. Avoiding the use of unclear or misleading abbreviations is a key step to

QUALITY

Table 1 – The Joint Commission’s 'Do Not Use' Abbreviation List' Do Not Use

Potential Problem

Use instead

U (unit)

Mistaken for “0”, the number “4” (four), or cc

Write “unit”

IU (international unit)

Mistaken for “IV” (intravenous) or the number “10” (ten)

Write “international unit”

Q.D., QD. q.d, qd (daily) Q.O.D, QOD, q.o.d, qod (every other day)

Mistaken for each other; period after the “Q” mistaken for “I” and the “O” mistaken for “I”

Write “daily” Write “every other day”

Trailing zero (X.0 mg)# Lack of leading zero (.X mg)

Decimal point is missed

Write “X mg” Write “0.Xmg”

MS MSO4 and MgSO4

Can mean morphine sulfate or magnesium sulfate; confused for one another

Write “morphine sulfate” Write “magnesium sulfate”

*Applies to all orders and all medication-related documentation that is preprinted handwritten (including free text computer entry) or on preprinted forms. # Exception: A 'trailing zero' may be used only where required to demonstrate the level of precision of the value being reported, such as for laboratory results, imaging studies that report size of lesions, or catheter/ tube sizes. It may not be used in medication errors or other medication related documentation.

preventing medication prescription errors.

This requires healthcare organisations to maintain a standardised list of abbreviations, acronyms, and symbols that are not to be used.

The National Accreditation Board for Hospitals & Healthcare Providers (NABH) a constituent body under the Quality Council of India (QCI), also mentions in its standard to avoid use of abbreviations to ensure patient safety.

In 2004 The JCI introduced the 'Do Not Use list of abbreviations (Refer to Table No 1). Also addition to the 'Do Not Use' list, the healthcare organisation is required to develop additional restrictions pertaining to the use of abbreviations.

Recommendations for improving communications through minimisation of abbreviation use i. Initiate a programme to eradicate the use of abbreviations in clinical practice and for that, an interdisciplinary approach is essential.  Post prohibited abbreviation lists on

hospital identification badges, in patient charts, newsletters, etc.  An intranet site, computer screen sav ers, and announcement boards.  Use peer-initiated accountability.

 Give rewards for non-usage.

ii. Educate staff on the harmful effects of abbreviations.

iii. Minimise the use of abbreviations, write out the drug name, schedule, and unit of measure.  Prohibit use in patient charts, pre-print ed order forms, computer programmes. iv. Clarify the intent to avoid misinterpretation if abbreviations are found. v. Introduce computerised physician order entry in a manner that minimises the use of abbreviations. vi. Include industry, organsational, educational, and professional bodies in error-prone abbreviation awareness and avoidance.

There were many misinterpretations of the abbreviations across the specialties that pose imminent clinical risk. While abbreviations may indeed save time, the observed inter-group variation in correct interpretation of these abbreviations is unacceptable.

It is recommended that the abbreviations have no place in the multi-disciplinary world and their continued use will only lead to eventual clinical errors. Hence to ensure patient safety and maintain quality in a healthcare organisation, the use abbreviations should be avoided.

Anup Kumar Mishra is AGM, BBC Heartcare Pruthi Hospital & Capitol Hospital, Jalandhar, Punjab.

HEALTHCARE RADIUS | MARCH 2018

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DIAGNOSTICS

1

Revolution by molecules of pathology Molecular pathology combines the principles or techniques of molecular biology with diagnostics technology of pathology practice

BY DR SUJAY PRASAD & HEMANTH K PRASAD

M

1. Molecular pathology is a highly dynamic and exponentially expanding field that continues to revolutionise our approaches to both diagnosis and therapy.

30

olecules are the biochemical foundation of life. Molecular pathology combines the principles or techniques of molecular biology with diagnostics technology of pathology practice to study these molecules in disease states to provide valuable insights for clinical management and research.

It is a highly dynamic and exponentially expanding field that continues to revolutionise our approaches to both diagnosis and therapy.

The relevance of molecular pathology has been demonstrated by the several outcomes of this approach, especially by

MARCH 2018 | HEALTHCARE RADIUS

successful landmark therapies targeting genetic alterations including:  Imatinib treatment of chronic myeloid leukaemia with BCR-ABL gene fusion.  The response of ERBB2 gene amplified breast carcinomas to the anti-ERBB2 antibody trastuzumab.  The efficacy of tyrosine kinase inhibitors erlotinib and gefitinib in the treatment of EGFR-mutated lung adenocarcinomas.

The potential of its applications in clinical diagnostics is ever expanding due to the continuous increase in the number of therapeutic targets and the tremendous demand for companion diagnostics. There are multiple facets of molecular techniques

DIAGNOSTICS

with an ever-widening scope and significance which necessitates great levels of comprehension with specialised skills for clinical integration.

1. Cytogenetics: The study of chromosomal number and structure by Karyotyping and FISH (Fluorescent in-situ Hybridisation) methods have established role in diagnosis, prognosis and treatment diseases particularly in haematological malignancies.

2. Polymerase Chain Reaction (PCR): This is based molecular assays use a pair of priming complementary sequences (oligonucleotide primers) to flank a genetic component (DNA/RNA) of interest, together with unique heat-resistant polymerases (DNA copying enzymes) to amplify and analyse these molecular targets to understand their clinical significance.

The development of specialised PCRs including RT-PCR, Methylation PCR and Digital Droplet PCR will only expand its applications in the study of the molecular pathogenesis for infectious pathogens, genes implicated in cancer and inherited diseases.

3. Microarrays: This is a multi-plex lab on a chip used for several clinical applications including the classification microbial pathogens, cellular responses to pathogens, drug and toxic exposures, tumour classification, single nucleotide polymorphism detection, the detection of gene fusions, comparative genomic hybridisation and gene expression profiling. Microarray-based clinical tests have become powerful tools in the diagnosis and treatment of diseases, particularly cancer related tissue arrays that are bringing together anatomic and molecular pathology.

4. Conventional sequencing: This includes platforms of Sanger sequencing and pyrosequencing which have been time tested but are limited about multi-target assays and still serve a crucial purpose of validating data generated from other methods.

5. Next-Generation sequencing: This massively parallel or deep sequencing are related terms that describe a DNA sequencing technology which has revolutionised several fields including molecular pathology. It can capture a broader spectrum of

2. Pathologists must play a crucial role in innovation.

2

HEALTHCARE RADIUS | MARCH 2018

31

DIAGNOSTICS

3 mutations or genetics targets and provide an option to analyse whole genomic data without any biases.

6. Immunophenotyping: Flow cytometric immunophenotyping offers the sensitive detection of antigens on cell surface and immunohistochemical (IHC) immunophenotyping involves the process of selectively imaging antigens (proteins) in cells of a tissue section for diagnosis of inherited and malignant diseases. These techniques have extensive applications in diagnostic hematopathology and histopathology, as cytogenetic and molecular findings evolve they will bring additional applications of immunophenotyping to the field of pathology.

A

3. The pathologist of the future needs to combine morphological methods with practical and theoretical knowledge.

32

s many molecular techniques including cell-free DNA analysis (circulating tumour DNA or liquid biopsies), single cell genomics (circulating tumour cells) make their expected transitions into the clinical arena, molecular diagnostics will become an integral part of our clinical practice and patient care forming the advanced molecular microscopes of pathology evaluation.

MARCH 2018 | HEALTHCARE RADIUS

The facts below highlight both prospects and challenges for molecular pathology in the future: 1. The first sequencing of the human genome with the traditional Sanger technology required approximately 13 years and cost of about $ 3 billion in 2003 during the completion of the milestone human genome project can now be analysed within a week at a cost close to $ 1,000 by NGS. 2. Currently even small bench top NGS instruments sequence 3–15 giga bases per day with the reduction in the cost of sequencing leads to enormous amounts of sequencing data, creating new paradigms of data analytics and validation for laboratory practice.

Pathology is changing, and thus a pathologist must play a crucial role in innovation, making the most of the opportunities offered by technology in all specialties to remain relevant, engaged and contribute to efficient patient care. The pathologist of the future needs to combine morphological methods with practical and theoretical knowledge in genetics, cell biology, biochemistry and bioinformatics to support definitive diagnosis and prognosis.

The way forward is to integrate to accommodate the wide variety of skill sets required to ensure a clinically effective molecular pathology programme. The message of the science must percolate across the boundaries of medicine forming multidisciplinary team including pathologists, biomedical scientists and genetic counsellors in the laboratory to support the clinical experts in various fields to harness the advances in science and technology and pilot the concept of personalised medicine with the ultimate goal of better patient care.

Dr Sujay Prasad is Medical Director, Neuberg Diagnostics and Hemanth K Prasad is HOD & Senior Manager, Scientific Applications and Support, Anand Diagnostic Laboratory and NeubergAnand Reference Laboratory.

CONSUMER CONNECT

Intelligent Technology Ventilator Model Flight 60 from Israel

O

n spending: "If you buy things you do not need, soon you will have to sell things you need." ~ Warren Buffet On saving: "Do not save what is left after spending, but spend what is left after saving." ~ Warren Buffet Operating ICU ventilators in critical care and emergency care environment is becoming a challenge for all size of hospitals, due to non-availability of trained and professional staff. With increase in patient turnover when a critical patient arrives into the emergency care area, patient stabilisation and fixing of ventilator is time consuming and needs trained professionals to make the ventilator settings.

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We have more than 400 hundred satisfied users of Flight 60 ventilators in India and around 2,500 worldwide including USA, Europe, Japan and Asia Pacific.

Remarkable performance and features in a portable and easy-to-use package, the Intelligent Ventilator Model Flight 60 is used in a range of hospital needs while improving patient comfort & independence, flow sensor interface technology allows patient friendly (Synchrony) and helps quick patients recovery. ⊲ Flight 60 Ventilator is supplied with advance modes as well as standard ICU Modes

Advance Modes • Volume / pressure and PRVC New volume guaranteed MVG mode Intelligent mode advance pressure control ventilation.

• Volume Guarantee ventilation: It is a dual control mode of ventilation, combining two basic ventilation controls (volume control and pressure control). When using the volume guarantee mode, the patient is given pre-set volume of gas even though it is pressure control ventilated. Flight 60 will ventilate patients at lowest pressure possible while guaranteeing set volume of gas to reach patient's lungs.

• New Bi-Lev Mode : Bi-Phasic Ventilation is a time cycle pressure mode. In this mode, the patient is allowed to breath spontaneously at both the high and low pressure baseline pressure support.

NIV Mode of Ventilation ⊲ Standard ICU Modes CMV-Pressure Control/Volume control, SIMV Pressure Control or Volume and Spontaneous/CPAP with pressure support with apnea back up ventilation. Flight 60 ICU Ventilator is FDA certified for use in intra hospital transport with the help of 8-hour power back up and also provides high pressure, low flow oxygen port available for mobile and rugged design ensuring patient safety ventilation on move.

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Phone : +91 040-27901151 / Mob : +91 9849742099

HEALTHCARE RADIUS | MARCH 2018

33

OPINION

Enhancing access

This year’s Union Budget has been a people’s budget with thrust on healthcare Ameera Shah, Promoter and Managing Director, Metropolis Healthcare Finance Minister Arun Jaitley announced a new flagship National Health Protection Scheme, providing health insurance cover of Rs 5 lakh per family in a year. The Scheme will cover 10 crore vulnerable families, with approximately 50 crore beneficiaries. This programme is said to be world’s largest healthcare programme ever. This is one of the path-breaking announcements made by our Government which will slowly take us towards universal health coverage. This ushers India firmly in the next generation of social security, as India moves aggressively

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MARCH 2018 | HEALTHCARE RADIUS

towards a progressive developing economy.

I am quite happy with the Government's plan to introduce 24 new medical colleges.

That is the only way to address the glaring lack of talent in the industry. Besides reinforcing access healthcare, the health insurance cover will lead to the creation of jobs in the sector as new facilities come up in districts and villages.

This move will go a long way in empowering India’s poor and underprivileged.

Another important announcement has been of the 1.5 lakh centres which will provide free essential drugs and diagnosis and is a step towards boosting the Government’s National Health Policy. Through the budget,

Dr Prem Nair, Medical Director, Amrita Institute of Medical Sciences, Kochi This is a comparatively much better budget for healthcare delivery system of the country.

The initiative on the Universal Health Care is commendable.

This will surely be one of the world’s largest healthcare programme that proposes to cover 10 crore vulnerable families, with approximately 50 crore beneficiaries. The scheme for creation of 1.5 lakh health and wellness centres, which are intended to provide free essential drugs and diagnostic services, will definitely make healthcare much more accessible to the people. However, no allocation has been made in the budget for private public partnership or even engaging private healthcare organisations in healthcare delivery by the Government.

Ferzaan Engineer, Co-founder & Chairman, Cytecare Cancer Hospital, Bengaluru 1

the Government has definitely shown its interest in making healthcare more accessible and affordable through the 'Ayushman Bharat' programme. In addition, the finance minister urged the private sector to support the government’s healthcare initiatives through their corporate social responsibility (CSR) and philanthropic activities which will give a boost to public-private partnership in this sector.

The Government is also paying close attention to life-threatening diseases encapsulating in the country. To curb this, Rs 600 crore corpus has been set up to help TB patients. This initiative will help cover more patients suffering from tuberculosis.

The focus on healthcare is a positive development, particularly the move to enhance medical education across the country. There is an urgent need to improve the patient to doctor ratio and also to train specialists in critical diseases such as cancer. The budget takes cognisance of three key challenges in healthcareawareness, access and affordability.

Long-term planning and high quality execution will be the key determinants of success.

1. There has been a good balance on short term respite from out of pocket health costs and building capacity in the long term.

HEALTHCARE RADIUS | MARCH 2018

35

OPINION

V Thiyagarajan, MD, India Home Health Care Hospital, Bengaluru We feel that this year's budget is aimed at touching the lives of the rural folk to bridge the gap between the rural and urban population. We feel that utilising 1.5 lakh healthcare centres across the country will bring the health benefits to almost all the households. We also welcome the Government's move to provide free essential drugs and diagnosis, as it will reduce the burden on people seeking treatments for life threatening diseases. It will also help in promote Universal Health Coverage for all under the National Health Policy. The launch of National Health

Sabesan, CFO Dr Agarwal Group Of Eye Hospitals The thrust on healthcare in this year’s union budget was indeed a long awaited one.

The National Health Protection Scheme proposed by the Government will help in bridging the accessibility gap significantly. It will reduce the healthcare cost burden and help all strata of society to avail cashless facilities. Also, the move to set up new Government Medical Colleges and Hospitals will bridge the lack of trained clinical specialist especially in the rural areas. Further, the tax rate relief on entities with turnover of upto Rs 250 crore will also positively impact the sector. It will allow the mid-sized healthcare players to invest and thereby improve the health care availability in the country.

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Protection Scheme with an enhanced Rs 5 lakh medical insurance and over 10 crore families is going to be a game changer in the healthcare industry. We also welcome the Government's new initiative to allocate Rs 600 crore to support tuberculosis patients. Overall, we feel that the budget is going to enhance productivity, better access to healthcare facilities for rural and urban population and generate more jobs in the sector especially for women. We also feel that the budget should have covered the areas of palliative care, chronic and critical illnesses.

Ganesh Sabat, CEO, Sahajanand Medical Technologies Pvt Ltd This year’s Union Budget has been a people’s budget with a focus to uphold Modi’s ‘Make in India’ campaign.

Schemes such as the launch of National Health Protection Scheme and bringing 24 new medical colleges pan India are some useful highlights being implemented by the Government.

Through the introduction of these massive health programmes, the Government is giving a clear signal that it is concerned about the healthcare and social security of the masses and they believe that healthcare is one of the backbones of the economy. This step is a productive move towards the path of universal healthcare for the poor and weaker section of our society.

OPINION

Vishal Bali, Co-Founder & Chairman, Medwell Ventures The big move towards the path of Universal Healthcare Coverage under the flagship National Health Protection scheme which will bring 50cr citizens with Rs 5 lakh /family for secondary and tertiary care hospitalisation is transformational for the country.

The question to answer is how will the scheme be funded and executed given the fact that health is also a state subject.

This move coupled with the announcement of 24 addi-

tional Government medical colleges and hospitals gives healthcare the centre stage in this budget.

In addition, the increase in tax exemption for senior citizens on health insurance premium and medical expenditure is a good move. This was also the opportune time for the FM to give infrastructure status to the healthcare sector and provide the much needed acceleration to capacity creation in the sector.

Dr Kaushik Murali, President, Sankara Eye Hospital There has been a good balance on short term respite from out of pocket health costs and building capacity in the long term.

Health can be one of the key job creators. More focus from the Skill India initiative with these announcements should see this sector contribute in this area too.

We hope that other announcements like the Pradhan Mantri Research Fellowship and the Research allocation would also spur healthcare research. With Rs 1200 crore to the National Health Policy, we look The Ayushman Bharath the scheme to forward to a continued impetus to the Naprovide health cover to 50 crore Indians tional Programme for Control of Blindness of Rs 5 lakhs is simply audacious in scale which is one of the most successful public and reach and could be a game changer. private healthcare programmes.

Healthcare needs to be universally accesIt would be interesting to see how these sible and also start from preventive care. would be funded, the finance minister This should be taken care of with the proindicated a widening of the tax base and an posed 1.5 lakh health and wellness centres . additional 1% cess, we only hope that the The idea to increase the number of doc3.5% fiscal deficit does not force a rethink tors is good with the 24 district hospitals on these allocations later. Also, it would be being upgraded. However, strengthening good to expand the ease of doing business of the other post graduate programmes to ease of working with insurance and like the DNB course would also need to be schemes and simplifying the process for done simultaneously. healthcare providers.

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TREND

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A new fitness community Many track their fitness regime and food habits through wearable devices and applications

BY JASAL SHAH

E 1. These applications more or less perform the same functions as a personal trainer or a health club membership.

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xercise is to the body what reading is to the mind! Exercising for at least two hours every week is integral to prevent lifestyle diseases like diabetes and cholesterol. It has also been proven that it can help people deal with stress better, focus on their work more and it even acts as an antidepressant. However health and fitness is increasingly taking a back seat, as people lead more sedentary lifestyles coupled with an affinity for junk food. In fact, it is said that most people take better care of their cars rather than their own bodies. While technology has made our lives far easier in every walk, it was also a major culprit in making people lethargic and ignorant about their overall health.

But the good news is that this trend has

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been slowly changing around the world. A majority of the population suffered in some way or the other for their unhealthy lifestyles which in turn forced them to take a long hard look at their lifestyles.

Rising obesity and health concerns have resulted in an increasing demand for wearable fitness tracking devices, fitness applications and smart watches that are today flooding the market. These devices are rapidly gaining popularity especially in the urban areas of the country. A study that was recently conducted across India’s leading metro cities reveals that over 97% of the respondents believe that it is imperative to stay fit and around 80% have started to track their fitness regime and food habits through wearable devices and applications. Apart from the fact

that they are always more or less accurate and user-friendly, people also enjoy the apps' or tools' features in allowing users to compare, sync and share their data with others.

Most of these applications can also chart out personalised work out schedules and diet plans to be followed at a minimal charge or mostly free of cost. It also allows fitness enthusiasts to network with other like-minded people which in turn helps keep them motivated. The devices or apps display a heart rate monitor, count the number of steps taken, remind users to drink enough water throughout the day, keep a track of the calories consumed, track the sleep patterns and even alert users when they have been idle for too long. They integrate seamlessly into our lives and help users adopt a healthy lifestyle by working around their schedules without daily inputs or effort to manage- all of which have made them a hot favourite among people of all ages.

The study found that applications like DailyBurn and MapMyRun have significantly higher user rates among the female population. People with higher MHI (Monthly Household Income) know more about different fitness tools, and commonly use a Fitbit, DailyBurn, Apple/Samsung Proprietary Apps or the Nike Training Club. While people with lower MHI mostly use free mobile applications, 3 out of 10 respondents said that they don’t have a membership in a fitness centre because it was expensive. These applications more or less perform the same functions as a personal trainer or a health club membership without users having to shell out large amounts of money.

Another interesting fact is that there are also city wise preferences for such apps and tools which depend on various factors like the amount of time they can spend exercising, what form of exercise they prefer and their personality type. Delhites mostly prefer to use MyYogaOnline while Mumbaikers usually turn to DailyBurn. The study also proves that most people prefer more traditional exercises like jogging or Yoga rather than core fitness activities like zumba or aerobics. This

2 could well be because of a lack of both time and disposable income. Different regions also have a different proportion of people who lead healthy lives. For instance; none of the respondents from Delhi have a fixed exercise routine, which is significantly lower than Kolkata where 14% of the respondents, 9% from Hyderabad and 6% from Mumbai said that they follow a certain routine.

More than 50% of the respondents said that they had never taken a health club membership and instead preferred to workout at home or outdoors in an open space. Around 30% also said that they have complete faith in the virtual mode of consulting and prefer it to the traditional model, especially since it offers them more flexibility.

It is important to remember that there is no one size fits all approach towards healthy living. An important component to maintaining a workout regime and eating right is to make sure that you make your own choices with some help from the experts, and most importantly ensure that you stick to these choices.

Jasal Shah is CEO and Managing Director of Markelytics.

2. There is city wise preferences for such apps and tools.

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ANALYSIS

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Modicare –A SWOT analysis The National Health Protection Scheme brings the Government to the forefront and positions it in the leadership role

BY ANAND GARG

T 1. The scheme plans to cover 100 million poor families and 500 million people.

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he National Health Protection Scheme (NHPS) aka Modicare announced by the Finance Minister Arun Jaitley in this year’s budget is a good initiative and is a welcome move. Under this plan, christened as ‘Ayushman Bharat’, the central Government will cover 100 million poor families and 500 million people, providing each family an insurance cover of up to Rs 5 lakh per year for secondary and tertiary care or for hospitalisation. The scheme is estimated to cost the Government

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exchequer about Rs 10, 000 crore annually.

In India, the secondary and tertiary care penetration is abysmally low with per capita expenditure on healthcare at Rs 13,000 compared with China at Rs 37,000, not to mention the USA at Rs 5, 75, 250 and the UK at Rs 2, 10, 275 respectively; an initiative of this kind is the need of the hour. The central Government’s intent to include poor people from rural, peri- urban and urban areas in the healthcare eco-system is a step in the right direction. In this context, it must be

ANALYSIS

acknowledged that the Government has not only been initiating long-term sustainable systemic reforms across sectors but has also been undertaking initiatives to ensure service delivery to its citizens, particularly in care, education and infrastructure areas.

Successful implementation of any such scheme is the hallmark of availability of adequate financial resources, infrastructure and skilled manpower besides business friendly regulatory environment. So, also is the deployment of technology, particularly in the 21st century where Artificial Intelligence (AI), M2M, Internet of Things (IOT) and Big Data are simplifying things and playing an enabler’s role in developing solutions to find answers to day-to-day problems, thereby making a huge impact in people’s lives and businesses alike.

It is here, though, that people maybe somewhat sceptical about successful implementation of such schemes in the present context.

Lack of understanding apart, given that, the contours of the full scheme have not yet been shared in the public domain, there may be concerns about how well the scheme may fulfil its objectives. Such scepticism may emanate from the lack of healthcare infrastruc-

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ture in the country where doctor-to-patient ratio stands at 1:1674 against the WHO guidelines of 1:1000. Further, India needs 30 lakh hospital beds to achieve desired target of 3 beds for every 1,000 people. As per an estimate, the country needs more than 10,54,000 doctors and more than 20,40,000 nurses and other para-medical staff respectively to meet the growing demand for healthcare. Clearly, there is a huge gap between the desired infrastructure and required trained manpower respectively and current availability of the same in the country.

It may be argued that ideally, the Government must make efforts to bridge this wide gap between demand and supply of healthcare infrastructure and trained manpower, both medics and para-medics, at the outset.

However, the financial resources and the time taken to build brick and mortar healthcare infrastructure of hospitals, medical clinics and medical educational institutes such as medical and nursing colleges and AIIMS in a vast country of 1.3 billion people and to ensure supply of trained manpower is likely to put humongous demands on the Government exchequer besides taking a lot of time before the above numbers are met. It is esti-

2. NHPS offers a great opportunity for deployment of technology to create a digitised healthcare ecosystem.

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ANALYSIS

3. The biggest threat to any such programme is inability of key stakeholders to implement it.

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mated that India may need an investment of Rs 55,900 crore to achieve this target. People may also argue that the Government should have preceded setting up of the necessary healthcare infrastructure and also ensured availability of skilled manpower before embarking upon such an ambitious healthcare scheme like NHPS, without which the desired outcomes - namely providing healthcare services to underprivileged people, particularly in under- served areas may remain suspect.

The good news, though, is that such a healthcare eco-system can be created, thanks to technology and some solutions which have already been developed in the field of healthcare in India as well as elsewhere, particularly in emerging markets. The first priority is to create technology enabled platforms to include people in the digitised healthcare eco-system.

A digitised healthcare eco-system comprising doctors, diagnostics and pharmacy stores across the length and breadth of the country using Cellular Technology, Internet of Things, the Cloud and Big Data may facilitate holistic healthcare delivery to people. Using the voice, video and text features of the system, in most states, thanks to increased and improved telecom services availability; online medical consultation can facilitate doctor prescription, diagnostic tests and supply of

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medicines and consumables locally without a need to travel to district headquarter town, state capital or metropolitan city.

This system can also facilitate referral to a tertiary care hospital for further investigations or hospitalisation in case of advanced or chronic disease management needs. Collaboration with local Government infrastructure and Common Service Centers (CSC), insurance companies and private hospitals through the NHPS will go a long way in institutionalising the digitised healthcare eco-system.

Similarly, Cloud and Big Data can help create and maintain digital patient health records for future disease management and ease of service delivery. Digitised patient health records are almost non- existent today, causing huge challenges to the doctors in mapping the individual disease life cycle and speedy and predictive and curative treatment.

Now, let me get back to the title of this piece: Modicare – A SWOT Analysis.

Originated by Albert S Humphrey, SWOT (Strength, Weakness, Opportunity and Threat) is a tool used in the business context to discover strengths, weaknesses and opportunities; and manage and eliminate threats of an idea, product, service or solution in the market place.

ANALYSIS

4 STRENGTH The NHPS brings the Government to the forefront and positions it in the leadership role to address a core priority area, such as healthcare in the country which has been experiencing a huge demand and supply challenge.

The scheme is expected to play the role of a catalyst in healthcare education, leveraging technology, development of entrepreneurship, growth of PPP model in healthcare and investment in the sector. If implemented well, it also has the promise to bring down significantly the disease burden in a young nation on one hand and also bring down the healthcare cost burden on poor people across the country, on the other. It also augurs well for the much needed job creation and encouragement to entrepreneurship, particularly in PPP model in the country.

WEAKNESS This scheme is unlikely to yield the desired outcomes of bridging the healthcare divide in the nation due to shortage of healthcare infrastructure, non-availability of adequate trained manpower – both medics as well as para medics, without adequate leverage of technology; and non-availability of funding due to hitherto lack of Government support.

OPPORTUNITY NHPS offers a great opportunity for deployment of technology to create a digitised healthcare eco-system to remove the bottlenecks of poor healthcare infrastructure and shortage of trained healthcare specific manpower in the country, thereby making healthcare services available and accessible

more pervasively in the country and more importantly, it has the potential to ensure inclusion of the masses in a cost effective and Government funded healthcare system.

THREAT The biggest threat to any such programme is inability of key stakeholders to implement it well – not having the ability to execute flawlessly is not an option. NHPS is no exception to this. Bureaucracy, central and state Government agencies, entrepreneurs, insurance companies, hospitals, doctors, pathology laboratories, diagnostic centres and political class (with bipartisan approach) must collaborate to make this scheme successful.

In conclusion, the NHPS or Modicare is yet another systemic change the Government proposes to invest heavily into, albeit, without adequate infrastructure and skilled manpower in place. However, adoption of technology to mitigate these bottlenecks and more importantly, to develop a digitised healthcare eco-system comprising doctors, diagnostics and pharmacy stores, coupled with Indian entrepreneurship spirit and encouragement to PPP model is likely to help bridge the healthcare divide in the country where 70% people still live in rural areas. It also promises to attract investment in the sector and fuel job creation.

Anand Garg is a healthcare industry advisor.

4. Modicare is yet another systemic change the Government proposes to invest heavily into, without adequate infrastructure and skilled manpower.

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CONSUMER CONNECT

Advance your diagnostic confidence The Ob/Gyn imaging solutions from Philips provide superb image quality for fast, confident decision making.

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ith a history of proven leadership and innovation fueling exciting new chapters in ultrasound evolution, our latest premium ultrasound platform is designed to meet changing healthcare needs and exceed our users’ highest expectations. As we integrate new applications, improve workflow and produce groundbreaking capabilities, we will continue to challenge how the industry defines ultrasound technology.

MaxVue high-definition display - Remarkable visualisation!

At the touch of a button, the new MaxVue high-definition display brings extraordinary visualisation of anatomy with 1,179,648 additional image pixels compared to a standard 4:3 display format mode. MaxVue enhances ultrasound viewing and provides 38% more viewing area to optimize the display of dual, side/side, biplane, and scrolling imaging modes.

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TrueVue - Making images more realistic!

TrueVue creates images that are more realistic, appealing and at the same time providing more clinical information. TrueVue, with its virtual light source, is a proprietary advanced 3D ultrasound display method that delivers amazing lifelike 3D ultrasound images and gives the operator the ability to move the light source anywhere in the 3D volume.

CONSUMER CONNECT

GlassVue – Going beyond the surface!

GlassVue goes beyond the surface to reveal bone, organs, and other internal structures.

GlassVue, with internal light source, provides an early, more transparent view of the fetal anatomy than traditional ultrasound. aRevealA.I – Revealing more details at a click of a button! aReveal is an AIUS (Anatomical Intelligence Ultrasound) feature that automatically sculpts away the soft tissues that lie in front of the fetal face, revealing much better facial features. Thus diagnosing cleft lips or cleft palates becomes easier and faster.

A.I.Breast – With this feature, Anatomical Intelligence is now applied for breast ultrasound for enhancing clinical efficiency, while simultaneously improving the ease of use. AI Breast allows visual mapping of screened anatomy, documenting full coverage of the breast during the acquisition phase. During acquisition, key images can be bookmarked for quick review. Images can be auto annotated and quick orthogonal views of anatomy can be retrieved easily for enhanced workflow and documentation.

MicroFlow Imaging Philips MicroFlow Imaging (MFI), is a proprietary imaging mode designed to detect low volume, low velocity blood flow found in fetal, placental, uterine and ovarian vasculature. MicroFlow Imaging overcomes many of the technical barriers associated with conventional methods to detect small vessel blood flow with high resolution and minimal artifacts. MicroFlow Imaging maintains high frame rate and 2D image quality while applying advanced artifact reduction techniques. New 2D image subtraction, 2D blending and side-by-side display options offer excellent visualization versatility

aBiometryAssit – Virtually every obstetrical ultrasound examination includes standardised measurements of fetal structures to assess age and growth trends. aBiometryAssistA.I. uses anatomical intelligence of fetal anatomy to automatically preplace measurement cursors on selected structures, which users can quickly accept or edit. This helps reduce conventional measurement steps and streamlines obstetrical report generation. aBiometryAssistA.I. allows selection of auto measure function for BPD, HC, AC, and FL fetal structures.

Evolution 4.0 and Continuum 2.0: Philips ultrasound has been constantly bringing to the fore, innovative technologies that are practically useful in the daily clinical practice. These technologies are focused towards improving the workflow while simultaneously delivering better clinical outcomes.

The latest Evolution and Continuum series further enhance our capabilities in the ObGyn ultrasound imaging. These include: TouchVue (TrueVue 2.0)– With the Evolution 4.0 upgrade, TrueVue adds a new interactive interface called TouchVue. The TouchVue interface utilises the touch panel to allow fingertip control of both volume rotation and position of the internal light source directly on the TrueVue 3D image. This obviates the need to use the control panel - including track ball – for working on the 3D/4D images. Similarly, the GlassVue is also now available on the touch panel itself.

Tilt –A new Tilt feature provides lateral steering of the 2D image plane to the right or left. 2D Tilt allows scanning access to anatomical structures that are off-axis without having to manually angle the transducer. This helps reduce the pain and discomfort to the patient, while allowing the user to scan a wider region of interest.

For further information contact; www.philips.co.in, 18004198844

HEALTHCARE RADIUS | MARCH 2018

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CONSUMER CONNECT

Carestream Health unveils new medical imaging Innovative solutions in medical imaging workflow, showcased using revolutionary interactive technology

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arestream Health demonstrated its expanding portfolio of medical imaging and healthcare IT systems at the 71st annual conference of the Indian Radiology & Imaging Association which was held in Mumbai from the 25th to the 28th of January. This year the IRIA was combined with the 17th Asian Oceanian Congress of Radiology, making this a not-to-miss event in the annals of radiology conferences in India.

With the theme 'Explore, Invent, Transform', Carestream invited attendees to explore and advance radiology, through innovative means which create a positive impact on patient care.

The company displayed an interactive touch wall which offered a first of its kind, unique experience of medical imaging workflow.

The fascia was once again futuristic and revolutionary in the true sense, especially in world of Indian radiology. The interactive touch wall exhibited the company’s innovative imaging solutions for acquiring, collaborating and sharing medical Images.

The Acquire interactive wall showcased the following products, highlighting the key benefits of each while displaying the workflow: • The DRX-Evolution Plus is a fully automated, ceiling suspended digital X-ray system with greater flexibility, extended tube column and a high performance Carestream generator. The forward looking design of the DRX Evolution Plus is devised to accommodate advanced imaging applications in the future.

• DRX-Revolution is Carestream's mobile x-ray system with a fully automatic collapsible column. Powered by a wireless DRX detector, this x-ray room on wheels drives like a dream and providing fast and high-quality images • The DRX Plus Detector: The DRX Plus detectors are lighter in weight, faster and more reliable than the earlier versions of the DRX family. Its Ingress protection rating and advanced enclosure design provides total protection against intrusion, dust and water.

• The Vita Flex CR System: The reason for the Vita Flex CR ‘s popularity includes its compact size, user-friendly nature, option for the radiologist to carry out simple repairs onsite, and a miniPACS option to view images on the go.

On the collaborate section Carestream displayed its’ Vue Clinical Collaboration Platform. Carestream’s healthcare IT portfolio includes a unified core architecture for its clinical collaboration platform that enhances security and complements healthcare pro-

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viders’ existing IT systems. This architecture delivers clinical image data acquisition, viewing, sharing and analytics, and allows healthcare facilities to add these features as needed. Physicians can use the company’s Vue Motion universal viewer to easily view and share patient medical images and reports using mobile devices.

On the interactive Output touch wall, the display included; Carestream’s Managed Print Solutions (MPS) which has brought about a revolution in the system of ordering, purchasing and stocking of x-ray films. The system, which operates through a dedicated web-portal designed by Carestream’s team of specialists, has made the entire process completely automatic.

The Carestream MyVue Center Self-Service Kiosk, which is the future of patient enabled imaging. This self-service radiology kiosk improves patient experiences by allowing them to print, store or share radiology images and reports while maintaining their privacy. It also helps busy radiology departments overcome challenges in meeting the expectations of growing patient populations amid reductions in operating budgets and staff, thus improving workflow productivity while reducing capital and operational costs.

The DRYVIEW 5700, DRYVIEW 5950 & DRYVIEW 6950 laser printers. The DRYVIEW 6950 Laser imagers’ extremely sharp 650 ppi resolution on every film size, provides exceptional image quality for general radiography and mammography.

The highlight of the exhibit was Carestream’s award winning OnSight 3D Extremity System which produces detailed threedimensional cross sectional images of injuries to bone or soft tissue in upper and lower extremities. It performs both 2D and 3D extremity exams which includes weight-bearing studies, thus enabling physicians to view these body parts under natural load. A huge advantage to the patient is reduced radiation exposure which is 50% lower than that of standard full-body CT. “From design features that ensure patient comfort and convenience to technologies that allow patients to view and manage their diagnostic images and X-ray systems that enable rapid diagnosis and timely treatment our advanced solutions support our customers in delivering true patient-centered care. This focus has enabled us to develop products like the MyVue Centre Self Service Kiosk, Onsight 3D Extremity System , Vue Clinical Collaboration platform and several other products,” said Sushant Kinra, Managing Director, Carestream India.