Healthcare Radius April 2018

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Aligning business and healthcare in India

Total number of pages 48

April 2018 Vol 6 • Issue 7 • `50

PATIENT SAFETY

TACKLING MRI ACCIDENTS

HR

TALENT RETENTION STRATEGIES

WHY DR HARISH PILLAI, CEO, ASTER DM HEALTHCARE, INDIA, IS BULLISH ON KERALA Published by ITP Media (India)

Contents 16 10 23

COVER STORY Dr Harish Pillai, CEO – Aster Hospitals and Clinics (India), Aster DM Healthcare, on creating the largest healthcare group in Kerala.

BULLETIN 10 This month's important news

SAFETY 35 MRI area should be physically

updates.

identified in four zones and personal into three levels.

IT 23 Healthcare players generate huge amounts of data everyday and saving it in the form of a hard copy only complicates matters.

INSURANCE 30 A high deductible policy brings down the amount you pay in premium.

HR 32 An employee should be

COMMENT 38 Modicare can provide the impetus to home healthcare.

MANAGEMENT 44 Deploying engineering simulation upfront in the design cycle will not only reduce the design and development time, but also ensure that the product is meeting the local needs.

engaged from the first day itself.

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EDITOR'S NOTE

The optimist Suave and erudite, Dr Harish Pillai emerged as one of the most promising leaders of the healthcare industry no sooner than he came back to India to join Aster DM Healthcare Group as the CEO of Aster Medcity, Kochi, in the year 2013. Within two years, he was promoted as the Cluster Head for Kerala and from April 1st onwards, he has been catapulted to the big league- he is now the CEO of Aster Hospitals and Clinics (India).

While Aster DM Healthcare has been a leading healthcare player in the GCC region for over three decades, its visibility in India occurred only around five years back. And in that short span of time, it exploded on the healthcare firmament to become the largest healthcare chain in Kerala.

It has been slowing spreading its tentacles in five Indian states and recently got listed in the bourses last February. And much of the credit for making Aster a pan India brand goes to Dr Pillai, who has made the Aster brand synonymous with cutting edge technology, world class doctors and quality healthcare delivery.

The fact that he has realigned services of some of the existing hospitals and planning projects to meet the regional healthcare needs of Kerala reflects his unswerving commitment to improving the healthcare infrastructure of his state. And despite the nursing strikes in Kerala that others perceive as a roadblock to growth, Dr Pillai is a die-hard optimist who sees the demand for higher wage to lead to retention of talent and enhancement in work productivity.

Besides charting out the growth of Aster in India, he does his bit to give a thrust to the industry as well. As National Co-chair of the FICCI MVT Task Force, his sincerity towards framing policy that will accelerate the process of positioning India as the global MVT hub has not gone unnoticed. He is truly an ace thinker, an astute strategist and a son of the soil, all rolled into one.

APRIL 2018 • VOL 6 • ISSUE 7

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BULLETIN

Columbia Asia receives investment of $210 Million

The fresh funds will be used primarily to build new hospitals and deepen the level of specialty care in existing facilities.

Columbia Asia Group , one of the largest and fastestgrowing healthcare companies in Asia, has announced that it has received an additional equity investment of $210 million, primarily from existing shareholders. The fresh funds will be used primarily to build new hospitals and deepen the level of specialty care in existing facilities.

Columbia Asia, owned by International Columbia US, LLC (ICU) and part of Seattle-based Columbia Pacific

Management, has 29 hospitals and two clinics across Malaysia, India, Indonesia, Vietnam and Kenya, built with an innovative business model focused on serving Asia's rapidly growing middle class. Columbia Asia facilities, with a wide array of specialised services, provide communities with accessibility to high value and modern efficient healthcare.

Dr Kelvin Loh, Group COO, Columbia Asia, said, "We are excited and pleased to announce receipt of additional equity to further expand our business across the region and continue our journey to meet the accelerating demand for cost-effective, quality healthcare in Asia. Besides expanding our network and improving the quality of our services, we will also be investing in digital technologies to make care even more convenient and cost-effective, in order to serve more patients."

Nate McLemore, Managing Director of Columbia Pacific Management which manages Columbia Asia, said, "Columbia Asia is one of the fastest growing hospital companies in Asia and now Africa. We believe there is still much more growth potential in the markets we serve and are pleased that this additional investment will further accelerate that growth."

HDFC invests in MedGenome MedGenome Labs Ltd., the leading genetic diagnostics company in India, has announced an investment by HDFC Ltd., HDFC Life and HDFC Asset Management to complete its Series C funding of $40 million.

MedGenome will utilise this capital to expand the clinical genomic testing market by penetrating all the tier II and tier III cities and democratise the critical genetic tests like noninvasive pre-natal screening (NIPT) and new born genetic testing. The company plans to establish more genetic centres in hospitals across the country to support clinicians and to enable patients to take informed decisions.

MedGenome has completed over 1,00,000 genomic tests and supported clinicians in diagnosing more than 40% unresolved cases. "We believe understanding genetic information can have a big impact on Indian healthcare industry through early detection of disease risk and development of new medicines. We are happy to support MedGenome in its endeavour to make genetic tests affordable and accessible widely," said Deepak Parekh, Chairman, HDFC Group.

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Bariatric surgery on a patient weighing 200 kilos Gleneagles Global Hospitals has successfully performed bariatric surgery on a patient with multiple health complications. Bariatric surgery has been shown to help improve or resolve many obesityrelated conditions, such as type 2 diabetes, high blood pressure, heart disease, and more.

Mueed Ahmed (35) approached Gleneagles Global Hospitals, Richmond Road, in December 2017. At the time he weighed 200 kgs with a high body mass index (BMI) of 87.2. Once a clearance was provided for surgery, the team at Gleneagles Global Hospitals, Richmond Road performed a laparoscopic sleeve gastrectomy and lap cholecystectomy.

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Dealership enquiries solicited for Ahmedabad, Bangalore, Chennai, Hyderabad, Kolkata, Mumbai. New Delhi, Pune.

BULLETIN

Wellthy Therapeutics raises $2.1 million Mumbai-based Wellthy digital therapeutic while Therapeutics, a digital developing solutions for therapeutics company other disease areas, build for chronic disease deeper integrations with management, anhealthcare stakeholders nounced that it has in South Asia and Asia, raised $2.1 million in and expand its team. seed funding. Dr Ranjan Commenting on the Pai through his famdevelopment, Abhishek ily office, along with Shah, Co-founder and Beenext Ventures, CEO, Wellthy TheraGrowX Ventures, Curpeutics, said, “Digital rae Healthcare and health interventions other strategic HNIs like are a necessity to enAshutosh Taparia and Abhishek Shah, Co-founder and hance the effectiveness Karan Bhagat particiof current chronic disCEO, Wellthy Therapeutics pated in the round. ease care. Our product Self-funded until this seed round, suite directly boosts outcome efficacy in Wellthy Therapeutics has spent the last incredibly significant ways, well beyond two years in clinical pilots and gatherwhat current healthcare is able to do. ing real world evidence of its solution This fund raise will help us continue to capability, and in the process has gradupioneer a new category of medicine that ated from the Merck Global Digital Health will revolutionise chronic disease care accelerator, Swiss Re’ Global and ICICI across Asia.”

Lombard’s Nova InsurTech accelerators.

As a part of this round, Siddharth The company plans to use this funding to Dhondhiyal would join the board as the enhance the efficacy of its type II diabetes investor representative.

Fortis, Shalimar Bagh, launches cancer care Fortis Hospital, Shalimar Bagh, has added a dedicated cancer care wing to its current array of specialties. The institute brings together experienced cancer care specialists backed with the latest technology under one roof. It aims to reduce the impact of cancer burden in the state by allowing for early screening and detection, thereby reducing late-stage diagnosis and mortality.

The centre is equipped with cuttingedge Radiation Therapy technology (VERSA HD) with world-class Monaco Treatment Planning System capable of

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APRIL 2018 | HEALTHCARE RADIUS

delivering therapies such as SRS, SBRT and SRT VMAT. Along with these, other radiation therapies such as 3D CRT, IMRT, IGRT are also available. In addition, the institute is equipped with Discovery GE HD PETCT, which provides crucial information regarding the stage of cancer and planning of radiotherapy.

Mahipal Singh Bhanot, Facility Director, Fortis Hospital, Shalimar Bagh, said, “The Fortis Cancer Institute offers a complete array of medical oncology, surgical oncology and radiation oncology services."

Fortis Malar performs rare transplant A team of doctors at Fortis Malar Hospital has recently conducted two complicated heart transplant surgeries by placing adult hearts into the heart cavity of children to save two lives here recently. Eight- year-old Roman and 12-yearold Sri Supriya were suffering from life threatening heart conditions that required urgent heart transplants. However, due to paucity of hearts of their age and size, the team of doctors led by Dr KR Balakrishnan, Director, Cardiac Sciences, Fortis Malar Hospital and Dr Suresh Rao KG, Head of Critical Care and Cardiac Anaesthesia, performed this clinical feat to transplant two adult hearts into the cavity of these two children respectively.

The first heart transplant was performed on Roman, from Russia who was admitted on 13th October 2017 at the hospital with prognosis of heart failure.

BULLETIN

MR Solutions launches a gradient coil upgrade for MRI MR Solutions, subsidiary This has substantially imMRS Magnetics, is launchproved system performance ing a gradient coil upgrade at a very competitive price. service for coil replaceProfessor Damian Tyler, ment within preclinical Associate Professor of MRI imaging systems. This Biomedical Science at will significantly improve the University of Oxford’s the magnet capability and Medical Sciences Division, system performance of said, “The system is quite older MRI systems including literally an order of magniBruker, Agilent, Varian and tude better in every respect, Magnex. and functions perfectly. The MR Solutions can also duty cycles are much better install smaller high strength The new gradient set allows to completely remove what was than our previous gradient removable gradient coils set, while the new set uses otherwise a substantial hardware limitation. within a larger gradient coil less power and therefore for research which requires higher gradient strength. As requires less cooling.” part of the upgrade service, the temperature sensor type David Taylor, Chairman, MR Solutions Group, added, and interface configuration would be upgraded to match “It seems a natural business progression to add gradient the gradient being replaced. coils to our preclinical MRI product portfolio as we have A new gradient coil and custom-built interface to fit our own manufacturing capability. This is just one of our the existing magnet has recently been installed within an MRI upgrade solutions which can bring older systems up existing Agilent MRI system at the University of Oxford. to modern specifications.”

Piramal Swasthya launches mobile health programme

Hinduja Hospital receives National Quality Award 2017

Ujjivan Financial Services in partnership with Piramal Swasthya, an initiative under the aegis of Piramal Foundation, has announced the launch of Mobile Primary Healthcare Programme in Pune, Mumbai and Nashik. The programme targets the unserved and under-served, and endeavours to make quality primary healthcare services available, accessible and affordable for all.

The infant mortality rate of 24 per 100 live births and maternal mortality of 68 per 1 lakh live births are significantly high in the state of Maharashtra. Inequity in access to healthcare services, as evidenced by health outcomes in Maharashtra, makes it imperative to come up with supportive programmes to provide available, accessible and affordable healthcare to the underprivileged communities.

Sudha Suresh, MD & CEO, Ujjivan Financial Services, said, “This financial year amongst other CSR initiatives, Ujjivan has partnered with Piramal Foundation for executing various CSR Programmes that endeavours to provide technology enabled health services to the community at large.”

PD Hinduja Hospital, Mumbai, was awarded the prestigious ‘IMC Ramkrishna Bajaj National Quality (RBNQ) Award 2017' in the healthcare category in March, 2018 in Mumbai. This Award makes Hinduja Hospital one of the few hospitals in India to be recognised the second time.

The hospital was evaluated by a panel of specially trained and expert judges who assessed the hospital on several parameters - quality of service, leadership, process management, strategic planning, and business results for over a period of few months. A team of auditors visited the hospital and studied the process of various departments along with presentations, data audit and interviews.

HEALTHCARE RADIUS | APRIL 2018

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BULLETIN

'Johnson & Johnson Institute on Wheels' kick-started The mobile surgical training centre was inaugurated by Dr Harsh Vardhan, Minister of Science & Technology, Government of India.

This unique mobile training centre will travel to various medical colleges and teaching hospitals across the country to train budding and practicing surgeons and para medical staff on specialities including general surgery, laparoscopic surgery, gastrointestinal surgery, cardio thoracic surgery, orthopaedic procedures, neurology, gynecology, colorectal, head and neck, pediatric, urology, infection prevention and OT management. Hands-on training using latest Minister of Science & Technology, Dr Harsh Vardhan, inaugurated Asia’s technologies will be provided by faculty members comprising experienced doctors first Johnson & Johnson Institute on Wheels. and surgeons.

“At Johnson & Johnson Medical India, we are comJohnson & Johnson Medical India has announced the mitted to supporting the Government’s ‘Skill India’ launch of its state-of-the-art Johnson & Johnson Instiprogramme through the delivery of educational tute on Wheels. This is a unique mobile training centre programmes to healthcare professionals for improvdesigned to build the surgical skills of doctors, nurses, ing the standards of care,” said Sushobhan Dasgupta, and para medical staff to address the demands of today’s Managing Director, Johnson & Johnson Medical India healthcare delivery system and provide better outcomes and Vice President, J&J Orthopaedics, AsPac. to patients of India.

Cabinet approves NHPM The Union Cabinet has approved the Centrally Sponsored National Health Protection Mission (NHPM) having central sector component under Ayushman Bharat, anchored in the Ministry of Health and Family Welfare. JP Nadda, Union Minister of Health and Family Welfare, said that the NHPM is a major step towards Universal Health Coverage.

“It will protect around 50 crore people (from about 10 crore families) from catastrophic healthcare spending. This shall boost our resolve to serve the poorest of the poor in the country, as there is an increased benefit cover to nearly 40% of the population, covering almost all secondary and many tertiary hospitalisations,” he said.

Nadda added that the coverage of Rs 5 lakh for each family has no restriction of family size and age.

“This will give underprivileged families the financial support required when faced with illnesses requiring hospitalisation,” Nadda added. .NHPM will subsume the on-going centrally sponsored scheme 'Rashtriya Swasthya Bima Yojana' (RSBY) and Senior Citizen Health Insurance Scheme.

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Cell-based therapy helps boy from Ghana walk When all the doctors at Ghana lost hope for 19-year-old Sylvanus, Dr Pradeep Mahajan, Regenerative Medicine Researcher, Adigos Stem Cells performed cell-based therapy that helped the patient walk again. The patient met with a road traffic accident while travelling on a bike and sustained injuries in his spine. He did not undergo any surgery to repair the fracture and the family was told that he will not be able to stand or walk in the future.

Dr Mahajan said, “The patient was advised two sessions of cell-based therapy along with neuro rehabilitation. In order to remove the scar tissue, Sylvanus also underwent a spine surgery by a team of orthopaedic and spine surgeons."

BULLETIN

Group CEO and MD, Ovum Hospitals

F

ormer Group CEO of Hyderabad’s CARE Hospitals, Dr Mudit Saxena, has taken over as Group CEO and Managing Director and a partner with Bengaluru’s Ovum Hospitals. The group, run by Neonatal Care & Research Institute, has a chain of four maternity and paediatric hospitals in Bengaluru.

In August 2016, Ovum Hospitals had raised Rs 33 crore from Norwest and IL&FS. The focus of the group is maternity, paediatrics

and NICU. Dr Mudit’s role would be to consolidate the current operations, develop clinical competency and improve service levels, along with overseeing the group’s expansion. Prior to CARE, Dr Mudit was Regional COO for Karnataka, Rajasthan and Madhya Pradesh regions of HCG. Dr Mudit has also worked with Fortis Healthcare and Wockhardt Hospitals.

COO, Aster Medcity

C

ommander Jelson Kavalakkat has recently joined Aster Medcity, Kochi, as Chief Operating Officer. Aster Medcity is the flagship quaternary care hospital of Aster DM Healthcare. The hospital, spread over 40-acre waterfront campus, is a quaternary care facility.

He is responsible for managing the entire operations of the hospital and would report to Group CEO, Dr Harish Pillai. Prior to

this, he was with Meitra Hospital as COO. He has also worked as Head of Operations and Administration in Hospitals at Hiranandani Hospitals and Fortis Hospital, Mohali.

He is an alumnus of the National Defence Academy and has done his management studies from Narsee Monjee Institute of Management Studies.

He took premature retirement from Indian Navy in 2011.

CEO, MGM Healthcare

D

r Rahul Menon has joined Chennai’s MGM Healthcare as Chief Executive Officer (CEO). MGM Healthcare is establishing a world class hospital in the heart of Chennai.

Prior to MGM Healthcare, he was with Aster MIMS, Calicut as CEO. He has also worked with Vasan Healthcare as Sr Vice President of Kerala region, as well as with Rabindranath Tagore International Institute of Cardiac Sciences as CEO, Global Hospital, Chennai, as COO, Jupiter Hospital, Thane, as COO, PVS Hospital, Calicut,

as Medical Superintendent and Omega Hospital as administrator. He has done his MBBS from Kasturba Medical College, Mangalore and MD in hospital administration from Kasturba Medical College, Manipal. He has also done his post graduate diploma in medico legal systems from Symbiosis Centre for Health Sciences, Pune.

He is a leader blended with successful experience with mission critical operations, and one who has shown accelerated growth in organisations and delivers strong and sustainable financial results.

HEALTHCARE RADIUS | APRIL 2018

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COVER STORY

The Pathfinder Dr Harish Pillai, CEO – Aster Hospitals and Clinics (India), Aster DM Healthcare, on creating Kerala's largest healthcare chain

BY RITA DUTTA

Aster DM Healthcare currently has 10 hospitals in India - four in Kerala, one each in Maharashtra, Telangana and Karnataka and three in Andhra Pradesh. The total functional bed strength is 3,845. The largest healthcare chain of Kerala, Aster DM Healthcare has two more Greenfield projects in Kerala in the pipeline, while the group is scouting for more projects to expand its footprint You have been instrumental in making the Aster DM Healthcare a pan India brand even as the Cluster Head of Kerala. How did the group manage to create this colossal awareness within a few years of it setting up multiple units in India?

The dream of our Founder Chairman and Managing Director, Dr Azad Moopen, was to set up a healthcare facility in Kerala similar to the Mayo Model of care. Our flagship hospital in Kochi, Aster Medcity, which is a quaternary care centre, was conceived to demonstrate the concept and showcase our management ability, prior to expanding our footprint further.

The Joint Commission International (JCI) accredited Aster Medcity has introduced several state-of-the-art technologies for the first time in Kerala. While the infrastructure and the clinical acumen are world class, our branding and communication strategy was focused to take our brand to the common man and achieve a top of the mind recall value across the state and southern India. Like the Amul brand which connects with the common man, our brand promise – ‘We’ll Treat You

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COVER STORY

HEALTHCARE RADIUS | APRIL 2018

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COVER STORY

1. Aster Medcity thus became the first centre in the world outside the UK and Iceland to deliver Core Medical Training (CMT).

Well’ has been accepted by all stakeholders. Our concept of Centers of Excellence (COE) evolved keeping the demographic and morbidity patterns of the state and reflects the needs of an aging population and that in which the percentage of non-communicable diseases is significantly high. In phase 1 of Aster Medcity, we launched COEs in cardiology, gastroenterology, urology & nephrology, orthopaedics, neurology & neurosurgery, oncology and child & women’s health.

In a short span of time, Aster Medcity established its credentials by obtaining all possible quality accreditations such as JCI, NABH, NABH for Nursing Excellence, NABH for Emergency Medicine, ISO 9001:2008, ISO 22000, Green OT Certification, LEED Gold Certification. We are also privileged that the Royal College of Physicians of United Kingdom (RCP-UK) has chosen Aster Medcity as one of its centres in India for conducting the Practical Assessment of Clinical Examination Skills (PACES).

Aster Medcity has also entered into a collaboration with the Joint Royal Colleges Physicians Training Board (JRCPTB) of the UK to conduct the Core Medical Training (CMT) for young graduate doctors. The training curriculum and the methodology is the same as in the UK. Aster Medcity thus became the first centre in the world outside the UK and Iceland to deliver CMT. As part of brand consolidation, all other existing subsidiary units of our company

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were brought under the same brand guidelines and SOPs. Significant efforts were made to align governance, clinical and service excellence and communications. The pooling of management talent brought in big improvements in efficiency that translated to better results.

Additionally, I supported our chairman by active participation in industry forums that helped to create the brand presence of Aster in India.

What has been your contribution to the group as the Cluster Head for Kerala?

As the Cluster Head, my main goal was to implement the Aster Governance structure that places a huge premium in clinical and service excellence. The incorporated structures helped in leveraging key management and clinical strengths within the network and showed immediate results. Our flagship hospital for North Kerala, Aster MIMS Calicut, is in the midst of a transition that will position it as a premium quaternary care centre. Aster MIMS Kottakkal, a secondary care hospital, has been totally realigned to meet the needs of the local community who otherwise had to travel long distances for quality healthcare services.

We are currently busy in the process of commissioning our Greenfield project at Kannur which will soon host India’s fourth largest international airport. It opens a totally new opportunity for further expansion of our

COVER STORY

services in the deep north. Our third flagship project positioned for south Kerala, and located in Thiruvananthapuram, is currently going through the process of regulatory approvals.

Thus, we have become the largest healthcare chain in Kerala, tapping virgin markets and introducing cutting edge medical technologies for the first time in the state.

What is the mandate given to you as the CEO for India operations- a role that you took over from 1st April, 2018?

My mandate as the CEO of Aster Hospitals & Clinics (India) for Aster DM Healthcare is to take the group’s presence to the next level in terms of expansion of existing facilities and improve footprints through organic and inorganic means. The responsibilities also include consolidation and standardisation of services, build a robust IT backbone and help build our growing reputation as a provider focused on service and clinical excellence.

How is the group multiplying units and flourishing in Kerala, despite the constant nursing strikes?

Despite external perceptions, the strikes in the health sector have not been frequent or without genuine grievances. Kerala has a highly literate population that is fully aware of their rights and needs an evolved mechanism to resolve disputes without disruptions. I am optimistic that the state will continue to lead the country in all possible healthcare indices.

The higher wages being demanded by the nurses will result in retention of better talent and reduce brain drain. Consequently, we expect work productivity and commitment to quadruple. The already exalted reputation of the Kerala health workforce is bound to emerge stronger. Groups like ours that understands the pulse of the evolving situation are best placed to navigate through perceived challenges.

How is the healthcare delivery in Kerala different from other parts of the country?

2 Right from 1957, the state of Kerala has allocated a large share of its GDP towards the health sector. Currently, it hovers around 6.5%. While we are comparable with the Organisation for Economic Co-operation and Development (OECD) countries on macro indicators, such as life expectancy, infant and maternal mortality, there is a massive burden due to rising non-communicable disease that have reached tsunamic proportions. The existing public infrastructure cannot cope with this demographic transition and change in the morbidity pattern.

This presents a large opportunity to commission large scale tertiary and quaternary care projects. At the same time, being a cost sensitive market one has to be very efficient to maintain the same operating margins as in rest of India. After the implementation of the Minimum Wages Act, the cost of operating a facility in Kerala would be 10% more than the rest of the country. This cost challenge can be managed through deployment of technological interventions and improvement in workforce productivity.

Please share details about your upcoming hospitals in Kerala. Dr Azad had announced an investment of Rs 600 crore over the next three years in Kerala.

2. The 175-bed group’s project in Kolhapur is slated for expansion.

HEALTHCARE RADIUS | APRIL 2018

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COVER STORY

The patient catchment area for the hospital would be from Alleppey to Thiruvananthapuram in Kerala to southern Tamil Nadu.

You have plans to open facility in Chennai and Vizag….

We cannot comment on market speculations.

3 Aster already has around 2,400 beds in its four hospitals in Kerala and it is our constant endeavor to improve healthcare services for the community. To consolidate our presence, we are building two more hospitals in Kannur and Thiruvananthapuram.

Amongst the two, Aster MIMS, Kannur; a 200-bed multi super specialty hospital at Chalain Kannur, is the first hospital of the group to be commissioned. The hospital would focus on cardiology, orthopaedics, neurology and gastroenterology. The construction of the hospital is underway and it is likely to be commissioned by September-October of this year. The patient catchment area for the hospital would be the entire Kannur to Mangalore belt. Residents of Kannur usually travel to Mangalore or Calicut for treatment, as these cities have existing reputed healthcare brands. There is a great vacuum in Kannur in terms of advanced healthcare services that Aster plans to bridge.

Kannur will soon get an international airport, which would be India’s fourth largest, and thus Medical Value Travel (MVT) patients are also expected to arrive in large numbers.

The next project of the group is Aster Capital at Thiruvananthapuram. We have acquired a land to build the 749 bed hospital at Akkulam in Thiruvananthapuram, where the first phase would have 510 beds. The hospital is still in the planning stage and would be commissioned in three years from now.

3. Aster CMI Hospital in Bengaluru would soon introduce oncology.

4. DM WIMS Medical College and Hospital in Wayanad.

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Why did you plan one more project in Bengaluru, a few years after starting Aster CMI? Improved access to healthcare is needed for a fast-developing city like Bengaluru with a population of over 10 million. In August 2016, we started Aster CMI, a 509-bed quaternary care multi-specialty hospital with dedicated centres of excellence.

Aster CMI now operates Aster Clinics which provide one stop medical facilities and healthcare services for the entire family and the neighbourhood. Aster CMI recently signed an agreement with Bangalore International Airport Limited (BIAL) as their healthcare partner and is now managing the medical services facility at Kempegowda International Airport, Bengaluru.

We have planned our second project at JP Nagar in south Bengaluru. We have entered into an O&M agreement with Rashtreeya Sikshana Samithi Trust (RSST), a leading educational institution, for the launch of ‘Aster RV Super-specialty Hospital’. This 200-bed multi-specialty hospital, being constructed by RSST, is expected to be commissioned by Q3 of this year. The hospital is expected to focus on providing quality care to the residents of Bengaluru, besides people coming from other parts of the country.

You have plans to introduce oncology in Bengaluru unit…

COVER STORY

We would offer comprehensive multi-disciplinary oncology services at Aster CMI, Bengaluru and will include medical, surgical and radiotherapy services with all sub specialisations that will be added in a phased manner Would the focus of the group continue to be in Kerala?

As a strategy, we will closely consider all opportunities that come our way and decide on a case-to-case basis. We already have a leadership position in the state, so it is logical to look beyond.

You have plans to expand your Calicut and Kolhapur facilities.

The 175-bed facility in Kolhapur has reached its optimum capacity and any expansion will be based on operational needs. Regarding Calicut, we are currently studying various models of infrastructure additions that will enhance clinical and service experience. Nothing has been finalised just yet.

ferral hospital and constantly upgrade the HR and technology deployments therein.

Aster uses robotics in pharmacy in Kochi. Do you plan to use that in other units as well?

Yes, we have been using the Rowa Smart System, to arrange medicines, check the date and dispense them. This has reduced medicine dispensation errors and dispensation time. Right now, we are conducting a study to find out the efficacy of the use of robots in pharmacy. There is no immediate plan to introduce them in other units.

How do you see the group a few years down the line, in terms of bed strength and geographic expansion?

Aster DM Healthcare is unique due to its strategic presence in nine countries and India will continue to be a key market for further growth. From a regional presence across five states, we hope to have bigger geographical footprint and soon emerge as

5. Aster MIMS Calicut is in the midst of a transition.

What strategies do you have in mind to turnaround the Hyderabad facility?

We invested in the infrastructure as well as technology, strengthened the management bandwidth and improved capacity utilisation. Now it is a 158-bed hospital, and I am optimistic that it would become one of the preferred healthcare centres in Hyderabad especially in and around Ameerpet.

What’s in the pipeline for Ramesh Hospitals?

Ramesh Hospitals is serving the growing needs of a new state, Andhra Pradesh, whose visionary Government is doing all it can to enhance the general level of healthcare delivery systems. Ramesh Hospital will be in the vanguard to provide high quality care at a reasonable cost to the local population.

What is in the pipeline for Kochi unit?

We will be focused on consolidating the pole position as a good quaternary care re-

5

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COVER STORY

6 a strong Indian healthcare group to reckon with. We will continue to be a brand that would be synonymous with cutting edge technology, world class doctors and quality healthcare delivery.

6. Aster has invested in infrastructure as well as technology and improved capacity utilisation of its project in Hyderabad.

22

Please share about the work that you are committed to doing in medical tourism.

I am the National Co-chair of the FICCI MVT Task Force that is working closely with GOI to frame policy that will accelerate the process of positioning our country as the global MVT hub. We envisage further acceleration of MVT arrivals as a result of liberalised policy framework and increased efforts of the private sector in this space.

Consequently our hospitals in Bengaluru, Hyderabad and other cities will witness an uptake in MVT numbers.

Various industry bodies have joined hands with the Government to promote Kerala as a medical tourism hub. Currently the maximum influx of MVT patients are towards Chennai and Delhi-NCR. If we promote the healthcare facilities of Kerala in a focused manner, then the state can have a higher number of international patients.

Kerala tops the indices for India’s lowest infant mortality and highest life expectancy rates. With a 100% literacy rate, Kerala has the highest Physical Quality of Life Index in India and is the only Indian state with macro health indicators on par

APRIL 2018 | HEALTHCARE RADIUS

with OECD countries.

The world class medical facilities, with accreditation from NABH, along the exotic locales, favourable climate, educated population and flight connectivity across countries are factors that would spur the growth of the state in the domain of MVT. Kerala enjoys a strategic placement on the Indian map offering seamless connectivity through the Middle East and Far East. International airports at Thiruvananthapuram, Kochi, Calicut and the upcoming one in Kannur allow visitors to fly to any part of Kerala in less than three hours.

Kerala, at present, attracts only 5-7% of MVT patients, but has the potential to increase the inflow of medical value tourists by 10–15%. This can be achieved by 2020 with a strong, focused marketing strategy.

A slew of regulations from the Government on price control have eroded revenue of hospitals. And now Kerala is likely to become the most expensive state in healthcare after the minimum wages implementation. How difficult would it be to open new projects in the state?

I don’t think the regulations would have such a massive negative impact in the long-run. It would rather make healthcare more efficient. Fiscal prudence should be a byproduct of efficient delivery of clinical services and healthcare groups need to get their models right to tap various market opportunities. India is a laboratory for process and product innovation and groups or units that are floundering due to change in regulations need to re-strategise.

Owing to the 100% high literacy rate, the residents in Kerala seek early healthcare intervention at the very onset of the disease.

This partly explains the current number one national ranking for the highest out of pocket expenses. We also believe that the penetration of public and private insurance will significantly increase. Hence accessibility and affordability will continue to drive the growth in the sector.

IT

Ensuring data security Data security is an integral part of the booming healthcare industry

BY BASKARAN GOPALAN

H

ealth information technology is the area of IT that involves the design, development, creation, use and maintenance of information systems for the healthcare sector.

In order to improve medical care, lower the costs, increase efficiency, reduce errors and improve patient satisfaction, health IT plays an important role.

The primary purpose of health IT is to ensure better healthcare outcomes for patients. Recording of patient data helps improve treatments and prevention of diseases. But, with the increased use of IT, the need for securing these data is imperative.

Need for IT in healthcare IT has become integral to the efforts to optimise costs and effectively manage operations. Technologies help with process management, patient care and management information systems (MIS) in hospitals. With the aim to grow, healthcare requires IT to store and retrieve information to cope with the tremendous pressure.

1 Integrated electronic medical records facilitate research as data is made available in a structured manner which helps track diseases and even provide the necessary medications. By digitizing patient records, each patient’s blood group, known allergies, etc would be documented and made available at the click of a button, and thus prevent manual errors. Management is easier with IT, from inventory to store, to even laboratory management.

Data analytics in Healthcare Players in the healthcare sector generate huge amounts of data everyday and saving it in the form of a hard copy only complicates matters. Hence, different data analytics are used for the better functioning and for future reference.

Electronic Medical Record (EMR): It is used to systematically organise and store the data of a patient in a digital format, so that it can be shared with different healthcare settings.

Patient flow: Data analysis can help reduce the waiting period for a patient, giving

1. Players in the healthcare sector generate huge amounts of data everyday and saving it in the form of a hard copy only complicates matters.

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IT

other healthcare providers and organisations like laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and clinics at workplace.

2 them timely treatment by predicting a surge in patient inflow.

Fraud analysis: Data analysis can prevent any fraud or abuse when hospitals have a large number of insurance claims on a daily basis.

Resource management: With the help of technology, it gets easier to track and manage both patients and the staff involved in patient care, and in effective staff management.

Patient profile analytics: This advanced analytics when applied to patients’ profiles can help identify any impending health risks and facilitate preventive care.

2. Information shared by a patient with a doctor is highly personal and should be secured and considered confidential.

24

Use of Electronic Health Record EHR was introduced to meet the demands in today's world where information on paper has completely been taken over by digitallyrecorded data. In the healthcare sector, it gets very difficult if even a single paper is lost, and this is its primary drawback.

Prompt decision-making is not possible in case the papers are misplaced, thus delaying work and risking the life of the patient in case of an emergency. Once lost, the information could be lost forever.

EHR provides accurate and complete information about a patient which involves recording a patient's current condition in the context of their medical history. During an emergency, it can provide quick information on the patient without delays. It also enables a family to play a part in taking decisions on the patient’s health.

EHRs are built to share information with

APRIL 2018 | HEALTHCARE RADIUS

Predictive analytics This form of analytics uses various techniques and lots of information to predict a patient’s future health. This tool has gained importance because it helps to take the necessary decisions on improving patient care and also in administration of the hospital.

Such analytics help doctors to make accurate diagnosis and early interventions that can prevent many diseases. The prediction of future medical costs can also be obtained.

Most importantly, the patients have potential benefits as they can receive treatment and medications that may work for them.

Improving revenue cycle management Revenue management is something in which a healthcare sector suffers a lot. It is important to have a stable financial performance for the continuity of the care given to the patients. Since healthcare In India relies on end-to-end billing services, all data relating to patients should be well-prepared and stored in order to prevent any future confusions.

The hospital has to incur expenses right from admitting patients till he/she is discharged.

Revenue cycle management takes care of the administrative functions, offering all healthcare and medical services. It is important to have a good service provider taking care of the medical insurance claims, medical billing and medical coding. It, therefore, helps boost the revenue from low-paid claims and also follow up with the insurance companies for faster settlement. This makes the hospital run with some profit.

Information privacy and security The information shared by a patient with a doctor is highly personal. Therefore, it should be secured and considered confidential. Patients need to share everything they know because it helps the doctor decide

IT

which possible treatment would prove effective to the patient and also what type of drug would give better results. The patient's medical record consists not only of the medical history, but also his identification and personal information. Safeguarding these information becomes crucial with the growth of technology.

Data breach Healthcare sectors store information or the data of patients on cloud-based platforms for marketing or medical purposes. With numerous cases of data breaches, healthcare data breaches are also increasing in terms of size and frequency. Relying on age-old computers that lack the latest security features make it easier for hackers to gather large amounts of personal data, including not only the names, phone numbers but also the billing information. These could be later used for extortion.

In order to prevent this, EHR comes into play, saving all the necessary information.

All the confidential information should be destroyed when they are no longer needed.

An annual security analysis is necessary to evaluate the potential threats to the IT systems.

Threats to healthcare security: Mobile devices With such huge amounts of health advice, health projects and techniques being easily accessible on the cell phones, hospitals and clinical practitioners must know about the risk of security breaks and hacking of healthcare data. Doctors, nurses, and clinical staff use cell phones and tablets, and so do patients and visitors to the hospital. This implies a potential for security ruptures on both sides of patient care.

Network access control (NAC) arrangements can be a brilliant move so as to keep healthcare data information as secure as possible. NAC distinguishes each user and gadget, and has the ability to check for dangers or obsolete spyware protection. NAC ar-

3 rangements can likewise keep the different equipment and gadgets secure where such huge numbers of gadgets are associated.

Insider misuse According to Becker's Hospital Review, some 15% of security rupture incidents in the health sector in 2013 were due to insider abuse. This term refers to situations in which workers of the organisation steal information or commit other crimes.

Shockingly, the reason for insider abuse is because that they can access the information of patients. They steal information for money or to commit tax fraud. To avoid insider misuse, organisations keep track of devices used by staff members.

Since the growth of digitisation in healthcare largely depends on the current data management system, the companies are obligated to invest in protecting data from breaches. Several firms have already adopted advanced methods to safeguard data.

However, the industry overall has to ensure that the stored data is leak-proof.

Baskaran Gopalan is Senior Vice-President, Strategic Management, Omega Healthcare Management Services Pvt. Ltd.

3. Some 15% of security rupture incidents in the health sector is due to insider abuse.

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CONSUMER CONNECT

Medical education: New frontiers Bollineni Adwik, Secretary, Aditya Educational Society, which manages Great Eastern Medical School and Hospital, on the institute's contribution to education

Bollineni Adwik, Secretary, Aditya Educational Society

What is your observation on the state of medical education system in India?

The medical education is quite archaic and should be changed to accommodate the technological advancements and the disease pattern, specially communicable diseases and preventive diseases.

The focus is more on theory rather than on clinical orientation and then there are too many examinations in the system.

The quality of the medical practitioners is also of question. There should be a system where the family physician should refer to super specialists for further guidance but that is not happening today. Patients are going haphazardly to doctors, irrespective of the speciality. At the same time, the specialists should not see unless there is a proper pattern of referral system.

For example a chest pain patient goes directly to a cardiologist. The chest pain may be due to many reasons, so the cardiologist will look thoroughly investigate only at the cardiac side but he will not look into other reasons of chest pain.

In our country the doctor to patient ratio is poor and young doctors are shying away from practicing in rural areas.

What is your view on this and how can we change this perception?

Yes the ratio is very low, we require more doctors, MBBS and as well as specialist doctors, and there are reasons why the doctors

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are not going to rural areas. As I mentioned above, the channeling of patients like a family physician and specialist/ super specialist is not there. Unless we build the hospitals in the periphery in this model, both doctors and patients would not be satisfied. Apart from that, the doctors should be well paid in the rural areas and special facilities should be provided for them.

How does your institute take up the responsibility of familiarising students with the different sides of medical studies?

We have developed a common system in which the student/ patient is benefited in all aspects: a) Conduct 2-3 awareness/ health programmes. b) As we are bound to maintain statistics of disease pattern, we can understand the disease pattern in the region by creating more awareness to the patient and also ensure the medical students understand the same. c) Students see clinical cases from the 1st MBBS year. d) Log books are being maintained from the Under Graduate/ Post Graduate level apart from what the university is asking to maintain in terms of all clinical cases.

What is your institute’s philosophy pertaining to medical education?

Srikakulam district is an underdeveloped area with a population of more than 25 lakhs. Most of the population are from below

CONSUMER CONNECT A MEDICAL GEM Great Eastern Medical School & Hospital has been serving the local populace of Srikakulam with dedication

poverty line category. The people there are in the dire need of tertiary healthcare.

A medical college best suits the need because it can give high-end quality healthcare services at a low cost to the patient.

When the healthcare services are made available to most of the needy population, and if they start utilising the services, there will be big opportunity for the institutions to impart training to the medical student. In that process, the institutions can churn out good number of doctors and fill the doctors requirement to some extent in the society.

The single-minded motto of Aditya Educational Society is to establish premier educational institutions in the fields of healthcare. It also envisions to develop Great Eastern Medical School and Hospital into a state-of-the-art general and super specialty hospital catering to the needs of Srikakulam and other adjoining districts of north coastal Andhra Pradesh. It also envisions to service the rural communities.

The hospital has state-of-the-art facilities such as ICU, 15 fully equipped OTs, etc and specialists from every faculty available round-the-clock at highly subsidised rates. The academic wing includes some of the best known people from every faculty to provide quality education to the students. Last but not the least, the institution is conceived, erected and administered by a group mainly comprising doctors with a vision to develop it into a world class destination for medical education and health services.

The hospital is strategically located in the temple town of Srikakulam, famous for the Surya Bhagvan Temple and soothing climate. Srikakulam Town, district headquarters of the Srikakulam district, is situated at the northeastern tip of Andhra Pradesh which happens to be an actively developing area in the coastal region. The town is well connected by road and rail with Chennai – Kolkata Highway (NH-5) and Rail routes passing right through. The nearest airport at Visakhapatnam is 100 km away.

Share details about our institute infrastructure and the type of courses the group offers.

We have a campus with lush greenery, ample functioning space with good ventilation. We have clinical blocks planned to save the movement time for the doctors, patients and students and the design is as per the MCI guidelines. We have state-of the-art technology in most of the departments and standard management practices are adopted.

What has been the USP of your medical institute?

We have an ideal learning environment, availability of best faculty for imparting medical education, accessibility to clinical material for every learner and availability of state-of-the-art technology for learning and management of patients, and all of these in serene and pleasant environment.

What is your recommendation and predictions to build a more fruitful medical education in India?

Medical science is developing at a galloping speed today. The higher technological advances are bringing a big change in quality of healthcare in the world.

Technology and infrastructure cost to any economy. Quality manpower also costs heavily. These two factors influence the

availability of resources.

To overcome this and to provide high-end quality healthcare and medical education, the Government should collaborate with private players. This would help to bridge resource crunch, provide best infrastructure which suits the needs of the country, offer best management practices which can deliver best results, and bring about transparency in decisions made by Government.

For more details, contact:

email: adwik@adityaeducationalsociety.org Mobile: 98491 49461

HEALTHCARE RADIUS | APRIL 2018

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INSURANCE

Complete healthcare cover While a corporate cover offers the security of being protected from illnesses, it does not cover one across all medical situations

BY PARAG GUPTA

A 1. It is a smarter option to secure yourself for a higher amount with minimum efforts.

30

pproach anyone for advice on choosing the right health plan for an individual/family and they would undoubtedly suggest you consider one with either low or no deductibles. But is that the right approach?

Today, lifestyle diseases are increasingly cropping up making it a ticking time bomb with an alarming rise in cardiovascular disease, diabetes, hypertension, asthma and respiratory diseases as well as cancers among Indians. Accordingly, to the Indian Council of Medical Research (ICMR), India reported an estimated 14.5 lakh new cancer cases in 2016 alone. Indians today are facing more and more health issues given the hectic, stress

APRIL 2018 | HEALTHCARE RADIUS

filled lives they are living.

It’s not just the health concerns that are inching upwards but also the healthcare costs. While a common heart valve surgery would cost anywhere around Rs 1,00,000 – 3,50,000, the cost of a liver transplant will easily reach Rs 30 lakh and up. Even the annual cost for a diabetic comes to Rs 10,000 and a regular full body health check-up is anywhere between Rs 12,000 – 15,000.

Almost every company these days provides healthcare benefits to its employees, with 96% providing for at least hospitalisation cost. With the increasing healthcare costs and health risks, the cost involved in recovery is a concern for many people when

INSURANCE

they approach a medical expert. In this situation, does a corporate cover adequately protect you in case of an expensive medical treatment? While a corporate cover offers the security of being protected from illnesses, it does not cover you across all medical situations. It’s important that one is fully covered in-order to combat any unexpected medical circumstance.

For instance, if Mr A is diagnosed with a condition that requires him to undergo a heart valve surgery, which cost around Rs 3 lakh. Will his standard group health insurance of 1 lakh be enough to cover him? No, in order to cover a treatment of Rs 3 lakh, he will have to take another health insurance policy, the premium for which would be around Rs 6,000 per year. Or he could take a high deductible health plan of Rs 3 lakh with a deductible of Rs 1 lakh on his existing plan.

For this, his premium would be nominal.

And since a high deductible cover can be taken on any existing health insurance plan from any provider, it is a smarter and more convenient option to secure yourself for a

higher amount with minimum efforts.

What is a high-deductible plan and how it works? More often than not, your insurance is not enough because it provides cover only up to a fixed amount, whereas, if you have a top-up plan alongside, it can cover you for higher costs as well. A high deductible topup plan, which works with your pre-existing insurance plan, requires you to decide a limit called deductible amount. In case of a medical emergency, the expense up to the deductible amount is paid by you or your company’s health insurance policy and the rest is covered by the top up plan.

A high deductible policy brings down the amount you pay in premium while covering expenses that you may incur towards hospitalisation and other costs. The deductible applies each time you file a claim. Your company’s insurance policy can come in handy when you pay off the hospitalisation expenses and all other major expenses will be covered by the high deductible policy.

Thus, by investing in an additional, a high deductible plan you become eligible to receive the below benefits/coverage and thereby ensure complete coverage in case of a medical emergency: 1) You are prepared to meet any expensive medical emergency as a high deductible plan insures you from a larger amount.

2) You save on accruing extra premiums as high deductible plans cost less.

3) You proactively manage your health and the healthcare cost since you know you will have to bare a share yourself.

4) One can avail a health deductible cover on an existing policy from any provider.

5) You pay less from your pocket because in a high deductible plan the premium is low and the deductible is covered by the existing policy.

Parag Gupta is Chief Underwriting Officer with Bharti AXA General Insurance.

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HR

1

Talent retention strategies An employee should be engaged from the first day itself

BY PARTHA DAS

T 1. The time spent on hiring and training is huge if the attrition rates are on the higher side.

32

he HR department is busy most the times getting people on board, but how long are we going to have them stay with us is the bigger question?

Recruitment and Selection, getting the right people for the right job, will always remain a big challenge for HR although a good challenge to have. Recruitment and Retention, two very important aspects in HR and equally challenging, one follows the other.

APRIL 2018 | HEALTHCARE RADIUS

We all know the challenges of hiring the right talent- we spend significant amount of our time sourcing and hiring the right talent and the right fit, keeping the cultural alignment in mind. People make the organisation and are responsible for its success.

The time spent on hiring and training is huge if the attrition rates are on the higher side. We go through the vigorous exercise of Recruitment and Selection process, ea-

HR

H

gerly waiting with crossed fingers for the on boarding of the employees. And, of course, breathe a sigh of relief when the employee joins on the expected date. Once the employee joins, we think our job ends there, but ‘No’ rather we fail to anticipate the nuances post the employee comes on board.

Handling the new employees is a challenging task these days. The initial few days are the crucial ones, as they experience anxious moments. They need to be engaged from the first day. He has joined us based on the agreed role, brand name of the organisation and other factors.

He is quite optimistic and this may be a dream job or a dream organisation for the employee. Did we live up to their expectations? Have we gone that extra mile to make them feel comfortable.

R has a very important job in hand in the shape of ensuring the retention of the key talent. The engagement starts from the recruitment phase and once the employee is on board it is the joint responsibility of the functional head and HR to take care of the new employee in terms of defining the roles and responsibility, a proper work station, introducing him/ her to concerned people and making the employee comfortable from the very first day till the employee settles down.

A warm welcome from the peers adds a lot of value. They should give a correct picture about the organisation, culture, etc. Giving the correct perspective of their career path and the performance element are a part of the mandate. They would do justice if they are also engaged and seem to be seen as a bunch of happy employees. Uncertainties looms large when an employee joins an organisation and many questions invade his mind. He starts comparing with their previous employer/s.

A 360 degree approach needs to be adopted in terms of induction and orientation to the organisation. The individual should feel convinced that he has joined the right place and it is going to shape his career. HR needs to be in constant touch with the new employee to ensure that he feels engaged. It is very important to keep a periodical tab on the orientation of the new employee.

Programmes like assigning ‘buddies’ to the new employees are of great significance. A buddy is not a superior or a reporting head, rather a peer or colleague who helps the new employee in settling down, clarifies the queries, shares the dos and donts of the organisation. It is an informal way of keeping the employee engaged. A real buddy can be a gamechanger in terms of helping the new employee settle well.

H

owever, the most important role in employee engagement has to be played by the functional manager. He should strike a rapport with the new em-

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33

HR

2

2. A 360 degree approach needs to be adopted in terms of induction and orientation to the organisation.

34

ployee from the day one. The role should be clearly defined and the job description to be handed over to the person from the very first day of joining, followed by the departmental induction. The functional manager should lead from the front, in terms keeping a track of the employee progress as well as helping him to achieve success.

The training needs to be rightly identified.

Appropriate training calendar and delivery are the next steps. The real training effectiveness is seen when the employee is able to execute or deliver based on his learning.

The functional manager is always a helping hand and chips in with support whenever the employee needs the most. There would be highs and lows but the manager is there to carry out the balancing act.

It is the joint responsibility of the HR business partner and the functional manager to carry out the employee engagement piece.

Employees feel happy as long as they feel wanted and motivated. Their KRAs (Key Result Areas) need to be well laid out, the performance discussions should happen periodically, ideally every month, to align to a performance-driven culture. They need to be appreciated for the good performance, given stretched targets and motivated to achieve those.

APRIL 2018 | HEALTHCARE RADIUS

More than anything, employees look forward at their career path, growth opportunities and a pat on the back from their manager. Good employees always have the urge to learn new things, contribute more and over achieve the goals. They are passionate workers, and they value performance more than anything else.

So, HR and the functional department have a very big role in hand and need to keep on brainstorming and continue to come up with innovative ideas to retain and nurture the talent as well as create a talent pool. This would lead to their success factor in terms of better employee engagement.

The functional managers have to play the role of the HR manager for their team members for the best impact of employee engagement. They recruit, train, groom, do the performance management and talent management. If they go an extra mile like ensuring the employee engagement, then the job is done and we are good to retain our talent.

Partha Das is Chief People Officer with Cytecare Cancer Hospitals, Bengaluru.

SAFETY

1

Tackling MRI accident risk MRI area should be physically identified in four zones and personal into three levels

BY DEEPAK AGARKHED

T

he pistol of the security guard escorting VIP got struck on MRI Gantry. Or two struck in MRI for four hours. Death by negligence at the MRI room. These are real-time incidents of accidents inside MRI canning room in hospitals. These incidents raise questions on the public mind about the safety of person undergoing diagnosis or treatment in hospital or any diagnostic centre.

Healthcare technology is advancing every year to improve patient care. The healthcare team accordingly needs to continuously

update their skills and adopt the latest practice. The new technologies also comes with new openings for harmful environment. The hospital should evolve strong implementation strategy to reduce hazard (i.e. potential source of harm) as a part of the risk mitigation strategy. The hospital accreditation standards encourage hospital to do regular to hazard identification and risk assessment as a part of proactive measures. The ECRI institute from the USA comes up with yearly report on top technology hazards to public, using a set of criteria like frequency, severity

1. The risk of preventing magnetic material getting inside the MRI can be addressed from facility planning stage itself.

HEALTHCARE RADIUS | APRIL 2018

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SAFETY

2. Safety training schedule must be provided to hospital staff.

and preventability.

Recently one tertiary care hospital conducted a survey to know the awareness on MRI safety. One of the questions was to know what was the difference between CT scan and MRI operation. Most of them wrongly answered stating that in MRI, the magnet is turned off during non-patient scanning time like CT scan, whereas in X-Ray the tube is switched off. This reflects a lack of knowledge that usually leads to near miss or accidents with respect to MRI. The fact is that MRI magnet is never turned off, it runs 24X7 throughout the year. It is prohibitive to carry magnetic material inside MRI room as with huge magnetic intensity around, the magnetic material flies with speed of bullet and gets attracted to MRI gantry.

The facility risk assessment is to know about hazards in work, evaluate the risk and implement the risk reduction measures based on descending order of risk.

The risk evaluation point is mathematical summation of frequency of occurrence of hazardous conditions (3 to 5), evaluation of accident severity (2 to 12) and evaluation of occurrence possibility (1 to 8). Any risk evaluation score more than 19 is severe and needs immediate attention. In case of hospital having an MRI unit, the frequency of using being

2

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high (score of 5) and accident severity on account of person with magnetic object will be fatal injury (score of 12). The occurrence possibility can be reduced using the following methodology: The risk of preventing magnetic material getting inside the MRI can be addressed from facility planning stage itself. The challenge with healthcare industries is also to do with lack of specialised architects who are well versed to the functionality of area, technology. As per the ACR safety guidelines, the entire MRI area should be physically identified in four zones and personal into three levels. Zone I is the region that includes all areas in hospital that are freely accessible to the general public. Zone II consists of MRI/ radiology reception, patient/relative waiting area and MRI patient hold area. The patient consent for the MRI is taken in this area.

Zone III is mainly MRI console room, MRI equipment room and transfer area to MRI Gantry room. This is restricted access under close supervision of MRI team members.

The vigilance should be more especially when there is a common console room between MRI and CT scanner unit, as there is possibility of patient in metallic shifting trolley is moving from Zone II to Zone IV i.e.

MRI Gantry magnet room wherein actual scanning take place. Level 1 MR Personnel are those individuals who have passed minimal safety educational efforts to ensure their own safety as they work within Zone III. Level 2 MR Personnel are mainly MRI technicians, radiologists and radiology nursing staff who are rigorously trained on MRI safety issues including patient burns.

Non-MRI personnel are patients, visitors, or facility staff who do not meet the criteria of level 1 or 2 MRI personnel.

The MRI infrastructure layout should be such that there is no direct entry of patient or staff from Zone II to Zone IV. The proper signage on MRI “MRI always active”, Zone signage, “No magnetic material inside MRI area” should be visibly displayed at designated location both in English and local language.

SAFETY

The zoning can be marked on floor, too. The door of magnetic gantry should be always locked when patients are not present. The ferromagnetic metal detectors should be ideally installed before entering zone III to identify in case if anyone is accidently carrying metallic objects especially in their pocket as supplement screening procedures.

The patient shifting trolley should be MRI compatible only for taking patient inside the Gantry room. The certain critical MRI patient condition demands necessary equipment to be available at MRI Gantry room. The MRI Gantry room should consider use of MRI compatible medical gas outlets for O2, Air, Vacuum & Nitrous oxide, MR compatible anaesthesia units, MR compatible IV stand, MR compatible infusion pump and physiological monitor. The availability or unavailability should be known to concerned hospital staff like anaesthesia, clinical engineering especially during emergency situation.

The facility service team members like housekeeper, engineer should only carry MRI compatible tool kits while attending routine & breakdown calls inside Zone IV. Their training on MRI safety is essential as major accidents occur due to non-MRI personnel entering into Zone IV without any notice by level 1 or 2 MRI personnel.

The radiology team should develop, display work instruction (SOP) on MRI safety and same must be trained to all in patient nursing staff, so that they are aware of safety precautions to be taken for patient to be sent for scanning. The induction programme for new staff should include MRI safety and regular refresher training needs to be taken to focus of hazard associated with MRI. It is good to have MRI safety training shown as projected loop in the MRI waiting area, so that patient and relatives are aware of safety associated with MRI. The informed consent should be taken from patient and their relatives before MRI scanning along with screening questionnaire and interview for any magnetic substances like pacemakers.

The nursing team should gown all patients

3 and two people should screen the patient before entering to zone III. Unauthorised person should not be allowed to bring patient to MRI zone III. Staff and hospital personnel wheeling in admitted patients who need assistance in terms of oxygen or even OPD patients who have relatives accompanying them must be extra careful. Under no circumstances, oxygen cylinders, metal trolleys, wheelchairs should ever be allowed in the MRI Zone III. More care should be taken especially during night and holidays wherein staff are limited and when emergency patients are rushed through emergency area.

Safety training schedule must be provided to hospital staff especially to transporters wheeling in patient and getting their relatives in the MRI Scan room is crucial especially when the patient is a child. Regular audit on MRI safety should be a part of facility safety calendar of hospital.

The MRI safe environment will surely be enhanced through reduced risk evaluation score by following the above mentioned best practices.

Deepak Agarkhed is General Manager-clinical engineering, quality and facility, with Sakra World Hospital, Bengaluru.

3. Lack of knowledge usually leads to near miss or accidents with respect to MRI.

HEALTHCARE RADIUS | APRIL 2018

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COMMENT

Expand scope of NHPS Modicare can provide impetus to home healthcare and people’s preference to more personalised care

BY ANAND GARG

1 1. Obamacare includes services like nursing, home health aides, physical therapy and consumer directed personal assistant programme.

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he central Government’s announcement of National Health Protection Scheme (NHPS), now popularly known as Modicare, has received unprecedented attention from various agencies, healthcare industry and the public since its announcement in the budget. Thanks to above, the contours of

APRIL 2018 | HEALTHCARE RADIUS

the scheme are beginning to emerge and its scope getting clarified. The NHPS envisages to provide insurance cover of Rs 5 lakh to 100 million families and 500 million individuals from the financially disadvantaged segments of the society for secondary and tertiary care. Additionally, the Government also proposes to set up 1,50,000 health and

COMMENT

wellness centres to provide treatment for non-communicable diseases and disburse primary care to young mothers and children, besides free supply of medicines and diagnostics are also a part of the plan.

Many healthcare experts and other stakeholders may think that the current scope of NHPS appears to be truly reactive in terms of providing insurance cover to enable individuals avail the services of a hospital for secondary and tertiary care – hospitalisation for chronic illness and treatment for terminal illness, respectively. For a country with population of 1.3 billion people having average per capita healthcare expenditure of $267, this scope does not appear to be robust enough.

Therefore, strictly from a preventive care and long-term sustainable and holistic healthcare program perspective, the current scope of NHPS may call for a closer look. The present scope will surely facilitate a positive response for a need to provide treatment to individuals with diseases and sufferings, thereof by way of hospitalisation. However, it may not necessarily work towards putting in place a holistic and long-term sustainable healthcare programme with its foundation on preventive healthcare programme to reduce the overall disease burden before it happens as well as post hospitalisation.

It is in this context that the scope of NHPS should be expanded to include other services. One such important service is home care.

The umbrella of services it encompasses are home health care facilities, assisting patients to recover, regain lost health and improve their overall quality of life.

Obamacare which is said to have inspired NHPS, incidentally includes these services: • Nursing • Home Health Aides • Physical Therapy • Consumer Directed Personal Assistant Program (CDPAP) A study conducted by Banner Health in America on using technology as a means for

2 providing remote care for patients indicated a 27% reduction in the cost of care, 32% reduction in acute and long-term costs and 45% reduction in hospitalisation.

Home Healthcare Assistants and Patient Care Assistants work flexible schedules based on the patient’s needs providing post-operative, palliative and other specialised care to individuals released home from a hospital or rehabilitation or sub-acute stay. Such services are also provided to the disabled. The Patient Care Assistants follow an individualised plan of care, which is created by a registered para medic or nurse who conducted an assessment before the start of in-home services. The care plan’s goals are comprehensive and address medical, psychological and emotional needs as follows: • Use of Medical Equipments, Supplies and Devices • Collection of Specimens • Measurements and Tests to Routinely Monitor the Patient’s Condition • Dressing Changes • Performance of Maintenance Exercise Programmes • Blood Pressure, Pulse and Temperature Monitoring

2. The global home healthcare market is expected to reach $364.69 billion by 2022.

HEALTHCARE RADIUS | APRIL 2018

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COMMENT

3

3. We should optimise on the Rs 5 lakh insurance coverage to individuals as not every individual will need hospitalisation every year.

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• Complex Modified Diets and Nutritionally Supplemented Diet • Medication Reminders • Special Skin Care • Assist with Splints and Prosthetics • Sleep Apnea Monitoring and Equipment set-up As per global research firm Markets & Markets, it is estimated that the global home healthcare market is expected to reach $364.69 billion by 2022 from $220.67 billion in 2016, at a CAGR of around 9%. The base year considered for the study is 2016 and the forecast period is from 2017 to 2022. By sheer size of our country, India will contribute significantly to the projected target numbers. Though in a nascent stage in India, and largely serviced by unorganised players, start-ups and recent hospital initiatives, the market stood at around $4 billion and expected to reach around $6 billion or more by 2020 as per the Cyber Media Research.

NHPS can provide the much needed impetus and encouragement to home healthcare and people’s preference to more personalised care vis-a-vis the hustle and bustle of a hospital. Such a step will help provide

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necessary growth engine to the following: • Home healthcare equipment manufacturers • Home healthcare service providers • Home health software vendors • Nursing services providers • Wound care product manufacturing companies • Pregnancy care product manufacturers and service providers • Supportive care product manufacturers and service providers • Diagnostic companies • Research and development (R&D) companies • Business research and consulting service providers • Medical research laboratories • Venture capitalists Inclusion of above services in NHPS will go a long way in providing holistic and preventive healthcare services to individuals. It will also help achieve the following: • Optimise on the Rs 5 lakh insurance coverage to individuals; not every individual will need hospitalisation every year.

• Encourage development of start-ups and entrepreneurship in healthcare.

• Reduce the burden of multi super speciality hospitals and enable them to focus on core activities such as procedures, surgeries and in providing treatmen.t • Help adopt technology for remote care • Fuel growth of healthcare education in the country.

• Create jobs for nurses and para medical staff.

Inclusion of these services will make NHPS a truly holistic healthcare programme which will include a pre, during and post hospitalisation programme and make it a global benchmark

Anand Garg is a healthcare industry advisor.

CONSUMER CONNECT

Focus on the core The 'Distinctive DNA' of NephroPlus is to run 10 – 20 bed dialysis centres efficiently, says Vikram Vuppala

E

very organisation at its core has a ‘Distinctive DNA’ which enables it to excel in a specific theme or dimension. It is crucial for leaders in every organisation to understand their firm’s ‘Distinctive DNA’ and articulate it to all stakeholders in their ecosystem. This will help the senior management, mid-management and team mates at every level in the firm to focus on this core strength and not pursue any objectives which do not align with this core.

Uber’s 'Distinctive DNA’ is to fiercely apply capitalism to transportation problem across the world. Tesla’s core strength is to innovatively and radically make the world live and thrive on sustainable energy while MD Anderson Cancer Care Center’s is to invest in research and bring the latest cancer treatments to its best-in-world cancer care programme. Berkshire’s strength lies in its ability to identify long-term value in both public and private stocks. Have you ever wondered why Berkshire does not take control of any large company and try to create superior returns for its shareholders? That is because they have no expertise to run a large company and their leadership is clear about their 'Distinctive DNA'.

At NephroPlus, we as founders have been quite articulate to our stakeholders that our ‘Distinctive DNA’ is to run 10 – 20 bed dialysis centres efficiently across the country. For the eight years since inception, we have relentlessly focused on our core dialysis value proposition and constantly and vigorously said ‘No’ to many adjacent opportunities that came along our way. By focusing relentlessly on our ‘Distinctive

DNA’ we have been able to build India’s largest dialysis network and with our scale as well as focus, we have been able to offer superior value to our hospital partners across the country. We have partnered with various companies for all non-core functions at NephroPlus such as our IT portal development, laboratory services wherever applicable, medical travel, pharmacy services, security and house keeping services, etc. This helps us maintain a razor sharp focus on the one thing we do very well – run dialysis centers efficiently.

Any hospital leader has to reflect on their 'Distinctive DNA' to ensure that they focus on and build a world class platform in that space and they also have to say 'No' to numerous other distractions. Many tertiary care hospitals in India have tried to set up mini clinics as outreach res and have not done very well. Most programmes I know of such kind are in retraction mode. Imagine a hospital which is used to the overhead associated with acute care and slap it on low ticket outpatient services! Such models break down in a few years at most.

The best way for them to offer superior care would be to strategically partner with focused factories in such spaces which are not their core. These partnerships in non-core dimensions would serve these hospitals well. Hence focus relentlessly on your 'Distinctive DNA' and identify strategic partners for noncore services should be your mantra for continued success over the years.

Vikram Vuppala is Founder & CEO of NephroPlus.

HEALTHCARE RADIUS | APRIL 2018

41

OPINION

Interventions in mental health Technology is an enabler that helps in creating awareness on mental health

BY ARINDAM SEN

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T

1. About 150million people are affected by mental illness.

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he mental health of our country is a cause for alarm with a very large number of people being affected by some type of mental ailment.

As per the last study by NIMHANS, in 2016, almost 10.7% of 18+ adults and over 7.3% of adolescents are affected by mental health issues. The actual range is actually 5.8% to 14.1% across states. These are very large numbers and only capture the morbidity in the sample population which covered 12 states. If one were to expand this study to a national level, the numbers could see dramatic changes. In total, about 150 million people are affected.

Prevalence of mood disorders was at 3.35%, 5.53% and 7.94% in the age groups of 18-29, 2039, 40-49 years respectively. There is also very high prevalence of depressive disorders at 3%, 5.3%, 7.47% for the above age groups. Thus, the age group of 20 to 49 seems the most vulnerable for mood and depressive disor-

APRIL 2018 | HEALTHCARE RADIUS

ders which corresponds with the phase when major life changes are happening. Urban India in general and metros in particular also clearly scores over rural areas in prevalence of the above disorders, thereby reflecting the stress associate with urban living with waning social and family support systems.

The other highlight of this situation is that a very large number ~80% of affected population never get access to any form of treatment in their lifetime. This is so unfortunate for a country like India and makes the overall progress of the country makes in terms of GDP and standard of living so hollow and meaningless. This is further compounded by the fact that there is severe shortage of skilled professionals who can treat or help people with mental health disorders. There is about 77% deficit of psychiatrists, 97% deficit of clinical psychologists and over 90% deficit in psychiatric social workers.

With less than 1% of the health budget being

OPINION

allocated to mental health, it is clearly not a Governmental priority at present. There is also very little data that is available or even tracked on a regular basis regarding incidence of the disorders across the country.

Urban India faces a bigger brunt of this condition due to lack of social support, job relocation and breaking family structures across the country.

Given the above scenario, it is imperative that the private sector shares a part of the burden of the state and does its bit in providing services which help this huge mass of affected people. Technology can play a crucial role here and private organisations need to partner with the Government in this initiative. The Government can further help by providing grants to finance projects which direct services to select groups affected by this condition. There could be tax benefits or tax holidays for companies engaged in this initiative.

Also the Government can launch awareness campaigns to help de-stigmatise mental health issues and promote activities which are preventive in nature in this segment.

Preventive care is very important, so that many people can benefit at an early state and not have the condition aggravate to the level of a clinical condition. Private companies engaged in preventive care have a vital role to play in preventing the conditions from increasing and also promote a healthy emotional wellness mindset across large sections of people. Services also need to be oriented at regional levels in local languages rather than only being directed in English.

Overall a very large section of people are affected and an active approach is required to prevent the issue from reaching epidemic levels in the next half decade or so.

Technology as an enabler can spread word about the urgent need for preventive mental health for the masses. Technology makes it easy for people to access trained and experienced professionals. There are many cases of college students calling us about stress with competitive exams, peer pressure,

2 relationships, issues related to sexuality, self confidence, to name a few.

NMHS 2015-16 reveals that nearly 15% of Indian adults (those above 18 years) are in need of active interventions for one or more mental health issues; Common mental disorders, severe mental disorders and substance use problems coexist and the middle age working populations are affected most; while mental health problems among both adolescents and elderly are of serious concern, urban metros are witnessing a growing burden of mental health problems. The disabilities and economic impact are ominous and affect work, family and social life. However, to address these problems, the current mental health systems are weak, fragmented and uncoordinated with deficiencies in all components at the state level.

Arindam Sen is Founder of Zyego.

2. The Government can launch awareness campaigns to help de-stigmatise mental health issues.

HEALTHCARE RADIUS | APRIL 2018

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MANAGEMENT

Safer and affordable healthcare Deploying engineering simulation in design cycle reduces design and development time and ensures the product is meeting the local needs

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BY RAFIQ SOMANI

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1. Simulation technology will forever change the way healthcare is today and make it accessible to all.

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ccess to affordable and advanced healthcare is a key to drive innovation for healthcare companies focusing on India. This is going to be especially crucial for the 1.25 billion population in India. With increasing insurance coverage and also the surge in Government spending, there is a large population in India that is looking at accessing high quality healthcare facilities. The need of the hour is better healthcare facilities. Along with this, there will also be a higher demand for medical devices and equipment. In the current scenario, there is a huge gap between demand and supply, especially local supply.

Approximately, 75% of medical devices and equipment in India are imported today. This makes the devices expensive and the treatment more expensive.

In future, medical treatment will evolve to towards P4 Medicine. This includes Preventive, Predictive, Participatory, and

APRIL 2018 | HEALTHCARE RADIUS

Personalised. To achieve this goal, we need to continuously measure the virtual parameters that can define patient health. It is only through digital technologies such as artificial intelligence, VR/AR, 3D-printing, robotics or nanotechnology, that this can become a reality. To make it accessible to all, it is pertinent to ensure that this is affordable.

Demand for affordable healthcare is never so high as it us today. The demand is huge when it comes to both cutting edge precision technologies as well as affordable low-cost technology. It is a fact that India requires both in order to provide quality healthcare access to its large population.

Reducing cost without compromising on key functionalities of any medical device requires one to look for non-traditional design and development approaches.

Yesterday's design practices will not help in achieving this aim. Design engineers need tools that help them explore large number

MANAGEMENT

of design options. This is nearly impossible to do using traditional build-n-test approaches. Design analysis and review in the virtual environment will enable engineers to study cost-effective approaches and in turn bring in affordable devices and treatment to patients. Simulation technology will forever change the way healthcare is today and make it accessible to all.

Engineering simulation helps in achieving both these goals simultaneously – that of cutting-edge technology and affordability.

Devices with complex designs can be tested in a virtual environment before making prototypes. This results in reducing risks and saving costs. Also, analysis in a virtual environment helps in reviewing several cost-cutting options. This helps companies' in coming up with low-cost alternatives for the Indian market.

Companies have also been laying emphasis in creating product lines specifically for the local market. Deploying engineering simulation upfront in the design cycle will not only reduce the design and development time, but also ensure that the product is meeting the local needs of India. Competing goals of reliability, robust connectivity and low-cost can be achieved to create India specific IoT enabled medical devices using extensive usage of engineering simulation in the device design.

Today, one can start building virtual prototypes of new product ideas and concept.

These virtual prototypes can be modified and tested with simulation hundreds of times- in the same time it would take to build and test one physical prototype – saving time and money in perfecting the product design. Companies are also using simulation to speed up new process designs and regulatory certification in drug manufacturing.

Simulation innovations are also instrumental in making healthcare safer. Medical devices are getting technologically very complex with IoT, large number of embedded software and controls, feature rich

2 user interface and so on. Physically testing each ‘what-if’ scenario may not cover all the blind-spots. Simulation helps scientifically testing the limits of safe operations of medical devices and equipment, thereby reducing chances of failure scenarios.

The medical devices sector in India is at a nascent stage with most of the indigenous manufacturing restricted to medical consumables. Considering the strong demand and the Government’s ‘Make in India’ initiative, global and Indian companies are investing heavily in India. The Government of India's initiative is also incentivising design and manufacturing for the local market.

What we have today is a very vibrant ecosystem of MNCs, SMEs, start-ups, Government funding projects and academic participation in India that are working to bridge the gap between affordability and the cost of quality healthcare. So there is no better time to adopt simulation technology to aid this revolution.

Rafiq Somani is Country Manager South Asia Pacific & Middle East at ANSYS, Inc.

2. Companies are also using simulation to speed up new process designs and regulatory certification in drug manufacturing.

HEALTHCARE RADIUS | APRIL 2018

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CONSUMER CONNECT

Carestream’s wireless digital X-ray technology High-quality medical images help physicians assess players’ health and injuries

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n addition to demonstrating their speed, agility and strength at the 2018 National Football League Scouting Combine, top college football players also undergo comprehensive physical evaluations that include X-ray exams. This year a CARESTREAM DRX Core detector is being used with the existing X-ray system at Lucas Oil Stadium (Indianapolis, Ind.) to produce high-quality diagnostic images in seconds.

A Carestream DRX detector has delivered rapid image access at the NFL Combine for seven consecutive years with CARESTREAM DRX-Ascend and CARESTREAM Q-Rad X-ray

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systems. The company’s DRX detector converts existing X-ray rooms and mobile units to the speed and convenience of full digital X-ray imaging in less than four hours.

Additional imaging exams to evaluate athletes’ health were conducted at Indiana University Health Methodist Hospital in Indianapolis. NFL coaches, general managers and scouts who are preparing to draft new players evaluated more than 300 top prospects at the annual Combine.

Multiple NFL teams—and other sports organisations worldwide—are using Carestream’s advanced digital medical imaging systems to diagnose and treat player injuries. The newest addition to Carestream’s growing portfolio is a cone beam CT (CBCT) imaging system that produces medical images for use in diagnosing conditions and injuries for professional athletes and recreational sports enthusiasts.

The CARESTREAM OnSight 3D Extremity System enables sports medicine and orthopaedic specialists to capture 3D and weight-bearing images of hands, wrists, elbows, knees, feet and ankles, which provide important diagnostic information that is not available from traditional CT systems and other types of patient extremity exams.

Carestream worked closely with leading orthopaedic specialists, sports medicine physicians and athletic trainers to develop this compact, affordable 3D imaging system for use in treating a variety of orthopaedic injuries and conditions.

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