Asian Hospital & Healthcare Management - Issue 34

I s s u e 34

2016

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Technology-enabled Advancements in Care Delivery

Mobile Image Access Saves Time Improving provider workflow and patient care

Emerging Technologies in Healthcare The role of technology in shaping the future of healthcare

Foreword Augmented and Virtual Reality in Healthcare Tools for providing better care From Telemedicine to PHRs to EMRs to mHealth, technology has for long been at forefront of providing better healthcare services to patients.

From digitization to mobile revolution, healthcare industry has seen it all. The world is slowly moving from mobile to wearable devices thanks to disruptive technologies like Virtual Reality (VR) and Augmented Reality(AR) that have been cutting across various industries retail to manufacturing to healthcare.

Withapplications and products like Pokémon GO and Google Glass, millions across the world know or are aware of these buzzwords Virtual and Augmented reality. These technologies seemingly have the potential to change the healthcare industry in day-today medical practice.

Interestingly VR and AR have been in use in healthcare for years. Now the enhanced versions of technologies signal a new way of working.These refined technologies are widely adopted for a revolutionised care.

AR is a technology that adds value to the real world by overlaying and displaying real-time digital information and media, such as videos and 3D models, via the camera view of your smartphone, tablet, PC or via wearable tech such as a viewfinder or smart glass. VRaids in surgery simulation, phobia treatment, robotic surgery and skills training.VR and AR technologies show new possibilities for indepth physician training; allow patients with pain management and rehabilitation programs. SIM-K and Virtual Interactive Presence and Augmented Reality (VIPAAR), among others, are products developed on the platforms of VR and AR respectively. Developed by clinicians at the University of Montreal, SIM-K is a simulator that teaches doctors how to perform complex knee replacements. The system incorporates

a screen as well as haptic sensors that mimic the buzzing of saws and drills. VIPAAR is an augmented reality technology developed at the University of Alabama at Birmingham, and uses Google Glass to superimpose a real-time projection of the mentor’s hands into the surgeon’s field of sight—from across the hall or around the world.

Skip Rizzo, director of medical virtual reality at the University of Southern California's Institute for Creative Technologies, believes both technologies create an environment well-suited for immersion or exposure-based therapy to treat fear and anxiety.

According to IDC estimates, augmented reality and virtual reality (AR/VR) market is expected to grow from US$5.2 billion in 2016 to around US$162 billion in 2020, accounting for a CAGR of 181.3 per cent.

These technologies are expected to play a key role in providing better healthcare, but the overall success will depend on realising the larger goal of improving care with reduced spending.

In this issue of Asian Hospital & Healthcare Management, you can find the articles—by Michelle R. Troseth, Chief Professional Practice Officer, Elsevier Clinical Solutions, USA; Sanjay Joshi, CTO Healthcare and Life Sciences, Emerging Technologies Division, Dell EMC and others—related to latest technologies helping the industry in improving the outcomes.

Prasanthi Potluri

Editor

HEALTHCARE MANAGEMENT 04 Medical Tourism ‘Win-Win’ for India!

Suhas Jadhav, COO, Bonanza Medical Tourism Pvt. Ltd., India

10 How Asian Healthcare Leaders Can Benefit From ISO 9001:2015 Robert Burney, ISO 9001 expert, US

Cover Story

Contents Technology-enabled Advancements in Care Delivery

17 Healthcare Outsourcing Julius Raj Stephen, Joint Head of Operations, Omega Healthcare, India

INFORMATION TECHNOLOGY 22 Technology and Improved Health Outcomes The friendship begins Stuart Kruger, GM, Enterprise & Commercial, SMG Technologies, Australia

26 Mobile Image Access Saves Time Improving provider workflow and patient care Jonathan Draper, Director, Product Management, Healthcare Calgary Scientific, Canada

32 Physicians in China Furthering digital landscapes Diana Tan, General Manager, Kantar Health, China Adele Li, Commercial Director, Kantar Health, China

40 Preparing and Engaging Nurses in the Informatics Revolution Michelle R Troseth, Chief Professional Practice Officer, Elsevier Clinical Solutions, USA

46 Emerging Technologies in Healthcare The role of technology in shaping the future of healthcare

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Sanjay Joshi, CTO, Healthcare and Life Sciences, Emerging Technologies Division, Dell EMC, USA

50 RESEARCH INSIGHTS 56 PROJECTS

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Advisory Board

Editor Prasanthi Potluri Editorial Team Grace Jones Nirosha K Vijaya Lakshmi Art Director M A Hannan Product Managers Jeff Kenney Senior Product Associate Ben Johnson Jennifer Wilson

John E Adler Professor Neurosurgery and Director Radiosurgery and Stereotactic Surgery Stanford University School of Medicine, USA

Sandy Lutz Director PricewaterhouseCoopers Health Research Institute, USA

Circulation Team Naveen M Nash Jones Sam Smith Subscriptions In-charge Vijay Kumar Gaddam IT Team Jareena K Ranganayakulu.V Sitaram Y Uday V Head-Operations S V Nageswara Rao

Peter Gross Chair, Board of Managers HackensackAlliance ACO, USA Asian Hospital & Healthcare Management is published by

In Association with

A member of

Pradeep Chowbey Chairman Minimal Access, Metabolic and Bariatric Surgery Centre Sir Ganga Ram Hospital, India

Confederation of Indian Industry

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Medical Tourism ‘Win-Win’ for India!

The medical tourism industry has witnessed a steady global growth in the recent years and India is establishing its footprints in this sector with a gusto. As the world population becomes more aware of healthcare options and as quality healthcare rises as a priority in the minds of the majority ages, patients are bound to pursue crossborder healthcare. The primary reasons for medical tourism therefore are high quality healthcare, specialised treatment options, immediate service opportunity for travel coupled with affordability. The Indian government’s Make in India initiative will contribute to the growth of medical tourism phenomenally for several reasons.

Suhas Jadhav, COO, Bonanza Medical Tourism Pvt. Ltd., India

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y far, Wikipedia has had the simplest definition of medical tourism: “Medical tourism is the travel of people to a place other than where they normally reside for the purpose of obtaining medical treatment in that country.” Although it is quite a new concept to a larger majority of people across the globe, medical tourism is not something that started in the last century or a century before that. According to historians, there are several documented texts that provide evidence of medical tourism being a thing as far back as the Egyptian and Greek civilisations. The term ‘medical

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tourism’ might have evolved somewhere in these last five to six decades, but the concept has been known to human beings for over 2000 years now, and has been in successful practice (on a minimalistic scale) since then. In all this, India has played an essential role and continues to do so. It is a known fact that the country has stock of distinctive flora spread through various regions, which has been a key contribution in the invention and continuation of the practice of Ayurveda. Sages and elderly of the community have promoted Ayurveda as a complete science since many centuries and it has proven to be a boon for overcoming various diseases and disorders. Before Vasco Da Gama discovered the route to India, people

from neighbouring lands in South East Asia and Asia Pacific used to travel here to seek medicinal treatment, yogic relief, and meditation therapy.

And today after 15 years of the 21st century have run out, India promises to be one of the most sought after health tourism destinations on the global map, which is a breakthrough achievement that continues to gain more and more significance with the passing day. A sector growing at 23-28 per cent on an average in the last three years according to the tourism ministry, medical tourism is a niche domain that India is certainly exploiting. The various medical centres in the country are bound to attract an exponential number of medical tourists in the next five years. While we are at

it, this has not been an ad-hoc growth just out of the blue. The efforts made by the central government in close collaboration with state governments has been a key boost for this staggering rise in the popularity of India as a hub for health tourism amongst Americans, Europeans, Africans, and Asians equally. That being said, there are few major factors that have driven the sector’s success, including inexpensive treatments across various hospitals in the country, implementation of technological advancements for high precision diagnosis and treatment, the policy decisions taken by government, and emergence of specialised care centres to cater the various needs of travelling patients and their families.

Factors Responsible for Growth of Medical Tourism in India Cost

It is expensive to receive medical treatment in most of the western countries and developed nations.

Whereas in India, which is on a rapid development path, there are certified and respected healthcare centres that provide inexpensive medical treatment as compared to other countries. According to industry estimates (which are revised from time to time), the average cost for a heart surgery performed in the United States is USD 30,000, whereas the same comes down to somewhere between USD 6000 to USD 7000 in India.

This is true not only for heart surgeries, but also for various other treatments like bone marrow transplant, eye surgeries, cosmetic process treatments, neurological treatments, etc. Bone marrow transplants could cost up to USD 250,000 in USA or Europe, but in India, the costs are as low as 10 per cent of the amount that would be spent in western countries.

Likewise, the transplantation of liver

is supposed to be a very specific and expensive process in USA or Europe, but the emergence of several hospitals in India that provide this treatment at lower costs, has largely contributed to patients travelling from across the globe. Advanced medication techniques and highly qualified doctors and healthcare practitioners at very reasonable costs is what attracts people from all over the world to seek treatment here in India.

Breakthrough Policies

It is of utmost essence for the development of any sector that the country’s policies regarding it are put in place in a concrete and helpful manner. The Indian government has been actually successful in taking drastic steps to improve the medical tourism business within the nation. The government has introduced specialised facility to provide medical tourists with Visa on Arrival in order to boost and promote the sector. At the same time, there

are multiple international exchange programs in motion throughout the year, which have helped in increasing ties with various countries. With the help of such programs, the potential of India’s medical tourism scenario has been constantly growing as people interact amongst themselves and the country’s healthcare and health tourism services are discussed. Moreover, there is now the ‘Make in India’ initiative kick-started by the central government, which promises to establish and develop hospitality and wellness centres across various booming tourist destinations of the country including Chennai, Bangalore, Goa, Andaman & Nicobar Islands, Lakshadweep Island etc. All these cohesive efforts have enhanced the way in which medical tourism operators work in the country. With the welcome policy changes and innovative implementation of efforts to raise proper infrastructure, more and more private players are investing heavily in the domain.

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like Chennai, Delhi, Mumbai, Kolkata, etc. With the help of video conferencing, collaborative networking, cloud space sharing, digital record storage, it has become very easy for patients to get in touch with Indian hospitals for the purpose of discussing their case with imminent doctors in India and has enabled them to plan their travels to the country accordingly. There are other cloud-based offerings that host medical records of patients with minimum annual charges while providing access to medical tourism solution providers and doctors. If a patient conducts tests in any part of the world, these reports can be updated in real-time, giving way for doctors, patients, and tour operators to connect with each other.

In the literal sense of the term, there

A sector growing at 23-28 per cent on an average in the last three years according to the tourism ministry, medical tourism is a niche domain that India is certainly exploiting.

are no such geographical barriers seen anymore, as medical tourists continue to flood in huge numbers from USA, UK, Europe, Afghanistan, Africa, and Australia.

Technological Revolution

It can be said that the progress of medical tourism in India is indebted to the emergence of the developments in the IT domain. The introduction of cloud computing, web applications, mobile platforms, and enterprise software solutions for efficient administration and management of healthcare facilities, wellness centres, hospitality centres, has proven to be an important

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factor for the development of medical tourism. Technology has provided the required thrust to set medical tourism in momentum, by making it feasible to improve healthcare services, enhance medical systems, and take up in-depth medical research. Due to these positive developments, awareness created about India’s potential to provide high quality medical treatments and care has been attracting people from across various countries as medical tourists to cities

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Qualitative Care Facilities

A misconception that there is lack of qualitative care was a negative aspect that affected medical travel to India in the last century. But, with all the growth and development and the progress that has been seen as well as witnessed by the world, India is gradually taking quite large strides in being recognised as a superpower in the healthcare and medicine sectors. Naturally, all of this is proving to be huge plus for the

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Health Tourism Hub Development

For the sustainable progress of any company, it is largely necessary that it creates a niche for its product or service in the market. Likewise, the entire progress of a sector like medical tourism is dependent on development of this niche in the form of ‘regional health tourism hubs’ within the country.For instance, let’s take the city of Chennai, which is called as India’s Health Capital.

The series of super-speciality and multi-speciality hospitals in the city are responsible for providing treatment to about 150 to 200 international patients on an everyday basis. The way it has been promoted by the state government has had a huge impact in the increasing number of patients that choose Chennai as their preferred location. More than 40 per cent health tourists who land in India are headed to Chennai for their respective medical treatment, whereas around 30 to 40 per

cent domestic medical tourists travel to Chennai for healthcare. This surge is heavily credited to the extremely low cost healthcare facilities available in the city where consultancy and treatment is provided within a minimal waiting period. Through various initiatives, different state governments are now collaborating with the centre to develop regional medical tourism hubs like Chennai in their own states, which in turn can boost the foreign exchange revenues of the country.

There is no doubt that the scope for the growth of medical tourism is tremendous, with reports estimating it to become a US$10-12 billion industry by 2020. The exponential growth of medical tourism for the last few years is certainly a huge factor in increasing healthcare sector’s contribution to the country’s GDP numbers. The global promotion of inexpensive and sophisticated treatment of various complicated conditions, along with the integration of advanced technologies to actually provide high-precision Author BIO

abundance of medical tourists that India received. There are 23 JCI accredited hospitals in the country that provide best-in-class healthcare facilities, qualified healthcare professionals for consultancy, experienced surgeons for complicated treatments, and much more. This has enabled patients living abroad to see India as one of the top choices to get their treatment done, not only for the low costs but for the level of care and consultancy that has been made available in the recent times.

Post treatment, patients are provided with an option to either recuperate at the hospital or at any other paid accommodation facility in the vicinity.

Also, India has been recognised by the United Nations as the country that has given ‘yoga’ to this world. There has been a surge in the number of yoga centres or yoga retreats coming up in scenic locations throughout the country, which is definitely acting as a major point of attraction for medical tourists.

treatment is the basic fundamental idea that keeps medical tourism alive.

In recent times, the country has been successful in challenging and competing with other medical tourism destinations like Costa Rica, Thailand, and Colombia. The slight advantage that India has over these countries is the communication part. Since most of these other nations function in non-English languages, and in India (although a diverse country), English is commonly used for business communication across all its regions, most of tourists prefer to come here instead. To top it up, India is being promoted and discussed amongst various communities as the country that gave birth to effective medical treatments in the form of Ayurveda.

There are just too many foreigners who come here in search of organic, natural, and hassle free solution to their problems. With some smart policy decisions, the medical tourism market certainly has a conducive environment to thrive, and thrive further!

Suhas Jadhav leads the operations and functioning of Bonanza Medical Tourism Pvt. Ltd as a COO of the company since December 2015. He is a qualified Physician and a Surgeon and has cleared his BAMS in the year 2010. He has joined Bonanza Medical Tourism Pvt. Ltd in the year 2011 and since then has been instrumental in setting up the various process and functioning of Bonanza Medical Tourism Pvt. Ltd.

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How Asian Healthcare Leaders Can Benefit From ISO 9001:2015 This article details the key elements of ISO 9001:2015 that Asian healthcare leaders should be aware of, detailing how this standard can have a positive impact on future hospital performance. This standard represents a significant change in structure and content and healthcare administrators will have until September 2018 to transition.

Robert Burney, ISO 9001 expert, US

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gainst a backdrop of rising incomes and an increasing population, the healthcare system in Asia faces a landscape of major opportunities and challenges. Navigating that landscape can be made easier by incorporating ISO 9001, a popular quality management system standard used around the world, which provides more efficient ways of working, better cost control and more effective implementation of new practices.

That’s especially important as more than 60 per cent of Asian companies, including healthcare firms, say they have increased their investment in quality—including

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technology, training, equipment and personnel—over the past three years, according to a new ASQ Global State of Quality study.

Asia has been a leader in ISO 9001 adoption, based on an annual ISO Survey, with China and Japan consistently in the top 10 destinations for many years. Studies from the United Nations Industrial Development Organization, or UNIDO, show that effective ISO 9001 implementation and accredited

certification has brought clear economic benefits to Asian developing countries and 98per cent of the certified organisations surveyed from various industries considered ISO 9001 implementation and certification to have been a ‘good’ (73 per cent) or ‘very good’ (25 per cent) investment. That’s a positive sign for Asian healthcare organisations.

Recently, the ISO published its updated ISO 9001:2015 standard that represents a significant change

in structure and content healthcare administrators will need to carefully review and adjust to over the next three years. Healthcare organisations that are currently registered to the ISO 9001:2008 quality management system standard will have until September 2018 to make the transition to the ISO 9001:2015 version. This provides time to transition to the new standard or acquire ISO 9001 registration and certification under the new standard.

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Registration to the ISO 9001:2015 standards also announces to the world that you have a management system in place that produces consistent results from your patient care processes, and that the system is heavily focused on patient satisfaction and improvement.

At initial review, the new ISO 9001 standard doesn’t look that different and, to some extent, it merely spells out requirements that were implied in the previous version. Basic principles remain — things like customer focus, leadership, engagement of people and using a process approach. Digging deeper, however, one sees that the standards introduce fundamental changes in thinking about quality management systems, adding new terminology and approaches to

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these key principles that can be more applicable to service industries like healthcare. They are also less prescriptive, giving organisations more freedom to innovate.

Leadership vs. Management

ISO 9001:2015 provides an opportunity for healthcare organisations to monitor and constantly improve key processes helping leaders to provide clear direction so that team members can spotlight real and potential problems.

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ISO 9001:2015 ensures a management system that produces consistent results from patient care processes, and aims for a system heavily focused on patient satisfaction and improvement.

Healthcare administrators familiar with ISO should note that the requirement for a management representative has disappeared in ISO 9001:2015 and the term ‘management responsibility’ has been replaced by an emphasis on responsibility of senior leaders for implementation of the quality management system, or QMS. The previous standards always noted that the management representative had to be a member of management, but this was not always the case in practice.

Now, it is very clear that the duties of the management representative belong to senior management or the chief executive. Healthcare leaders must now be personally involved in the hands-on implementation of the quality management system including determining quality policy and defining quality objectives. However, some clerical and administrative duties may still be delegated.

Risks and Opportunities

Thus far, few healthcare organisations have actually performed Failure Mode and Effects Analysis, so the standards now talk about ‘risks and opportunities,’ which the organisation must identify and address. No specific risk methodology is prescribed, but organisations must show some effort.

This should not be a challenge, since even a retrospective technique like a Cause & Effect analysis can produce systemic change to a process that will prevent future errors. Risks, therefore, may be positive as well as negative. The term ‘risk’ just means the outcome is uncertain or not fully under the control of the organisation.

While healthcare organisations are quite accustomed to monitoring environmental factors that affect their business, now they will have to

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demonstrate this process to auditors according to the new ISO 9001:2015 standard. So they must have mechanisms to identify risks and opportunities and a plan to address them.

There are no specific requirements in ISO 9001:2015 for a Quality Manual or for key written procedures. However, it’s perfectly fine to continue to have a set procedure for tracking documents, performing internal audits etc. The message is to focus on bigger issues and know that specific procedures are no longer required. Written procedures may thus be more relevant to the needs of the organisation.

Technology and data collection bring opportunities to every phase of healthcare, but these are accompanied by some risk. One important question is what to do with important data related to quality objectives or required by regulations. One easy answer is to feed the results back to employees who will use the feedback to alter processes to produce better outcomes, thus demonstrating the improvement required by ISO 9001.In healthcare that means including data on complaints and near misses. For example, that might mean the wrong medication was sent out but caught before delivery to a patient.

Also, not every unhappy patient will register a formal complaint, and employees must be trained to recognise situations that need to be changed. For example, a patient request for a blanket translates into a complaint that the patient is cold. Perhaps the temperature needs to be increased in that area, or perhaps blankets/robes need to be issued pre-emptively to forestall heat loss.

Making patient data more widely available in electronic format carries the risk that such data might be accessed by unauthorised individuals. Physicians may want information about their hospitalised patients in their office, in their home, or in the parking lot on their cell phone. This is an opportunity for improved care and efficiency but also a risk for data loss. Preventive strategies are available, but they must be used, and they must be effective.

One frequent problem is the loss of an unencrypted laptop containing patient data. This situation is easily prevented.

Electronic devices throughout the hospital report data to the medical record system, but that same data is also accessible to the sales representative in the lobby. There’s an example of a medical student who found he could write orders in patient charts with his phone from the sidewalk outside the

hospital. While one doesn’t want to be so risk averse as to not take advantage of new opportunities, the key is to be aware of the risks and use ISO 9001:2015 to create a plan for dealing with undesirable outcomes so you are never surprised.

Considering the Customer

According to the ASQ Global State of Quality 2 Research, 56 per cent of Asian organisations say enhancing the customer experience is a top priority.

So it’s positive that customer needs remain a central focus in ISO 9001: 2015 revision, including anticipation of problems before they occur. The term ‘customer’ now includes other interested parties. In healthcare, this might mean family members, employees, medical staff, payers, suppliers, and even the local community. All have an interest in the local healthcare organisation, but their interests are different and sometimes conflict.

The healthcare organisation must consider these varied demands and develop a system to satisfy as many as possible. As healthcare systems move more to preventive care, organisations will need to demonstrate this new demand is being met in addition to care for illness and injury.

Internal Audits

This is a hidden strength of the ISO 9001 management system.

Various employees from all sections of healthcare organisations can audit sections where they do not work against the ISO 9001 standards. This, of course, requires some training, which means that knowledge of the standards will be widely dispersed within the organisation. Internal auditors must be trained not only in the ISO 9001:2015 standards, but also in the skills of auditing. By auditing another section, these employees become familiar with another aspect of the company, and better understand where they fit in the overall process. These employees

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PATHOLOGY UPDATE

2016

3 – 4 November 2016 | Dusit Thani Abu Dhabi, UAE

www.ascpme.org

Topics to be covered

Who should attend?

Diagnostic Errors and Patient Safety - The IOM Report

Pathologists

How to Implement a Successful Laboratory Quality Audit Program?

Laboratory professionals

Implementation of MALDI-ToF in Microbiology

General practitioners

Innovations in Laboratory Medicine

Infection control practitioners

Pre-Analytics and Send Out Sections: How to Improve Quality & Patient Safety?

Residents and students

Bioinformatics Role in Laboratory Medicine

Laboratory managers and directors

WHO Update on Classification of Bladder Tumors

Nurses

The Immune System in Health and Disease

400

PATHOLOGY UPDATE 2015

+ Attendees

25 Speakers

9 Sessions

Conference Secretariat: MCI Middle East – Tel: +971 4 311 6300, Fax: +971 4 311 6301 www.asianhhm.com Email: ascpme@mci-group.com

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also become local champions for the QMS within their own section. There is some direct cost for the training and time investment for the auditing, but these balance against the improvements mentioned. It is a good practice to schedule internal audits so that every key process is audited once a year, although problem processes may require auditing more frequently. Results of internal audits go to management for use in management review, improvement efforts, and overall assessments.

Updated ISO 9001:2015 standard that represents a significant change in structure and content healthcare administrators will need to carefully review and adjust to over the next three years.

More Attention to Process

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outside the organisation that also need to be monitored. Some of these may affect your internal processes or interact directly with patients or other customers.

Changes in Terminology

When reviewing ISO 9001:20151, healthcare administrators will notice some changes in terminology, partly to make the standards more applicable to service industries, like healthcare.

For example, ‘products and services’ replaces ‘products’. ‘Records’ are now ‘documented information,’ and a ‘supplier’ has become an ‘external provider.’ These changes are mainly a new way of looking at things, and use of the exact terminology is not required for compliance.

‘External provider’ might be a more meaningful way of thinking about an outside entity that furnishes goods or services to the organisation. In any case, organisations are free to continue to use existing terminology.

1 http://asq.org/learn-about-quality / iso-9000 / iso-90012015/

Author BIO

This new ISO 9001:2015 standard emphasises process even more and healthcare organisations must monitor key processes and demonstrate their use of data to make improvements.

There is also a requirement to look at processes from the standpoint of risks and opportunities. Think about what inputs are required and what outputs are expected. Then consider what has to happen within the process to make that transition. Are there metrics to monitor processes and does the organisation use those metrics for improvement? Don't forget processes performed outside the organisation that should also be monitored. For example, if you are purchasing, assembling and sterilising operating room supplies outside of your facility, make regular visits to that facility to confirm the quality of their processes.

Make a short list of the key processes in your organisation. Supplies, IT, and medical records contribute widely to processes in any healthcare institution, but these are support processes and not the main focus of the organisation. To look at any high level process, establish specific objectives and related metrics to demonstrate progress. Review these metrics at specific intervals, and invite the various process owners to discuss ways to make their process operate more efficiently.

In looking at process metrics, don't forget processes performed

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For this revision, all terms are included within the ISO 9001 standard.

There is no need to refer to another list of definitions. Terminology within ISO 9001 is also compatible with similar terminology in other standards, such as environment, health and safety, etc.

Value

There is, of course, value to the organisation in having a clear vision and direction for leaders and employees.

Under the discipline of ISO 9001: 2015, processes will be monitored and constantly improved. The organisation will run efficiently, and leaders will know where real and potential problems are. The standards require those things.

Registration to the ISO 9001:2015 standards also announces to the world that you have a management system in place that produces consistent results from your patient care processes, and that the system is heavily focused on patient satisfaction and improvement.

That should be reassuring to prospective customers from other regions who do not know you well.

In summary, if ISO 9001:2015 is seen as part of the organisation's culture, all of the changes outlined here should be relatively easy to implement.

A positive outcome of these revisions is healthcare leaders will now be required to use the standards as the powerful management tool they were designed to be. Ultimately, the key is for a healthcare organisation to be able to say, "This is the way we do things here, and everyone from the CEO down knows it."

For more information on ISO 9001:2015, visit ASQ Quality Management Standards.

Robert Burney, is a quality consultant and ISO 9001 expert who is co-author of "Using ISO 9001 in Healthcare: Applications for Quality Systems, Performance Improvement, Clinical Integration, and Accreditation." Burney, a member of the American Society for Quality, was previously Director, Quality Improvement, Medical Services for the US State Department.

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Healthcare Outsourcing Successful implementation of ICD - 10 and the growing needs & challenges of medical coding & billing in India are highlighted in this interview.

Julius Raj Stephen, Joint Head of Operations, Omega Healthcare, India

1. Prior to conceptualising Omega Healthcare in 2004, you had a sizeable amount of experience within the realm of Healthcare Outsourcing. Kindly shed some light on your journey thus far.

I started my career in early '96 as a Charge Entry, Payment Posting Executive. A good schooling from Kendra Vidyalaya, that moulded my communication skills, was the key factor that paved way for my long stint in this industry. This, and my desire to learn more about Revenue Cycle Management (RCM), put me on to the next role as an AR Executive. Each day was a new learning, communicating directly with customers and the providers. This role helped gain a thorough understanding of the functionality of the RCM business process.

At a time when healthcare outsourcing was in its infancy in India, being a part of healthcare outsourcing industry was akin to being in the midst of a vast ocean of knowledge. I was determined to charter my career in tandem with the growth of the industry. Starting out as an executive to being a team lead and thereafter an Account Manager, these varied roles have taught me the nuances of healthcare outsourcing, strategies to leverage its advantages and how all these were packaged into a successful business model. I have seen and been part of the continuous transition this industry has been through.

I joined Omega Healthcare in 2003 as an Assistant Manager. My journey here has been remarkable and has further enriched my knowledge on the healthcare BPO industry. With two decades of experience, I can see how the USP in the healthcare outsourcing sector has evolved from competitive pricing to Value Adds – it is no longer about the monetary benefits alone. As a service oriented industry, success stories have now become about customer delightment and going the extra mile.

Today as the Joint Head of Operations

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for Omega, it fills me with immense pride to be a part of an organization that staunchly abides by this principle.

A 13 year journey, that continues, has been remarkable and the amount of knowledge being gained in the process is truly phenomenal and valuable.

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2. Your organisation’s mission clearly postulates that it doesn’t intend to deal with physicians and hospitals directly. What is the ideology behind this practice?

To quote our founder Anurag Mehta, “The most important differentiator of our company is the fact that we don’t compete with our clients, and what I mean by that is we are a wholesale type of company as opposed to retail”.

Partnering with our aggregator clients and growing together has been the reason for our success. It would be against our ethical business practice to directly work with physicians and hospitals, which could possibly result in business conflict as well. Working primarily in the US healthcare sector, this policy has worked well for us in gaining a wide clientele.

we establish and strive to maintain a standard across our locations, be it the infrastructure, culture, values, or the basic modality of operations.

Adding to this, we have real time dashboards and good reporting by the work force management team.

Omega has invested heavily on good data analytics and BI tools which makes my job easier.

3. As the Joint Head of Operations, would you say that administering an organisation across variegated geographical zones has its fair share of challenges?

We are constantly locating at expanding our facilities in each of the locations. One would not feel any difference in the culture and atmosphere across our locations. Tier-2 and Tier-3 cities did prove to be a challenge for us, given the conservative culture of these places. But with continuous coaching and mentoring, we have helped these places strike a balance and sync with our corporate values and culture. The induction and on-boarding process, especially, follows a uniform process and has been of immense help to the new employees settle in to our “Omega Family”. As an organization,

4. How efficacious are your training programmes as well as facilities in terms of shaping up the potential generation of Healthcare outsourcing leaders? Please delineate the workings of the Omega Medical Coding Academy.

At Omega, we believe in creating strong leaders. Learning and skill building is our core DNA. Our culture strongly advocates & encourages associates to keep learning on a continuous basis.

Our training programs are designed to create this pool of business& domain savvy professionals. This is done through a series of industry recognised, domain certification programs, and business acumen programs. CPC certification in partnership with AAPC, ‘First Time Leader’ &‘First Time Manager’, are a few examples of our training programs.

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Based on our tie ups with AAPC and Gallup, our programmes are delivered using the most modern learning science like ‘multiple learning intelligence’, ‘strength based learning’ etc. We use some of the most modern learning delivery methodologies like ‘4-stage learning architecture’, ‘Outcome based instruction models’. These programs are designed using methodologies like ‘ADDIE / SAM’ to ensure agile learning and outcome aligned to the business requirements.

Our associates have a wide range of opportunities to choose from and can learn either via an instructor led or web based, self-learning model. Social learning is a part of our agenda in the months to come to pioneer different learning styles in this industry.

All these efforts pay off;and the proof of the pudding lies in the fact that over 70 per cent of our top leadership is organically grown over a period of 12 years. Ex-Omegans also hold key positions in other organisations in the healthcare Industry. Clients onsite peg Omega at the top of the line on domain & delivery of their projects.

Omega Medical Coding Academy (OMCA) is a division of Omega Healthcare — the preferred BPO partner to the US healthcare industry, OMCA is

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the brain-child of Mr. Gopi Natarajan, created to leverage Omega Healthcare Management Services’ (OHMS) vast experience and benefit both students and the industry in general. This first-of-its-kind business-academia collaboration will deliver high-calibre professional medical coders to cater to the expanding industry.

With highly-qualified trainers having extensive experience, OMCA will continue to tap the huge base of graduates emerging from educational institutions, and help India become a force to be reckoned with in outsourced healthcare services. OMCA certification provides fresh graduates with the opportunity to work on critical processes for Fortune companies in the US. 5. Is your Data Management service integral part of the holistic group of healthcare outsourcing solutions that you do offer? Does data validation play a big part in this service?

We don’t do any data management services to our clients. All the data which includes coding, billing and PHI sits in client system.

6. What are the challenges that you face while endeavouring to deftly carry out medical billing and coding for multifarious organisations and businesses?

Maintaining 98 per cent quality of service delivery to each and every single client is by far the biggest challenge in any service sector. It is an even bigger challenge in the healthcare sector where one has to handle critical information such as PHI and insurance claims. There is a perennial demand for trained and skilled workforce in this sector. The need of the hour is a curriculum that not only imparts the requisite training and education, but also nurtures and moulds the young talent. This curriculum should also empower them with necessary communication skills to be more

customer-centric and engage in a collaborative service delivery business culture.

The transition from ICD-9 to ICD-10 was smooth, even though the industry overestimated the difficulty of the transition. We invest significantly in training all our people and stay up to date with the industry standards.

Since any change will take time, we had more employees to offset any drop in productivity and that helped.

These efforts stood out and even today we have very little attrition, despite attempts of poaching by competitors.

It was a big change and we have been well prepared, way ahead of the competition. As a result, we were able to grab opportunities much faster than the others. We plan to add over 1,000 coders to our rolls this year.

7. Considering the dynamic nature of regulatory policies and government rules, is there a vast possibility of error when it comes to insurance?

When it comes to insurance claim processing, there does exist a possibility of errors which results in claims being processed incorrectly (denied, overpaid/underpaid). On the basis of sample taken we have 3 per cent to 4 per cent of claims being processed incorrectly by insurance payers on an average. In order to get these erroneous claims identified and corrected, we utilise automated reports built into our systems and seasoned claim analyst who have been specifically trained to study system reports, identify the issues and take the appropriate corrective measures. These two mechanisms

have immensely helped us to keep a check on our insurance claim errors.

8. What are the prospective strategies that Omega Healthcare plans to execute in order to ensure an enduring growth in the imminent years?

On the business front, we are growing at about 30 – 35 per cent and will further this momentum over the next 3-5 years. We have doubled our turnover over the last two and half years; you can imagine the kind of growth we have been achieving.

It is important to have a rich and healthy workforce in any organization for the company’s stability and scalability. Thus, building an HR structure that is aligned to the business structure and well positioned to service the needs of business is vital to any organization. It also requires designing jobs in a manner that promotes accountability as well as professional development. At Omega Healthcare, we constantly design and implement effective people processes, building capabilities in all the functional areas of HR like staffing, on-boarding, performance management, rewards, talent development, employee engagement and so on. Recently, we launched Parivarthan, an employee assistance programme, aimed at providing counselling and wellness services to help our people to deal with various issues. It is one of the many holistic HR approaches taken

by Omega that can have a lasting impact on employees’ lives. Today, at Omega we are about 10,200 people and continue to grow.

Julius is one of the founding members of Omega and has played a crucial role in Omega’s growth – right from its early days as a start-up to its current position of dominance. He presently leads the operations team spread across multiple geographies. Julius bring a customer-centric approach and a track record of increasing revenues and reducing cycle time, to the table. He leverages vast process knowledge in revenue cycle management to enhance efficiencies, improve quality and boost productivity for clients.

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VACUETTE® System – more than just blood collection

Sample collection trendsetter Greiner Bio-One developed the first-ever blood collection system made of PET plastic back in the mid-1980s. Sold under the VACUETTE® brand name, the system not only helps to simplify the process of collecting samples of bodily fluids in hospitals, laboratories and in doctor's surgeries, but also, and more importantly, helps to make it more safe.

One step ahead in Asia After founding its first production subsidiary in Thailand in 2008, subsequent years have seen Greiner Bio-One set up new sales locations in

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China and in India to enable the company to better cater for the requirements of the rapidly growing Asian market, and also to help guarantee universal healthcare provision. At the start of 2015, Greiner Bio-One Preanalytics also began distribution of the VACUETTE® specimen collection system in Japan.

VACUETTE® line provides extensive range of products The main benefit provided by this user-friendly vacuum sample collection system is it collects a clearly defined amount of blood, urine or saliva without the need for any other steps. The crystal-clear

VACUETTE® tubes are made of almost unbreakable plastic and can be changed quickly and hygienically, without any risk of coming into direct contact with the sample material.

Its reliable results and simple use make VACUETTE® "the" primary tube for all popular analysers. All tubes bear the CE mark and all products that are also produced or distributed in the USA are approved by the F.D.A. US health administration.

Blood collection and more with the VACUETTE® System This comprehensive product range not only includes vacuum tubes for blood, saliva and urine collection, but also collection accessories and safety products to avoid needlestick injuries. The extensive range of safety products available offers users protection against infectious diseases contracted mainly in an occupational setting that are attributable to needlestick injuries. Using VACUETTE® safety products reduces the risk of this happening to almost zero. An audible click signals to the user that the safety device is firmly fixed in place around the cannula, ruling out the possibility of a needlestick injury.

Greiner Bio-One has also developed safe and straightforward systems for analysis of urine and saliva. VACUETTE® urine collection and the GBO saliva collection system give customers a head-start when it comes to improving their sample quality and guaranteeing the efficacy of test procedures.

Other products in the VACUETTE® System's range The VACUETTE® System is completed by a range of special products and accessories such as the VACUETTE® Super-T Disposable Tourniquet, the VACUETTE® Transport Line for safe carriage of samples and the VeinViewer® Flex vascular access device, which provides a HD image of peripheral

veins in real-time. Manual and automatic BSR (blood sedimentation rate) systems, disposal boxes, shipping containers and equipment to automatically decap tubes round off the range.

Greiner Bio-One International GmbH Greiner Bio-One specializes in the development, production and distribution of high-quality plastic laboratory products. The company is a technology partner for hospitals, laboratories, universities, research institutes, and the diagnostic, pharmaceutical and biotechnology industries. Greiner Bio-One is split into four divisions – Preanalytics, BioScience, Diagnostics and OEM. In 2014, Greiner Bio-One International GmbH generated a turnover of 427,5 million euros and had over 1,890 employees, 23 subsidiaries and numerous distribution partners in over 100 countries.

Greiner Bio-One is part of Greiner Holding, which is based in Kremsmünster (Austria).

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INFORMATION TECHNOLOGY

Technology and Improved Health Outcomes The friendship begins

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INFORMATION TECHNOLOGY

The good news is that appropriate technologies exist and are ready to be implemented by forward-thinking healthcare providers.

Stuart Kruger, GM, Enterprise & Commercial, SMG Technologies, Australia

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t is no secret that healthcare services around the world are facing systemic challenges caused by demographic change and lifestyle-related conditions.

While a considerable effort has gone into understanding the origins of these problems, comparatively little progress has been made in harnessing the power of technology to help provide solutions. There are many challenges facing the healthcare sector, three in particular being: the ageing population, the growth of lifestyle-related chronic illnesses, and the financing of services.

These three significant issues cannot be addressed effectively without appropriate technologies in place to support the speed of potential solutions. The good news, is that these technologies exist and are ready to be implemented by forwardthinking healthcare providers.

The Role of Technology in Improving Healthcare Outcomes

While these (and other) challenges have been dissected, quantified and analysed, the sector in general seems rather delayed at identifying, adopting and applying relevant technology to help overcome these big picture challenges.

There are clear areas in which technology can play a vital role, and one of the most vital, is in connecting and making sense of the vast, but disparate silos of data. These silos contain anything from claims, to screening programmes, coaching efforts, health records, loyalty environments, the list goes on. These silos, equally, are representative of the significant investments made over time.

Healthcare providers, insurers, and public services, all perceive to have valuable

information, and it may very well be.

The challenge, however, is that these pools cannot be optimally leveraged due to the fragmented nature across different (and many) platforms, departments, and organisations, or just hidden among the organised chaos. Possibly even in the too hard basket.

Technology comes in many forms, and in particular, the form of intelligencebased, advanced analytics, helps to connect, interrogate, correlate, and make sense of these disconnected data sets.

Analytics do everything from bringing data sets together to derive greater value from insights and analysis, to improve the precision of enrolments into wellness programs, targeted prevention campaigns and coordinated care strategies.

So while one of the primary roles that advanced analytics play, is substantiating and enhancing existing data within an organisation, more broadly speaking it breeds connectivity among services, networks and programmes.

The aggregation and analysis of data does not work in isolation though. It is about looking at the overall picture without applying a one size fits all approach.

The subtle nuances between individuals and cohorts must be recognised. And with technological advancements, the two-way connection to, many (if not all) customers, providers and networks is vastly improved.

How it Works in Practice – the SMG Technologies Approach

SMG Technologies has pioneered a solution that connects disparate silos of data from any format on to a single platform with minimal disruption, whilst

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INFORMATION TECHNOLOGY

The three big challenges facing healthcare services today

supporting scale, reach, efficiency and effectiveness of intervention programs & strategies. This is applied at a population, cohort and individual level.

SMG Technologies provides advanced insights into existing data offering further, deeper insights derived from the application of their proprietary intelligence-based, advanced analytics engine. Additionally, they help clients create a dynamic risk propensity modelling strategy to improve the understanding, assessment and management of risk profiles, and they help identify the areas of opportunity within data acquisition roadmaps, and how best to go about acquiring that knowledge.

In addition to a full suite of digital delivery tools, a key advantage that SMG Technologies brings, is their own authoritative datasets offering extremely valuable information on human function, prevention, rehabilitation and applied subject matter expertise. This means the

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Education plays a vital role here, both of the condition itself, and how best to manage the condition as a unique individual.

The third challenge, may be as a consequence of the two previous ones, and relates to legacy funding models.

The changing nature of healthcare needs continue to place further strain on funding models that appear to have been designed to deal with very different levels of current circumstances. Many countries have grappled with the thorny issue of who should shoulder the burden of the cost –-whether it is the state, private sector or the individual–-and who should provide the services to the end user. Of course, regulations have a role to play, and the more chronic the circumstances continue to become, the more difficult the transition is likely to be.

company has data against which clients can benchmark wellness, prevention, intervention and performance outcomes & expertise. This offers reductions to learning periods of data references.

It is Time for the Healthcare Sector to see Technology as a Friend

We have heard many times, that knowledge is power. If knowledge is power, then applied knowledge becomes incredibly powerful. There is clear appeal for all levels, local to global, public and private, to tackle lifestylerelated and preventable illnesses by

Author BIO

An ageing population requires more funding to support the improvement of care coordination. Without this funding there cannot be an effective solution in place to acquire the desired improvements. Moreover, the suggestion is that as improvements in healthcare continue, this will likely flow through to the average age of populations, so the sooner we can understand, and influence this dynamic, the better.

Globally, lifestyle-related chronic illnesses are on the rise. Many lifestylerelated illnesses are preventable.

However, when left unchecked, poorly identified, and sporadically managed, they place a great strain on the healthcare sector in its current structure.

Prevention, as well as treatment, is critical if these conditions are not to further swamp our healthcare systems.

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influencing patterns of behaviour and supporting sustainable modification of related factors. By providing information in a real-time manner, that is meaningful, purposeful, unique and educational for the individual, means that each individual will have access to increased knowledge, more personalised options and more time to modify their behaviour for the better.

About SMG Technologies

SMG Technologies is the master brand and owner of proprietary software products that employ leading edge analytics for any organisation or individual seeking to get an edge in training, performance, health and wellness across a range of industries. All SMG products have a predictive analytics engine in situ that provides the power to seamlessly collate disparate data sets, analyse any range of variables and return insights, trends and predictions of patterns in behaviours.

SMG Technologies offers a range of innovative and leading edge solutions unique to the specialised needs of different market sectors including; elite sports and individual athlete; Gym, Fitness centre and Box management, Human Resources and corporate wellness, Enterprise and healthcare services, tertiary education, Academies and schools, community duty of care functions and Community Services. We currently work with leading organisations and sporting teams across multiple codes globally.

SMG Technologies is head quartered in Brisbane, Australia, with teams located globally.

Stuart is a highly flexible executive with nearly 2 decades of experience across both B2C & B2B channels. With studies in both marketing and business, he has held senior management and leadership roles with industry leaders across a number of industry verticals, in multiple international markets. Stuart's particular areas of expertise are; business strategy & execution, business development and channel partner relationships.

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INFORMATION TECHNOLOGY

Mobile Image Access Saves Time

Improving provider workflow and patient care Electronic access to images improves provider workflow, clinical operations and patient care through time savings and efficiencies. This article reviews the clinical and patient care time savings of electronic image exchange using mobile devices and describes the features that mobile image viewers require to achieve these efficiencies safely and securely.

Jonathan Draper, Director, Product Management, Healthcare Calgary Scientific, Canada

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n today’s healthcare environment, the ability for providers to exchange and share imaging is becoming increasingly critical on many fronts.

Electronic access to images improves provider workflow, clinical operations and patient care through time savings and efficiencies. When providers access images with mobile devices, these benefits increase. Mobile devices are perfectly suited to the pervasive mobile workflow of clinical care

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providing untethered access to patient information and communications.

When used for mobile image viewing, mobile devices support faster interpretation and consultations and improve patient outcomes. This article reviews the clinical and patient care time savings of electronic image exchange using mobile devices and describes the features that mobile image viewers require to achieve these efficiencies safely and securely.

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Mobile Image Access and Provider Efficiency in Clinical Settings

Using smartphones and tablets for clinical patient care is rapidly becoming the norm for providers. Physician adoption

INFORMATION TECHNOLOGY

rate of mobile devices has risen rapidly going from 53 per cent in 2010 to 84 per cent in 2015, according to research from Kantar Media. Until recently most providers were using them

to conduct research or communicate with colleagues but those use patterns are changing. According to research from Black Book Market Research, between 2013 and 2014 the percentage

of U.S. physicians using mobile devices for patient care tasks, such as ordering prescriptions, accessing records, ordering tests or viewing results, has grown from 8 to 31 per cent.

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INFORMATION TECHNOLOGY

One reason for this rapid adoption of mobile health IT among clinicians is that applications which run on desktops interrupt workflow and hamper efficiency by requiring doctors to sit in one place while using them. According to a study published in the November 2013 issue of the Journal of the American College of Radiology, time spent simply accessing images on PACS workstations before reading them, for example, can total as much as 173 minutes, or over two hours, per day.

A study published in the May 2015 issue of the Journal of Medical Internet Research reports on research testing the hypothesis that mobile image-viewers provide faster image access. The study tested time-to-image speed and showed that improving this speed is a primary clinical benefit of mobile imageviewers.

For the study 19 clinicians, including 9 radiologists, 3 surgeons, 4 neurologists, and 3 physician assistants, compared time-to-access a PACS viewer, an internally-developed desktop viewer and a mobile image viewer. Data was collected for 565 image-viewing events, conducted over two separate 7-day periods. Time to first image for the PACS viewer and internally-developed viewer included time required to get to a workstation, log-in and display the first image.

For the mobile viewer, time to first image covered logging into the virtual private network (VPN), launching the mobile image viewer application and displaying the first image.

The mobile image-viewer’s mean time to first image of 2.4 minutes was significantly faster than both the PACS viewer, which had a mean time to first image of 12.5 minutes, and the custom desktop viewer, which had a mean time to first image of 4.5 minutes. Diagnostic confidence was similar for the mobile image-viewer and PACS viewer, and was worst for custom desktop viewer.

For providers that are constantly viewing patient images on mobile

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devices can transform workflow and standard practice. Christopher Duma, MD, a neurosurgeon that practices in Orange County California, says that using an iPhone to access to patient information, he can now provide better, more effective care.

“If I’m walking around the hospital and I need to look at a patient’s image I don’t go to a PACS terminal, I just use my iPhone. It’s easier and it’s faster,” he says.

For radiologists, mobile access offers both the benefit of better workflow and the ability to participate on patient care teams. Today’s radiologists typically practice their profession in rooms populated with the hardware of dozens of PACS. They roll between monitors, opening a different user interface at each PACS to read images, write or record reports and send them on to colleagues, a practice called “swivel chair workflow.”

One path to bringing health IT and efficient physician workflow together is

Physician adoption rate of mobile devices has risen rapidly going from 53 per cent in 2010 to 84 per cent in 2015, according to research from Kantar Media.

liberating patient data from proprietary information systems and allowing it to flow freely across all types of devices, including smartphones, tablets, laptops and workstations, from any and all locations. Mobile access to patient data not only meets provider needs, it is also essential for healthcare institutions need to remain competitive. Simple, secure access to patient images, for example,

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eliminates the need for repeat imaging, saving both time and money.

Electronic Access Enables Care Coordination, Saves Time and Improves Outcomes

Mobile image access not only improves the workflow of radiologists, it also allows them to hold in-person meetings with referring physicians and patient care teams. Research shows that this face-to-face communication improves patient care. A study published in the February 2016 issue of the Journal of the American College of Radiology, shows that in-person communications between radiologists and acute care physicians improved patient care.

For the study, researchers analysed the results of rounds held between an acute care surgery team and abdominal radiologists. In 43 per cent of these in-person meetings, the acute care physicians changed their diagnosis, making significant changes in their surgical plans for the patients.

The benefits of such care coordination reach across all providers. Electronic image sharing supports patient care coordination, giving providers timely access to critical patient data. When patients travel between providers and clinical settings, image availability at the point of care is critical to making effective care decisions.

Many providers use CDs as a method of providing this access between providers and hospitals. This method, however, does not always work. CDs are frequently lost or misplaced requiring re-imaging, which takes time and delays diagnosis and treatment. They can also be damaged making images inaccessible. In addition, if the CD does not have an image viewer included on it, providers have to take the images, upload them to a local PACS and then viewed, a significant amount of manual effort which also delays patient access to treatment. Without access to outside images, trauma patient transfers can lead to a much as 25 minutes of treatment

INFORMATION TECHNOLOGY

delay according to a study published in the Journal of Trauma Injury Infection and Critical Care.

Electronic access to images eliminates these problems and also improves care coordination. A typical care coordination use case includes the following phases of care as described in a HIMSS/SIIM paper on image exchange for improved patient care: A patient with a head injury arrives at the Emergency Department (ED) of a community hospital and care providers perform a CT scan. To access a neuroradiologist, the ED physician reaches out to a tertiary care facility.

The patient scan from the PACS is transferred to the tertiary care center within a few minutes and provided to the neuroradiologist. The neuroradiologist accesses the patient scan and then calls the ED physician to discuss the exam.

With simultaneous access to the patient scan, the neuroradiologist and ED physician are able to make care

decisions together. Instead of transferring the patient and possibly performing another CT scan, the neuroradiologist can diagnose right away and make a determination if a transfer is needed or not. If, for example, the patient requires surgery and a transfer is necessary, the surgery team can prepare for the patient arrival during the transport, saving even more time and improving outcomes.

When this scenario includes mobile devices, efficiencies are even greater.

For example, if the neuroradiologist is on call but not physically present at the tertiary care facility, he or she can access the patient scan and diagnose from any location.

Telestroke: Time is Brain

Electronic image sharing is a key component of telehealth, which connects providers over long distances.

“Electronic image sharing has really opened the doors to telehealth,” says Amy Vreeland, founder of Imaging

Strategies of Waban, Mass., a consulting firm focused on enterprise imaging.

With electronic access, specialists can view images from rural providers, providing expert diagnosis without requiring time for patient travel.

One area where telehealth and image access plays a key role in saving patient lives is stroke care, which is extremely time-sensitive. For stroke patients, minutes can mean the difference for patients between recovery and permanent disability, or even death.

Patients in rural areas, or even city boroughs, who don’t have local access to a stroke specialist waste precious time getting transported to specialists’ care. With stroke care “time is brain.”

For the past 20 years, telestroke has offered a solution to this problem, linking local doctors via video conferencing systems with stroke specialists to consult on patient care.

A 2013 study from the University of Arkansas for Medical Sciences

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INFORMATION TECHNOLOGY

What a Mobile Enterprise Image Viewer Needs

To make mobile access to images safe for patients and to maintain the security of patient information, mobile image viewers need to offer specific diagnostic and security features.

Security Providing users with access to patient data from outside enterprise firewalls requires careful and secure management of users and servers.

User groups need to be defined and authenticated and servers need to be configured for safe and secure external connections. Cloud-based access provides one method for securely connecting multiple, approved users to patient data with a minimal amount of technical support.

User authentication management Ensuring that users are who they say they are is the job of authentication systems. In large enterprise environment, users often have multiple accounts—each with its own login procedure—to access health information systems. Multiple sign-ons are not only confusing to users and can slow their access to information, but are also hard for IT departments to manage.

They also open multiple points of network access to potential break-ins.

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Mobile access to images allows more efficient provider work flow and better patient care.

Single sign-ons for all enterprise network software, including mobile applications, offers the most secure user access. Using mobile applications that support standard authentication technology such as Lightweight Directory Access Protocol (LDAP), for example, ensures that new applications do not compromise user authentication safety and security.

End-to-End data protection Mobile devices make it simple to share and view electronic patient information from virtually any location at any time, which increases the amount of patient data traveling both inside and outside enterprise firewalls. Using data encryption with HTTPS protects data as it travels over networks making it a key component of network security.

Data Access without Data Transfer Systems that provide mobile access to patient information and then transfer and store that data on mobile devices are unsafe. When devices are lost or stolen, that information then becomes available to the thief. High-level mobile security includes the ability to share and view information without transferring it permanently to a mobile device.

Author BIO

concludes, “Stroke patients treated at telestroke hospitals had a significantly lower mortality rate than those treated at non-telestroke hospitals, with the same cost of care.”

Telestroke has been thoroughly studied and is now widely accepted as a standard of care. One area of telestroke that has been studied in depth is the use of mobile devices for stroke patient scan viewing, interpretation and diagnosis. This research provides evidence that stroke diagnosis on mobile devices is at least as effective as diagnosis using PACS workstations, enabling providers to use mobile devices from anywhere, anytime to provide critical patient care.

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These applications also purge all patient information from mobile devices at the close of a session.

Accreditation for diagnosis In patient care settings, ensuring that a mobile image viewer has accreditation for diagnosis is critical for patient safety. Providers have neither the time nor expertise to interrupt their workflow to determine whether the application on their smartphone can be safely used for diagnosis.

Kyle Hall, telehealth coordinator for Nebraska Medicine located in Omaha, NE, is careful to acquire health IT that has FDA clearance in place.

“When doctors have the information they need at their fingertips, they react by diagnosing first and think about the rest later,” explains Hall.

Another important point of consideration is clearance for both web and mobile use so that providers can be using a single image viewer across desktops, laptops, tablets and smartphones with diagnostic confidence.

Mobile Image Access: Transformational for Both Providers and Patients

In conclusion, mobile access to images can open doors to more efficient provider workflow and better patient care. The future points clearly towards the increasing use of mobile technology for delivering cost-effective, efficient and high-quality patient care.

To stay on top of this trend, health care institutions should begin the steps to embrace mobile technology and transform their health IT strategy to support mobile devices.

References are available at www.asianhhm.com

Jonathan Draper is the Director of Product Management, Healthcare at Calgary Scientific. Jonathan directs the product roadmap and works closely with healthcare partners and institutions globally to develop innovative solutions that address clinical needs and meet the technical requirements of healthcare enterprises.

CONNECTING & ADVANCING THE HEALTHCARE INDUSTRY

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INFORMATION TECHNOLOGY

Physicians in China Furthering digital landscapes 2016 study finds innovative channels account for more than 60 per cent of medical information acquired.

Diana Tan, General Manager, Kantar Health, China Adele Li, Commercial Director, Kantar Health, China

A

s traditional methods of targeting doctors become less effective and online usage within the healthcare community grows, it is becoming increasingly important for pharmaceutical stakeholders to understand exactly how doctors consume information and communicate digitally.

Digital Life Physician 2016, conducted by Kantar Health and DXY, reveals that innovative information channels—such as social media, online meetings, video conferences and mobile applications.—now account for more than 60 per cent of the medical

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information acquired by physicians in China. More than 10,000 respondents participated in the survey, now in its fourth year, from both web and mobile survey apps, covering more than 20 specialty areas (Figure 1 & 2).

Furthermore, 85 per cent of the physicians commented that they had responded positively to digital

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marketing activities or tools. Over half of the physicians also commented that they are receptive to receiving pharmaoriginated online meterials, but are more interested in impartial information such as case studies, medical updates and literature reviews (Figure 3).

"With each generation of our study it is becoming abundantly clear

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that physicians in China are rapidly adopting digital information channels as a primary means to consume information and communicate," said Diana Tan, General Manager of China at Kantar Health. "This deep and unique insight about how physicians are accessing and using digital resources presents opportunities for astute healthcare stakeholders, as marketers will benefit from deeper, more productive engagements that will ultimately improve patient care."

About the Study Figure1 Web survey respondents: 4,750 completed online surveys

Figure2 Mobile survey respondents: 5,281 online surveys

Figure3 Chinese Physicians Optimistic about Digital Marketing

Digital Life Physician 2016 is the largest online physician survey in China that is purely focused on picturing the real life, online behaviour of physicians in China and the competitive digital landscape.

The study measures three elements: 1. Physician Behaviour–featuring an evaluation of customer behaviours on digital channels and platforms. Data collected and insights formulated include physician online time and segmented professional time, device ownership rates and usage, innovative activities engagement, and professional and academic needs and preferences.

2. Company Performance–featuring a ranking, overall and by innovative platforms, of leading players and competitive benchmarking based on customer voices. Here we include a ranking of digitally savvy pharmaceutical companies and digitally active marketers by company and brand segments.

3. Best Practices– featuring case studies that showcase key execution details and findings. This includes best practices and examples, as well as key learning and strategic implications.

The 2016 edition of, Digital Life Physician offers physician segmentation based on their online behaviours and receptiveness toward

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digital marketing tools, giving pharma stakeholders an improved perspective in target-marketing and a more customised application (Figure 4).

Digital Life Physician offers a comprehensive view of the physician digital landscape in China that is based on a large, robust and recent sample encompassing more than 20 medical specialties. The structure of the online sample is designed to resemble the structure of the true physician population as closely as possible, including both geographic and specialty distributions. For example, the geographic distribution of our physician sample was 54 per cent from East China, 28 per cent from Middle China, and 18 per cent from West China, compared with the actual China physician population of 47 per cent from East China, 29 per cent from Middle China, and 24 per cent from West China.

Key Findings

Information channels such as social media, online meetings, video conferences and mobile applications now account for more than 60 per cent of the medical information acquired by physicians in China, according to Kantar Health and DXY study, Digital Life Physician 2016.

Figure4 The six digital imprints to an improved understanding in physicians’ digital attitudes and involvements

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According to data from Digital Life Physician, doctors spent more than half of their connected time on professional activities in 2016, up slightly from 2015. Physicians spent an average of 27.4 hours online per week in 2016 compared with an average of 24.2 hours in 2015. The 2016 study revealed that an average of 14.6 hours was spent on professional-related activities versus12.3 hours in 2015.

In addition, senior-level physicians (Chief Doctor), Tier I cities and Level 1/community hospitals recorded an increase in time spent on work-related activities via the internet (Figure 5).

Most Popular Online Activities

The focus of physicians' online, medicalrelated activities can be categorised into the following six categories, of which ‘Knowledge’ and ‘Search’ attracted the largest amount of time.

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Figure5 The increase in time spent on medical-related activities and in accordance to physicians’ designation, the general public living in the same region or city, and hospitals’ treatment-care status; expressed in percentage per cent.

• Continuous Medical Education (CME)– CME and online training, including online courses and lectures, surgical videos, patient case analysis, webinars and online examinations.

• Knowledge – Physician sourcing of professional information online using medical portals, medical information websites, product websites, encyclopaedia websites and association websites to acquire disease and treatment, product, and conference and exhibition information.

• Tools – Physicians’ use of online devices that assist their clinical practice, research and education, including online professional dictionaries, pharmacopoeia, reference retrieval, scaling and atlases.

• Peer – Physicians connecting and sharing articles with peers online; writing professional blogs, articles, reviews and comments; and following, communicating or cooperative authoring with peers on social networking sites (SNS) and bulletin board systems (BBS).

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• Caring – Physician interaction with patients, participation in patient education and counselling, support programs, answering of patient questions online, and provision of online consulting services.

• Search–Physician use of professional search engines and/or databases to find articles, books, guidelines, literature and related information.

WeChat and Medical-Related Accounts

WeChat is a popular communication application and messenger among Chinese mobile consumers. Data from Digital Life Physician found that WeChat is also an important means for physicians to acquire medicalrelated information. Over 94 per cent of Chinese physicians own a smartphone and nearly all physicians have installed WeChat. Among medical physicians, more than 97 per cent subscribed to receive news updates from medicalrelated public accounts on WeChat (Figure 6).

More than 50 per cent of physicians commented that they read all or most

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‘push messages’ sent from medical-related sources on WeChat. Interestingly, of respondents 44 per cent canceled their medical-related subscriptions within the first four weeks.

Furthermore, Digital Life Physician 2016 uncovers some alarming trends regarding medical-related mobile applications. Most notably, while more than 90 per cent of physicians have installed medical-related apps on their smartphones, over 60 per cent have deleted these apps, most often within four weeks of installing. The main reasons given for deleting the apps are that they are not useful or fail to meet physicians' professional needs.

Deeper, More Productive Engagement

Digital Life Physician demonstrates that digital physicians have arrived in healthcare and they are here to stay with the community. This illustrates that more opportunities are abound for astute pharmaceutical companies as they engage and increase their presence in China's digital landscape.

In our latest study, Chinese

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Figure6 Smartphone and WeChat usage among physicians from web and mobile surveys expressed in percentage per cent.

Author BIO

physicians highlighted that they welcome digital activities developed by pharmaceutical companies, with 58 per cent saying they are willing to participate in online activities developed by pharma companies.

As physicians are spending an increasing amount of time on the internet and are more willing to participate in more diverse professional activities, pharmaceutical marketers are likely to benefit from deeper and productive engagements

from physicians. Physicians' online needs are growing and their overall receptive attitudes toward digital marketing and online activities developed by biopharma companies are optimistic and positive.

Chinese physicians perceive that there is a competitive advantage to be gained by ‘going digital.’ The pharmaceutical industry's significant investment and efforts in the digital environment is already paying off for many companies.

Diana Tan leads the China team in providing evidence based insights and consultancy services for healthcare clients to grow their businesses. She helps healthcare clients to understand how doctors are responding to the new digital, multichannel environment in which they operate and how this environment will help them better treat their patients.

As the primary business engagement Director for Kantar Health, Adele Li leads its business growth and development in China. She focuses primarily on utilizing innovative research methodology, developing unique syndicated offerings and managing a high quality research team to deliver industry leading services for pharmaceutical and medical device companies.

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MEDICAL FAIR THAILAND 2017

The Region’s Most Complete Medical & Healthcare Exhibition Returns!

6 - 8 Sep 2017, QSNCC, Bangkok, Thailand.

The 8th installment of the international exhibition on Hospital, Diagnostic, Pharmaceutical, Medical & Rehabilitation Equipment & Supplies continues its proud tradition of show-on-show growth, with an expected international participation of 700 exhibitors, 17 national pavilions and country groups as well as an anticipated attendance of 8,500 qualified trade buyers and decision makers from across Asia.

Creating an international marketplace that allows global companies to access a targeted audience is MEDICAL FAIR THAILAND’s strongest suits that have contributed to making it one of the most influential shows on the region's medical and healthcare trade

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calendar. In 2017, MEDICAL FAIR THAILAND will take place at the Queen Sirikit National Convention Centre in Bangkok, from 6 - 8 September.

What to Expect in 2017?

In the spotlight at MEDICAL FAIR THAILAND 2017 are two special platforms in the areas of Rehabilitative Care and Connected Healthcare.

Complementing these dedicated showcases will be a suite of co-located conferences, technical seminars and themed workshops presented by key thought leaders and industry experts in their

“Gain access to Southeast Asia’s dynamic medical and healthcare market. Bookings for exhibitor spaces are now open! For more information visit www.medicalfair-thailand.com”

About the Organiser

respective fields, involving delegates, visitors and exhibitors in meaningful discussion on the future of health care. Among them is ARTeC 2017, returning for the 3rd edition, the Advance Rehab Technology Conference, will emphasise innovative and effective technological solutions that could decrease mobilityrelated disability, reduce related complications and improve quality of life.

Connecting Healthcare Innovations with Medical Professionals An unparalleled opportunity to showcase your latest products and build invaluable relationships with key industry players from around the globe. Be part of MEDICAL FAIR THAILAND 2017 and tap into the region’s burgeoning growth potential.

Organised by Messe Düsseldorf Asia, MEDICAL FAIR THAILAND is the region’s number 1 event for the medical and healthcare industry, bringing together all facets of the industry for networking, sharing of best industry practices, as well as products, services and solutions development. Part of MEDICA – World Forum for Medicine, a global series of medical events, MEDICAL FAIR THAILAND’s contribution and growing relevance to the region and its associated industries is further underlined by the endorsement and continued support it receives from hospitals and medical associations all across Asia as well as from the Ministry of Public Health Thailand and the Thailand Convention and Exhibition Bureau.

For more information, please visit mda.messe-dusseldorf.com Advertorial www.asianhhm.com

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INFORMATION TECHNOLOGY

Preparing and Engaging Nurses in the Informatics Revolution Many APAC countries are going ‘SMART’ – healthcare IT spending in APAC is expected to grow 8 per cent through 2018. Nurses, who are the majority serving at the frontline of healthcare, are often left out of discussions around IT adoption although they are central to delivering patient-centered care. The author talks us through three emerging technology trends that will change nursing practice.

Michelle R Troseth, MSN, RN, DPNAP, FAAN, Chief Professional Practice Officer – Elsevier Clinical Solutions, USA

T

here is no question we are living in a time of exponential growth of technology. Many Asia Pacific (APAC) countries are investing heavily in Health Information Technology (HIT) which has significant impact on the healthcare workforce. In APAC, like other regions in the world, the nursing profession comprises the largest workforce delivering patient care so to prepare and engage nurses is critical to advance the transition to digital health.

This was recognised in the United States when the country began to lay out

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a plan to focus on digitalising the health system. While structures were beginning to be put in place to support a collective shift towards healthcare technology, the significance of having nurses at all levels and areas engaged became glaringly apparent. The first and most impactful grassroots effort was the launch of the TIGER (Technology Informatics Guiding Education Reform)1 Initiative.

TIGER began as a grassroots initiative in 2006 within the US nursing 1 http://www.himss.org/professionaldevelopment/tigerinitiative

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community, convening a Summit, with support from over 70 contributing organisations including HIMSS, two grants from the Robert Wood Johnson Foundation and a personal endowment.

Today, the TIGER Initiative is a part of the HIMSS organisation focusing on education reform and fostering international community development.

The spirit of TIGER is to contribute to a learning health system that maximizes the integration of technology and informatics into seamless practice, education, and research resource development.

Elsevier Clinical Solutions2 was one of the contributing organisations of the TIGER Summit in 2006 and has continued to support the TIGER efforts in several ways, including supporting my engagement in various leadership roles for TIGER to advance the vision and mission set forth a decade ago.

At Elsevier Clinical Solutions we are focused on integrating evidence-based content and technology to enable knowledge, clinical decision support and adoption of new ways of delivering care across the continuum. My recent visit to several APAC countries during and following HIMSS AsiaPac 2016 was filled with stories of the hopes and challenges of technology and specifically how current trends are evolving the roles of nursing.

in nursing practice. NI supports nurses, consumers, patients, the inter-professional healthcare team, and other stakeholders in their decision-making in all roles and settings to achieve desired outcomes. This support is accomplished through the use of information structures, information processes, and information technology. (Nursing Informatics: Scope and Standards of Practice, 2nd Edition, ANA 2015).

Nursing Informatics

Nursing informatics is a recognised nursing specialty and has been gaining momentum as health information technology advances. The American Nursing Association (ANA) recognised Nursing Informatics as a specialty in 1992. Nursing Informatics (NI) integrates nursing science with multiple information management and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom 2 https://www.elsevier.com/clinical-solutions

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Informatics competencies are needed by all nurses whether or not they specialise in informatics.

As nursing practice environments become more ubiquitous computing environments, all nurses must be both information and computer literate.

One of the first priorities of the TIGER Initiative was to develop a collaborative workgroup to establish the minimum set of informatics competencies for

INFORMATION TECHNOLOGY

all practicing nurses and graduating nursing students. The minimum set of competencies are organised into three categories: basic computer skills, information literacy, and information management (including use of the electronic health record).

In 2015, the TIGER International Committee, with representatives from 21 countries, began comprehensive activities to compile recommendations for “core international informatics competencies”. Their activities included a compilation of international case studies and development of a survey to evaluate and prioritise a broad list of core competencies. Based on the results of the survey, TIGER will identify the core informatics competencies of healthcare professionals in five domains: • Nursing management • IT management in nursing • Quality management • Inter-professional coordination of care • Clinical care The next phase was the creation of a competency harmonisation matrix that outlines shared and countryspecific competencies (including the United States) to provide guidance to the TIGER community and beyond.

To stay connected to this exciting work follow the TIGER International Informatics Competency Synthesis Project3.

The first and most impactful grassroots initiative TIGER (Technology Informatics Guiding Education Reform) was in 2006 within the US nursing community.

With the proliferation of capturing data in the electronic health record and mobile devices, nurses and other professions will need to develop competencies on big data analysis as well. Nurses will also need to be advocates for capturing sharable and comparable nursing data. For APAC regions that are just beginning the electronic health care record journey, there

are lessons to be learned from other regions that have had the outcome of data that is difficult to collect and impossible to compare due to lack of standardisation and coded data elements. This is important because big data and analytic tools / data visualisation are imperative to drive operational efficiency and improving patient safety and quality of care.

Recognising the challenges of sharable and comparable data in the US, the University Of Minnesota School Of Nursing convened a group of experts in 2013 and 2014 to participate in the Nursing Knowledge: Big Data and Science to Transform Health Care4 consensus conferences.The goal is to build national consensus on a plan for sharable and comparable data so that big data research could be accomplished to continuously improve clinical practice and patient outcomes. This nursing big data initiative has continued in 2015 and 2016 with expanded stakeholders; including professional nursing organisations, government, education, research, industry, terminology experts and more. There has also been intentional alignment of efforts by other

3 http://www.himss.org/professional-development/tigerinitiative/tiger-international-informatics-competencysynthesis-project

4 http://www.nursing.umn.edu/centers/center-nursinginformatics/events/2016-nursing-knowledge-big-datascience-conference

Big Data

major nursing organisations such as the American Academy of Nursing Expert Panel of Informatics and Technology, the Alliance of Nursing Informatics, HIMSS Nursing Community with the nursing big data initiative. In 2015, the HIMSS CNO-CNIO Roundtable formed a workgroup that further developed recommendations on how nursing can help advance and use big data by providing Guiding Principles for Big Data in Nursing5.

Elsevier Clinical Solutions has been actively engaged in the above work efforts because a big part of our contribution is standardised evidence-based content leveraging a professional practice platform embedded in multiple electronic health record platforms. In addition, to integrate with other clinical disciplines when automating clinical documentation and care planning, the Elsevier Clinical Practice Model Framework6 advances big data beyond nurses, to include other health professional providers caring for the same patients and families as described in the linked article (Christopherson, Troseth & Clingerman, 2015).

Patient Engagement

As care shifts from provider-centric care to patient-centered care, how the nurse leverages technology and information is rapidly changing as well. Patients are becoming more engaged in their care as they have access to the internet and come to rely on other technologies in their day-to-day life such as smart phones, automatic banking, and on-line shopping. The next generation will demand tools that integrate their voice and health IT tools with their providers to increase collaboration and shared decision-making. As an emerging trend, nurses have the opportunity to lead efforts to promote patient engagement.

5 http://www.himss.org/sites/himssorg/files/FileDownloads/ HIMSS_Nursing_Big10_flyer_04082015.pdf 6 http://www.jieponline.com/article/S2405-4526(15)00003-8/pdf

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7 http://www.himss.org/himss-patient-engagementframework

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• Patient portal adoption (encouraging use and accessing information for care provided) • Providing interactive patient education across the continuum of care • Advocating for collaborative tools to enhance shared decision making • Integrating self-management tools into the care process.

There are also culture changes nurses can advocate for and rolemodel that are critical for patient engagement: • Integrating patient values and preferences into care planning and

Author BIO

Patient engagement is ultimately about the patient and provider working together to improve the health and well-being of the patient. A patient’s greater engagement in his or her care contributes to improved health outcomes, and health information technologies can support engagement.

One resource is the HIMSS Patient Engagement Framework7 which is designed to guide healthcare organisations in developing and strengthening their patient engagement strategies through the use of eHealth tools and resources. There are multiple touch points for nurses to play important roles moving from informing patients to totally engaging them and their community with eHealth tools.

Health information technology tools that nurses can leverage in their engagement with patients are:

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education (a critical element of evidence-based practice) • Establishing patient/family advisory councils • Assessing patient/family health literacy.

In summary, it is an exciting time for APAC as it shifts to full digital healthcare. It is my hope that we can learn from each other as the informatics revolution evolves in APAC and the role of nursing is recognised as a critical success factor for the adoption of health information technology to improve health outcomes.

Michelle is the Chief Professional Practice Officer of Elsevier Clinical Solutions. She has over 25 years of experience in codesigning and implementing evidence-based practice and technology infrastructures to support patient-centered care and interprofessional integration at the point of care across hundreds of healthcare settings.

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Emerging Technologies in Healthcare The Role of Technology in Shaping the Future of Healthcare The Internet has brought much technological advancement to healthcare – elevating patient care, speeding up access to patient record and enabling the delivery of personalized medicine through the use of emerging technologies such as telemedicine.

Sanjay Joshi, CTO of Healthcare and Life Sciences, Emerging Technologies Division at Dell EMC, discusses the role of technology in the future of healthcare and how IT will drive digital transformation for the sector.

Sanjay Joshi, CTO - Healthcare and Life Sciences Emerging Technologies Division, Dell EMC, USA

1. Where do you think the Indian healthcare system is heading— and what needs to be done?

India has the second-highest number of hospitals worldwide (excluding private hospitals and clinics as well as nursing homes). However, the country

ranks low in terms of life expectancy.

The Economic Times1 also noted that India has the highest deaths of children under the age of five and 21 per cent of the world's burden of disease, worsened by poor basic health and sanitation. Yet, government spending on healthcare

in India was estimated at 5 per cent of its GDP2 in 2013 and is expected to remain at the level through to 2016, a disproportionate amount compared to its population.

Against this backdrop, the private sector has emerged as a vibrant force 1 The Economic Times,

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2 Deloitte,

3 IBEF,

4 Indus.org

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in India’s healthcare landscape. The healthcare industry is growing rapidly at a CAGR of 17 per cent3 and is expected to become a US$280 billion industry by 20204. In partnership with the private sector, the government has also committed to healthcare reforms aimed at uplifting the standards of healthcare delivery and to make healthcare available for all.

What needs to be done? A core focus on Translational Medicine both in terms of budget and technologies is critical. For example, the US has allotted almost half (US$60 billion) of its US$121 Billion National Institutes of Health (NIH) budget from 2012-2015to ‘translational’ groups – the Food and Drug Administration (FDA), Centers for Disease Control (CDC) and the Health and Human Services (HHS).

I have spoken with several groups about the ‘Aadhar’ program in India and its healthcare vision. Our (Dell EMC) Centers of Excellence (CoE) in Bengaluru and Pune are contributing in a small way toward Aadhar. This is a great start, but we need to focus more on the macro-economic and macrodisease issues within India: Stress, Pollution, Diet, Water and Sanitation.

One opportunity is to link initiatives such as Digital India to help elevate the healthcare system. This points to a ‘mash-up’ between digitisation in healthcare, smart cities and an ecological approach toward water and sanitation. India is in a position to leapfrog past other emerging economies due to its stability as compared to the other BRIC countries.

2. What are the greatest challenges and opportunities facing the healthcare system, and how will technology help in meeting them?

Across the world, the key challenges facing the healthcare industries include an ageing population; rising incidence of lifestyle-related non-communicable diseases such as diabetes and heart

diseases; as well as a growing pool of digitally-empowered patients.

Technology can be the answer to these challenges. However, many healthcare organisations are not refreshing their IT investment fast enough and adopting new solutions with respect to data collection (Electronic Medical Records), data transfer (protocols), privacy and security.

I believe that most important innovations will come in the ‘protocol’ layer for healthcare. Healthcare organisations will need to be able to pool data from any structured or unstructured source into an organised data lake, and use this to keep refining the treatment options for patients.The use of data lakes, over a period of time, can also help institutions uncover trends that can help improve knowledge on patient care, drug options and treatment. For institutions, such insight can also mean new business models and new incentive models at large scale.

Another key area is security. In the US, it is well known that there is a more than 96 per cent probability that any hospital’s data will be breached.

The healthcare industry is the least prepared to recover after a breach.

In fact, in the recent Global Data Protection Index commissioned by Dell EMC, only 24 per cent of public healthcare providers in Asia are very confident of fully recovering systems and data to meet business service level agreements in the event of a data loss incident.

3. How do you see healthcare changing in the coming years?

Predictive Analytics and the Internet of Things (IoT) will shape the future of many industries, including healthcare. However, before these new technologies can truly deliver value to patients such as increasing survivability and life expectancy or providing predictive and prescriptive indicator for diseases, healthcare

organisations must first get their data strategy right.

This includes recording of data, saving raw data and keeping it safe and secure and leveraging it for greater patient insights. Dell EMC’s Emerging Technologies Division (ETD) provides the base technologies that build Data Lakes (multi-protocol, scalable data containers that store these raw data and provide analytics engines to work on these raw data) that will guide that change in the healthcare systems. Data Lakes eliminate data silos within the healthcare ecosystem and incorporate technologies such a cloud, big data, mobile and social to empower healthcare organisations to leverage real-time data at the pointof-care.

4. What’s the role of technology in the future of healthcare?

Healthcare modernisation is being driven by a number of trends including rising healthcare costs, an ageing population and the growing incidence of chronic conditions that will require long-term care (such as diabetes and heart diseases).

The future of healthcare will rest upon three pillars: a digital approach, data intelligence and a patient-centric culture. IT will be at the centre of this transformation, helping to cut costs, drive productivity gains and uncover new economies of scales for greater efficiency and better patient care. Beyond that, IT can also disrupt today’s systems and fundamentally change healthcare delivery through personalised medicine and connected care.

5. How do you see the role of IT in healthcare transformation?

Healthcare represents a significant percentage of the overall Digital Universe, and is growing at 48 per cent per year. As organisations adopt more electronic medical records and incorporate the deluge of new data from genomics, pathology and medical

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internet of things, care providers will need to transform their IT infrastructure.

Analytics will become the driving force in the future of healthcare and traditional silos must be replaced with new approaches to enable valuable insight from that will help improve the quality and efficiency of care. Vendor Neutral Archives and Data Lakes are the foundation on the journey to precision medicine.

Most healthcare providers have made IT investments to establish the foundation for collaborative care —the digitisation and sharing of healthcare data across caregivers involved in a patient care episode. They’ve deployed transactional systems including EMRs, operational, revenue cycle management, and financial systems. Yet, the vast majority of the growing amounts of medical data is coming from unstructured and semi-structured data found in PACS and medical imaging, clinical research, doctors’ notes, pathology reports, and more. Healthcare providers today will require solutions that analyse data from many sources across the continuum of care and provide actionable insights to meet the clinical and business demands of the ever-changing healthcare industry.

Healthcare as we know it will disappear in less than 25 years, especially in Primary Medical Care.

To quote a famous futurist, Systems Biologist and Seattle native, Dr. Leroy Hood (whom I have had the privilege of working with) on the “4 Ps” that will aid modern medicine for the physician: Predictive, Preventive, Personalised and Participatory. All of these are IT-based.

6. What provisions are there for managing personal healthcare data and keeping them secure?

Healthcare providers have been confronted with a growing wave of destructive, malicious attacks from a new breed of cybercriminals who target clinical and financial data for

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its high value. These cyber threats are also getting more sophisticated and damaging. Attacks such as fraud, identify theft, and ransomware can leave healthcare organisationscompleted locked out of their systems. The healthcare organisations of today need to take extraordinary measures to protect their most vital patient, financial, and operational data.

Two-thirds of healthcare respondents in the HIMSS Cybersecurity

Survey reported a significant security incident in the recent past with 64 per cent noting an incident had been conducted by an external actor such as an online scam artist or hacker, or through social engineering. In addition, the 2016 Sixth Annual Benchmark Study on Privacy and Security of Healthcare Data by the Ponemon Institute estimated the average cost of data breaches for healthcare organisations over the last two years at more

Sanjay Joshi is the CTO of Healthcare and Life Sciences, Emerging Technologies Division at Dell EMC. Based in Seattle, Sanjay's 28+ year career has spanned the entire gamut of life-sciences and healthcare from clinical and biotechnology research to healthcare informatics to medical devices. His current focus is a systems view of Genomics and Proteomics for infrastructures and informatics. Recent experience has included Electronic Medical Records; Proteomics and Flow Cytometry; FDA and HIPAA validations; Lab Information Management Systems (LIMS); Translational Genomics research and Imaging. Sanjay holds a patent in multi-dimensional flow cytometry analytics. He began his career developing and building X-Ray machines.

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than US$2.2 million per breach with criminal attacks as the leading cause.

With this current landscape in mind, healthcare IT leaders have ranked security and data protection as a top organisational priority.

With stringent requirements from HIPAA, HITECH, and the EU Data Protection Directives, healthcare providers need solutions that minimise risk; detect, investigate and respond to advanced threats; confirm and manage identities; and ultimately, prevent identity theft, fraud, and cybercrime. And, to combat growing cyber threats and preserve the integrity of the health IT infrastructure, Chief Information Officers (CIOs) and Chief Information Security Officers (CISOs) must take a comprehensive approach to security and establish plans to address as many scenarios as possible. This is what we called the layered data protection approach. Equally important is the need to put in place a recovery plan, in the aftermath of any security incident.

7. Which areas of rapidly advancing technologies do you feel could benefit current healthcare industry?

Anything related to telemedicine.

The Indian population is more than two-third rural. Yes, there is a large middle class in the burgeoning large cities – however, it is the rural populations with affordable care that will benefit the most.

Telemedicine will be the largest transformative change for healthcare, especially in places that lack access (which are typically the communities that need health services the most).

8. How has IT changed the patient care landscape in India? What developments are likely to occur in the near future?

I don’t think IT has changed the macro health landscape of India much, to date. India needs to invest in IT infrastructure specifically for

cols. We need EMR systems with better Clinical Decision Support.

Not just in India, everywhere.

The future of healthcare will rest upon three pillars: a digital approach,data intelligence and a patientcentric culture. IT will be at the centre of this transformation, helping to cut costs, drive productivity gains and uncover new economies of scales for greater efficiency and better patient care.

healthcare in a national imaging database, a national registry for diseases, a CDC-like approach toward real-time reporting and self-reliance in all of the above. India needs to take a sovereign approach toward research and translating research into clinical use with large changes in current trends for disease. I have visited Indian Institute of Science (IISc), National Centre for Biological Sciences (NCBS) and National Tuberculosis Institute in Bengaluru, AIIMS staff in Delhi conducting Genomics research along with various Indian Council of Medical Research (ICMR) institutes, Indian Institutes of Technologies (IITs), Pharma companies as well as Healthcare organisations. India is catching up in the ‘h-index’ of major academic journals in clinical and biotechnology research. The real question is translation.

9. What challenges does the healthcare industry face in terms of communication technologies?

We need better protocols. We need web services and object-based proto-

10. What are the market opportunities for Indian medical equipment Industry in the future?

The market opportunities are enormous. India has a very healthy Healthcare start-up economy now; it is just waking up to its potential.

Medical devices represent the ‘frontend’ of what technology advancements can deliver to healthcare.This is also where the healthcare world will benefit most from unstructured data, a piece that has been missing in healthcare analytics. In tandem with this rise, healthcare organisation will also need to look at integrating these devices to the core IT infrastructure, the connectivity to support data collection from these devices to a data lake as well as the storage, management, protection and archiving of these data.

11. Any other comments?

Let me close,as I had opened with my current Seattle roots, by quoting Dr. Roger Perlmutter, Executive Vice President Merck and President at Merck Research Laboratories, also a Seattle native, talking about the human body: “Since we don’t know how the machine works, we don’t know what to do when it breaks.”

Most medicine has been empirical, observational and grows with our knowledge (and stutter steps along the way).

Let us not forget that at the end of all of this technology there is the patient and their families. This is best paraphrased with Sir (Dr.) William Osler’s comment “The good physician treats the disease; the great physician treats the patient who has the disease.” IT is an enabler and a helper, a wonderful one at that. Let us put it to good use.

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Research Insights CT or MRI Which is better for Rectal Cancer Imaging?

Authors: Rajul Rastogi, Teerthanker Mahaveer Medical College& Research Centre, Moradabad, Uttar Pradesh, India Meena GL, S.P. Medical College and PBM Hospital, Bikaner, Rajasthan, India Yuktika Gupta, Teerthanker Mahaveer Medical College& Research Centre, Moradabad, Uttar Pradesh, India Pragya Sinha, Teerthanker Mahaveer Medical College& Research Centre, Moradabad, Uttar Pradesh, India Pankaj Kumar Das, Teerthanker Mahaveer Medical College& Research Centre, Moradabad, Uttar Pradesh, India Mohini Chaudhary, Teerthanker Mahaveer Medical College& Research Centre, Moradabad, Uttar Pradesh, India

Received date: September 01, 2016; Accepted date: September 19, 2016; Published date: September 26, 2016 Citation: Rastogi R, Meena GL, Gupta Y, et al. CT or MRI – Which is better for Rectal Cancer Imaging?. Colorec Cancer 2016, 2:3.

Abstract Colorectal cancer is one of the common causes of cancer-related mortality with rectal cancer representing a significant proportion. Cross-sectional imaging techniques especially computed tomography (CT) and magnetic resonance imaging (MRI) play an important role in preoperative staging of rectal cancer. There has always been a debate about the single best imaging modality for staging of rectal cancer in order to achieve the best surgical outcome. Hence, this article focuses on the comparative role of CT & MRI in staging of rectal cancers.

Vijai Pratap, Teerthanker Mahaveer Medical College& Research Centre, Moradabad, Uttar Pradesh, India

Keywords Colorectal; Rectal; Cancer; Computed tomography; Magnetic resonance imaging

Corresponding Author: Rajul Rastogi, Department of Radio Diagnosis, Teerthanker Mahaveer Medical College & Research Center, Moradabad, Uttar Pradesh, India. Tel: 919319942162, E-mail: eesharastogi@gmail.com

Introduction Colorectal cancer is second most common malignancy worldwide representing fourth commonest cause of cancer-related mortality. More than a third of these occur in rectum near the anal verge. Cross-sectional

CT Vs MRI

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imaging modalities like computed tomography (CT) and magnetic resonance imaging (MRI) is usually the first tool for evaluation of suspected cases of rectal cancer that not only help in detection but also in local staging as well as in delineating the distant spread of cancer. With the advent of preoperative neoadjuvant chemoradiation therapy and increasing en-bloc resection of mesorectum to reduce postsurgical recurrence, local staging has assumed great significance.

Hence, this review article primarily focuses on the role of CT and MRI in local staging for preoperative evaluation of rectal cancer.

Discussion The outcome of rectal cancer as with any other cancer depends largely on local and distant staging or in short, the TNM staging system. T1 tumor extends up to submucosa while T2 tumor reaches up to muscularis propria. T3 tumor extends beyond the muscularis propria in to the mesorectum while T4 tumors involve visceral peritoneum, adjacent structures (like prostate, seminal vesicles, uterus, vagina, lateral pelvic walls & sacrum) or levator ani muscle with or without anal sphincters. T3 tumor is further divided in to T3a & T3b based on extension of tumor beyond muscularis propria in to mesorectum by <5 mm and >5 mm respectively.

Both T1 & T2 tumors are treated almost similarly in most cases while T3 tumors show reduced risk of recurrence when treated preoperatively with chemotherapy and / or radiation therapy. T3b tumor is associated with poorer 5-year survival rates than T3a tumor. Besides the T-stage, the proximity of tumor to mesorectal fascia also affects the prognosis in cases of rectal cancer as tumor within 1 mm of this fascia, also known as circumferential resection margin (CRM) is associated with significantly increased risk of recurrence. T4 tumor with involvement of sphincteric complex may necessitate abdominoperineal resection with en bloc resection of sphincter complex.

N-stage denotes the involvement of locoregional nodes in the mesorectum & pelvis by rectal cancer. The shortaxis criterion of 5 mm diameter of mesorectal node gives a sensitivity of less than 70% but a specificity of

nearly 80% of harbouring metastases. Presence of nodes adjacent to mesorectal fascia may necessitate wider surgical margin while presence of nodes outside the mesorectum may need wider radiation field in addition to wider surgical margin. Involvement of obturator, external iliac or retroperitoneal nodes corresponds to M1 stage.

High-resolution MRI of pelvis with distension of rectum by positive contrast agent is an investigation of choice for local staging of rectal cancer due to its superior soft tissue contrast resolution. MRI is definitely superior to CT in local staging except in T1 & T2 stage where both have comparable accuracies (Figures 1 and 2). Though T2W images in axial plane play a key role yet sagittal images are equally important in infiltrative tumors and tortuous rectum. Coronal images are especially useful in detecting levator ani & sphincteric complex involvement. Rectal cancer as well as the involved node appears hyperintense on DW images with slight hypointensity on ADC maps though it is not specific for metastatic nodes. Involvement of mesorectum and CRM is very well predicted by MRI with specificity of up to 95%.

For distant spread, MRI has limited role in detecting pulmonary parenchymal metastases less than 10 mm in diameter where CT scores over MRI. Role of MRI in detecting distant spread in cases of rectal cancer is reserved as a problem solving tool in sub centimeter hepatic lesions where the diagnosis of cyst / hemangioma or metastatic lesion is in question.

In such cases, MRI is superior to CT as metastasis is hypointense on T1W and hyperintense on T2W (though less hyperintense than cyst / hemangioma) & DW images showing peripheral contrast enhancement.

Conclusion MRI is superior to CT in local staging of rectal cancer helping the surgeon in preoperative planning to achieve negative surgical margins. For nodal staging and distant spread, CT & MRI show similar performance except in small pulmonary metastases where CT is superior to MRI and small hepatic metastases where MRI is excellent.

References are available onlineâ&#x20AC;&#x192;

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Research Insights VEGF Polymorphisms do not contribute to the risk of congenital heart defect Authors: Weiyan Zhang, Department of Paediatrics, Nantong First People’s Hospital, Nantong 226001, P.R. China Xuming Mo, Department of Cardiothoracic Surgery, Nanjing Children’s Hospital, Nanjing Medical University, Nanjing 210008, P.R. China Di Yu, Department of Cardiothoracic Surgery, Nanjing Children’s Hospital, Nanjing Medical University, Nanjing 210008, P.R. China Changfeng Fan, Department of Cardiothoracic Surgery, Nanjing Children’s Hospital, Nanjing Medical University, Nanjing 210008, P.R. China Zhongyuan Wen, Department of Cardiothoracic Surgery, Nanjing Children’s Hospital, Nanjing Medical University, Nanjing 210008, P.R. China Liang Hu, Department of Cardiothoracic Surgery, Nanjing Children’s Hospital, Nanjing Medical University, Nanjing 210008, P.R. China Ming Xu, 1Department of Paediatrics, Nantong First People’s Hospital, Nantong 226001, P.R. China Corresponding Author: Ming Xu, Department of Paediatrics, Nantong First People’s Hospital, Nantong 226001, P.R. China.

Tel: +86 (513) 8501 2131 E-mail: 1015853308@qq.com

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Abstract Objective: To clarify the role of VEGF polymorphisms in CHD, we performed a meta-analysis to determine the association between these three variants and risk of CHD. Methods: Our meta-analysis included a total of 6, 4, and 6 research articles for each of the C2578A, G1154A, and G634C polymorphisms, respectively. Data extraction and study quality assessment were performed in duplicate. Summary odds ratios (ORs) and 95% confidence intervals (CIs) of allele contrast and genotype contrast were estimated using either a fixed or random effects model. The Q-statistic test was used to identify heterogeneity and a funnel plot was adopted to evaluate publication bias.

Results: Six articles containing 1080 cases and 2289 controls were relevant to C2578A, 4 researches containing 528 cases and 1036 controls were relevant to G1154A, and 6 articles containing 1081 cases and 2281 controls were relevant to G634C. The results of overall metaanalysis showed that none of the VEGF C2578A, G1154A, G634C increased the susceptibility of CHD. In summary, this meta-analysis demonstrates that the three analyzed VEGF polymorphisms do not increase the risk of CHD. Conclusions: Our meta-analysis suggests that the common VEGF polymorphisms C2578A, G1154A, and G634C do not alter CHD risk.

Received date: May 03, 2016; Accepted date: May 18, 2016; Published date: May 20, 2016

Keywords Endothelial growth factor; Polymorphism; Congenital heart defect

Citation: Zhang W, Mo X, Yu D, et al. VEGF Polymorphisms do Not Contribute to the Risk of Congenital Heart Defect. Interv Cardiol J 2015, 2:2.

Introduction Congenital heart defect (CHD) is one of the most common birth deformities, with approximately 0.6-0.8% of live infant births receiving the diagnosis.

Despite this prevalence, the pathogenesis of CHD

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abnormal development of both cushion and myocardial structures.

VEGF gene polymorphisms may play a role in susceptibility to congenital valvuloseptal heart defects. It has also been reported that VEGF genetic polymorphisms may also be associated with CHD, including tetralogy of fallot (TOF) and ventricular septal defect (VSD).

Materials and Methods

remains unknown. However, a small number of CHD cases are caused by a single gene mutation or other chromosomal aberrations, leaving the remaining 90% CHD diagnoses resulting from a heterogenous etiology including a variety of genetic factors and environmental factors.

The heart is the first organ to form and function during development. Numerous signaling pathways contribute to its development, and include vascular endothelial growth factor (VEGF), GATA4, and Nkx2.5. Of these pathways, VEGF signaling has been shown to be linked to CHD, with its spatiotemporal expression pattern indicating a potential role. The VEGF gene is located on chromosome 6p12 and consists of eight exons, which can be alternatively spliced to form a family of proteins.

It has been reported that VEGF is required for proper heart morphogenesis at stages. Additionally, VEGFexpressing endothelial cells located in the cushionforming region may be a unique subpopulation of endothelial cells that are predetermined to transform from endocardium to mesenchyme (EMT).

Importantly, maintaining an appropriate timing and dosage of VEGF during heart development has been shown in animal models to be shared in various cardiovascular developmental defects. This work includes work with transgenic mice heterozygous for the VEGF allele, which showed a two- to three-fold increase in VEGF levels. Past work has also shown that increased VEGF levels during the development of the right ventricular outflow tract can lead to

Identification & eligibility of relevant studies We carried out an online search in PubMed and Web of Science databases for related articles published before March 31, 2016 using the following terms: “congenital heart defects or congenital heart diseases or heart, malformation of heart abnormalities or CHD” and “mutation or polymorphism or variation” and “vascular endothelial growth factor or VEGF”. To expand the range of our studies, we also used the same terms in Chinese to search the Chinese National Knowledge Infrastructure (CNKI), Wangfang Database, and Chinese Biology medicine disc (CBM). References of the retrieved articles were also scanned for additional studies.

We included case-controls with human subjects that studied the relationship between VEGF C2578A, G1154A, and G634C mutations and CHD susceptibility in both English and Chinese languages.

All phenotypes of CHD, including ventricular septal defect, patent formen ovale, atrial septal defect, patent ductus arteriosus, and coarctation of the aorta were included in this meta-analysis. However, CHD patients who had additional congenital, co-morbid anomalies such as Down syndrome were excluded.

Research articles utilizing animal subjects, reviews, commentaries, case reports, and unpublished reports were also excluded. Studies that did not provide raw data of allele frequencies in the initial publications were excluded, though we attempted to obtain primary data by writing to the authors. Finally, when the research populations overlapped, we avoided repetition by including only the research with the broadest data set for the meta-analysis.

Discussion VEGF is located on chromosome 6q21. 33 and includes eight exons. Alternative splicing can result in

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Research Insights several different protein isoforms. Past work has shown that some of VEGF polymorphisms may be associated with differential VEGF expression in vitro. Among these, polymorphisms in the VEGF promoter region (0.2578 C>A, rs 69994) and located on VEGFI exon 634 (G>C, rs 2010963) may be associated with the 3’ noncoding region. Other studies have also implicated these VEGF mutations disease states, including in CHD. For instance, Vannay et al. found that VEGF polymorphism 634C (+ 405 c) increased the risk of CHD, while Lambrecht et al. showed that VEGF haplotype 2578A/1154A/634G significantly reduced the risk of tetralogy of fallot (TOF), a form of congenital heart disease.

Griffin et al. was the first to perform a study on the relationship between VEGF C2578A, G1154A and G634C polymorphisms and the risk of CHD. The results of this work indicated that there was no relationship between these three polymorphisms and CHD. Li et al. found that the allele, genotype, and haplotype of VEGF were identified with an association for susceptibility to CHD. Furthermore, that there were differences between CHD with or without DiGeorge syndrome; namely, that specific haplotypes (CGC) had significant protective effects for reducing the risk for CHD in a non-DiGeorge syndrome population. Given these discrepancies in the literature, the purpose of this meta-analysis was to assess whether or not there was an association between VEGF C2578A, G1154A, and G634C polymorphisms and the risk for CHD. In this meta-analysis, our results showed that none of the VEGF C2578A, G1154A, and G634C polymorphisms were significantly associated with risk for CHD. However the studies of VEGF C2578A and G1154A polymorphisms were too few to sufficient exam heterogeneity. Therefore, we adopted a Galbraith plot to assess the sources of heterogeneity of VEGF G634C, and eliminated one study based on the result.

We conducted our statistical analysis again, but still failed to find a relationship between VEGF G634C polymorphism and CHD. One reason for this failure could be that only six studies were included in this analysis and that our statistical power was too low to allow for robust statistical conclusions. Moreover, there is significant difference in the genetic background, exposure to environmental factors, and risk factors in life styles between Asian, American, and European populations. Since our meta-analysis included all three

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of these populations, it is possible that this diversity masked any significant findings.

Future work will need to address some of the limitations present in this meta-analysis. First, all of the studies were carried out using only four different countries, including only Asian, American, and European populations. Second, most of the studies selected grouped all heart defects together. Uniform deﬠnitions and categories of CHDs might be needed in later investigations to parse out more specific genetic contributions to each type of CHD. Third, recent work has shown that peri-conceptional use of multivitamins containing folic acid can reduce the incidence of CHD. As we did not assess the folate intake of the populations in question, it will be important to include this variable in future work as a potential factor in the prevention of CHDs. Finally, the influence of other environmental factors, such intrauterine infection as well as high doses of radioactive material and/or drugs should also be taken into consideration. Despite these limitations, our meta-analysis offers more evidence for the association (or lack thereof ) between VEGF C2578A, G1154A, and G634C gene polymorphisms and the risk of CHD. Collectively, future studies using larger samples and better-matched controls will be needed to further confirm the findings from our meta analysis.

Conclusion This meta-analysis did not provide evidence for an association between VEGF C2578A, G1154A, and G634C genetic polymorphisms and CHD risk. These results do not support the hypothesis that VEGF C2578A, G1154A, and G634C polymorphisms may be a susceptibility marker of CHD. However, largersized sample studies will be needed in the future to validate our findings. Additionally, other factors such as plasma homocysteine levels, enzymatic activity, parental genotypes, and vitamin complex intake will also need to be included. Finally, more gene-gene and gene-environment interaction studies will be needed in future work, which should lead to a better and more comprehensive understanding of the association between VEGF polymorphisms and CHD risk.

Role of Funding Source This work was supported by funding from the National Natural Science Foundation of China (No. 81370279).

References are available online

Total Kissing Balloon: A Novel Technique to Treat Aneurysmal Left Main Coronary Artery Authors: Alfonso Jurado-Román*, Andrea Moreno-Arciniegas, Ignacio Sánchez-Pérez, María T López-Lluva, Jesús Piqueras-Flores and Fernando Lozano-Ruíz-Poveda

calcified plaque with a minimal luminal area (MLA) of 3.9 mm2 (Figure1A-asterisk) and a reference diameter of 5.8 mm. A percutaneous coronary intervention (PCI) was scheduled the following day.

Interventional Cardiology Department, University General Hospital of Ciudad Real, Ciudad Real, Spain

However, several hours later the patient presented intractable angina with diffuse ST depression and hemodynamic instability with severe hypotension that needed intravenous inotropic drugs. Thus, an emergent PCI was performed. Predilatation with a 4 × 8 mm balloon was performed and, due to the unavailability of a larger diameter drug eluting stent (DES), a 4 × 12 mm DES was implanted at ostial LM.

*Corresponding Author: Alfonso Jurado-Román, Interventional Cardiology Department, University General Hospital of Ciudad Real, Ciudad Real, Spain. Tel: 0034629871863, E-mail: alfonsojuradoroman@gmail.com Received date: August 01, 2016; Accepted date: August 28, 2016; Published date: August 30, 2016 Citation: Jurado-Román A, Moreno-Arciniegas A, Sánchez-Pérez I, et al. Total Kissing Balloon: A Novel Technique to Treat Aneurysmal Left Main Coronary Artery. Interv Cardiol J 2016, 2:2.

Visit for more related articles at Interventional Cardiology Journal

Abstract An 84 years-old male was admitted for stable angina and an early positive treadmill test. He presented an angiographic severe ostial stenosis of the left main (LM) with no other significant lesions. Intravascular ultrasound image (IVUS) showed a fibro-calcified plaque with a minimal luminal area (MLA) of 3.9 mm2 (Figure1A-asterisk) and a reference diameter of 5.8 mm. A percutaneous coronary intervention (PCI) was scheduled the following day.

Case Blog An 84 years-old male was admitted for stable angina and an early positive treadmill test.

Under expansion and malapposition were observed so post dilatation with the largest available diameter balloon (5 mm) was performed. Although improved, no optimal apposition was achieved, so we performed a simultaneous inflation of two 3 × 10 mm non-compliant balloons placed at the same level of the LM without reaching the carina (“Total Kissing balloon”) obtaining optimal stent apposition with a MLA of 21.7 mm2 and without any distortion of its platform (Figure 1).

Large size LM PCI may be challenging due to the absence of DES or balloons that are large enough to reach the reference diameter of the vessel.

Simultaneous inflation of two balloons contacting between themselves in their entire length and without involving a bifurcation is a variant of the kissingballoon technique [1]. This "Total Kissing-Balloon" technique, which to our knowledge has not been described in this setting, could be useful in this scenario.

References George BS, Myler RK, Stertzer SH, Clark DA, Cote G, et al. (1986) Balloon angioplasty of coronary bifurcation lesions: the kissing balloon technique.

Cathet Cardiovasc Diagn 12: 124-138.

He presented an angiographic severe ostial stenosis of the left main (LM) with no other significant lesions.

Intravascular ultrasound image (IVUS) showed a fibro-

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Projects 1) Foundation Stone Laid for Amrita Hospital New Charitable 2000 Bed Medical Facility in Delhi, NCR Introduction:

Foundation stone was laid for the construction of Amrita Hospital new charitable state-of-the-art 2000 bed medical facility in Delhi, NCR. Haryana Chief Minister Manohar Lal laid the foundation stone for Amrita Institute of Medical Sciences & Research Centre (Amrita Hospital) on May 9, 2016. The construction of the hospital is planned on a total plot area of 10000 sq m to be constructed at Faridabad, Haryana. The total built up area will be 416368.87 sq m.

Features:

The hospital will be constructed based on national and international green building standards. The materials used in construction will be environmentally friendly. It will have a minimal carbon footprint, zero wastewater discharge, and to be powered eventually by more than 45 per cent solar power. The hospital is being constructed to be GRIHA – and LEED-certified.

More than 70 per cent of the campus land is planned to be filled with local varieties of plants, trees, shrubs, and water bodies. The state-of-the-art healthcare facility is spread across nearly 100 acres in Sector 88, Greater Faridabad.

The hospital will focus on low cost healthcare solutions for poor people and will have an emphasis on maternal, infant and child healthcare. It will also include a specialised multidisciplinary Children’s Hospital with maternal and foetal medicine and all paediatric subspecialties.

The Amrita Institute of Medical Sciences & Research Centre is set to become the largest hospital in DelhiNCR with a planned facility of 2,000 beds.

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• 2000 bedded hospital • Institute of medical sciences in first phase • Auditorium, hostels and staff quarters and allied facilities in Phase II Location: Delhi, NCR

Benefits:

The new hospital will feature complete range of specialities, super specialities and centres of excellence.

It will also dedicate an entire block to conduct original research with an aim to find low-cost solutions to healthcare problems that helps to make medical care more affordable.

Future Plans:

Initially, the management of the hospital planned a facility of 2,000 beds but gradually they are looking to increase it by 2,500 beds looking at the need of healthcare facility in the region.

Specifications: Name: Amrita Hospital Location: Delhi, NCR Type: New 2000 bed medical facility Area: 100 acres Key Players: Amrita Hospital Investment: Not specified Resources: Amrita Hospital

Objective:

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Project Details The total built up area will be 416368.87 sq m. Project will provide the following facilities.

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Schedule of Delivery: 2018

Area Statement for Proposed Project: Project Area Details

Area, in Sq. m

Total Plot Area

308957.04 sq. m.

Proposed Built Up Area

416368.87 sq. m.

Permissible Ground Coverage Area (35%) Proposed Ground Coverage Area (10.4%) Permissible FAR Area (150) Proposed FAR Area (80.37) Green Area Proposed (30% of Plot Area) Table1.Area Statement for Proposed Project

Key Highlights:

• Centres of Excellence: Heart institute, high-precision cancer diagnosis and therapy institute, organ transplantation, advanced centre for neurosciences and epilepsy, diabetes and metabolism institute, centre for liver and biliary diseases, institute for minimally invasive and robotic surgery, etc • Research and Development block • Sustainable Architecture • Teaching Hospita

2) CPMC hospital’s US$2.1 billion Geary and Van Ness hospital construction project reaches halfway mark Introduction:

California Pacific Medical Centre (CPMC) has hit the half-way milestone on construction of its new US$2.1 billion Geary and Van Ness hospital.

Features:

New US$2.1 billion Geary and Van Ness hospital is being constructed with 274 bed facility. The construction project includes two state-of-the-art facilities that are essential for San Francisco patients.

The Van Ness and Geary campus contains twelvestory home for the women’s, children’s, cardiology, emergency, oncology, and transplant departments and will create 740, 000 square feet of diagnostic, treatment, and inpatient bed space.

An adjacent 253, 000 square foot, nine stories medical office building will accommodate outpatient services and also support the health care professionals next door. A pedestrian tunnel below ground will be allotted for the hospital office, respectively. The campus will have 376, 000 square feet of underground parking space. An integrated communications system that is used during the Van Ness and Geary Campus construction ensures coordinated design and construction delivery.

Geary and Van Ness hospital will be one of the largest LEED certified hospital campuses in the world and the fourth LEED certified hospital in California

Objectives:

Geary and Van Ness hospital aims to provide stateof-the-art and cost-efficient medical services to meet the challenges of high impact, visibility and complex

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Projects infrastructure project. The Van Ness and Geary Campus is designed to be an inviting and welcoming hospital and medical office building persistent on the well-being of patients, families, health care providers, and so on.

Project Details The campus is being constructed in an area of 250, 000 square foot. Construction of the 274-bed facility is expected to complete in 2018’s third quarter and will be ready for patients by early 2019 as installation of metal panels, exterior glass and equipments for the new structures central utility plant require more time.

Location: San Francisco, United States

Specifications: Name: Van Ness and Geary Campus Location: San Francisco, California, United States Type: Construction of medical campus Area: 250, 000 square foot Investment: US$2.1 Billion Key Players: California Pacific Medical Centre Suppliers and Constructors Year of Completion: Early 2019

Maine Medical Centre (MMC) proposes a plan of US$512 million expansion, the largest expansion ever.

This would increase the footprint of the hospital’s main campus in Portland by 25 per cent. With this, Maine Medical Centre will be the state’s most advanced medical centre. The renovation is intended to enhance patient comfort and privacy and to help reduce bottlenecks throughout the system.

MMC Features:

MMC would include a new wing as part of its expansion. Two floors will be added to an existing building, creating 20 new operating rooms and 128 patient rooms. Chief Medical Officer Joel Botler said that many of the existing patient rooms would be converted from double to single occupancy.

“We start our day with either a handful of available beds or none at all,” Botler said in a news release. “The lack of available beds routinely backs up our emergency department as patients wait there for an in-patient bed to become available,” he added.

The project would also add 1,200 space parking garage, on Congress Street, tack floors to two others.

The hospital’s helipad will be moved to the top of the facility’s easternmost building from its present location.

Maine Med expects the project would add 300,000 square feet to the main campus.

Location: Portland, Maine, US

Key Highlights:

Specifications:

• Green Roofs • Energy and Water Efficiency

Name: Maine Medical Centre

• Reuse, Recycle

Location: Portland, Maine, US

• Storm Water Management

Type: Expansion of the hospital

3) Maine Medical Centre Plans US$512 million Expansion Introduction:

Budget: US$512 million Key Players: Fundraising and tapping Maine Med’s existing financial reserves, Maine Medical Centre Schedule of Delivery: 2022

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4) Apollo Hospitals plans to add 600 beds in 2016-2017 Introduction:

Apollo Hospitals Enterprise Ltd plans, a Chennai based hospital chain major, plans to add 600 beds to its existing 8400 bed infrastructure across the country during fiscal 2016-2017.

Features:

Apollo Hospitals management mentioned that the funding would be met through internal accretions and debts. â&#x20AC;&#x153;We have laid out plans for greenfield expansions for the current fiscal. Our two big projects will come up in Vishakhapatnam and Navi Mumbai soon. We have also planned next round of expansions," said Sangita Reddy, Joint Managing Director, Apollo Hospitals Group, during a media interaction.

Location: Across the country

Future Plans:

5) Columbia Asia Plans to Open 8 New Hospitals Across the World Introduction:

Columbia Asia is planning to open eight more hospitals across the world in the next 4 years, three in Malaysia, three in India and two in Indonesia. The main strategy of Columbia Asia is to create clusters of hospitals in large urban areas.

Features:

The company plans to open three 150-160 bed hospitals in India at Bangalore, Pune and National Capital Region. It plans to invest another US$ 150 million to expand its network to 34 hospitals and one clinic by 2018 with modern amenities.

Specifications: Name: Columbia Asia

A standalone cardiac care unit will be set up in Ahmedabad called Apollo Heart Centre. This new centre will be completed within 12 months and will be set up with an investment of about Rs 65 Crore (US$90 million). It will be equipped with superior technology which will be useful for CT scan.

Location: India, Malaysia, Indonesia

Specifications:

Schedule of Delivery: 2018

Name: Apollo Hospitals, Chennai

Type: New hospitals establishment Investment: US$ 150 million Key Players: Columbia Asia

Statues: Planning Stage

Location: Across the Country Type: New 600 bed medical facility Investment: US$90 million Key Players: Combination of debt and internal accruals, Apollo Hospitals Schedule of Delivery: During fiscal 2016-2017

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Products&Services

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www.messe-duesseldorf.de

Power Of Safety 9$&8(77(Ù Blood Collection System Special needles for comfortable venipuncture Closed system for hygienic sample collection Easy opening of tubes via unique safety screw cap Compatible with all common analysis equipment Safety products to avoid needlestick injuries

Greiner Bio-One GmbH | Bad Haller Straße 32 | A-4550 Kremsmünster Phone: (+43) 75 83 67 91-0 | Fax: (+43) 75 83 63 18 | E-mail: office@at.gbo.com

www.gbo.com/preanalytics