Asian Hospital & Healthcare Management - Issue 35

I s s u e 35

2017

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Connected Devices The new panacea?

Emerging Trends in Medical Innovation for 2017

Locating India on Medical Tourism Map

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Foreword Connected Devices Bridging the healthcare information gap The growth in connected medical devices and mobile medical apps can boost long-term patient-engagement. New data from Juniper Research suggests that the number of Internet of Things (IoT) connected devices would be US$38.5 billion in 2020, up from US13.4 billion in 2015. The proliferation of connected devices—accounting for US$3.3 billion in 2013, and an expected US$8 billion by 2018 in the US—is revolutionising the way we approach health and well-being.

It is also evident that several software, service, and product companies are showing interest in connected devices with a view to make their primary product or service more attainable. Connected devices have been helping patients and healthcare professionals in various forms. Tracking health information on the go is vital to view health records, lab results, and treatment plan whenever required. Usage of smart devices helps healthcare professionals by delivering valuable patient data that in turn helps patient follow-up interactions. This reduces the dependence on direct patientphysician interaction and patients can seek care when needed.

Numerous applications are being developed to help bring patients and healthcare professionals closer and thus make healthcare

more effective and accessible. The development of applications or connected devices in conjunction with educating and training the healthcare professionals would make them more efficient and successful. However, the challenge lies in how well the healthcare providers adopt these.

Nevertheless, emergence of connected mobile devices does pose security challenges.

The primary issue would be securing and maintaining patient data and avoiding misuse.

Regulating authorities will continue to work for the adoption of modern technology and applications. The key to making connected healthcare more successful lies in healthcare and technology companies working in tandem.

In the cover story Gurrit K Sethi, CEO, Canta Health, India says that connected devices promise to be the solution in conjunction with analytical tools that can preempt and aid better the comprehensive results and health scores.

Prasanthi Sadhu

Editor

Contents 36

HEALTHCARE MANAGEMENT 06 Locating India on Medical Tourism Map Vinay Kaul, Sr. V. P. Sales and Marketing, Columbia Asia Hospitals, India

12 Hospital for Sale Lease The hospital market in your hands Amrit Pal Singh, Founder & CEO of www.hospitalforsalelease.com, India

MEDICAL SCIENCES 16 Intermittent Hypoxia Therapy A non-invasive treatment Alexey Platonenko, CEO, AiMediq, Luxembourg

20 Managing Diabetes Better Diabetacare Clinico-Technology Solution Sanjiv Agarwal, Founder &MD, Diabetacare, India

26 Targeting Angiogenesis An unmet need in gastric cancer Wong Seng Weng, Medical Director & Consultant Medical Oncologist The Cancer Centre, Paragon Medical & Mount Elizabeth Novena Specialist Centre, Singapore

Gurrit K Sethi, CEO, Canta Health, India

Technology, Equipment & Devices 26

30 Emerging Trends in Medical Innovation for 2017 Brian Wyatt, Head, Medical Technology and Healthcare Unit, Cyient, USA

INFORMATION TECHNOLOGY 42 Digital Health Opportunities Amit Varma, Managing Partner, Quadria Capital, India

48 Telehealth and Telehomecare Caring remotely

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SB Bhattacharyya, Member, National EHR Standardisation Committee, MoH&FW, Govt. of India Member, Health Informatics Sectional Committee, India

25 EVENTS 52 BOOKS 54 RESEARCH INSIGHTS

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Advisory Board

Editor Prasanthi Sadhu Editorial Team Grace Jones Vijaya Lakshmi Art Director M Abdul Hannan Product Managers Jeff Kenney Senior Product Associate Ben Johnson Jennifer Wilson Peter Thomas

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 Sankar K 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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Locating India on Medical Tourism Map

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HEALT HCARE MANAGEMENT

Indian medical tourism market is highly competitive and is expected to touch US$ 8 billion by 2020.

Some of the major contributing factors behind the success of India in medical tourism includes latest medical technologies, standard quality medical services, facility of mass use of English language and key private players in healthcare domain.

Vinay Kaul, Sr. V. P. Sales and Marketing, Columbia Asia Hospitals, India

T

he word ‘tourism’ adds a new dimension to the concept of ‘Wellness’, where medical value is added to the travel of tourists seeking healthcare beyond borders. It is this value of service for which patients prefer to undertake travel rather than using medical services available in their own country.

According to a Grant Thornton study, Medical tourism in India is set to touch US$ 8 billion by 2020.Amongst the several global medical tourism corridors, India has the largest number of accredited facilities, second only to Thailand. Offering a rare confluence of warm ‘hospitality’ and advanced ‘specialty hospitals’, India is a preferred medical tourism destination followed

by Singapore, Malaysia, Taiwan, Mexico and Costa Rica.

Increasing Popularity of Medical Tourism in India

A substantial number of patients prefer developing nations for healthcare and India is the most preferred destination with the number of medical tourists rising tremendously. With 1.2 million patients visiting India for healthcare services in 2014, the figure is projected to rise to 4.9 million tourists by 2025.

Columbia Asia Hospitals, India have received more than 7000 international patients in FY 15-16, which is almost 20 per cent higher than FY 2014-15.

While an increasing number of patients from Iraq, Yemen, Nigeria, Maldives, Oman, Tanzania and Bangladesh are opting for healthcare services, in India, patients from US and Europe also prefer India instead of other medical tourism destinations.

Nigeria and Iraq have traditionally been the key contributing geographies, in the recent times there has been a steady rise in patients from the Middle East and SAARC region.

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HEALT HCARE MANAGEMENT

With 1.2 million patients visiting India for healthcare services in 2014, the figure is projected to rise to 4.9 million tourists by 2025.

Reasons for Increasing Popularity of Medical Tourism in India

Out of the many factors that contribute to a country’s medical tourism, the most prominent one is ‘Trust’ on the medical service provider.

One such case is of a Fifty-sevenyear old Dr. KapetiniLasangulira, a professor in Massachusetts who came for his treatment at Columbia Asia hospitals, India, after he heard from his colleague about the superior skill set and expertise of the specialists who had also conducted his surgery with excellent outcomes.

Many medical tourists seek offshore medical services due to unavailability of reliable medical aid in their own country. One such case is of a 65-yearold wheel chair bound Naeesha from Iraq, who waited for many years, consulted several doctors, before she

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underwent a bone reconstruction surgery at Columbia Asia Hospitals and is now able to walk on her own.

Some of the other factors that are responsible for the increasing popularity of medical tourism in India include: Economic considerations : India, being a developing country, offers a wide variety of medical services at par to that of many developed countries which is the driving force for medical tourism. Therefore, an increasing number of people in developed countries are opting for medical services in India available at affordable costs.

Influence of technology : With increasing impact of technology, people find it easy to avail healthcare services in any part of the world. With Modern technology enabling potential medical

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tourists to investigate and enquire about healthcare services available in India, medical tourism is all set to take gigantic leaps.

High cost of health insurance : Health insurance in many developed countries is out of the reach of middle income population. Therefore, a majority of patients from developed nations are attracted by the low cost yet highly efficient services provided in the Indian market. These people find it feasible to invest in low cost medical tourism destinations than to avail services in their own market.

Limited scope of health insurance: A majority of patients pursue medical tourism to seek treatments that are not included in health insurance. These services include cosmetic surgery, dental reconstruction, fertility treatment and others.

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To avoid healthcare delays : In countries where governmental system controls access to healthcare services, patients prefer offshore medical care to avoid delays associated with long waiting lists. Therefore, patients with complex and serious medical conditions find it feasible to travel to medical tourism destinations where they can get immediate medical services.

Confidentiality : Many patients prefer medical tourism destinations to protect their privacy and confidentiality.

This happens mostly in cases where patients undergo plastic surgery, drug rehabilitation or gender change procedures.

Dominance of private players: The Indian healthcare industry is mainly dominated by private players, where each one is trying to excel and provide advanced medical treatment options.With many well-known service providers making available best of the medical treatments with latest medical advancements in Bangalore, Mumbai, Chennai and New-Delhi, India is attaining the attention of medical tourists.

Mass use of English language: With the mass use of English in Indian private hospitals, foreign tourists find it easy to communicate and understand.

educating the patients about the risks and preventive measures.

Connectivity to major medical tourism hubs needs to be looked into.

While cities like Delhi and Mumbai are relatively well connected with the rest of the world, the upcoming medical tourism hubs like Bangalore and Pune can immensely benefit provided there are more direct flights especially from key African and Middle East countries.

Technology Affecting Medical Tourism Landscape

With technological advancements in healthcare technologies such as mobile apps, tele-medicine, tele-radiology and tele-consultations, healthcare services can be easily made available across globally, while restoring trust and confidence between medical professional and patient.

A prior screening through telemedicine ensures proper examination of the patient’s condition and establishes the appropriateness for his / her travel to avail medical

services at hospital beyond borders.

These advancements can save unnecessary patient travel to hospital by certifying surgery fitness. Teleconsult also increases comfort & confidence level of the patients with the treating doctors, who are miles apart.

The Continuing Evolution of Medical Tourism in India

Medical tourism industry in India is fueled by patients who generally do not have access to quality healthcare available back home. Most of these foreign patients choose India for medical services ranging from general surgeries, joint replacements, spine and neurosurgery to complex tertiary care procedures like pediatric cardiac surgeries, organ transplants (kidney and liver) etc.

Presence of large number of quality healthcare providers, international air connectivity, and large foreign student presence in the country, continue to boost Indian medical tourism industry.

Quality and safety in medical tourism is still a very important consideration.

Faced with the choice of a wide variety of medical institutions in diverse countries, medical tourists may find it very difficult to identify well-trained physicians and modern hospitals that consistently provide high-quality healthcare.

There have also been concerns about the risk of complications resulting from travel and vacation activities in postoperative care. Measures have been taken up by management of many medical corridors to minimize the risk of postoperative complications by

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Author BIO

Key Challenges

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Vinay has over 16 years’ experience in a wide variety of sales, marketing, business development and commercial roles spanning several industries and market sectors including Pharmaceuticals, Medical devices, Consumer, Dental and Healthcare delivery.A leader in healthcare delivery, Vinay is responsible for all sales and marketing activities at Columbia Asia India.

NATIONAL HEALTHCARE CMO SUMMIT March 13-14, 2017 | The Langham Huntington | Pasadena, CA The 5th National Healthcare CMO Summit is a premium forum bringing senior level medical executives and solution providers together. Our one-on-one business meetings methodology provides access to senior medical executives within the largest healthcare organizations across the United States.

KEY TOPICS: •

The CMO Perspective: Implications of MACRA, MIPS and APMs

•

Increasing Physician Alignment and Integration to Meet Organizational Goals

•

Reducing Medical Errors and Keeping Your Focus on the Patient

•

The Rise of the Retail Clinics: Successfully Building Meaningful Partnerships

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On the Mend: Preventing Physician Burn-Out

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Building a Clinical Integrated Network to Enhance Quality of Care

KEYNOTE SPEAKERS: • Bruce Bethancourt, Chief Medical Officer, Dignity Health • Adam Myers, Chief Medical Officer, Operations Officer, Texas Health Physicians Group • Keith Starke, Chief Quality Officer, Mercy Health • Herman Williams, SVP and Chief Medical Officer, RCCH Healthcare Partners • James Labelle, Chief Medical Officer, Scripps Health • Michael Coffey, President and Chief Medical Officer, Collaborative Health ACO • Matthew Hanley, Senior Vice President and Chief Medical Officer, Carolina’s Healthcare System Metro Group

Great forum to network with peers, across the country to exchange ideas. Topics were relevant to challenges faced by all CMIOs. CMIO, Baptist Health System

FOR MORE INFORMATION, PLEASE CONTACT DANAE DERMATIS AT: email: danaed@marcusevanscy.com www.asianhhm.com

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Hospital for Sale Lease The hospital market in your hands

1. You’ve a vast career of having worked for over 22 yrs. worldwide after doing your MBA. What are your strengths?

I am passionate about creating out of the box solutions for problems which affect mass population worldwide. I see myself as a change agent, catalyst, team builder and a venture capitalist for various businesses across industries worldwide.

2. How did the idea of making https://www.hospitalforsalelease. com/ come to you?

When I worked as part of the top management in the healthcare industry for business development, I was moved after seeing the plight of patients undergoing: • Unwanted lab tests • Unwanted room, ICU admissions • Unwanted expensive medications • Unwanted surgeries • Unwanted implants in the body • Unwanted huge patient bills

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• Unwanted mediclaim insurance claims.

On the other hand, I saw the plight of hospitals under great stress and in huge financial losses forcing them to do the above mentioned.

This made me curious to fix this problem worldwide to make an impact in the life of patients.

3. What are the challenges which a hospital owner / top management face?

The various challenges are like soaring infrastructure costs, medical equipment costs, staff challenges, evolving healthcare compliances and fewer patient walk-ins have pushed many hospitals out of business.

The ROI doesn’t happen as projected while taking huge loans to setup the new hospital and revenue shortfalls severely impacts the income of the business and hospital management are subjected to high stress and pressure, often leading to bankruptcy.

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4.How have you used your portal to revolutionise healthcare?

The need of the hour is not to build a new hospital with huge loans and investment but to buy / lease a distressed hospital available worldwide.

Hence, an investor gets a ready hospital, staff, infrastructure, medical equipment’s and existing patient flow which he can upgrade ASAP with minimum investment as compared to building a new hospital.

Now since the investment is the least as compared to building a new hospital, there is no need for the hospital to setup huge revenue targets for everyone in the hospital and focus is on providing ethical treatment to the patients with complete transparency. This will result in a winwin situation for both the hospitals and patients which we have highlighted in our video https://www.youtube.com/ watch?v=2QgsPUXwLKs

HEALT HCARE MANAGEMENT

5. How can hospitalforsalelease.com leverage an investor who plans to setup a hospital?

On our portal, hospitals worldwide who want to sell / lease their hospital / medical equipment upload details which investors are looking for and investors worldwide can browse the

database and shortlist those hospital based on their criteria from the comfort of their home, office which saves them tremendous time, huge money and travelling worldwide. Now the investors can contact the hospital directly and do the deal offline as per terms and conditions suitable

to both of them which was never possible earlier.

6. What does the ‘Invest in hospital Equipment’ mean? How can it bring a positive change in the health sector?

Medical equipment is very expensive and a huge cost in building a new hospital. On our portal, you can find lot of medical equipment for sale / lease by hospitals which investors are looking for. Hence by buying / leasing medical equipment already available in a hospital, it is a huge saving for the investors.

7. How is hospitalforsalelease. com a competitive differentiator for healthcare service providers?

On our portal various things are unique like: • Hospitals and investors worldwide are listed on one single platform • Complete confidentiality as database is encrypted and secured • Registration is free • 0 per cent brokerage charges as you can close the deal directly offline amongst yourself.

Amrit Pal Singh, Founder & CEO of www.hospitalforsalelease.com has 22 yrs. of experience in the field of strategy, planning and marketing in India and abroad. Amrit likes to work on ideas, which makes an impact in the life of people on the ground by providing out of the box solutions to problems.

Amrit also developed www.retiredsikhs.com for retired Sikhs and www.gurdwarajob.com to provide free service to people worldwide looking for a job in a Gurdwara.

8. What is your vision about https://www.hospitalforsalelease. com/ My vision is to make an impact in the life of patients worldwide where a patient doesn’t have to undergo unwanted lab tests, expensive medication, surgeries and implants in his body because the hospital where he has gone for treatment in emergency or otherwise is having financial losses and the hospital is under stress to do anything unethical with the patient to make money.

Our portal makes a sincere effort to help investors find hospitals to invest and run the operations profitably with minimum investment and not be under unwanted stress to do anything unethical with the patient.

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Dates announced for MEDICAL FAIR THAILAND 2017

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The 8th edition of MEDICAL FAIR THAILAND, the leading medical and healthcare event in Thailand and the region, will take place at the Queen Sirikit National Convention Centre (QSNCC) in Bangkok, Thailand from 6 – 8 September 2017.

from 42 countries including 15 national pavilions and country groups from Austria, Belgium, China, France, Germany, Japan, Malaysia, Singapore, South Korea, Taiwan, Thailand, UK and for the first time the USA, Turkey and Italy.

Since its inception in 2003, MEDICAL FAIR THAILAND has grown in size, stature and is recognised as Thailand’s most important resource and business platform for both international and regional suppliers from the medical and healthcare sectors.

The testament to the exhibition’s success was further reflected in the number of visitors, as the 7th edition welcomed 7,226 quality trade buyers and decision makers from mainly Thailand and the ASEAN region.

In 2015, MEDICAL FAIR THAILAND held its largest edition to date as it welcomed 600 exhibitors

Focused on equipment and supplies for the hospital, diagnostic, pharmaceutical, medical and reha-

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government bodies, hospital administrators, doctors, nurses and other healthcare professionals sourcing for the latest innovations in medical and healthcare, MEDICAL FAIR THAILAND 2017 is expected to draw 700 exhibitors, 17 national pavilions and country groups and 8,500 quality trade visitors.

Bookings for exhibitor spaces are now open and exhibitors are urged to secure their booth space early. More information on MEDICAL FAIR THAILAND 2017 can be found at medicalfair-thailand.com

About Messe Düsseldorf Asia

bilitation sectors, MEDICAL FAIR THAILAND 2017 will once again bring together new and innovative technologies, solutions, products and services from around the world.

In its upcoming edition, the exhibition will emphasise on Connected Healthcare and Geriatric Rehabilitative Care across two dedicated platforms and numerous concurrently held events. For one, the Connected Healthcare platform aims to demonstrate innovative digital solutions such as wearables that are transforming the understanding of patient’s health statuses, improve care and deliver greater results. At the same time, and returning for its 3rd edition, the Advanced Rehab Technology Conference (ARTeC) will focus on innovative and effective technological solutions to decrease mobility related disabilities.

Co-organised by the Thai Rehabilitation Medicine Association, the Royal College of Physiatrists of Thailand and Messe Düsseldorf Asia, the academic conference will welcome international key thought leaders to share insights on robotic transfer systems, robotic arm training devices, robotic gait training and wearable devices.

Serving as a converging point for healthcare providers, medical suppliers, industry professionals,

Messe Düsseldorf Asia is a subsidiary of Messe Düsseldorf in Germany, one of the world’s leading trade fair organisers, responsible for organising more than 20 global No. 1 exhibitions in various industries including medicine and health, specifically MEDICA, COMPAMED and REHACARE INTERNATIONAL held in Düsseldorf, Germany. With extensive expertise in organising trade fairs in Southeast Asia, Messe Düsseldorf Asia has developed a portfolio of numerous trade fairs in the region since 1995.

For more information, please visit: www.medicalfair-thailand.com For more information on the exhibition please contact: Exhibitor Contact:

Daphne Yeo

Senior Project Manager Tel: (65) 6332 9682 medicalfair-asia@mda.com.sg Press Contact:

Maria Wesson

Senior Marketing & Communications Executive Tel: (65) 6332 9652 maria@mda.com.sg Advertorial www.asianhhm.com

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Medical Sciences

Intermittent Hypoxia Therapy A non-invasive treatment

In addition to improving athletic performance, Intermittent Hypoxia Therapy (IHT) has been found to have positive effects on conditions such as coronary heart disease, cardiological disease, bronchial asthma and chronic obstructive pulmonary disease, metabolic disorders (obesity, type II diabetes) and aids in recovery after spinal cord injury.

1. IHT is not well known in the west, how long has it been used in Russia?

How many people have undergone IHT so far?

There are references to crude attempts at treatments that seem similar to intermittent hypo-oxidating back to the middle ages. However, modern scientific study of intermittent hypoxia therapy (also known as periodic hypoxia, interval hypoxia, hypoxic preconditioning etc.) really took off in the 1930s in the Soviet Union, driven mainly by military requirements.

In the past three decades intermittent hypoxia, and its possible applications, have again been the subject of a considerable amount of research.

ALEXEY PLATONENKO CEO, AiMediq, Luxembourg

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A market intelligence leader delivering research and consultancy for the Global Healthcare Industry

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Medical Sciences

The number of publications indexed in PUBMED under the keywords ‘intermittent hypoxia’ increased from 15 in 1983 to 385 by 2013. As a result the use of Intermittent Hypoxia Therapy (IHT) has been extended beyond its already established roles in altitude pre-acclimatisation and sports performance enhancement to treatments for a variety of clinical disorders.

Because it offers a drug-free alternative with very few contraindications,IHT has been widely prescribed in Russia and the formerSoviet Union countries for two decades, with patient numbers now around 2 million. Of those 75 to 95 per cent have reported good or satisfactory results.In recent years IHT has been gaining recognition among healthcare professionals and has grown in popularity in Europe and the USA. 2. How is your device different from those that were used in Russia for so many years?

The ReOxy device varies greatly from its Soviet predecessors and trying to compare them is like comparing an old model T Ford to the latest Tesla; they are both cars but they use very different technology.

The ReOxy is the first device of its kind that allows precise calculation and dosing of hypoxic load tailored individually for each patient. ReOxy uses SelfRegulated Treatment (SRT) technology that relies upon the principle of biological feedback, where the patient’s bodily reactions define and control the therapeutic parameters throughout the treatment session.

It is important to correctly calculate the individual dose to be used for every hypoxia treatment and not to over or underdose. Overdosing hypoxia can result in negative effects similar to those caused by obstructive sleep apnea syndrome. Underdosing hypoxia, on the other hand, can reduce the procedure’s efficacy. In ReOxy’s case, the hypoxic load dose is calcu-

lated pretty much the same way as pharmacological substances. It can subsequently be repeated and / or adjusted higher or lower as required.

That is why ReOxy is the first device certified for medical application of IHHT in accordance with MDD 93/42/ EEC medical EU directive.

3. What makes you think MEDICAL FAIR ASIA (MFA) 2016 is the best place for you to showcase the ReOxy? When we were researching for a platform to launch the ReOxy device in Asia, MEDICAL FAIR ASIA 2016 stood out as the premier event of its kind with the greatest reach in the region.

It seemed the obvious choice that will allow us to introduce our innovative breathing therapy device ReOxy into the Asian market and share the recent developments in the field of IHT. 4. What kind of response are you expecting from MFA 2016, both qualitatively as well as quantitatively?

Considering ReOxy’s growing popularity in Europe, we are expecting widespread interest and acknowledgment from the Asian professional audience.

ReOxy and IHT have multiple applications in many medical fields including: cardiology and neurology (for treat-

Image source from wikimedia.org

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Alexey Platonenko graduated from the Moscow Medical Academy with a degree in oncology and surgery in 1998 after which he pursued post-graduate studies in high-tech and diagnostics equipment. He worked for three years as the Chief of the Diagnostics Department at the Moscow Hospital Ministry of Internal Affairs and is currently the CEO of AiMediq.

ment, rehabilitation and prevention), metabolic diseases, pulmonology, and gerontology; so we are expecting great interest from potential distributors.

5. What sort of patients is IHT best suited for?

IHT can be used on patients with a wide variety of conditions.

Beneficial results from IHT application have been obtained for cardiological disease (arterial hyperten-

Medical Sciences

sion, coronary artery disease), bronchial asthma and chronic obstructive pulmonary disease, metabolic disorders (obesity, type II diabetes);recovery after spinal cord injury as well as for preparation for surgery. The use of IHT, as a drug-free alternative, is especially important in paediatrics. IHT has also been successfully used in many other areas of medicine such as functional neurological and psychosomatic disorders, depression, Parkinson’s and Alzheimer’s.

6. While conceptualising IHT, what kind of pre-emptive measures were executed to ensure its safety and easy deployment?

From the beginning it has been Ai Mediq’s intention to bring the USSRdeveloped concept of IHT to Europe and the wider global market; and to do that we knew we would have to develop a device that meetsthe strictest international standards.With that in mind we have invested a lot of resources into the development of multiple safety systems. ReOxy uses advanced software that reads and analyses information from a built-in pulse oximeter to adjust the supplied air mixture and

timing for each patient individually in response to changes in vital indicators, i.e., blood oxygen saturation (Sp 02) and heart rate.

We have also had several iterations of the user interface with each generation being deployed with limited user groups for testing. After every such deployment we gathered feedback to analyse the user experience and revised and improved the whole user interface accordingly.

The patient/ user experience was another we looked at carefully when developing the ReOxy. It has taken three years of non-stop research and liaising with leading industry suppliers from all over the world to develop the individual breathing set we currently use and which we believe offers the best user experience.

Our pursuit of excellence has not stopped and we continue to research and develop the next generation of accessories that will benefit our patients even more in the future.

At Ai Mediq, as well as applying our own safety and control standards at every stage of production, we ensure all our suppliers are certified in the EN ISO 13485 and ISO 9000:2000 standards.

The therapeutic effect of IHT method relies on adaptive responses to mild repeated shortterm hypoxia aimed at improvement of oxygen delivery and utilisation.

7. Apart from cardiovascular conditions, are there other types of conditions that respond well to IHT? Hypoxia is a highly non-specific impact factor and causes a large variety of physiological reactions on various levels in human body. The therapeutic effect of IHT method relies on adaptive responses to mild repeated short-term hypoxia aimed at improvement of oxygen delivery and utilisation. These compensatory mechanisms of adaptation have been scientifically proven to effectively treat a variety of pathological conditions where hypoxia and/or oxidative stress play a significant role, such as COPD, obesity and Metabolic Syndrome, neurological diseases (transient ischaemic attack, recovery after stroke and spinal cord injury)Parkinson’s disease and vascular dementia.

8. Have any contraindications such as pregnancy or asthma been established /detected?

As with every treatment methodology, the ReOxy has some contraindications: • Diseases with symptoms of decompensation • Acute somatic diseases • Acute inflammatory diseases • Life-threatening arrhythmias • Myocardial infarction and/or revascularisation (< 8 weeks prior to IHT treatment) • Episode of unstable angina • Severe systemic non-cardiac disease 9. Do you reckon that IHT can be used concurrently with other therapies and prescription drugs?

Being a non-invasive, non-pharmacological treatment, IHT can be safely used in combination with other therapies and prescription drugs.

Additional data

1.Basovich SN. Trends in the use of preconditioning to hypoxia for early prevention of future life diseases. Biosci Trends. 2013 Feb;7(1):23-32. Review.

PMID: 23524890

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Medical Sciences

Managing Diabetes Better

Diabetacare Clinico-Technology Solution Diabetacare Clinico-Technology Solution enables efficient close monitoring and management of people living with diabetes. Aim is to enhance patient care, enabling healthcare providers to asynchronously communicate with their patients in a technology enabled, and high-touch model minimising risk of errors and improving clinical outcomes.

Sanjiv Agarwal, Founder &MD, Diabetacare, India

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T

he prevalence of diabetes is rising globally. About 70 million people live with diabetes in India and the World Health Organization estimates that an additional 36 million remain ignorant of their condition.

This means that nearly 1 in 10 Indians suffers from this condition but is either unaware of it or is slipping through the treatment cracks with inadequate reporting and monitoring. As the number of people with diabetes grows worldwide, the disease takes an ever-increasing proportion of not only the patient's household budgets but also the overall healthcare budget. Poor glucose control results in higher rates of diabetes-related complications and an increase in healthcare expenditure. Without primary prevention, the diabetes epidemic will continue to grow. Even worse, diabetes is projected to become one of the world's main

Medical Sciences

disablers and killers within the next twenty-five years.Immediate action is needed to stem the tide of diabetes and to introduce cost-effective treatment strategies to reverse this trend.

Tremendous improvements have modified diabetes management from pure clinical diagnosis and the discovery of insulin, to Continuous Subcutaneous Insulin Infusion (CSII) coupled with Continuous Glucose Monitoring (CGM). This has allowed patients to adapt insulin delivery to glycaemia on a virtually ‘real-time’ basis. Insulin was first discovered in 1923 and, in less than a century, it has been purified, humanised and now synthesised by genetically modified microorganisms. Although advances in medicine can improve diabetes health outcomes and potentially help control medical costs, recommendations for care are often neglected. As a result, diabetes often is poorly controlled despite adequate access to healthcare resources.

Diabetes can be managed effectively with multidisciplinary care and self-managing by patients.

Good management reduces the risk of developing complications, enhances health-related quality of life and reduces hospital admissions to a great extent. Conversely, poorly managed diabetes is associated with serious complications including stroke, blindness, heart disease, kidney disease, nerve damage, amputations, and may even lead to death.

A productive and informative interaction between the patient and the care team by using information technology based interventions can lead to improved diabetes care. Existing and emerging technologies such as wireless devices (cell phones) with email and text messaging (SMS) functionality, pagers, and the internet can help facilitate patient selfmanagement of diabetes. These types of devices offer a practical and cost-

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effective method for monitoring clinical outcomes and increasing patient adherence to treatments.

Wireless technologies can be used as intermediary tools to facilitate the information between patient and provider and treatment advice between clinic visits.

At Diabetacare, we understand that a physician’s concern for their patients goes beyond managing their blood glucose levels. We also know that diabetes management needs treatment and care options above and beyond basic consultations. To ensure that the physicians are best supported in providing their patients complete diabetes management solution, we have developedunique products and services thatwould complement their services and ensure 360-degree care.

Diabetacare Clinico-Technology Solution enables efficient close monitoring and management of people livingwith diabetes. Aim is to enhance patient care, enabling healthcare providers to asynchronously communicate with their patients in a technology enabled, and high-touch model minimising risk of errors and

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improving clinical outcomes. Our Diabetes management Centre is a 24x7 clinical contact centre, staffed with doctors, diabetes specialist nurses and diabetes educators. This team supports patients, physicians and patient families in improving compliance and providing round the clock care for better outcomes.

Diabetacare Technology Components

DiabetaCartSM : This has been designed to provide comprehensive investigations focusing on Diabetes complications and consultation to improve lifestyle and compliance. DiabetaCartSM a technology marvel; ‘Diabetes-in-a-box’ is designed to screen most of the end organs involved due to uncontrolled Diabetes. Early and timely diagnosis of these complications improves quality of life and reduce economic burden on the individual and the family. DiabetaCartSM consists of diagnostic components interconnected & integrated to DxNET™ and patient records. This enables early prompts to the caregiver thus enabling early intervention

Medical Sciences

and overall improved outcomes.

Some of the components of DiabetaCartSM are: • Retinal Camera for early and rapid Diabetic Retinopathy screening • 12 Lead ECG as a component of assessing Cardiovascular Risk • Dynamic Foot Pressure Mapping not only enabling measurement of ‘hot’points but also providing an appropriate prescription for ‘pressure offloading’ driven by smart clinical algorithm inbuilt in the system • Vascular Doppler to pick up vascular compromise due to diabetes • Biothesiometer (Vibration Perception & Heat & Cold Perception) for pickingup small fibre neuropathy • NCV to monitor changes in Diabetic Peripheral Neuropathy • ANS tool to measure Autonomic Nervous system involvement if required • Body Fat & Composition Analysis thus enabling setting targets and goals for lifestyle intervention • POC Biochemical Analyser providing instant results for Lipid, Renal & Diabetes Profile including HbA1c

DXNET™: Comprehensive Diabetes Electronic Medical Record (EMR) system with Intelligence built for clinical decision making (CDM), which provides prompts and nudges to the caregiver (Physicians, Diabetes Specialist Nurses, Diabetes Educators, Super Specialist Physicians) and to the people suffering with diabetes.

System has evolved with many clinical decision making algorithms helping care givers in personalising diabetes

Insulin was first discovered in 1923 and, in less than a century, it has been purified, humanised and now synthesised by genetically modified microorganisms.

management for the individuals. Clean data is captured primarily by physician support staff (Diabetes specialist nurses / Nutritionist) with no technology burden to the treating physician.

DxNET not only has clinical modules but has evolved as a comprehensive ERP solution tracking people involved in providing the care, processes deployed for the care & monitoring governance in delivery of the service.

DIABETAPAD: Physician can access patient’sclinical trends; visualise the history& relevant sections of patient’svitals and investigation in an easy to use electronic tablet and INTOUCH™ Physician app (in iOS & Android).

InTouch™ Physician App: The InTouch™ Physician App helps you manage and monitor patients that require extra care and attention. The app is compatible with both iOS and Android devices, including tablets, phablets, and smartphones. dCare Smart™ : dCare Smart™ is a connected ‘smart’ glucometer. Results are transmitted within 30 seconds to DxNET™. That way, you’ll always

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Medical Sciences

knows how your patients are doing. It is powered by Vodafone GSM SIM and connected to secured award winning M2M platform. It has been recently awarded “The Best Innovative Healthcare IT Product of the year” by THIT 2015 conference. dCare 2-in-1™: dCare 2-in-1™ is a bluetooth-enabled glucometer and blood pressure monitoring device for patients at higher risk. Just like the dCare Smart™ glucometer, it transmits measurements to DxNET™ within 30 seconds.

DIABETA™ app: The Diabeta app acts as companion tool for the patients for reminders and alerts (for checking BGL, BP, taking medication, doing exercise, tracking calorie intake). Patients and authorised family members can easily visualise the trends, reports, care plan in thiseasy to use interface. This is available for download on bothiOS and Android platforms.

Snap a Meal app: ‘Snap a Meal’ captures information on calorie intake and helps control weight and blood sugar level. The app allows the physicians to stay up-to-date on their patient’s health and provide timely care. With Snap a Meal, the patient needs to take photograph of a meal using the app. Diabetologists/Nutritionists will send the nutritional value of the meal on a real-time basis with calorie values along with details of its carbohydrates, fat and proteins.

Self-monitoring of blood glucose continues to be an effective tool for the management of diabetes. Wireless technologieshelp in effective lifestyle management and can potentially improve self-care for lifestyle driven chronic conditions. There is much enthusiasm amongst industry and patients to use digital tools for diabetes self-management. Large randomised control trials are needed to establish the effectiveness and cost-benefits of digital tools in improving diabetesrelated outcomes.

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The future of the digital health industry is promising.If a self-monitoring device is useful, and if patients are motivated to use the technology, then it is beneficial for both doctors and patients alike. Healthcare providers may in turn discover that they have more reliable clinical information and improved communication with their patients through the usability feedback they might obtain as a result of patient self-monitoring technologies.

Technology intervention in diabetes management has significant potential for improving patients’ care, preventing development of diabetic

complications, and generating cost savings. Barriers of adoption may relate to IT characteristics, individual or professional or organisational level. Important barriers to using IT in diabetes care include privacy and confidentiality concerns, lack of time and anxiety about change, inadequate funding, workforce shortages, and lack of or inadequate training. However, using IT for self-care is highly dependent on the individual’s motivation; without the patient’s willingness to be an active participant in their care; IT implementation will not generate the desired optimal outcomes.

Author BIO

Sanjiv Agarwal is the MD & Founder of Diabetacare. With over 20 years of entrepreneurial experience in the field of healthcare in India and the UK, he has a brilliant knack of understanding the healthcare needs of the consumer.

The gaps and voids he noticed in diabetes management programs in India led him to establish Diabetacare, a 24x7 diabetes care service that utilises mobile technology to manage and monitor diabetic patients’ health.

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EVENTS

19 -23 FEB 2017

26 -27 APR 2017

The 2017 HIMSS Annual Conference & Exhibition

Hospital Management Congress 2017

Orange County Convention Center Orlando, FL himss@compusystems.com

New Delhi, Madeha Management Services Pvt. Ltd., info@madeha.org

11 -13 FEB 2017

29 -30 MAR 2017

India Medical Device 2017

IoT Asia 2017

29 -30 APR 2017

Bangalore International Exhibition Centre, FICCI, mdf@ficci.com

Singapore EXPO, SingEx Exhibitions Pte Ltd, marcom.iotasia@singex.com

4th Asia-Pacific Gastroenterology Cancer Summit (APGCS)

03 -05 APR 2017 15 -17 FEB 2017

Medical Japan 2017

Asia Health Exhibition

INTEX Osaka, Reed Exhibitions Japan Ltd., medical-japan@reedexpo.co.jp

Suntec Singapore Convention & Exhibition Centre, Informa Life Sciences Exhibitions, asiahealth@informa.com

17 -19 FEB 2017

12 -13 APR 2017

6th Asia Pacific Breast Cancer Summit (APBCS)

IT Healthcare Congress 2017

Kowloon Shangri-La, MCI Middle East, apbcs@mci-group.com

Grand Hyatt, Singapore, MCI Middle East, apgcs@mci-group.com

New Delhi, Madeha Management Services Pvt. Ltd., info@madeha.org

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Medical Sciences

Targeting Angiogenesis An unmet need in gastric cancer

Gastric cancer is the fifth most common cancer in the world and the third-leading cause of cancer-related deaths. Asia in particular has the highest incidence rates and remains a significant public health problem as it often presents itself at the advanced stages with poor prognosis. The focus of research on new therapeutic strategies has moved from standard chemotherapy agents to designing agents that would target specific receptors and pathways. Encouraging developments and results from significant clinical trials have injected new hope of increased survival for patients. How does this impact the way advanced gastric cancer is treated?

Wong Seng Weng, Medical Director & Consultant Medical Oncologist The Cancer Centre, Paragon Medical & Mount Elizabeth Novena Specialist Centre, Singapore

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T

argeted therapy for disrupting tumour blood circulation anti-angiogenesis â&#x20AC;&#x201C; has finally found its place under the sun in advanced gastric cancer.

Despite the declining incidence of gastric cancer worldwide, statistics from the International Agency for Research on Cancer (GLOBOCAN 2012) showed that, nevertheless, close to a million new cases are diagnosed annually worldwide making gastric cancer the fifth biggest cancer scourge on the globe. Coupled with a mortality rate in excess of 65 per cent, gastric cancer stands today as the third most common cause of cancer death around

Medical Sciences

the world. East Asia and Southeast Asia, in particular, carry more than their fair share of this disease burden given the relatively higher incidence of gastric cancer in these regions compared with the rest of the world.

Precious little progress has been made over the last decade in the field of chemotherapy for stage IV gastric cancer (stage IV being the commonest stage at diagnosis worldwide) beyond the use of a platinum analog and fluoropyrimidine cytotoxic doublet as first line treatment.

While survival has reached crescendo after crescendo in other major cancer types such as breast cancer, colorectal cancer and lung cancer with beaucoup success stories in research, gastric cancer has been very much of a laggard.

The results of the ToGA trial in 2010 demonstrating the benefit of the addition of a monoclonal antibody â&#x20AC;&#x201C; trastuzumab - in the subgroup of advanced gastric cancers with amplification of the Human Epidermal growth Receptor 2 (HER2) represented the first major breakthrough beyond platinum and fluoropyrimidine. This HER2 over-expressing subgroup, however, forms only about a quarter of all advanced gastric cancer encountered in the clinical setting. Hence, this strategy was not widely applicable.

Breakthrough in Anti-Angiogenesis Strategy

2014 brought more good news by way of the REGARD and RAINBOW trials firmly establishing the role of ramucirumab (CyramzaÂŽ) and the importance of anti-angiogenesis in the treatment of advanced gastric cancer beyond first line.

The formation of a new blood microcirculation, known as angiogenesis, has long been recognised as one of the hallmarks of cancer survival, proliferation and dissemination. Novel treatment targeting tumour angiogenesis with a monoclonal antibody â&#x20AC;&#x201C; bevacizumab - had considerable success in multiple tumour types, notably

colorectal cancer, lung cancer, ovarian cancer and brain cancer (glioblastoma multiforme).

Disappointingly, the first foray into anti-angiogenesis in gastric cancer using the same antibody hit a brick wall. The large-scale AVAGAST trial failed to demonstrate any significant prolongation of survival with the addition of bevacizumab to first line chemotherapy in gastric cancer. A tweak of the anti-angiogenic strategy using ramucirumab finally achieved the long awaited breakthrough.

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Medical Sciences

The underlying mechanism for tumour blood vessel formation involves, inter alia, the interaction between the growth-signal-generating receptor on blood vessels, the vascular endothelial growth factor receptor (VEGFR), and the activating ligand, known as vascular endothelial growth factor (VEGF).

While bevacizumab works by binding to the latter (VEGF), ramucirumab blocks the former (VEGFR).

New Standard of Care in Second Line Treatment

The current regulatory approval for use of ramucirumab in Asian jurisdictions (Japan, South Korea, Taiwan, Hong Kong and Singapore) stands on the back of two phase III randomised trials comparing ramucirumab against placebo (REGARD trial) or ramucirumab in combination with chemotherapy against chemotherapy alone (RAINBOW trial), following the failure of standard first-line treatment.

The REGARD trial proved that the use of ramucirumab reduced the odds of death by 22 per cent over placebo.

The RAINBOW trial demonstrated a further reduction in the odds of death by 20 per cent with the addition of ramucirumab over and above the benefit accorded by second-line chemotherapy alone.

Better therapeutic options in the setting of second line treatment of advanced gastric cancer is of great interest in the medical oncology community as chemotherapy alone is of very limited efficacy in this situation with generally poor treatment outcomes.

The two trials further gave assurance of the safety profile of ramucirumab.

The adverse effects encountered by trial patients were graded, as commonly practiced in well-conducted clinical trials, into 4 categories according to severity. Side effects related to the mechanism of action of treatment targeting tumour angiogenesis includes abnormal bleeding, thrombosis of

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either the arterial or venous circulation and high blood pressure. Serious side effects (grades 3 or 4) in each of these categories were below 10 per cent when ramucirumab is used on its own. Serious bleeding, a side effect of particular concern, occurred in only 3 per cent of cases.

For patients with advanced gastric cancer, gauged by their treating oncologists to be well enough to tolerate further treatment with chemotherapy following the failure of standard firstline treatment, the combination of ramucirumab with chemotherapy as second-line treatment should now be considered the new standard of care.

Developments to Watch in Gastric Cancer Research

Ramucirumab has also received approval for use in second line treatment of advanced colorectal cancer and advanced non-small cell lung cancer in Singapore.

Going forward, oncologists await with bated breath the results of the phase III clinical trial â&#x20AC;&#x201C; RAINFALL exploring the role of ramucirumab as first-line treatment in combination with platinum analog and fluoropyrimidine chemotherapy in treatment-naĂŻve patients with advanced gastric cancer.

Lastly, another space to watch in gastric cancer research is the role of immuno-oncology in the treatment of advanced gastric cancer. Antibodies directed against the immune checkpoint PD-1, may yet find a new role in gastric cancer. Riding on the tail wind of the encouraging results from the early-phase KEYNOTE 012 trial using pembrolizumab - an antiPD1 monoclonal antibody - a phase III trial, KEYNOTE 061, exploring its merits vis-Ă -vis chemotherapy in the second-line setting is rapidly accruing.

After a long hiatus, the recent success marked by the newly established role of anti-angiogenesis in the treatment of advanced gastric cancer, will hopefully herald a new dawn of treatment breakthroughs in research, in the days to come.

Author BIO

Wong Seng Weng is currently the medical director and consultant medical oncologist of The Cancer Centre, and a visiting consultant of Mount Elizabeth Hospital, Mount Elizabeth Novena Hospital and Gleneagles Hospital in Singapore.

His sub-specialties include breast cancer, lung cancer and gastrointestinal cancers. Dr Wong obtained his basic medical degree from the National University of Singapore (NUS) under the Lim Boon Keng and Tan Siak Kew Scholarships.

He completed his post-graduate training in Internal Medicine and obtained his membership of the Royal College of Physicians of the United Kingdom (MRCP UK). In the area of research, he holds the appointment of adjunct clinician scientist of the Institute of Bioengineering and Nanotechnology (IBN) in the Agency for Science, Technology and Research (A*STAR).

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Technology, Equipment & DEvices

These past few years have continued a trend for being transformative in the world of medical innovation. Emerging trends of 2017 likely will be no different with established foundations for Internet of Things (IoT) and wearables and other diagnostics. We will continue towards a growing integration of information technology, connectivity, access and personalized medicine. For both established and growing economies this will help drive the demand for more cost effective services and products and the desire for the consumer to be more empowered and engaged. Also, this supports the emphasis on preventative care that is a focus for most healthcare systems. In addition, med-tech focused companies will continue to examine how they build efficiencies and cost savings for success in unique emerging markets.

Emerging Trends in Medical Innovation for 2017 Brian Wyatt currently leads the Medical Technology and Healthcare business unit at Cyient. He is responsible for design, manufacturing and maintenance, predictive analytics serviceofferings with a focus on driving affordable healthcare. Brian has a bachelor's degree in economics from Boston College and a master's degree in business administration from the Kellogg School of Management at Northwestern University.

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Technology, Equipment & DEvices

T

he past few years have been transformative in the world of medical innovation with the use of personal and portable devices and advances in integrating these with personal healthcare and information technology systems. In 2016, we have witnessed tremendous growth in portable and mobile devices. Looking forward to 2017, we will likely expand on this growth with a number of high impact trends, including:

â&#x20AC;˘ Increased Integration of Internet of Things (IoT), wearables and other diagnostics â&#x20AC;˘ growing integration of information technology, connectivity, access and personalised medicine â&#x20AC;˘ innovative technology platforms and processes leveraged from other industries.

For both established and growing economies, we will continue to see how rapid changes and developments are

fuelled by three main problems: ageing populations, high patient volume and the need to build cost-effective healthcare. These macro trends will help drive the demand for more cost effective services and products and the desire for the consumer to be more empowered and engaged. This will also support the emphasis on preventative care and population health and how to build efficiencies and cost savings for success in unique emerging markets.

Integrating Portable Healthcare

Around the globe, patients are becoming more empowered to monitor and improve their well-being through the use of personal and wearable devices.

Consumer desire for better and more cost-effective healthcare and personal devices provide individuals a sense of control in managing their health.

Although developed for various productivity and other applications, utilisation of tablets and smartphones for health monitoring purposes for a growing number of conditions continues to increase. There is also growth in remote and virtual monitoring devices owned by healthcare organisations that patients take home for a period of time.

In this sense, the remote monitoring industry, which has been around for relatively fewer years, has just begun to transform medical care.

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Technology, Equipment & DEvices

The overall medical device market is expected to reach US$343 billion by 2021 and is forecast to grow data CAGR of 4.6 per cent between 2016 and 2021, according to news reports from Research and Markets (a market research company). As evidence the medical device connectivity market is speeding up, it is expected to grow

at a CAGR of 38 per cent until 2020.

An ageing population, demand for personalised treatment, and increased availability of healthcare are the major drivers behind this growth.

In accordance with this trend, the remote and virtual healthcare industries are anticipated to benefit from this growth.

A growing segment of monitoring devices are available for collecting and tracking data related to general vital signs (heart rate, blood pressure and temperature) or other metrics such as electrocardiograms (ECG) for those with heart issues or blood sugar for diabetics. Some of these products not only provide diagnostic monitoring

Tying healthcare data and solutions together

Interoperability solutions for exchanging patient data across care settings is another technological development that is shaping the future of healthcare organisations and the way clinicians relate to patients. Recognised as value-based care and health information exchanges, these strategies play an increasingly important part of the overall healthcare landscape. The ability for all providers—from general practitioners and specialists to postacute care organisations—to connect with and assess their patients will only grow in the coming year. The Cleveland Clinic has recently named Fast Healthcare Interoperability Resources (FHIR), a new programming interface for exchanging patient records, as one of the top 2017 innovations that will improve sharing of records between and across institutions who do not typical exchange data or have different IT standards.

By including post-acute care in interoperability strategies, healthcare organisations can ensure that critical patient information across all care settings will be connected, providing a more detailed patient picture for more specific treatment plans and improved patient care. Companies leading the way here have already proven the value of extending connected solutions for patients who live in remote or rural

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areas or have transportation issues and would otherwise be challenged to return to the point of care (physician’s office or hospital).

Research shows hospitals potentially lose more than US$75mn annually per 100 affiliated physicians due to referral leakage and other communication errors, a weight that can be reduced by a proper referral network management programme that database and consulting companies can help monitor. Hospitals are reportedly starting to make changes in their budgets to identify programs that can truly help patients receive better care, and save their staff’s time in the process.

Beyond large hospital systems, small-to-mid sized practices also struggle with different workflow requirements with suppliers and other providers that do not necessarily interact. Without an ability to exchange information digitally, the process breaks down, time is wasted, and there are risks that information becomes in accurate.

This may also give patients more flexibility to change if their preferred provider is in a different network.

A more integrated system could help reduce visits or stays in hospitals as patients may be able to recover better in their homes. For example, in a COPD pilot study published in 2014 in the Journal of Telemedicine and Telecare, patients

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were given a mobile phone to record major symptoms. Ultimately the rates of hospital admissions were significantly lowered and general physician visits were reduced, demonstrating the value of home monitoring.

Traditional healthcare companies generally have been reluctant to adopt some of the fast moving technology changes, instead choosing to watch first for regulatory agency guidance given to these new products and uses along with market place acceptance. This has allowed entrepreneurs with smaller companies to open up innovation to stakeholders within healthcare.

Also, coming with these new healthcare strategies of technology and information collection is the ongoing

Technology, Equipment & DEvices

but also apply physical therapy or even adjust ongoing therapy of implantable devices. Using Bluetooth and similar technology, caregivers can also track movements of elderly and vulnerable patients.

Once collected, data is transmitted to health professionals in facilities such as monitoring centres in primary care settings, hospitals and intensive care

units, skilled nursing facilities, and centralised off-site case management programs. Health professionals monitor these patients remotely and act on the information received as part of the treatment plan. Soon there could be less of a need for someone to visit the physician’s office.

Monitoring programmes are tools to help achieve the ‘triple aim’

of healthcare, by improving patient outcomes, expanding access to care and making healthcare systems more cost-effective. These devices then provide the clinicians access to current and ongoing data to track the health of their patients for developing and managing individual health plans or to study trends across a defined population.

growth of health informatics – with a goal of improving overall healthcare using IT. Most US hospitals continue to scramble to implement record systems and managethe flow of information on patients and care. While electronic records have been shown to save large hospitals tens of millions of dollars, many hospitals and healthcare organisations are struggling to keep up with government mandates to bring these systems up to date. Studies have shown that half of all healthcare dollars are wasted on inefficient record keeping processes that are not up to par with the new systems. The new software and processes being updated streamlines the medical care process, lowers malpractices claims

and increases coordination between providers and patients. All in all, additional major investment is required to drive down costs and improve patient outcomes.

Practitioners and medical researchers can look forward to technologies that enable them to apply data analytics to develop new insights, find cures or treat difficult diseases. Healthcare CIOs and other IT leaders will have responsibilities for managing all the new data and devices that will be transforming healthcare as we know it.

Although 2016 will be seen as the year of more informed treatments and faster innovations leading to greater insights, it will be important to make certain that in the next few years we retain the

hearts and minds of physicians in this new way of relating to patients.

In the US, many health systems are building their own innovation centres, but have not yet built the framework on how to judge their performance and key metrics. While local, entrepreneurial companies focused on innovation are creating products with local materials at affordable prices, there is potential for established global companies to capitalise on these markets.

Building on their manufacturing expertise, device makers have to rethink efficiencies and cost savings for a successful concept-to-market product cycle to enter these markets – they need to find new ways to meet local demands for technology, utility, and costs.

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Technology spillover: innovation across industries

By leveraging innovative technology platforms and processes from other industries, medical device and imaging markets will reduce development time, save investment costs and lower barriers to market entry. As these products are being developed, they need to consider any distinguishing features and technology for their market

adoptability and suitability for establishment of both health practitioner and consumer interest.

Medical technology design has addressed this by being in-line with global megatrends, with many innovations carrying forth a technology convergence that is prepped for a ‘smart’ world.

Expanding with Value

presented by both end users and localised regulatory and quality issues.

Companies like Cyient collaborate with medical technology firms to identify efficiencies and costs savings for new and next generational products, from concept to market product lifecycle. Working with these companies also means finding

Manufacturers will require a great deal of flexibility and innovative management solutions and tools to meet the global medical device demand.

Our interconnected world may give some commonality of how people want to approach their healthcare, however there will still be differences

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As noted previously, top tier companies who have previously been cautious of cutting edge technologies in a highly regulated industry are showing an openness for taking this on developing these new products directly or indirectly—through investments and acquisitions—to stake a claim in these high impact personal and integrated monitoring devices. These trends are also seeing non-healthcare companies such as Google, IBM and others investing in technologies or building partnerships to be a part of this growth.

In an age becoming known for knowledge spillovers, where innovation within one firm or sector often has the unintended effect of stimulating growth with a neighbouring sector or rival firm, this effect can make spectacular innovations possible, as companies start identifying seemingly unrelated collaborators for value. For example, Ford is working with the healthcare industry by working with WellDoc on a solution that would notify a nearby hospital to send an ambulance if a person suffers a heart attack in their car. While Google and Ethicon, a Johnson and Johnson company, began a partnership in late 2015 to develop a surgical robot.

In some cases, manufacturers may initially consider launching technologies in less-regulated markets in the developing world, from which more innovation originates and laws governing the use of such devices isn’t as strict.

new ways to meet local demands of technology, utility and costs for engineering, manufacturing and analytics. Much of these solutions could involve voice of customer and value engineering expertise, which combine to make certain needs of the users and provides return on investment for the company.

Technology, Equipment & DEvices

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Information Technology

Connected Connected Devices Devices The new panacea?

The new panacea?

As a patient, today, the expectation from the provider is five fold – record maintenance, secure information transmission, 24X7 support, Interaction with provider with minimal physical presence necessity, regular analysis of symptoms, treatments and outcomes.

Overall a continuum of care program that holistically looks at one’s health chart and not just deals with sporadic health issues. All of this is conceivable today with technology revolution in healthcare. Today technology can bridge the gaps in the traditional treatment methodology - giving what the patients want and simultaneously fulfilling the physician requirements to better health outcomes. Connected devices promise to be the solution in conjunction with analytical tools that can preempt and aid better the comprehensive results and health scores.

Gurrit K Sethi, CEO, Canta Health, India

E

mergence of connected health has changed the way healthcare is delivered to patients today – extending treatment from an in-patient setting to continuing care outside hospitals and clinics. Having worked for start-ups in spaces like diabetic clinics and standalone dialysis centres, I have been a direct witness to

this transformation. The advent of chronic life style diseases has also accentuated this need along with other factors. And what’s more, the general populace has greatly benefitted from this!

Innovation and IT makeover are opening up immense possibilities in healthcare…

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Information Technology

Reducing Cost of Care

Innovation inprocesses has helped in improving standards of care while reducing cost. On the other hand, IT has helped by enabling automation. A significant example for this combination is analytics on data collected by electronic health records that aids superior treatment.

IT has also enabled information sharing which has aided therapy vs cost comparisons and assessments of clinical outcomes which, accordingly, has initiated additional research.

The resulting outcome of all these innovations and improvements has translated into one of the biggest value proposition for the end consumer – increase in transparency for the patient. Health IT tools are increasingly

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finding their place in consumer’s life, and by including the patient in their own care, the circle of medical care is led to completion.

Availability of Care in Remote Areas

Today, one does not have to travel to a provider location as care is available at one’s doorstep. With the click of a button or on one’s screens, one can avail and schedule care as desired.

Both the method and the medium of care have been revolutionised through innovation and technology. We have options of online consultations with the best doctors, for second opinion in case we wish to double check, online pharmacies, connected diagnostic devices, mobile apps to track health changes… so on and so forth.

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These particular range of ideas and innovations have undeniably changed the way people live,even in the remotest regions. Small remote hospitals have also learnt to thrive on connected ICUs - overcoming the challenge of finding medical talent in such locations.

Round the Clock Care

A few years ago, 24/7 access to homecare, geriatric care, nursing care, urgent care was merel ya concept, but today, this is a clear reality. These ideas, aided by the right technology, have made life easy and convenient for many of us.

Continuum of Care

Today, we need not limit ourselves to the walls of a hospital. Whether in a chronic or acute state of illness/injury

Information Technology

or in need of generic geriatric care, we can choose the medium of care for long term. Dialysis need not be done only at the hospital, it can be a better experience in a local and pleasant day care setting or even at home today.

Having started a few years ago, the industry is still evolving. Starting with telemedicine, at a very basic level and video conferencing with doctors from remote locations, which is the earliest version, I witnessed while heading a small specialty boutique hospital, to connected devices today, unceasing innovation has helped march these possibilities forward. Led by the need of providing care at lesser cost, with accessibility everywhere and every time – the ease and comfort of these possibilities is continuously being lapped up by consumers and investors alike.

As patients / providers and incumbents of support from the industry of the care chain, we are looking forward to a world where we have care at affordable levels, in the comfort of whichever zone we are in… where all of our stakeholders can derive value from each other’s experience, while working with each other in an environment of trust and regulatory comfort.

And this is possible with:

• Proactive use of analytical tools • Clinical analytics and decision support • Enable patient education • Interoperability support Healthcare providers want to get better clinical outcomes for their patients through best treatment methodologies. This further boosts their own practice’s health. The EHRs and EMRs, with the repository of the physician data, offer boundless opportunities when supported with real time analytics and benchmarking.

This not just supports clinical but also

Health IT tools are increasingly finding their place in consumer’s life, and by including the patient in their own care, the circle of medical care is led to completion.

expands to other areas like financial forecasting and more importantly operational trends.

Now what does the patient want?

We as patients also look for great clinical outcomes, a better health risk score and a rewarding seamless experience on our trips to care providers. And this experience is what a physician looks to build, for improving practice reputation, hence leading to realisations of financial and other related outcomes.

To achieve this objective of churning better results, what we need is the latent data from the practice’s data warehouse.

The recent proliferation of performance indicators and clinical quality metrics has been the reason of multiple sleepless nights for the stakeholders, because of the time and effort it takes to report on them.

An answer has emerged in analytics which has demonstrated a noteworthy contribution towards reduction in healthcare spending, coordinating care across disparate systems and improvement in clinical research outcomes. This has led and continues to lead the industry growth.

Together, hospital and ambulatory providers have a great deal of room to grow by leveraging performance

benchmarking tools for quality improvements that may translate into advancing healthcare metrics as well as patient experience.

Today, population health is fast becoming the foundational aspect of accountable care. If all healthcare organisations and industry stakeholders pour their resources into creating and supporting technology tools, we can all embrace this new way of thinking. This will in turn: • Reduce the risk of medication errors • Provide the entire care team with consistent, reliable information • Improve efficiency and patient throughput • Enhance accessibility: All information at one place.

Talking of need for research, this alone can propel crucial cost reduction, bettering clinical outcomes and healthier populace. While similar needs of other industries has been met by advanced analytics techniques, looking at the landscape of healthcare, the adoption and use of such techniques varies across different segments. While tertiary care organisations have recognised the value and adopted these to find solutions to various problems, and quickly so, also on the brink of replacing trials, ambulatory care lags far behind. Having seen the state of clinical trials and how they are conducted leaves a lot to be desired – personally to me a real time data-based solution can help us overcome a lot of these travails to success.

Fact is, that as we look up to population health to solve these grave problems for us, there is a great need to bring these tools into the ambulatory care segment as well.

To reach some wholesome solutions, we need to conjoin all these areas into a consolidated database as well as share insights from these with other stakeholders of the industry to elevate the value in the care chain.

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Author BIO

Information Technology

Gurrit K Sethi, CEO of Canta Health, started her career from the shop floor working her way up to lead and set up different healthcare businesses. In her words, her significant achievements have been in bringing to life different small startups signifying a change in the Indian healthcare scenarios, as the opportunity paved the way along the healthcare growth curve in the country. With more than 16 years in healthcare under her belt, across different healthcare verticals, she had carried transformational changes in the companies she has lead, four of those being early stage startups in the healthcare segment.

Gurrit is an avid traveler and voracious reader of varied genres, attributes which she says, provide her with incisive insights about people and what drives them.

In All

Technology has proven to be a great enabler in this time and space. A lot has been done in other industries for many decades and healthcare is now catching up finally. We have seen the results in large institutes and we now need to let the elixir flow into the smaller etches of the industry as well.

Doing this will not only bring better visibility to what services and how they are delivered but also insight into performance and profitability both on the financial and clinical side. This will bring a lot of value to the struggling ambulatory care businesses of different sizes and different verticals within healthcare.

And then expand this and the learnings across verticals of healthcare to see the magic happen.

Having moved from being a service provider to support services to solution development â&#x20AC;&#x201C; itâ&#x20AC;&#x2122;s a heady feeling to see the growth happen real time and being able to enable it.

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Information Technology

Digital Health Opportunities The article focuses on how digital health is helping manage chronic conditions through the use of technology and the solutions that are being developed keeping in mind the aging population globally.

Amit Varma, Managing Partner, Quadria Capital, India

T

he healthcare ecosystem is witnessing a paradigm shift in the way the services are being delivered and consumed. This is driven by the pressing need to have an inclusive, high quality, cost-effective and decentralised model of healthcare delivery. While these needs lead to creating ambitious targets for our society and government, the enterprising side of the society is busy creating options

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and models to help move in the right direction. One such option is the digital health model. Digital health will significantly improve the continuum of care, providing solutions that aide people from birth to end of life, from well to sick.

Digital health will help achieve variety of objectives such as shifting healthcare delivery from curative to preventive, providing accessibility,

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helping affordability, offering qualityand generating resource efficiency.

With rising incomes, lifestyle changes and changing consumer behaviour towards wellness, the healthcare industry is transitioning to a consumer-driven industry from a provider-driven industry. Additionally, with increasing healthcare costs and an inadequate healthcare infrastructure, efforts are being made to shift

Information Technology

healthcare to consumption-based set up. Healthcare is moving towards an anticipatory combination of “Predict and Prevent Model” that addresses the root causes of health afflictions and focuses on staving off future issues by advocating major lifestyle changes, behavioural changes, or preventative practices. These changes are driven by the underlying need to provide empowerment, convenience and enhanced experience to the patients and the proliferation is fueled by technology and entrepreneurship.

In emerging markets the new digital health model will play a pivotal role in overcoming many of the challenges impeding healthcare delivery, including improving healthcare access, affordability, quality and safety.

Numerous developing countries are hampered in their efforts to deliver healthcare services, especially in rural areas, by an acute lack of resources and infrastructure. Sixty-two per cent of Africa’s entire population resides in rural areas, where there is poor access to medical facilities. A persistent power crisis in South Africa is making it difficult for hospitals to maintain continuous services, especially in their critical care units. India, with an average 0.7 hospital beds per 1,000 of its population, has a patchy public healthcare system with underfunded hospitals and clinics, and ineffective health-related schemes.

India’s limited healthcare resources are heavily skewed towards urban areas (65-70 per cent of infrastructure and manpower), while ~70 per cent of the population resides in rural areas.

There is continued need for improved healthcare infrastructure in China’s tier II and III cities, even though the government has spent a huge amount of money on increasing healthcare infrastructure. Such infrastructure still needs trained doctors, clinicians who know how to run diagnostics, and other medical capabilities to run and utilise the infrastructure. Digitisation of health services, if done in a different model, can help to improve the quality of and

privacy of patient information, consumer protection, fraud and patient safety.

access to care while reducing costs.

Most developed countries have moved away from paper-based healthcare solutions and have adopted or are in the process of adopting ‘traditional’ digital healthcare models.

Key Trends Evolving In the Digital Healthcare Space

The innovations in the health technology havegrown leaps and bounds in the recent times. Numerous devices and technologies have emerged in the digital space, which are accelerating the pace of growth in consumer and institutional healthcare delivery. Some prominent ones are 1.Wearable Technology Wearable technology is playing a prominent role in today’s healthcare transformation.

Wearables are closely intertwined with an evolving healthcare delivery model of bringing care closer to patient rather than patient having to go to a hospital. Wearable pedometers and heart monitors have been around for years, letting people keep track of how far they walk on a daily, weekly, or even monthly basis, further letting them track the amount of calories they’re burning when they exercise. However, with the advent of technology, these are expected to revolutionise healthcare. The overall market for wearable technology is expected to reach over US$30 Billion by 2020, at a CAGR of 17.8per cent between 2015 and 2020.

The newly released gadgets, such as fitness bands and smart watches, have

Globally, healthcare IT market is estimated at US$ 120 billion and is poised to reach US$ 220 billion by 2020 at a CAGR of 13 per cent. Digital innovations are helping to facilitate new diagnostic and treatment options, increase process efficiency and reduce costs. Technology advancements are also connecting developed and emerging markets — and participants along the entire healthcare value chain. This is also demonstrated from the fact that over the past year, digital health companies in USA alone, raised about US$4.5 billion in funding. Further, the segment witnessed 302 financing deals, with an average size of US$14.8 million.

However, as the convergence of healthcare and technology continues, the regulatory frameworks are still under evolution and hence companies are increasingly finding themselves lost in a thicket of unique legal issues, enforced by unfamiliar regulators, including

Healthcare Expenditure (Vs. Emerging markets)

Developed Emerging

0.15

0.22

0.26

0.29

0.35

0.85

0.78

0.74

0.71

0.65

2005

2010

2015

2016

2025

Table 1

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Information Technology

given wearers the ability to track an array of different types of health stats, generating huge amounts of data that can potentially be used in conjunction with medical records, doctors, and hospitals to provide a better, more personalised level of service. Better still, we’ve seen the recent emergence of a slew of health-related apps — programmes that act as personal trainers, help track and analyse basic health and exercise data, provide nutritional and dietary instruction while counting the calories oneconsumes, offer a litany of brainteasers and games that improve cognitive and linguistic faculty, regulate sleep cycle and help meditate, and encourage productivity through incentives and gentle reminders.

2.Telemedicine Telemedicine is another platform, which, if harnessed optimally, can help both accessibility and affordability. It is a big tool to bridge the rural-urban divide by extending low-cost consultation and diagnosis facilities to the remotest areas via highspeed Internet and telecommunication.

The global telemedicine market was

Digitisation of health services, if done in a different model, can help to improve the quality of and access to care while reducing costs. Most developed countries have moved away from paperbased healthcare solutions and have adopted or are in the process of adopting ‘traditional’ digital healthcare models.

healthcare cost, increasing government funding and grants for telemedicine, and increasing prevalence of chronic and lifestyle associated diseases. Several major hospitals in emerging markets are adopting telemedicine services and entering into public-private partnerships (PPPs) with respective governments. The new models like critical care management, home-based vital parameters mapping and PERS have created additional volumes for telemedicine services. These will be an additional enablers, transforming current practices in chronic disease care from ongo-

valued at over US$17 billion in 2015, and it is expected to grow at a CAGR of 18.7per cent during 2016 - 2020. The global telemedicine market is growing at a significant rate, due to growing geriatric population, increasing

Evolution of Biosensor technology in remote monitoring: From wearables to injectable

2015 2013

2012 2006 Nike and Apple developed finess trackers to monitor data such as time, calories burnt and distance covered. From 2007, other, Companies such as Fitbit, Jawbone and Garmin Vivofit, Started entering the wearable space.

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An ingestible sensor was developed by Proteus Digital Health which was approved by FDA in the same year. Companies such as Google and other research teams began developing 'smart' pills to detect disease markers or indicators.

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A team in EPFL in Switzerland developed an implantable device to monitor critical biomarkers in the blood.

Technology giants such as Medtronic developed implantable sensors, with other advances boosting growth in miniaturisation, including the development of e-patches.

Rhythm Solutions announced the development of an injectable sensor for realtime detection of cardiac arrhythmias.

Injectable nanosensors are now being researched worldwide. There is hope that with enhanced technology access this could be the answ er to various incurable diseases.

Information Technology

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4 Aditive Manufacturing - Often referred to as ‘3D printing,’ additive manufacturing’s prospective benefits are numerous as it can spur additional innovation, improve patient access to life-saving devices, simplify and accelerate the supply chain and production process and achieve considerable savings. As of 2014 the global 3D printing healthcare market recorded revenues of US$487 million and is expected to grow by 18.3 per cent annually until the year 2020.Medical technologies often are expensive when they enter the market, becoming cheaper over time, but many of the new 3D-printed solutions are coming in at a reasonable price point. This shift has the potential to disrupt the alarming trajectory of rising health care costs at exactly the moment when ageing Baby Boomers will be putting more pressure on the healthcare system.

image source from 3dprint.com

science, and mining technology. Such volumes can only be managed by technology, with the ability to cross reference individual with population level

Author BIO

ing or continual acute care episodes to a more proactive approach that empowers a patient to return to their benchmark threshold of health through appropriate device monitoring, behaviour modification and interaction with care providers – all remotely. As many chronic illnesses require daily monitoring, using remote monitoring technology, patients are able to closely monitor vitals, such as blood pressure, glucose levels, and weight and then relay the information to the right people at the right time –- all from the comfort of their own home.

3.Biosensor While the benefits of remote and patient-empowered monitoring are now proven, making things smaller, convenient and non-invasive is where drug manufacturers, technology leaders and start-ups are placing much of their focus and resources.

Biosensor miniaturisation has become a market of its own, whichis fast-growing and attracting investment. With this, however, come new industry challenges. From managing data privacy to overcoming adoption and implementation barriers, there are multiple constraints to be addressed.

5.Electronic Health Records The global EHR market was valued at over US$18 billion in 2014 and is expected to grow at approximately CAGR of 5.5 per cent from 2015 to 2023, to reach an estimated value of US$25 billion by 2020. One trend impelling growth in EHR market is the increased adoption of predictive analytics. Healthcare organisations generate massive amount of clinical data such as patient health data and non-clinical data such as administrative and financial data.

IBM estimates that we are now creating 2.5 billion gigabytes of data every day, with >90 per cent of the data which currently exists having been created in the last two years alone. The ever increasing volume, variety, and velocity of clinical and non-clinical data have compelled healthcare organisations to implement statistical tools, data

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data, or to learn from everyday interactions between patients and physicians, key to some of the most innovative digital healthcare models.

The desirability of an EHR that can be easily accessed by a patient and by the physicians treating them across GP surgeries and secondary facilities has been clear for a generation, yet very few countries worldwide have a functioning national system. Privacy concerns have been a key barrier, as has the sheer scale of the logistical challenge in connecting up the disparate elements of healthcare systems. But over the next few years most European countries will seek to implement national EHR systems. In the US, a subcategory of digital healthcare companies providing an EHR system has emerged, with individual organisations and practices choosing from a range of providers, although limited interoperability of these systems makes a national or regional EHR a challenge.

The EHR is not only a great way of empowering the patient and facilitating choice, which is essential for the success of digital healthcare, but also opens up the possibility of integrating an individual’s medical history into a digital consultation or treatment plan.

The above factors will help the digital world to evolve at a rapid pace and propel the importance of digital health amongst various stakeholders such as companies, governments and communities. This will consequently transform healthcare and the organisations that contribute to patient experience.

Amit Varma is the Managing Partner of Quadria Capital, a US$ 304 Mn healthcare focused private equity fund that invests in healthcare sector across South and Southeast Asia. He also spearheaded India Build Out Fund, US$100 Mn Healthcare and Education focused domestic Private Equity Fund. Dr. Varma has Over 20 years of Private Equity, strategic & operational leadership and board level experience in healthcare organizations across USA, Asia and Australia. Previously served in various roles including managing and operating P&L’s in organisations such as Fortis Healthcare (Chief Operating Officer), Narayana Hrudayalaya Private Limited and Manipal Heart Foundation.

OK !

BO OW N

Chicago, Illinois July 10-11 2017

3RD DIGITAL PATHOLOGY CONGRESS: USA

Understanding & Utilizing Digital Pathology as a Tool for Advancing Pathology Practice & Enabling Enhanced Patient Care As experts position themselves for FDA approval, our speakers examine the applications and benefits of adopting Digital Pathology, as well as the business case to be made.

The congress provides the opportunity to take home cutting edge strategies, analysis techniques, case study examples and methods to allow you to fully understand both the technology and accompanying informatics and image analysis tools, allowing you to utilize digital pathology to its greatest potential.

Visit our website for more information and to read the full agenda: www.global-engage.com/event/digital-pathology-usa

SPEAKERS INCLUDE:

DARIUSZ BORYS

ROHIT BHARGAVA

Loyola University Medical Center

University of Illinois at Urbana-Champaign

Associate Professor of Pathology and Orthopaedic Surgery,

Professor, Department of Bioengineering,

T: +44 (0) 1865 849841 E: info@globalengage.co.uk www.global-engage.com/event/digital-pathology-usa/

SLYVIA ASA

Professor, Department of Pathology,

University of Toronto/University Health Network, Canada

METIN GURCAN

Associate Professor Biomedical Informatics & Director of the Clinical Image Analysis Lab, Ohio State University

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Information Technology

Telehealth and Telehomecare Caring remotely

Affordable high-speed Internet, smartphone and wearables are rapidly transforming patient care through telehealth and telehomecare (24x7 home-based monitoring). Instead of patients waiting endlessly for a review consultation, they can now be alerted regarding their health and illness status instantaneously in the comfort of their home / workplace.

SB Bhattacharyya Member, National EHR Standardisation Committee MoH&FW, Govt. of India Member, Health Informatics Sectional Committee, India

T

elemedicine has been around for quite a while but has largely been unable to fulfil on its various promises with only the video-conferencing and remote consultation seeing the light of day amongst the many functionalities that it successfully is able to execute. With the advent of faster Internet speeds at very affordable rates coupled with ready availability of smart phones and rapid acceptance of wearable healthcare devices, the ground realities are getting altered dramatically very rapidly.

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Information Technology

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Information Technology

Telehealth

Instead of being merely esoteric, telemedicine, in its new avatar as telehealth and telehomecare, is quickly transforming the way individuals are accessing care. Instead of patients having to make that extra effort at additional costs to visit care providers just for a review, they are now being informed whether everything is hunky-dory or they need to get in touch with their providers right away, without having to move from the comforts of their homes. This change is truly transformational and definitely holds the promise of better affordable care in terms of better outcomes and increased efficiency at reduced costs.

Telehealth is a collection of means or methods for enhancing healthcare, public health, and health education delivery and support using best of available telecommunications technologies. Thus, it encompasses a broad variety of technologies and tactics to deliver virtual medical, health, and education services.

Telehomecare Telehomecare refers to care delivered at the receiverâ&#x20AC;&#x2122;s location (home) by providers from a remote location (facility). Thus, it is a form of telemedicine that is based in the patientâ&#x20AC;&#x2122;s home and is a digital communication and clinical information ecosystem that enables the interaction of voice, video, and health-related data using best of available telecommunications technologies. Although the term is often interchanged with

Some Terms Explained

To obtain a proper perspective, it is important to first get someclarity regarding some of the terms that have become part of the digital healthcare lexicon.

remote patient monitoring, it strictlyis not.

Remote Patient Monitoring (RPM) Remote patient monitoring is a technology that enables monitoring of individuals outside of conventional clinical care settings (healthcare facilities and inpatients) and has the potential of increasing access to care and delivery efficiency while decreasing delivery costs. As a type of non-inpatients healthcare that allows a patient to use a mobile medical devices to perform routine tests and then electronically send the test results to a healthcare professional in real-time, remote monitoring helps bring care to the receiver instead of the traditional method of a receiver visiting a healthcare facility to access it.

Internet of Healthcare Things The Internet of Healthcare Things (IoHT) is the collection of healthcare devices and applications that connect

Remote Care Ecosystem

Care Provider Base Unit

CIS

Homebased Monitors Internet

Body Sensors Handheld Device @ Individual-end 50

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Information Technology

to healthcare IT systems using online digital networks. This is accomplished by connecting various healthcare ‘things’ like wearables, apps, monitors, etc. to a central system that performs storage, analysis & monitoring via dedicated device gateways, home routers, smartphones and PCs located at the care receiver’s site.

With the advent of faster Internet speeds at very affordable rates coupled with ready availability of smart phones and rapid acceptance of wearable healthcare devices, the ground realities are getting altered dramatically very rapidly.

Discussion

quality of life while containing costs.

By leveraging high performance computing to provide feedback in real-time and using evidence based medicine, better clinical outcomes can be ensured. Using healthcare big data analytics and appropriate monitoring systems, care providers cansignificantly augment their ability to supervise the health and wellness of the individual, intervene on-demand through appropriate alerts / warnings or by asking them to visit a care provider on a priority basis or even making emergency visits forcare delivery in a home-setting. Measurable benefits of such connected healthcare devices include reduction in mortality rates, clinic visits, emergency admissions and length of inpatients stay. Regulations, use of appropriate healthcare expertise and machine learning are all key success factors for this ecosystem.

Overall Assessment

The benefits of telehealth and telehomecare include lowered cost of care and improved provider efficiency by reducing the loss of productivity and the need to travelresulting in Author BIO

As everything else, healthcare too has been evolving moving from the traditional encounter-based illness care, whichis episodic in nature,to the ‘never discharged’ preventive and wellness care, which is continuous in nature. This is achieved through constant monitoring an individual’s health and proactively intervening to ensure to an optimal extent that the person is kept healthy and disease-free by intervening before any clinicallysignificant health-event occurs.

Digital technologies are used to collect health data from individuals in one location that aresecurely transmitting them to health care providers at a different location for assessment and recommendations, all in a digitalised ecosystem. Such monitoring programmes collect a wide range of health data, such as vital signs, weight, blood pressure, blood sugar, blood oxygen levels, heart rate, and electrocardiograms from the point of care. The collected data is sent to the care providers using cloud-based applications. This permits the providers to monitor these individuals remotely and act on the information received as part of the overall treatment plan. A schematic diagram depicting this is as follows.

Monitoring programmes can also help keep people healthy, allow older and disabled individuals to live at home longer and avoid being forced to move into skilled nursing facilities.

Remote monitoring can also serve to reduce the number of hospitalisations, readmissions, and lengths of stay in hospitals—all of which help improve

reduced patient flows. This helps in redistribution of precious resources like provider time, facilities and equipment to those who actually need closer attention.Consequently,improved clinical outcomes and quality of life overallis achieved.

Yet, the fact that these are technologies that require high capital expenditures must not be lost sight of.

It is vital to note here that although paying for all this proves to be a costly affair in terms of money, time and resources at the beginning, the overall savings and efficiencies achieved thereby leads to very attractive returns on investment in medium to long term.

With rapidly growing population andpeople tending to live longer with increased disease-burden, the healthcare industry is unable to keep maintaining the receiver to provider ratio at manageable levels worldwide. Adoption of telehealth and telehomecare proves to be a very sound and insightful decision to help address the underlying health-related issues best.

References are available at www.asianhhm.com

SB Bhattacharyya is a general practitioner and business solution architect for digital applications in healthcare, pharmaceutical and medical devices domains with more than 29 years of experience.

His main interests include standardisation and designing of EHR, predictive analysis in medicine and application of machine learning techniques for clinical analytics.

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Books

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Transformative Healthcare Practice through Patient Engagement

Participatory Healthcare: A Person-Centered Approach to Healthcare Transformation

How to Implement EvidenceBased Healthcare (HOW - How To) 1st Edition

Editor: Guendalina Graffigna (Catholic University of the Sacred Heart, Italy) No of Pages: 382 Year of Publishing: 2016 Description: Recent literature suggests that patient participation and engagement may be the ideal solution to the efficacy of healthcare treatments, from a clinical and pragmatic view. Despite the growing discussions on the necessity of patient engagement, there is no set of universally endorsed, concrete guidelines or practices.

Transformative Healthcare Practice through Patient Engagement outlines the best practices and global strategies to improve patient engagement.

This book features a convergence of healthcare professionals and scholars elucidating the theoretical insights borne from successful patient education, and the technological tools available to sustain their engagement. This book is a useful reference source for healthcare providers, students and professionals in the fields of nursing, therapy, and public health, managers, and policy makers.

Editors: Jan Oldenburg, Mary P. Griskewicz No of Pages: 337 Year of Publishing: 2016 Description: This book is written through the lens of patients, caregivers, healthcare representatives and families, highlighting new models of interaction between providers and patients and what people would like in their healthcae experience. It will envision a new kind of healthcare system that recommends on how/ why providers must connect to patients and families using HIT, as well as suggestions about new kinds of HIT capabilities and how they would redesign systems of care if they could. The book will emphasize best practices, and case studies, drawing conclusions about new models of care from the stories and input of patients and their families reienforced with clinical research.

Editors: Trisha Greenhalgh No of Pages: 288 Year of Publishing: 2017 Description: How to Implement Evidence-Based Healthcare clearly and succinctly demystifies the implementation process, and explains how to successfully apply evidence-based healthcare to practice in order to ensure safe and effective practice.

Written in an engaging and practical style, it includes frameworks, tools and techniques for successful implementation and behavioural change, as well as in-depth coverage and analysis of key themes and topics with a focus on: Groups and teams, Organisations, Patients, Technology, Policy, Networks and systems.

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How to Implement Evidence-Based Healthcare is essential reading for students, clinicians and researchers focused on evidence-based medicine and healthcare, implementation science, applied healthcare research, and those working in public health, public policy, and management.

New Health Systems: Integrated Care and Health Inequalities Reduction 1st Edition

Introduction To Health Care Management 3rd Edition Edition Edition

Essentials Of Health Policy And Law (Essential Public Health) 3rd Edition

Editor: Stephane Callens No of Pages: 200 Year of Publishing: 2017 Description: New Health Systems: Integrated Care and Health Inequalities Reduction presents studies that explore other ways to construct sustainable and equitable health systems architectures. The advantages and disadvantages of different ways of integrating care and management of health information systems are explored, and the persistence of health inequalities is presented.

• Explains the dynamics that animate Health Systems • Explores tracks to build sustainable and equal architectures of Health Systems • Presents the advantages and inconveniences of the different ways of care integration and the management of Health information systems

Editor: Sharon B Buchbinder, Nancy H Shanks No of Pages: 676 Year of Publishing: 2016 Description: Introduction to Health Care Management, Third Edition is a concise, reader-friendly, introductory healthcare management text that covers a wide variety of healthcare settings, from hospitals to nursing homes and clinics. Filled with examples to engage the reader’s imagination, the important issues in healthcare management, such as ethics, cost management, strategic planning and marketing, information technology, and human resources, are all thoroughly covered. Guidelines and rubrics along with numerous case studies make this text both student-friendly and teacher-friendly. It is the perfect resource for students of healthcare management, nursing, allied health, business administration, pharmacy, occupational therapy, public administration, and public health.

Editor: Joel B Teitelbaum, Sara E Wilensky No of Pages: 324 Year of Publishing: 2016 Description: Essentials of Health Policy and Law, Third Edition provides students of public health, medicine, nursing, public policy, and health administration with answers to and analytic frameworks for these complex questions, including in-depth discussions of the essential policy and legal issues impacting and flowing out of the healthcare and public health systems and the way health policies and laws are formulated. Concise and straightforward, this textbook is an introduction to the seminal issues in U.S. health policy and law, with a particular focus on national health reform under the Affordable Care Act (ACA). The Third Edition is a thorough revision that offers updated information on the ACA, Medicaid, CHIP, Medicare, state health policy, public health preparedness, and health care quality.

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Research Insights Location of Receipt of Initial Treatment and Outcomes in Long-Term Breast Cancer Survivors AUHTORS: Arup K Sinha, Jenil R Patel, Yu Shen, Naoto T Ueno, Sharon H Giordano, Debu Tripathy, David S Lopez, Carlos H Barcenas

outcomes in the OTH-group in both the univariate analysis and the multivariable analysis (OS: HR = 4.8, 95% CI = 3.9–6.0; RFS: HR = 5.8, 95% CI = 4.8–7.0; DRFS: HR = 5.4, 95% CI = 4.5–6.6).

Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America

Conclusion Long-term breast cancer survivors who initiated their treatment at MD Anderson had better outcomes.

Location of initial treatment could be an independent risk factor for survival outcomes at specialty care hospitals. This analysis has limitations inherent to retrospective observational studies such as other unmeasured variables may be associated with worse prognosis.

ABSTRACT Purpose Cancer outcomes differ depending on where treatment is received. We assessed differences in outcomes in long-term breast cancer survivors at a specialty care hospital by location of their initial treatment.

Methods We retrospectively examined a cohort of women diagnosed with invasive early-stage breast cancer who did not experience recurrence for at least 5 years after the date of diagnosis and were evaluated at The University of Texas MD Anderson Cancer Center between January 1997 and August 2008. The location of initial treatment was categorized as MD Anderson (MDA-treated) or other (OTH-treated).

Outcomes analyzed included recurrence-free survival (RFS), distant relapse-free survival (DRFS), and overall survival (OS). The Kaplan-Meier productlimit method was used to compare outcomes between the two groups. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI).

Results We identified 5,091 breast cancer survivors (median follow-up 8.6 years), of whom 89.1% were MDA-treated. The 10-year OS, RFS, and DRFS rates were 90.9%, 88.4%, and 89.0% in the MDA-treated group and 74.3%, 49.8%, and 52.7% in the OTH-treated group, respectively. We observed worse

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Introduction The impact of the location or hospital setting where a cancer patient receives treatment on the patient’s health outcomes has been studied with great interest owing to concerns about cost and quality of care [1–3]. Multiple studies have shown that high-volume hospitals, high physician volume, and specialization are associated with better cancer outcomes [4,5]. A recent study reported that, across all cancer types, the 1-year mortality rate in specialty care hospitals was 10% lower than in community hospitals, and this pattern remained consistent for up to 5 years [6].

However, specialty care hospitals commonly treat a heterogeneous group of patients where some patients may receive their initial treatment within these specialty care hospitals and others may initiate their treatment in community hospitals and eventually establish follow-up care in the specialty care hospital.

This heterogeneity of location of initial treatment could potentially lead to substantial differences in outcomes within a specialty care hospital.

Breast cancer (BC) survivors are still at risk of disease recurrence and death 5 years after diagnosis [7]. Therefore, in the current study, we sought to determine whether the location of receipt of the initial treatment affected late (>5 years) cancer outcomes

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Research Insights among BC survivors who had presented to a single specialty care hospital and had not experienced recurrence for at least 5 years after diagnosis.

Specifically, we assessed recurrence-free survival (RFS), distant relapse-free survival (DRFS), and overall survival (OS).

Methods Study Population and Hypothesis This retrospective cohort consisted of women diagnosed with invasive early-stage (I-III) BC who had presented to The University of Texas MD Anderson Cancer Center between January 1997 and August 2008 and had not experienced any recurrence for at least 5 years after the date of diagnosis. This cohort was identified from the Breast Cancer Management System database housed in the Department of Breast Medical Oncology at MD Anderson, which contains records for all BC patients who have presented to MD Anderson since January 1, 1997. For the purpose of this study, the BC survivors were categorized into one of two groups, based on the location where initial treatment was received: 1) those who had received their initial treatmentâ&#x20AC;&#x201D;chemotherapy, surgery, or radiationâ&#x20AC;&#x201D;at MD Anderson (MDA-treated) or 2) those who had received their initial treatment at a facility other than MD Anderson (OTH-treated) but had presented to MD Anderson at some point in their care for any reason, including but not limited to second opinions or transfer of care to MD Anderson. We hypothesized that survival outcomes would differ between these two groups of BC survivors. Keeping in mind that the inclusion of survivors presenting to MD Anderson 5 years or more after the initial BC diagnosis could introduce bias by design if a substantial number of them presented with disease recurrence, we also conducted a separate analysis excluding such survivors.

Measurements of Exposure, Confounders, and Outcomes A BC survivor was considered MDA-treated if 1) she had been diagnosed with invasive BC within 180 days before her initial consultation visit to MD Anderson with one of the BC subspecialists (in medical oncology, radiation oncology, or surgical

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oncology), and 2) she had received initial treatment for BC at MD Anderson. This specific categorization has been used previously by others [8]. BC survivors who did not meet at least one of these criteria were categorized as OTH-treated. Standardized Definitions for Efficacy Endpoints in Adjuvant Breast Cancer Trials criteria were used to define the outcomes of interest [9]. RFS was measured from the date of diagnosis of the primary cancer to the date of the first invasive ipsilateral breast tumor recurrence, local or regional invasive recurrence, distant recurrence, or death from any cause. DRFS was measured from the date of diagnosis of primary cancer to the date of first distant recurrence or death from any cause. Patients were censored at the last day of follow-up.

We collected demographic factors such as age at diagnosis, year of diagnosis, race/ ethnicity (selfreported), and menopausal status at diagnosis.

We classified the tumors as hormone receptorpositive if the tumor was estrogen receptor (ER)- or progesterone receptor (PR)-positive and hormone receptor-negative if the tumor was both ER- and PR-negative, as determined by immunohistochemistry staining using institutional laboratory thresholds.

Human epidermal growth factor receptor 2 (HER2) status was determined by immunohistochemistry or fluorescence in situ hybridization. We grouped the tumors into one of three categories: 1) hormone receptor-positive (ER- or PR-positive and HER2negative or unknown), 2) triple-negative (ER- and PR-negative and HER2-negative or unknown), or 3) HER2-positive (independent of ER or PR status).

Tumor stage was determined using the American Joint Committee on Cancer (AJCC) 5th edition staging method for patients diagnosed before 2003 and the AJCC 6th edition for patients diagnosed in 2003 or later. Tumor grade and histologic findings were extracted from biopsy and surgical pathology reports. We captured treatments received, such as chemotherapy, surgery, radiation therapy, and endocrine therapy, by reviewing the patientâ&#x20AC;&#x2122;s medical record. We determined the most recent vital status of each patient using data from the Tumor Registry at MD Anderson and from medical records. We received institutional review board approval to conduct this study (PA13-0424).

Statistical Analyses Demographic characteristics were summarized and compared using chi-square analysis or the t test, as appropriate. We used the Kaplan-Meier productlimit method to estimate the survival functions.

The survival function provides the probability of observing a survival time greater than or equal to a specified time. Without imposing any parametric assumption, Kaplan-Meier estimator of survival function is obtained by multiplying a sequence of conditional survival probabilities with information from both uncensored and censored observations. We used log-rank statistic to test the equality of survival functions by group. The log-rank test compares the observed and expected number of events across all failure time points. Cox proportional hazards

regression was used to estimate the effect sizes of covariates on the hazard of failure, where the hazard function measures the instantaneous rate of an event to occur, given the individual has survived till that time point. We used univariate Cox proportional hazards regression models to evaluate the crude associations between the main exposure of interest (i.e., MDA-treated or OTH-treated) and potential confounding variables and the outcomes of interest.

Variables that showed significant association in the univariate log-rank test were considered potential confounders and were entered in the multivariable Cox proportional hazards model. A backward selection process was used and significant variables were retained in the final model. We used a complete case analysis to handle missing values. All statistical

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Research Insights tests were performed with a two-sided significance level of 0.05. Statistical analyses were performed using SAS software, version 9.4 (SAS Institute, Cary, North Carolina), and STATA software, version 12 (Statacorp, College Station, Texas).

Results We identified 5,091 female long-term BC survivors with a median follow-up period of 8.6 years, of whom 4,534 (89.1%) were MDA-treated (median follow-up period 8.6 years) and 557 (10.9%) were OTH-treated (median follow-up period 8.9 years).

In the OTH-treated group, 131 (23.5%) did not receive their initial treatment for BC at MD Anderson despite having a consultation visit at the institution within 180 days after diagnosis, likely representing those who presented for a second opinion; 195 (35.0%) had a consultation visit at MD Anderson at 180 or more days after diagnosis, but did receive some treatment at MD Anderson; and 231 (41.5%) neither received their initial treatment at MD Anderson nor visited MD Anderson within 180 days after diagnosis.

Briefly, the mean age at diagnosis for the total cohort was 53.3 years, and most were white (73.2%), around half were diagnosed with stage I disease (52.4%), most had hormone receptor-positive tumors (72.5%), and most had received chemotherapy (66.2%), endocrine therapy (72.9%), or radiation therapy (66.7%). Compared with the MDA-treated group, those in the OTH-treated group were younger at diagnosis, and less likely to be white, and less likely to be postmenopausal. They had more advanced disease, had more triple-negative tumors, were less likely to have received endocrine therapy, were more likely to have received chemotherapy, and were more likely to have received radiation therapy compared with the MDA-treated group.

We observed a statistically significant difference in vital status between the two groups; 29.3% of the OTH-treated group (median follow-up period 8.6 years), compared with only 7.6% of the MDA-treated group (median follow-up period 9.0 years), had died at the time of our analysis (p < 0.01). We also observed a higher rate of death as the first event in the OTH-treated group (10.2%) than in

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the MDA-treated group (5.3%). Distant disease recurrences were more common than local recurrences (5.8% compared with 1.6%) in the overall cohort, as well as within each group.

Fig 1 shows the Kaplan-Meier product-limit estimates of the cumulative probabilities of OS, RFS, and DRFS for both groups. The log-rank tests showed statistically significant differences in all outcomes between the groups (p < 0.01). The 10-year OS, RFS, and DRFS rates were 90.9%, 88.4%, and 89.0% in the MDA-treated group and 74.3%, 49.8%, and 52.7% in the OTH-treated group, respectively. These results indicate that the MDA-treated population had a higher chance of survival and freedom from recurrences than did the OTH-treated population.

Univariate Cox proportional hazards regression analysis showed a significantly increased risk of death (OS: hazard ratio (HR) = 3.3, 95% confidence interval (CI) = 2.7–4.0) and recurrence (RFS: HR = 5.6, 95% CI = 4.8–6.6; DRFS: HR = 5.0, 95% CI = 4.2–5.9) in the OTH-treated group compared with the MDA-treated group. When adjusted for selected confounding variables in the multivariable Cox proportional hazards model (age at diagnosis, year of diagnosis, race, stage, surgery type, chemotherapy, and endocrine therapy, as well as grade for the recurrence analyses), these risks remained for the OTH-treated population (OS: HR = 4.8, 95% CI = 3.9–6.0; RFS: HR = 5.8, 95% CI = 4.8–7.0; DRFS: HR = 5.4, 95% CI = 4.5–6.6). In the sensitivity analysis, in which patients who presented at MD Anderson 5 years or more after their initial BC diagnosis were excluded, the differences in outcomes between the groups remained statistically significant in the multivariable analysis (OS: HR = 3.6, 95% CI = 2.8–4.8; RFS: HR = 3.1, 95% CI = 2.4–4.0; DRFS: HR = 3.0, 95% CI = 2.3–3.9).

Citation: Sinha AK, Patel JR, Shen Y, Ueno NT, Giordano SH, Tripathy D, et al. (2017) Location of Receipt of Initial Treatment and Outcomes in LongTerm Breast Cancer Survivors. PLoS ONE 12(1): e0170081. doi:10.1371/ journal.pone.0170081 Editor: Nancy Lan Guo, West Virginia University, UNITED STATES Copyright: © 2017 Sinha et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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