Asian Hospital & Healthcare Management - Issue 22

I s s u e 22

2010

w w w.asianhhm.com

Paying Attention

Connecting Knowledge

Improving safety through leadership involvement

How IT solutions can enhance collaboration www.asianhhm.com

1

www.asianhhm.com

2

Foreword Customising care There is a slow but assured move in healthcare towards a model that revolves around the patient.

To what extent should the patient be responsible for managing chronic care? This was one of the questions asked to the world's top healthcare leaders. An overwhelming 57 per cent of world's leaders responded "to a great extent".

Only three per cent said that the patient should not be involved at all.

The leaders were taking part in the Global Health Leaders Survey by the research firm PricewaterhouseCoopers. Their response is a sign of things to come for healthcare. Major trends shaping the industry, such as technology, globalisation, and regulatory reforms centre around one entity: the patient. Some might say this is long overdue, but most would agree that it is better late than never. Healthcare as an industry has been slow in taking up the road to a consumer-centred model. But as the power of individual increases in influence, it will reshape the way healthcare is directed and delivered.

At the centre of this is a realisation on the part of governments and providers that involving patients in the delivery of care. As healthcare volumes spiral towards unmanageable, the current models are wearing out.

This issue's cover story "Leaving the comfort zone" by PWC Health Research Institute Managing Director Sandy Lutz, identifies chronic disease, digitisation and the convergence of care as the forces driving this change.

Customisation of care could lead to easing of some of the complicated delivery structures of today. Patient wait times will be the prime indicator of how things change.

PwC's survey also found that close to half of the leaders believe medical tourism will increase in the coming years.

It is thus up to providers and regulators in countries that have been leading in medical toursim to ensure that they do not miss out on the upcoming surge in patients.

Yet there are clear signs that technology will play a vital role in how care is delivered. Instead of patients coming to the provider, technology will make it possible for care to reach the patient at their homes. Could there be a more bigger indicator of care becoming more patient-centred?

Countries with ageing populations could be first in adopting this model. For them, it could result in crucial cost savings on the both the sides.

But to say that these transformations will happen easily would mean ignoring the inherent slowness of change in healthcare. There are systemic factors that make creating a collaborative model difficult. This is not the case with other industries that have developed consumer-centric models.

Yet if there was one industry that needed this change to happen most, it would undoubtedly be healthcare.

Akhil Tandulwadikar Editor

www.asianhhm.com

1

Contents 16

Sandy Lutz Managing Director Health Research Institute PricewaterhouseCoopers USA

Healthcare Management

Medical sciences

06 Chronic Illness and Cultural Diversity Communicative challenges for patients and physicians Bernd Meyer, Senior Lecturer Universität Hamburg, Germany

28 Advanced Diabetes Care Moving from delayed interventional to predictive, preventive and personalised medicine

10 Prevention through Anticipation A key to success in occupational risk prevention

Olga Golubnitschaja, Head, Molecular / Experimental Radiology Division, Department of Radiology, Rheinische Friedrich-Wilhelms-University of Bonn, Germany

Jukka Takala, Director, European Agency for Safety and Health at Work, UK

Vincenzo Costigliola, President, European Medical Association, UK

22 Paying Attention Improving safety through leadership involvement Yosef D Dlugacz, Senior Vice President and Chief of Clinical Quality, Education & Research, Krasnoff Quality Management Institute A division of North Shore-LIJ Health System, USA

26 Health 2.0 Smarter patients, smarter healthcare Apoorv Surkunte, PMP Lead Business Analyst, USA

2

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

ISSUe - 22 2010

06

22

40

Surgical Speciality 34 Books Complications in Vascular and Endovascular Surgery How to Avoid Them and How to Get Out of Trouble

Editor(s): Jonathan J Earnshaw, Michael G Wyatt

The Evidence for Neurosurgery

Editor(s): Edward C Benzel, Zoher Ghogawala, Ajit A Krishnaney, Michael P Steinmetz, H Hunt Batjer

Anesthesia and Perioperative Care for Aortic Surgery

Editor(s): Kathirvel Subramaniam, Kyung W Park, Balachundhar Subramaniam

Three-dimensional Echocardiography

Editor(s): Thomas Buck, Andreas Franke, Mark J Monaghan

Retinal and Vitreoretinal Diseases and Surgery

Author: Boyd S

Global Surgery and Public Health: A New Paradigm

Author (s): Catherine R deVries, Raymond R Price

Technology, Equipment & Devices 36 Do We Need Artificial Organs?

Jรถrg Vienken, Vice President, BioSciences, Fresenius Medical Care, Bad Homburg, Germany

Facilities & operations management 40 Designing the Hospital of the Future in Times of Economic Uncertainty Bill Rostenberg, Principal, Director of Research, ANSHEN+ALLEN, USA

information technology 46 Connecting Knowledge How IT solutions can enhance collaboration within healthcare organisations Werner Van Huffel, Industry Technology Strategist, Industry Market Development Manager, Healthcare and Social Services Public Sector, APAC region, Microsoft Corporation

www.asianhhm.com

3

Advisory Board

Editors Akhil Tandulwadikar Prasanthi Potluri Art Director M A Hannan Copy Editor Sri Lakshmi Kolla Jenny Jones

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

Sandy Lutz Director PricewaterhouseCoopers Health Reseach Institute, USA

Malcom J Underwood Chief Division of Cardiothoracic Surgery, Department of Surgery The Chinese University of Hong Kong Prince of Wales Hospital, Hong Kong

Peter Gross Senior Vice President and Chief Medical Officer Hackensack University Medical Center, USA

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

Vivek Desai Managing Director HOSMAC INDIA PVT. LTD., India

Sales Team Khaja Ameeruddin Aravind Maroju Jeff Kenny Ben Johnson Malvin Antony Carol Smith Compliance Team P Bhavani Prasad K Lavanya Sam Smith Megan John CRM Yahiya Sultan Subscriptions incharge Vijay Kumar Gaddam IT Team Ifthakhar Mohammed Azeemuddin Mohammed Krishna Deepak Head - Operations S V Nageswara Rao

Asian Hospital & Healthcare Management is published by

A member of Confederation of Indian Industry

Ochre Media Private Limited, Media Resource Centre 6-3-1219/1/6, Street No. 1, Uma Nagar, Begumpet, Hyderabad - 500016, Andhra Pradesh, India Tel: +91 (0) 40 30455000, Fax: +91 (0) 40 30455140 / 41 Email: asianhhm@ochre-media.com www.asianhhm.com | www.verticaltalk.com | www.ochre-media.com

Š Ochre Media Private Limited. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, photocopying or otherwise, without prior permission of the publisher and copyright owner. Whilst every effort has been made to ensure the accuracy of the information in this publication, the publisher accepts no responsibility for errors or omissions.

The products and services advertised are not endorsed by or connected with the publisher or its associates. The editorial opinions expressed in this publication are those of individual authors and not necessarily those of the publisher or of its associates.

Copies of Asian Hospital & Healthcare Management can be purchased at the indicated cover prices. For bulk order reprints minimum order required is 500 copies, POA.

4

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

ISSUe - 22 2010

www.asianhhm.com

5

Healthcare Management

Chronic Illness and Cultural Diversity Communicative challenges for patients and physicians Medical communication is always a tightrope walk between the medical expertise of the physician and the more or less naĂŻve and lay perspectives of the patient.

Bernd Meyer Senior Lecturer Universität Hamburg, Germany

I

t has been observed that the quality of mediated communication in the context of chronic diseases (or chronic medical conditions) does not only depend on the availability of competent mediators, but also originates from difficulties in the patientprovider relationship. Thus, knowledge differences, individual life-style decisions, lack of continuity on the side of the provider etc. hamper communication; linguistic and cultural barriers may aggravate matters. For health experts, it seems to be rewarding to study the general challenges of communication with patients with life-long conditions, and the specific challenges of communication across linguistic and cultural divides.

Chronic illness and cultural diversity in hospitals

Communication with chronically ill patients is a major challenge for patients and clinical staff because it requires close collaboration and a wellestablished working alliance between patient and provider. This challenge is difficult to meet especially in contexts of cultural and linguistic diversity. First of all, medical institutions in many countries are still not prepared to ensure communication with patients who do

6

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

ISSUe - 22 2010

not speak the majority language well.

Second, interpreters are often untrained bilinguals, such as family members or medical staff. Finally, the interpreter-mediated medical encounter is a complex interaction whereby providers and interpreters negotiate meaning across languages, cultures, and expertise.

While providers often expect interpreters to be a neutral conduit, studies have show that unbeknownst to physicians, interpreters (both professional and ad hoc) often actively influence the medical encounter.

Healthcare Management

Medical consultations are not only characterised by hierarchies and differences in social status between providers and patients, but also by knowledge differences regarding the biophysics of the body, the interrelations between illnesses and life-styles, and the origin of illnesses. Thus, medical communication is always a tightrope walk between the medical expertise of the physician and the more or less naĂŻve and lay perspectives of the patient. Without addressing and integrating the views of the patient, however, the success of

treatment becomes doubtful: diagnostic information is difficult to obtain if physicians are not willing or able to listen to the patient’s narratives, and adherence to prescribed medication or behaviour is almost unforeseeable if the life-world and living conditions of the patients are not taken into account by the medical doctor who prescribes the treatment. Therefore, medical communication is a complex challenge even in contexts that are not strongly characterised by cultural and linguistic diversity.

In settings where patients and medical providers do not share the same linguistic and cultural background, communication becomes even more complex. This is due to a reduced level of common ground: diversity hampers communication not only because patients and providers do not share certain beliefs, but also because clearing up misunderstanding is much more difficult if the basis for communication is narrow. Thus, diversity first of all deepens the gap between patients and providers – a gap that is already deep among people belonging to the same ethnic group.

In the context of chronic illness, these difficulties are aggravated because chronic illness is characterised by long duration and phases of higher and lower medical acuity. Patients usually have to invest a certain amount of time every day to manage the condition, and family members are usually affected by and involved in the treatment regimes.

The fact that chronic illness by definition cannot be treated in one go usually leads to an overuse of amateurish and impromptu solutions for bridging language barriers. Studies have shown that even in the context of chronic illness, ad hoc or lay interpreters are used more often, even if professional interpreting services are available. One reason for this is that interpreting services are often not well implemented. Another reason, however, seems to be that family or proxy interpreters are available, and that they are usually well integrated into the daily care management procedures of the patient. Thus, ad hoc-interpreters are available, and they are informed about the medical conditions of the individuals. Therefore, it is tempting for medical providers to use them. However, it is also a well-known fact that obscure linguistic competence alone is not sufficient to overcome language barriers.

Members of family and other ad hocinterpreters more likely to aggravate communication problems, rather than solving them.

www.asianhhm.com

7

Healthcare Management

How ad-hoc-interpreters influence communication in the context of chronic illness

8

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

Patients have to invest a certain amount of time every day to manage the condition, and family members are usually affected by and involved in the treatment regimes.

that tries to convince her father to accept a diet instead of letting the diet instructor trying to convince him, or the nurse that carries out the medical interview herself instead of translating the questions of the physician. In such cases, the immediate effect of ad hoc-interpreting might even be judged positively because the individuals pushed the conversation into the right direction. However, providers should be aware that such positive effects are purely coincidental.

Therefore, clinics who have a culturally and linguistically diverse clientele should establish rules and routines to manage this diversity.

How can hospitals bridge cultural and linguistic divides?

Clinics are usually not well-prepared to account for the linguistic and cultural diversity of the population they work for. Solutions, if any, are mostly ad hoc, non-permanent, and not reflected. In several countries, providers of medical services accept family interpreters, or they ask staff members to interpret for their colleagues. These practices are not necessary and in every single case inadequate, but with ad hoc-interpretAuthor BIO

Ad hoc-interpreters are known to bring their own agenda into the clinical encounter. This may be good in some cases, and it may be negative in others.

Providers usually overestimate the linguistic competence of lay interpreters, and they use to underestimate the communicative challenges associated with mediation across languages and cultures. Ad hoc-interpreters battle with language at all levels, they are usually not balanced bilinguals, they are not familiar with specialised knowledge, and they often do not know what is behind a certain formulation. A person from outside a clinic cannot know why things are the way they are, and how the flow of communication is organised. This knowledge, however, is important for competent linguistic mediation. Scholars in translation and interpreting studies widely agree that the conduit model of interpreting, where the interpreter is perceived as a neutral conduit that acts in a technical fashion, is not valid.

Good interpreting requires background knowledge and expertise – it is almost impossible to bring a message across if you only have the words spoken, without any further information.

The wrong perception of the interpreting task by providers allows ad hoc-interpreters to intervene even more actively into the encounter. Instead of working in close connection with the interpreters, providers produce long turns, they use technical language, they do not backchannel with interpreters, they accept child or adolescent interpreters although they are obviously swamped by the task. As a consequence, ad hocinterpreters make do with their limited linguistic resources. Instead of rejecting the burden of being the interpreter, they try to make something out of it. This leads to severe mistranslations, but also to versions that contain much of what the interpreter perceives as adequate or desirable. Typical cases are: the daughter

ISSUe - 22 2010

ers the quality of communication is much more difficult to control. In some countries, such as Switzerland, Sweden, Japan, or Australia, NGOs or governmental institutions provide community interpreting services, but these services usually do not account for all kinds of communicative demands and situations. Furthermore, access to them is often limited to specific places, regions, or institutions. In the context of chronic illnesses, this limitation is even more obvious because patients with chronic illnesses have to see doctors more often and treatment is organised on longterm, or even life-long basis. It will be more than difficult to communicate with such patients without relying on family members or other ad hoc-interpreters at least from time to time. Thus, clinics need to reflect communicative demands in order to enhance communication with allophone patients i.e. patients that have limited proficiency in the official language or languages of the clinic. This means that clinics have to identify communicative needs of allophone patients, investigate existing linguistic resources among staff members, and treat the development of linguistic competencies as an integral part of their human resources development. Furthermore, medical staff needs clear guidelines regarding the handling of linguistic diversity in standard situations. Solutions for bridging language barriers need to be adaptive and in line with the wishes of the patient. Such solutions need to reflect that the provision of high-quality medical services is possible only on the basis of good communication, and that good communication makes the patients speak, instead of letting them fall silent.

Bernd Meyer is Senior Lecturer for German as a foreign language at the University of Hamburg and member of the Research Center on Multilingualism. His research focusses on linguistic diversity managment in public service institutions.

w w w . a s i a n hAdvertorial hm.com

9

Healthcare Management

Safety and health is one of the major problems in workplaces. In 1996 the European Agency for Safety and Health at Work was set up with the aim to make workplaces safer and healthier for the working population of the 27 European Member States. It collects, analyses and disseminates information on occupational safety and health for the whole EU. Jukka Takala Director European Agency for Safety and Health at Work, UK

10

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

A

vast majority of work-related accidents and health problems can be prevented. Safety and health prevention is not a one-off project — it is continuous, systematic work; the challenge is to build and maintain a preventive safety and health culture that permeates all society. Such a culture must be based on the right to a safe and healthy work environment and on the principle of prevention, on a systems approach.

The World Health Organization (WHO) defines health as not merely the absence of physical, mental and/ or social illness; true health is a state of balance within a person. A healthy workplace is, first of all, a workplace where, as far as possible, there are no occupational hazards which could, in the broadest sense, directly harm the workers’ health. In other words, a working environment in which there are no accidents, no occupational diseases, no other health problems, no gender- or other types of discrimination, and which allows a work-life balance, adequate rest periods etc. But it must also be an environment where

ISSUe - 22 2010

there is room for professional development and for promoting workers’ wellbeing.

Safety and health is one of the major problems in workplaces: every three and a half minutes, somebody in the EU dies from work related causes.

In the EU 27, there are 167,000 deaths a year as a result of either workrelated accidents (7,460) or occupational diseases (159,000). Worldwide, around 2.3 million deaths per year are work-related.

The role of the European Agency for Safety and Health at Work

Europe’s occupational safety and health (OSH) challenges are too complex to be tackled by a single organisation, or even a single country, so, in 1996 the European Agency for Safety and Health at Work was set up. The Agency’s aim is to make workplaces safer and healthier for the working population of the 27 European Member States.

Located in Bilbao, Spain, the Agency has a dedicated staff of occupational safety and health (OSH) specialists and a network of partners in all EU

CaseStudy

Prevention through

Anticipation

A key to success in occupational risk prevention

Member States and beyond. We collect, analyse and disseminate information on occupational safety and health for the whole EU. Identifying and sharing good practice is one of the Agency’s main goals in order to achieve genuine security and promote a risk prevention culture across Europe. This good practice incorporates solutions which have been successfully implemented in the workplaces of Member State governments, companies or public organisations.

We analyse and raise awareness of measures which can be adapted to suit other organisations and countries and which provide practical, specific and cost-efficient ways to improve safety and health at work. We use a variety of communication channels to communicate our message on safety and health at work, such as our conferences and campaigns, the Agency’s website (including our monthly newsletter OSHmail) and a wide range of printed and online publications.1 1 The information on the Agency’s website http://osha. europa.eu is available in 22 official EU languages.

Community strategy on health and safety at work

The Europe’s occupational safety and health (OSH) Agency’s work programme for the next few years is connected to the priorities set by the new Community strategy published last year called ‘Improving quality and productivity at work: Community strategy (20072012) on health and safety at work’ of which one objective is to reduce by 25 per cent per cent the total incidence rate of accidents at work per 100,000 workers in the EU 27.

The strategy clearly defines the Agency’s role in the pursuit of these objectives. In order to ensure that the new strategy is implemented, one of the priorities the Agency has included in its work programme is to focus on small and medium enterprises, or SMEs, (in particular, micro enterprises), which employ most of the EU’s working population, have the highest accident rate (above all, in sectors such as agriculture, construction and transport) and often have less access to information and advice.

Goals over the next few years

The Agency's priority is to create and maintain a safety and health culture in Europe's workplaces. This objective is in line with the Lisbon strategy which aims at making the European Union the most competitive economy in the world.

The changing world of work is creating different risks and different needs.

Therefore, prevention measures must be adapted to the new occupational realities. For this, new approaches and new practices may be necessary and traditional prevention measures for common risks might need to be replaced or complemented. Often innovative and holistic approaches have to be taken.

Musculoskeletal disorders and ergonomics risks, as well as psychosocial and organizational demands are becoming more and more important, in terms of absence of work and long term disability. At the same time, chemical emerging risks and nanotechnologies will be also tackled by the Agency.

In the coming years, we need to look at lifetime health issues as well as accident prevention.

www.asianhhm.com

11

CaseStudy

Healthcare Management

This is why workplace health promotion, in addition to traditional protection and prevention, will be an important issue for health and safety practitioners. Employers should learn that general health promotion can contribute to a better OSH management and is a vital component of their corporate social responsibility.

This is precisely another important field where occupational safety and health has made its entrance. Many companies are now convinced that - apart from quality, productivity and profits - safety and health is paramount and that risk management has to be included from the very beginning.

Prevention through anticipation

Demographic changes as well as changes in work organisation and production methods are leading to new types of risks. Keeping up with the rapid pace of change in our workplaces is a key challenge for the EU. The Agency’s Risk Observatory identifies new and emerging risks and anticipates changes in work and their likely consequences for safety and health.

The Observatory collects and analyses data to give risk prevention specialists and legislators an understanding of the implications of the changing world of work for occupational safety and health and thereby helps to shape future risk prevention measures.

Through its European Risk Observatory, the Agency has published a series of expert forecasts on the main new and emerging risks regarding physical, biological, psychosocial risks and chemical risks.2 Psychosocial risks

EU-OSHA has very recently released findings of the biggest workplace health and safety survey in Europe. The ‘European Survey of Enterprises on New and Emerging Risks’ (ESENER) was conducted in spring 2009, involving 31 2 http://osha.europa.eu/en/publications/reports

12

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

countries and 36,000 interviews.

Concern about psychosocial risks such as stress, violence and harassment is increasing, the survey reveals. With the financial crisis in full swing, 79 per cent of European managers voice their concern about stress at work, which is already recognised as an important burden on European productivity. But despite the high levels of concern, it is clearly worrying that only 26 per cent of EU organisations have procedures in place to deal with stress.

The survey also reveals that 42 per cent of EU companies consider it more difficult to tackle psychosocial risks, compared with other safety and health issues. The sensitivity of the issue (53 per cent) and lack of awareness (50 per cent) are the main barriers for dealing effec-

The World Health Organization (WHO) defines health as not merely the absence of physical, mental and/or social illness; true health is a state of balance within a person.

tively with psychosocial issues.

The ESENER survey highlights the importance of providing effective support for enterprises to tackle stress, which will be crucial in ensuring we have the healthy productive workforce needed to boost European economic performance and competitiveness.3 Raising awareness

'Healthy Workplaces' is the Europewide information campaign organised

by EU-OSHA and its partners in the 27 EU Member States. The Agency 3 The report, a summary in 22 languages and an interactive mapping tool are available at www.esener.eu

ISSUe - 22 2010

has been running OSH Information Campaigns from 2000 on a wide range of different topics, activity sectors and priority groups.

The campaign covers more than 30 European countries and the approach it promotes is based on employers, employees and their representatives working together. Every two years, EU-OSHA is campaigning to raise awareness on a different topic, currently of the importance of proper maintenance.

The campaign follows a networkbased approach and is organised in all of the EU Member States and beyond. Our network of focal points, the national health and safety bodies in the EU Member States, and many other partners in Europe support a wide range of events and activities to promote safe maintenance, based on employers, employees and governments working together.4 Risk assessment

Something that we were able to see clearly over the course of the Healthy Workplaces campaign on Risk Assessment (2008-2009) is the need for interactive tools that small and medium-sized enterprises (SMEs) throughout Europe can access to make the risk assessment process easier.

The online tool that we have developed will be a fitting legacy of the campaign. By building on the efforts of the Dutch government and social partners developing a tool for the Netherlands, our Online interactive Risk Assessment (OiRA) tool should encourage and help many thousands of SMEs across the EU to carry out risk assessments.

We are working with social partners and relevant national bodies to develop sector-specific versions that will make the process even simpler for organisations working in particular areas. There have been proposals to exempt SMEs from the legal requirements to make a written risk assessment to reduce the 4 http://osha.europa.eu/en/campaigns/hw2010/

www.asianhhm.com

13

administrative burden, but that would mean that employees in smaller organisations were not being given the same levels of protection as those in bigger ones. Risk assessment is an investment into workers’ health and the OiRA tool offers – a simple and cost-effective way for SMEs to carry out risk assessments, resulting also to a printed output by a single press of a button.

Economic incentives

The Agency is currently running a big project around economic incentives to improve occupational safety and health.

A report will be launched in September 2010 at the IOHA Conference in Rome. There is rising interest in such economic incentives as instruments to motivate organisations to invest in OSH, as regulatory enforcement alone is often not sufficient to persuade them of the importance of OSH. Economic incentives can complement regulatory dictates as they stimulate organisations at the financial level and thus add weight to the business case for good OSH in a way that is clear to company managers across all Member States.

Workplace health promotion

The Agency is currently working on a Workplace Health Promotion project.

Supporting a healthy lifestyle pays off for everyone. It benefits employees themselves and their employers, but it also helps the wider society, by reducing the burden on healthcare systems. And with an ageing working population, the importance of Workplace Health Promotion schemes is only going to increase – we need to help people stay healthier for longer, and to achieve this we need employers and employees to work together, to create a healthy working culture. Workplace Health Promotion leads to better health, reduced absenteeism, enhanced motivation, and improved productivity. Employers have an important role to play in encouraging workers to adopt healthy lifestyles. In addition to the health benefits for work-

14

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

ers, every Euro invested in WHP leads to a Return on Investment (ROI) of between 2,5 – 4,8 Euros due to reduced absenteeism costs.5 Corporate social responsibility

In recent years, the concept of corporate social responsibility (CSR) in Europe has undergone a transformation in terms of its direct influence on business activity and its relationship with occupational safety and health. It has been proven that customers and clients are influenced by a company’s reputation in social and environmental areas, and that social and environmental responsibility reduces running costs.

In fact, CSR can bring OSH closer to other issues which are important for companies, such as: human resource issues, the balance between work and life, environmental issues, public safety and health issues (including product safety), profitability and productivity and other fundamental rights at work.

A safe working environment is good business. It is not only essential for the well-being of employees, but also for ensuring that enterprises are successful and sustainable, and that economies thrive in the long term. Showing companies that there is also a business case for investing in the safety and health of their workers may motivate them to go beyond basic legal requirements. Bigger companies have already identified safety and health as a key business issue – in fact, as mentioned above, those Member States that have the best conditions of work also have the highest productivity.

The challenge is to get the smaller companies to adopt the same measures 5 http://osha.europa.eu/en/topics/whp

Author BIO

CaseStudy

Healthcare Management

ISSUe - 22 2010

and convince them that in the long run competitiveness depends on a motivated, healthy workforce.

In recent years, many CSR initiatives have started at the level of organisations, of branches, of countries and even in transnational projects. The European Agency for Safety and Health at Work has published a report presenting a number of different company cases, selected as inspiring examples, which show that corporate social responsibility is a development strategy.

Building a preventive culture in Europe

The new Community strategy on health and safety at work warns that while the rate of workplace accidents fell over the period 2002-2006, (over the period 2000-2004 rate of fatal accidents at work in the EU 15 fell by 17 per cent), the latest results of the fourth European survey of working conditions show that many workers in Europe continue to perceive that their jobs pose a threat to their health or safety. It is, therefore, necessary to pursue risk prevention methods and continue to endeavour to promote health and safety at work in the EU-27, which is, essentially, the primary concern of the European Agency of Safety and Health at Work.

Finally, it is necessary to build a sustainable preventive culture, integrate OSH into education and occupational training, promote the exchange of good practice among Member States and, if possible, improve risk anticipation in order to prevent deaths and illness and make workplaces increasingly healthy and safe environments.6 6 http://osha.europa.eu

Jukka Takala serves as Director of the European Agency for Safety and Health at Work, since September 2006. Dr Takala is a director of ILO’s Safework Programme and posts in ILO Kenya, Thailand and Geneva 1978-2006. He is also in the Ministry of Social Affairs and Health and Ministry of Labour in Finland from 1973. He did his MSc Eng, DSc Tech.

www.asianhhm.com

15

Healthcare Management

B Chart 1

To what extent should the patient be responsible for managing chronic care?

Source: PwC Health Research Institute Global Health Leaders Survey

16

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

ISSUe - 22 2010

etween now and 2020, healthcare’s vital signs will be under pressure. Health systems must turn from reactive medicine to proactively understanding and supporting individuals in managing their own health. Many health systems say they deliver patient-centered care, but PricewaterhouseCoopers' research has found only pockets in which this is true. Health organizations remain too focused on their own organizations, not necessarily what is best for the patient.

Customising care to the individual takes health systems out of their comfort zones, forcing them to integrate people, technologies and organiszations that are not part of their current routines. “In an integrated world, no one provider owns chronic disease care. The patient owns the chronic disease,” said Gary Belfield,

Like in other industries the power of the individual is increasingly influencing how healthcare is directed and delivered, enabled by the technological and the virtual world we live in. Incumbent models of care are struggling to keep up as healthcare volumes become more unmanageable.

Sandy Lutz Managing Director Health Research Institute PricewaterhouseCoopers USA

who leads commissioning for National Health Service’s (NHS) Department of Health in England.

What is happening to healthcare is no different from other industries — the power of the individual is increasingly influencing how healthcare is directed and delivered, enabled by the technological and the virtual world we live in.

Government officials are increasingly worried about the need to wring value from rising health costs. They are realizing that engaging patients and customising care to their needs can be more effective and efficient. By 2020, individuals will access a newly networked model of care, research and financing.

Rather than architects of health systems, health leaders will become agile caretakers of interdependent networks that get smarter as they get to know and support each individual.

Global leaders believe that patients should be more responsible for managing their care (See Chart 1).

However, individuals need support to be engaged in their own care. Care in the future will be customised to the individual as performance metrics, payment, outcomes, incentives, services and treatments address differences in the needs and preferences of individuals. Incumbent models of care are struggling to keep up as healthcare volumes become more unmanageable. A burning platform for change is being driven by three key issues: Chronic disease: Both young and old consumers are developing chronic diseases in record numbers, leading to explosive growth in the consumption of resources that is driving up spending and creating liabilities for future generations.

Digitisation: Technology is leading healthcare into a new era of ‘mass customization,’ following other industries such as auto manufacturing, media and entertainment. PwC research shows that consumer attitudes on healthcare vary widely, depending on gender and age, and that is just the leading edge of the mass customisation.

Broader view of converged health influences: It is widely accepted that chronic diseases are associated with behavioural, socio-economic, and genetic factors that are not within the control of today’s medical delivery system.

Health will be customised around a framework of six vectors that customise diagnosis, care and cure for individuals.

Incentive-based payment: Public and private payers are ending volume- and

www.asianhhm.com

17

Healthcare Management

Chart 2

Should funding redistributed towards wellness?

Source: PwC Health Research Institute Global Health Leaders Survey

budget based payment and moving toward payment based on patient outcomes. This could result in a major redistribution and prioritisation of health spending. Three-quarters of health leaders surveyed by PwC favoured more incentives for physicians to follow best practice guidelines.

More than 80 per cent of health leaders surveyed said there needs to be more incentives for patients to be compliant with their medications.

Broad-based regulatory reforms: Many of the world’s largest economies are tackling major regulatory reforms that will alter how behavioural, genetic and medical delivery components drive personal health spending.

Funding: Payment and financing are redistributing funding from sickness to wellness. Global leaders believe more of funding should be redistributed towards wellness. (Chart 2). They also believe they should be reimbursed based on performance (Chart 3.)

Patient communication: When PwC surveyed global health leaders about the most effective strategies to engage individuals in their own health, the

18

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

Chart 3

Do you think providers should be reimbursed on the basis of the following

Source: PwC Health Research Institute Global Health Leaders Survey

top two answers were health education and greater awareness. The third was increased patient responsibility, but the ordering shows that health leaders know there is a lot of communication needed to support patients.

Electronic medical records (EMRs) and IT: By 2020, health systems will move from predominantly paper records controlled by the industry to digital ones controlled by individuals. Ninety per cent of health leaders surveyed said making EMRs available to clinicians and patients would make their systems more efficient and effective. Effective implementation will be difficult and expensive; regardless, global systems are moving towards them. (Chart 4.)

Workforce: Seventy per cent of health leaders interviewed by PwC said their systems would be more efficient if they had more primary care physicians and 79 per cent per cent said they needed more nurses. Systems must redesign care models to meet the expected workforce shortages amid demands for customised care.

Individuals’ relationships with health delivery models are changing

ISSUe - 22 2010

and will be shaped in the future by five touchpoints that make care more personalized and efficient. Health systems can use these touchpoints as a toolkit to activate a change in the patient’s role in healthcare.

Coordinated care teams Consumers want better coordination of care, and payment methodologies are being altered to enable packages of care that better serve the needs and preferences of patients. Two-thirds of global consumers surveyed by PwC said coordinated clinical teams are important to them. Yet, most health leaders surveyed by PwC said handoffs among clinicians are difficult or very difficult. (Chart 5) For example, in the UK, integrated care is gaining prominence on the healthcare reform agenda. Currently, the NHS is conducting 16 integrated care pilots covering a range of diseasespecific and full cradle-to-grave initiatives that will impact more than two million residents. In addition, in 2008, Somerset County devised an innovative COPD programme, which disrupted the traditional hospitalbased model in exchange for a more

Healthcare Management

community-focussed model.

The programme, which is now being emulated by other PCTs across England, is dependent on the seamless transition of COPD patients through the medical system. Too frequently, however, coordinated care networks entail adding additional layers onto already complicated delivery models, raising costs and convoluting pathways. “For every service you commission, you generally need to decommission something — it’s a Newtonian equation,” said Tony Felton, director, FH Partnership, Ltd. “Otherwise, you get inefficiencies, added costs and fragmentation. Ultimately, it is up to the commissioners to commission seamless care pathways.”

Fluent navigators Regardless of whether they live on US$1 a day or in the richest cities of the world, chronically ill patients need help to navigate the health system.

While nearly half of global consumers said it was easy or very easy to understand their medical condition, consumers also said it was much harder to access a specialist than a primary care physician.

The growing success of community health workers with underserved

communities can provide lessons about how to navigate complex systems. For example, in India, the government decided in 2005 to try to reduce the country’s infant mortality rate, which is 10 times higher than Japan, through Accredited Social Health Activists (ASHAs). Since then, India has trained more than half a million women with the goal of having one for every village of 1,000. “Payment of incentives is influencing them to be more proactive,” said Gubbi Venkatesh Nagaraj, M.D. ASHAs receive Rs 200 (US$4) when one of their patients delivers in a hospital, and Rs.25 (50 cents in the US) for getting a child immunised.

Patient experience benchmarks Access to care was the top attribute that defines quality care, according to PwC’s survey of global consumers.

Many governments are responding to this by setting access targets, such as wait times for primary care, emergency care, and surgery. Such mandates have been shown to increase productivity by causing providers to re-engineer their processes and rethink workforce definitions.

Among the most visible patient experience benchmarks are wait times,

which are increasingly being mandated by law. Both health leaders (85 per cent) and consumers (66 per cent) surveyed by PwC said short waiting times are important or very important for an “ideal” health system. A focus on wait times is a key trend, in that it forces health stakeholders to make the appropriate adjustments in determining resources and care pathways to meet the government standards.

For example, Australia has published a preliminary set of standards that assure patients access to primary care within a day and home visits to new mothers within two weeks of giving birth.

Medical proving grounds Research and delivery systems are converging to slash the time it takes for innovation to reach patients. In PwC’s survey of global health leaders, almost half said they thought medical tourism would increase in the next five years.

The medical tourism industry will split between those shopping for low-cost and those searching for new science and value.

Through collaboration and investment, some regions are making themselves medical proving grounds for a new

Chart 4

How close are your health systems to having EMRs for patients?

Source: PwC Health Research Institute Global Health Leaders Survey

Chart 5

How difficult is electronic information sharing across the health system?

Source: PwC Health Research Institute Global Health Leaders Survey

www.asianhhm.com

19

Healthcare Management

20

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

About the research PricewaterhouseCoopers Health Research Institute (HRI) conducted more than 200 in-depth interviews with global thought leaders and executives representing government, hospitals, pharmaceutical companies, insurance companies, clinicians, academics, and the business community to gather insights on current challenges and best practices. These interviews were conducted in more than 25 countries around the world. HRI also surveyed 3,500 consumers in seven countries (the U.K., Germany, the Netherlands, Norway, U.S., Canada, and Australia) and 590 leaders of health plans, providers, government, employers, physician groups, and pharmaceutical/life science firms in 20 countries (the U.K., Germany, the Netherlands, U.S., Canada, South Africa, Australia, New Zealand, Argentina, Brazil, China, India, as well as multi-territory geographies including central Europe, Scandinavia, the Middle East and Asia).

said Kevin Holland, managing director of Baxter Healthcare in the Middle East and Africa. According to the HealthCast global leader survey, 55 per cent of respondents said that increasing the distribution of service delivery will make their health system more efficient.

Author BIO

generation of medicine that customises care to the individual. This also represents a new type of medical tourism.

Just as France is known for wine and Switzerland for watches, biomedical centres are building global reputations in the new biological sciences.

While medical tourism represents a small slice of overall delivery, medical proving grounds will attract patients, researchers and providers looking for a faster cycle from bench to bedside. In PwC’s survey of global health leaders, almost half said they thought medical tourism would increase by 2015.

However, while the previous trend in medical tourism has been built on low cost, the new one will focus on the value consumers put on coordinated research and care systems.

Care-anywhere networks The definition of access is being redefined by the ubiquity of wireless mobile devices. One-third of consumers surveyed said they’d consider healthcare that’s delivered over the phone or Internet. Half of health leaders surveyed said they’re expanding access to care in patients’ homes, which are increasingly wired with networked devices.

Mobile EMRs, telecommunications and in-home and implantable devices will reduce utilisation of hospitals, nursing homes and physician office visits. For example, remote monitoring systems now enable eICUs with physicians and nurses reaching out to homebased patients via a remote “command and control” centre. “Individuals won’t have to leave their homes for basic services, allowing for virtual visits of all kinds and from care practitioners of all levels,” said Kaiser’s Fasano. The past few decades have seen government financing and incentives for hospital construction. The government’s investment in bricks and mortar is turning to funding virtual access points, broad-band networks and telemedicine.

“Healthcare is convenience-driven — patients need good access from home,”

ISSUe - 22 2010

Conclusion

No sector can achieve success on its own; common goals require collaboration efforts. As Erwin van Leussen, manager of healthcare innovations for Achmea, an insurance company in the Netherlands, said: “Innovation in the healthcare sector is a very complex process. In other industries, it is often enough to create a winwin situation between two parties. In healthcare, there are so many parties whose interests are intertwined, that you need at least a win-win-win-win situation in order to gain stakeholder acceptation for an innovation.” The drive toward customisation could increase consumer demand for services. However, this will be offset by a proliferation of incumbents and new entrants bargaining with government for payment and investment on the basis of savings.

Health leaders will work together to achieve solutions for customised diagnosis, care and cure. Following are recommendations for health stakeholders: Develop incentives that encourage partnership Work on regulatory reforms that reward competition and innovation Plan for redistribution of funding from sickness to wellness Provide individuals with better information to support shared decisionmaking, concordance and choice Explore workforce models that allow greater flexibility and effectiveness Prepare for complexity of agile, interoperable IT framework for realtime, customer-driven market.

Sandy Lutz is managing director of the Health Research Institute (HRI) of PricewaterhouseCoopers. Ms. Lutz leads national and global thought leadership and research initiatives for the firm and clients. She has more than 20 years of experience consulting to and writing about the healthcare industry.

www.asianhhm.com

21

Healthcare Management

Paying Attention Improving safety through leadership involvement

22

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

ISSUe - 22 2010

Healthcare Management

I

Yosef D Dlugacz

t has long been recognized that patient safety suffers when communication among care-givers is poor.

It is also recognized that holding professionals accountable improves not only patient safety but organizational and clinical processes as well. Although ‘communication’ and ‘accountability’ have become buzzwords in many healthcare organizations’ improvement strategies, few organizations have actually implemented successful models targeted at enhancing communication and increasing accountability.

Let us look at the impact of corporate leadership’s interest in establishing a methodology to address the problem of why risks, hindrances and obstacles to safety were not effectively established in a healthcare system of 14 hospitals. It was clear from the complaints, incidents and data that safety remained a problem, even with identification of issues and attempts at corrective actions. The COO maintained that appropriate accountability and proper communication with immediate feedback to close the loop would be vital, and he assigned the final accountability for corrective actions to the administrative director of each hospital. He also believed that ongoing education to bedside staff is important, and thus he established ongoing safety rounds in the hospitals at fixed times with corporate leadership involved.

Rather than relying on committees and delegating responsibility, a more direct line of communication was established via these weekly safety rounds.

Leadership mandated that not only a dedicated time be set aside each week for

Senior Vice President and Chief of Clinical Quality Education & Research Krasnoff Quality Management Institute A division of North Shore-LIJ Health System, USA

The Krasnoff Quality Management Institute (KQMI) has developed a relational database to support weekly system patient safety rounds. The tool offers users a method to input the information gathered at the weekly hospital safety rounds and to create a repository of safety concerns.

100% 90% 80% 70% 50% 40%

56.7%

62.6%

65.5%

68.4%

59.2%

56.5%

66.7%

65.8%

60.3%

66.2%

57.9%

61.2%

62.0%

62.0%

Hospital B

Hospital C

Hospital D

Hospital E

Hospital F

Hospital G

Hospital H

Hospital I

Hospital J

Hospital K

Hospital L

Overall System

AHRQ National Rate

AHRQ Mid Atlantic /New England

10%

64.4%

20%

Hospital A

30%

0%

Figure 1

‘safety rounds’ but that their focus should be on problem identification, resolution, and time of resolution; also staff education should be enhanced with a short question and answer session. Meetings were not to be scheduled during that dedicated time, and senior staff at each hospital were expected to join system leadership in identifying safety issues, communicating the issue, implementing improvements, and reporting back that the issue was indeed resolved. Although patient safety rounds have long been rganization as useful for identifying safety hazards, staff have often remained unconvinced of their effectiveness about bringing problems to resolution. Staff complain that there is little feedback as to resolution of articulated problems and express dissatisfaction about their seemingly invisible role in the improvement process.

When 12 hospitals in the 14 North Shore-LIJ Health System participated in a national survey (developed by the AHRQ) to discover staff attitudes toward communication openness, leadership realised that staff dissatisfaction needed to be addressed. Staff were questioned on three aspects of communication: they will freely speak up if they see something that may negatively affect patient care; feel free to question the decisions or actions of those with more authority; are afraid to ask questions when something does not seem right. 11,558 employees responded. The results indicate that the overall system score was 61.2 per cent, ranging from 56.5 per cent to 68.4 per cent. (Figure 1.) Leadership took notice of the data.

Taking such staff concerns seriously, the Krasnoff Quality Management Institute (KQMI), of the North Shore-LIJ Health System, developed a relational database to support weekly system patient safety rounds. This database could be used to gather information about safety hazards, to standardize the reports, to ensure effective communication, and to track improvements in a web-based, user-friendly tool, a tool

www.asianhhm.com

23

Healthcare Management

Common Issues Environmental Services Space Cleanliness Clutter

Engineering Equipment Availability Repairs Maintenance

Safety Fall Hazards Security Access Visitors

Patient Safty Rounds Database

Communication Multi-disciplinary Hand offs

Policy & Procedures Orders Isolation Abbreviations

Inventory Control Stock-outs Unit Specific Care hours Competencies

Figure 2

tor the results of their respective innovation efforts. Examples of commonly identified issues include issues regarding equipment and inventory, issues involved in the environment, staff competency, patient identification, falls hazards and communication during hand-offs. The shared issues help everyone learn from each other. (Figure 2)

Average number of days to close issues

Average Days to Issues Close by Week (May 7, 2010 - July 29, 2010) For System

28% Average Days to Close Issues

that tries to capture experiences from the point of view of everyone involved.

The tool offers users a method to input the information gathered at the weekly hospital safety rounds and to create a repository of safety concerns. KQMI analysts worked collaboratively with hospital staff to customise a flexible database and provide real-time reports to accommodate the specific requirements of the end users. The safety database is tailored to various lines of inquiry. For example, users can track how many days between problem identification and resolution were necessary or how many hospitals reported similar safety issues and how successful were their improvements.

The ability of hospitals to share issues involved in safety has generated a large bank of survey questions that leadership can use to educate and monitor safety concerns across the system. It encourages knowledge transfer among peers, enables them to share ideas and to moni-

The safety database tool enabled an efficient automated method of reporting problems and a method for system leadership to improve their oversight about specific problems at hospitals. Since safety rounds are completed weekly and reports on open issues generated in real time, frequent assessment and reassessment of open issues are continually accomplished. Most important, accountability for safety is increasingly transparent. Issues identified and discussed at one week’s rounds are less likely to remain open for the following week since an individual is charged with improvement and follow-up. With the involvement of senior system leadership, administrators are expected to oversee improvements. Also, by being actively involved in the safety rounds, leadership better understands the specifics of safety problems and they can prioritize how to spend resources on improvements.

The safety rounds and the safety database have led to a dramatic reduction in the number of days that an issue remains unresolved. KQMI staff educated and trained users on the specifics of the tool. Administrators or safety leaders at individual hospitals were trained to use the tool to track the status of safety issues and to note whether and when the issues were successfully resolved. Figure 3 shows the ‘Average Number of Days to Close Issues.’ Over a period of months, the number of days

24% 20% 16% 12% 8% 4%

13

26

14

11

9

9

9

May 02, 2010

May 09, 2010

May 16, 2010

May 23, 2010

May 30, 2010

June 06, 2010

June 13, 2010

5

4

4

June 20, 2010

June 27, 2010

July 04, 2010

0%

3

2

July 11, 2010

July 18, 2010

Week of (Survey Date) Notes: Data as of July 30, 2010. Data subject to change. *Illustrates the average amount of time (in days) between issue notification and issue resolution.

Figure 3 24

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

ISSUe - 22 2010

Healthcare Management

100%

Hand Hygiene Compliance Rate Hospital A

80% 60%

90%

90%

95%

79%

78%

88%

82%

79%

81%

73%

84%

64%

83%

75%

66%

81%

79%

2009-02 (N=343)

2009-03 (N=540)

2009-04 (N=323)

2009-05 (N=267)

2009-06 (N=259)

2009-07 (N=265)

2009-08 (N=185)

2009-09 (N=125)

2009-10 (N=212)

2009-11 (N=130)

2009-12 (N=209)

2010-01 (N=140)

2010-02 (N=145)

2010-03 (N=169)

2010-04 (N=140)

2010-05 (N=167)

2010-06 (N=175)

0%

80%

20%

2009-01 (N=434)

40%

Notes: N is the total number of observed episodes

Figure 4

Patient Falla Index

5.00 3.00

7/2010 135

6/2010 2.06

5/20010 262

4/2010 0.96

3/2010 0.89

2/20010 2.38

1/2010 098

12/2009 1.01

11/2009 1.17

10/2009 238

9/2009 290

8/2009 2.20

7/2009 238

6/2009 2.59

5/2009 1.52

4/2009 1.69

0.00

3/2009 1.72

1.00

2/2009 4.15

2.00 1/2009 211

Index

4.00

Figure 5

Survey Name: Hand Hygiene Survey Date: June 11, 2010

Survey Name: Fall Prevention Survey Date: June 02, 2010

Can Healthcare works who give direct hands on care have artificial nails?

How do you communicate to the healthcare team that the patient is at risk for falls?

How often is the Fall Risk assessed and documented?

What are some of the fall prevention interventions?

Where is the risk assessment documented?

How long should you was your hands?

When should Alcohol Hand Gel not be used?

When should hand hygiene be performed?

Overall #Correct #Incorrect Total %Correct Responses 3,012 198 13,210 94% Total:

Author

BIO

Figure 6

both at the local hospital level and at the system level. When top leadership pays attention to the small details of safety, taking every problem seriously, it is a way to formalise accountability and communication on a local level. The result is that improvements to the safety of the environment occur.

to close an issue decreased from twentysix days to two days. (Figure 3) Education during safety rounds also proved effective. For example, data collected at one hospital revealed that hand hygiene compliance was a problem in one hospital and patients’ falls at another (Figures 4 and 5).

Leadership implemented education programs to improve understanding of the issues involved. Post-education surveys given at the bedside during safety rounds established that the staff responded with 94 per cent and 90 per cent correct answers respectively (Figures 6 and 7). It is hoped that as more people participate in the safety rounds, behaviour on these issues and others identified during rounds will improve.

By promoting staff involvement in the weekly rounds, and by supporting the development and use of the common database, effective communication among different levels of staff, management, and leadership has increased.

Overall #Correct #Incorrect Total %Correct Responses 3,012 198 13,210 94% Total: Figure 7

Yosef Dlugacz has published widely in healthcare and quality management journals on a variety of clinical care and quality topics. He is a frequent participant expert in national audio and video teleconferences promoting quality and safety. One of his books Value Based Health Care: Linking Finance and Quality (2010) recently received the 2010 Bugbee-Falk Award from the Association of University Professionals in Health Administration and nominated for the ACHE/Hamilton Book of the Year Award.

www.asianhhm.com

25

Healthcare Management

Health 2.0 Smarter patients, smarter healthcare

Health 2.0 would make it possible to stem the increase in healthcare expenses, relieve the pressure on staffing levels in hospitals and make healthcare systems more efficient.

Apoorv Surkunte PMP Lead Business Analyst, USA

P

rimary role of Technology has been to make life easier and bring down the associated costs for end user. Be it banking, retail or healthcare domain, this basic definition of technology holds good. The way we pay our bills has changed dramatically over the years. Gone are the days when we used to stand in queue to pay the bills, all we need is a few clicks of mouse sitting in the drawing room today to make those payments.

26

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

US Healthcare industry has been relatively slower when it comes to technology adoption. We see many big ticket technology implementations happening within Healthcare right now with Electronic Health Record implementation, EDI 5010 changes and ICD 10 implementation. These projects call for investments worth billions of dollars and promise big returns in terms of better healthcare and cost effectiveness in long run.

There is another set of innovation happening backing on concepts of health 2.0 which is making difference in our day to day lives.

Health 2.0 has evolved from the concepts of Web 2.0. The term Web 2.0 is commonly associated with web applications that facilitate interactive information sharing, interoperability, user-centered design, and collaboration on the World Wide Web. Examples of Web 2.0 include social-networking sites like Facebook and Orkut, blogs, wikis, video-sharing sites like YouTube, hosted services, web applications etc.

On the similar lines of web 2.0 definition, health 2.0 can be defined as use of a specific set of Web tools (social media, blogs, communities, Podcasts, search, wikis, etc) in healthcare that promote the collaboration

ISSUe - 22 2010

among doctors, patients, and other stakeholders in healthcare eco system.

Defining characteristics of health 2.0 are active participation, with direct communication - between patients, between professionals, and between patients and professionals.

If the jargon used in above paragraph sounds a bit overwhelming, let us talk about how health 2.0 applications are helping us in day to day life with examples. A decade ago, when someone in my family fell sick, I would have identified the doctor specializing in the treatment related to the ailment, I perhaps would have spoken to family and friends to identify the doctor. Doctor would then render services to treat the patient.

Often times, I would not know much about the medical condition and go by what doctor would advise.

Back to present, when someone in my family fall sick today, I may log on to one of health 2.0 based portals like zocdoc.com or vitals.com for scheduling appointment where I would identify the doctor who treats the medical condition and is contracted under my health plan. I would also read the reviews about the doctor before I schedule the appointment online. After the doctor identifies medical condition during hospital visit, I would go back

Healthcare Management

plan based on various factors like cost and benefits. I could check for drug interactions, side effects, symptoms or abnormal lab tests to see if drugs are causing those by visiting websites like doublecheckmd.com.

Doctors may interact with each other on social media platform like osmosis that enables verified U.S. licensed physicians to exchange medical knowledge which helps improve patient care.

And the best part is all these innovations in health 2.0 do not cost much to end user. These rather help entire healthcare eco system by transAuthor BIO

and read details pertaining to the cause of medical condition, precautions my family member needs to take, experience of other patients who have been treated for similar medical condition on various health content websites like webmd.com. My sick family member could also join support community for specific medical condition on portals like dailystrength.com and derive inspiration from other patients and also make friends on the portal.

I can keep track of my health records online to make sure that I don’t end up spending for unnecessary tests. I could directly upload information from health and fitness devices in moments, automatically to my online health record with help of portals like Google health, MS Health Vault, myoptumhealth.com.

I can compare various health insurance plans in my locality on portals like vimo.com before I zero in on the right

forming patients into active partner in healthcare delivery process where patients make sure they understand the diagnosed medical condition, take extra effort to stick to medication and healthy diet. health 2.0 would make it possible to stem the increase in healthcare expenses, relieve the pressure on staffing levels in hospitals and make healthcare system more efficient.

Health 2.0 would shift the spotlight back onto most important aspect of healthcare, the prevention of various diseases with emphasis on healthier lifestyle, which may bring down the costs substantially.

Apoorv Surkunte has been working in Healthcare IT field for about six years. His expertise lies in healthcare innovations, health reforms and insurer side applications such as provider networks and claims. He is certified project management professional and possesses various international healthcare certifications.

www.asianhhm.com

27

Medical sciences

Advanced Diabetes Care Moving from delayed interventional to predictive, preventive and personalised medicine

28

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

ISSUe - 22 2010

Medical sciences

Inadequacy of current diabetic care

Advanced diabetes care requires the creation of new guidelines, timely predictive diagnostics, effective prevention and creation of individualised treatment algorithms.

Olga Golubnitschaja Head, Molecular/Experimental Radiology Division, Department of Radiology, Rheinische FriedrichWilhelms-University of Bonn, Germany Vincenzo Costigliola President, European Medical Association UK

Diabetes mellitus (DM) is a lifelong progressive disease. It is classified as a group of heterogeneous metabolic disorders characterised by hyperglycemia as a common feature. The vast majority cases of DM fall mainly into three broad etiopathogenetic categories, classified as type 1, type 2 and type 3 DM. Type 1 DM is induced by beta cell destruction, whereas pancreatic beta cell dysfunction and insulin resistance are hallmark features of type 2 DM. Alzheimer Disease is considered as Diabetes type 3 due to insulin resistance in particular organ – the brain. As reviewed earlier1 the prevalence of DM has already achieved epidemic proportion with around 300 million patients worldwide and will more than double over the next 30 years. It is projected to rise from 4.4 per cent in 2000 to 7.7 per cent in 2030. Consequently, the worldwide prevalence of diabetes among adults (20-79 years of age) is expected to increase up to about 439 million by the year 2030. The projections for DM prevalence are becoming more pessimistic year by year.

Wolrdwide every 10 seconds a person dies due to a diabetes-related pathology: DM is documented to be the fourth leading cause of death. In the year 2010, the global mortality attributed to diabetes was estimated to be 3.96 million, showing an increase of 5.5 per cent when compared to the mortality in the year 2007. The percentage of all death in the diabetic population between 20-79 years of age was lowest (6 per cent) in the poorest African countries and highest in the North American region (15.7 per cent) (Figure 1). The highest number of deaths due to diabetes is projected to 1 The EPMA-Journal, Springer, V.1-1, 2010

occur in countries with large populations such as China, India, USA and the Russian Federation.

The percentage of excess deaths due to diabetes was highest in people 55-59 years old, currently having the largest effect in South East Asia (Figure 2).

When comparing similar age groups of DM-affected versus general population, the annual mortality rate has been documented to be two-fold higher in diabetic patients.

Diabetes care faces a whole spectrum of problems including the necessity for population screening, targeted preventive measures, ethics, economics, and broad dissemination of the issuerelated information that still await a dramatic improvement in each aspect.

Diabetes mellitus (DM) frequently results in diverse severe complications, such as retinopathy, nephropathy, silent ischemia, dementia, and cancer. Despite the current progress in individualised insulin therapy, the common onset of DM type 2 in early adulthood results in dramatic consequences that are linked to the early onset of diverse severe complications such as retinopathy, nephropathy, silent ischemia, and dementia.

Advanced (pre)diabetes care: timely prediction, prevention and personalised treatment

Given the high risk and prevalence of secondary complications as well as individual predisposition to target organ injury, DM is the best model for the application of predictive diagnostics aimed at preventive measures and personalised treatment. As it is analysed below, generally there are three levels desirable for advanced pre- and diabetes care2.

2 . Golubnitschaja, The EPMA-Journal, Springer, V.1-1, 2010

www.asianhhm.com

29

Medical sciences

FIRST LEVEL South and Central America 9.5%

Africa 6% Europe 11%

North America 15.7% South-East Asia 14.3% Eastren Mediterrarean and Middle East 11.5%

Western Pacific 9.7%

Continents

Figure 1. Worldwide documented DM-associated mortality for the population aged between 20-79 years in contest of regional differences as updated for 2010. Diabetes accounted for over 1 in 20 deaths. Total percentage of diabetic mortality is very high particularly in North America (15.7 %) and South-East Asia (14.3 %), both regions with large populations.

Number of deaths (thousands) Figure 2. Number of deaths (in thousands) attributable to diabetes by age groups and gender. Global mortality was lowest in the Eastern Mediteran and Africa regions, while the highest numbers were documented in South East Asia and America. DM-associated deaths are particularly increased for the age group 35-64 years, in regions where the prevalence of diabetes is very high in younger ages (South East Asia, America and Africa). In Europe, DM mortality tends to be more frequent in men than in women. On the other hand, for all other regions, the prevalence of DM mortality is higher in female population, mainly in the age group older than 64 years. Among the younger age group of 0-34 years, the numbers of deaths were high in South East Asia (29.1 thousand men and 33.1 thousand women) and Africa (20 thousand men and 32.2 thousand women).

30

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

ISSUe - 22 2010

Postnatal diagnostics in term of general predisposition to diabetes, preventive measures early in life, personalised treatment, and educational measures in population

There is a growing body of evidence demonstrating certain endogenous and exogenous factors to be strong contributors to the prevalence of DM worldwide. Parents should be educated about the risk factors and potential long-term outcomes in predisposed newborns / children, in order to possibly prevent a development of severe pathologies including DM. Promising noninvasive blood tests are currently under development that would allow a more precise diagnosis and reliable prognosis for severe pathologies (diabetes, cancer, etc.), which can be potentially developed later in life. Further educational measures should consider well-known pathology-relevant exogenous and endogenous factors such as environmental aspects, genetic background, nutrition, life style, stress, infections, job- and physical-activities. Some of the central factors and consequent recommendations have been recently reviewed. Physicians should be educated about medication with antipsychotics: it is advised to be cautious with the prescription of diabetogenic agents. Particular care is required when treating attention-deficit / hyperactivity disorder (ADHD) in childhood and youth: special attention should be paid to highrisk patients predisposed to onset of DM. Monitoring of DM-relevant parameters (such as dynamic of body-mass-index and bloodglucose levels) is advised for careful set-up of individualised treatment approaches.

Medical sciences

SECOND LEVEL Early diagnostics and personalised treatment of pre-stages of Diabetes mellitus in adolescence and adulthood Ageing is one of the strongest contributors to the development of the majority of human pathologies including DM. In particular, early or even premature aging is especially of concern, since this supports or even triggers the (pre)lesions, pre-stages and the consequent pathologies early in life.

Early ageing can have diverse origins and usually results from the interaction of genetic, epigenetic and various environmental factors. The well-known causes of the early / premature ageing are inborn genetic disorders, deregulation of longevity-associated genes, disconnected functional interaction between nuclear and mitochondrial genomes, environmental factors and inappropriate reaction towards any kind of stress. The common resulting effect is an imbalance in the production of aggressive reactive species, amounts of antioxidants and the activity of detoxification pathways that altogether support extensive organdamage. Recent innovative diabetes-

related tests offer a more precise definition of the diabetic phenotype at the molecular level that may prove useful in delineating diabetogenic genes or gene products in diabetes prestages that include an identification of secreted and pancreas specific proteins/ peptides responsible for abnormalities of insulin secretion in type 2 DM - the predictive markers for cell dysfunction in diabetes pre-stages. Currently, for individuals highly predisposed to the early ageing / extensive ageingprocesses generally and, in particular to diabetes pre-stages, the following preventive and therapeutic measures are recommended: the life-style should be personally discussed with the specialists to develop individualised nutrition and optimised physical and further activity taking into account all related stress contributors including the relevant environmental factors; targeted metabolic corrections might be performed; Gene-therapy and alternative forms of individualised therapy approaches can be potentially applied.

THIRD LEVEL Prediction followed by personalised treatment slowing down or even preventing severe complications secondary to diabetes.

A prime target of hyperglycemiainduced injury is the endothelial cells, the damage of which contributes to organ-damaging complications secondary to DM. Differential susceptibility to chronic diabetic complications indicates that, aside from hyperglycemia, other factors (e.g. genetics) modulate an individual’s risk for secondary pathologies. These aspects emphasise the need for an individualised approach to detection and management of DM. As a result, identification of effective diag-

nostic markers and prognostic indicators unique to diabetes mellitus should prove valuable for early diagnosis and targeted preventive or individualised interventional measures. Since diseasespecific changes in blood-plasma and vascular proteomes occur up-stream towards the majority of organ systems in type 2 diabetes, predictive indications for developing secondary diabetic complications should be sought in plasma and blood cells. A detection of pathology-specific circulating nucleic acids in blood-plasma is considered as one of the most potent diagnostic approaches in the individualised treatment of diabetic patients. A non-in-

vasive molecular diagnostic approach based on disease-specific gene expression patterns in circulating leukocytes has been recently suggested for the predictive diagnosis of secondary diabetic complications. This approach is based on disease- and severity-specific alterations in the gene expression patterns of circulating leukocytes and protease activity in serum that can be ex vivo evaluated in individual blood samples.

The test foresees a precise expression profiling of selected genes in circulating leukocytes isolated from fresh blood samples. These genes, which have been proposed to play a role in the pathology of type 2 diabetes, belong to the stressproteome and have a function in the following pathways: cell-cell communication, cell-adhesion, apoptosis, tumorigenesis, transcription regulation, tissue remodelling and neurodegeneration. A clinical application of the test is currently under consideration, and a nanotechnology which should provide a possible easy and relatively inexpensive routine application of the test is under development.

Innovative highly accurate diagnostic approaches should aim at personalised preventive arrangements in diabetes care, in order to restrict consequences of severe complications. From the view point of economical burden in diabetes care, the effective prevention seems to be the only plausible solution. Thus, a successful treatment of half-a-billion diabetics expected in years around 2030 worldwide is not realistic at all. Furthermore, therapeutic approaches of manifest severe complications should consider individual parameters of diabetics to make treatment more personalised and as effective as possible. Multifunctional therapeutic strategies (“cocktail�-therapies) should be developed for single multi-factorial pathologies in order to improved inadequate treatment. All these aspects should be strictly regulated by new guidelines for advanced pre-diabetes care.

www.asianhhm.com

31

Medical sciences

Figure 3

UNO-Vice-Secretary General Sergej Ordzhonikidze, EPMA-Secretary General Olga Golubnitschaja.

Predictive diagnosis and targeted prevention as the reliable platform for personalised medicine to reduced costs: The overall EPMAconcept

Predictive diagnostics is considered as a reliable navigation system for targeted preventive measures and consequent development of individualised treatment approaches. Predictive perinatal diagnostics and pre-selection of healthy but pathology-predisposed individuals followed by targeted preventive measures represents the primary task in the overall action. Those highly effective measures would lead to reduced prevalence of severe pathologies, better long-term outcomes, increased portion of socially active members in elderly population, improved quality of life for patients, and reduced costs in advanced healthcare systems. This concept is considered as the medicine of future and has been recently elaborated by 60 leading experts from 16 countries3: Editor: O. Golubnitschaja, Nova Science Publishers, New York, 2009. The overall concept in the field is conducted by the “European Asso-

Conclusions & Outlook

From the above given facts we can conclude: DM micro- and macro-vascular complications are one of the leading health problems of 21st century.

Over the next 20 years, DM-affected

B I O

From left to right: EPMA-President Vincenzo Costigliola,

ciation for Predictive, Preventive and Personalised Medicine” (EPMA, www. epmanet.eu). Issue-related innovative European and intercontinental projects, which EPMA introduces for further consideration at the EU-Commission, European Parliament and UNO are elaborated by the consortium of the world-leading professionals and professional groups (Europe-unrestricted).

The first meeting of the EPMARepresentatives with the Vice-Secretary General of UNO took place in Geneva on December 8th 2009. The EPMAMission and -Objectives in the field of Predictive, Preventive & Personalised Medicine (PPPM) have been introduced to the Vice-Secretary General of UNO. The participants of the meeting agreed that the paradigm change from curative to PPPM can be achieved only by coordinated measures well-focused on solving the accumulating problems in healthcare and the concomitant economical burden that societies across the globe are facing more and more.

This is a new philosophy in healthcare and the platform for personalised patient’s treatment considered as medicine of future.

A u t h o r

EPMA goes global in consensus with United Nations.

3 Predictive Diagnostics and Personalized Treatment: Dream or Reality

32

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

ISSUe - 22 2010

population is likely to be increase by 50 per cent.

Although prevalence of diabetes continues to rise in every nation, the highest increase is expected to occur in countries with large populations- India, China and USA. Urban population in developing countries is projected to double which apparently will lead to a highly increased diabetic prevalence.

Most important demographic change on DM prevalence across the world appears to be the increase in older population (age of 60-79 years), as a consequence of longer life span expectations.

Severe complications lead to highly increased morbidity and mortality of DM. Global excess mortality due to diabetes is more pronounced in developing countries.

The progressing prevalence of DM will lead to very high economical burden worldwide.

Urgent measures that should be considered:

Early prevention of DM in childhood and adults Improved educational measures among professionals and general population Stressed impacts of body culture, individual nutrition and lifestyle Application of innovative diagnostic approaches followed by Personalised treatment in (pre) diabetes.

Olga Golubnitschaja is Professor at several European Universities and Programmes for Personalised Medicine. Author of more than 200 international publications in the field, Secretary-General of “European Association for Predictive, Preventive & Personalised Medicine”, Editor-in-Chief of “The EPMA-Journal” and worldfirst book with overall-concept of “Predictive Diagnostics & Personalised Treatment”, NSP, New York 2009.

Vincenzo Costigliola was graduated in Medicine, Naples University; since 1972 - Family Practice; 1973/1983: Chief of Medical service in Italian Navy (outpatients clinic, legal, occupational and preventive medicine), Chief of the Internal Medicine Service and Medical Staff on Military ships; currently - President of EMA, IRMA, EDA, EPMA (European Association for Predictive, Preventive & Personalized Medicine)

www.asianhhm.com

33

Surgical Speciality

Books

Complications in Vascular and Endovascular Surgery: How to Avoid Them and How to Get Out of Trouble Editor (s): Jonathan J. Earnshaw, Michael G. Wyatt No of Pages: 400 Year of Publishing: 2011 Description: The title has been inspired by the rapid development in the treatment of patients with vascular disease, which embraces the new endovascular techniques and changes to medical management that are revolutionising our treatment of these patients. Each chapter presents up-to-date evidence-based information on the prevention and treatment of vascular and endovascular complications. There is a particular emphasis on the tips and tricks of 'how to get out of trouble', and we hope this will help the reader in their practice of vascular and endovascular surgery.

34

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

The Evidence for Neurosurgery

Anesthesia and Perioperative Care for Aortic Surgery

Editor (s): Edward C Benzel, Zoher Ghogawala, Ajit A Krishnaney, Michael P Steinmetz, H Hunt Batjer No. of Pages: 350 Year of Publishing: 2011 Description: Neurosurgery represents one of the most specialised arenas in modern medicine. Today, more than ever, patients with neurological disorders seek opinions from a variety of specialists and are often treated by teams of physicians. While consensus is often reached within institutions, regional variation is found between institutions.

The lack of high quality clinical evidence contributes to this problem. This is a textbook that will challenge current dogmas in many instances, provide an organised framework for understanding where current evidence can be applied clinically, and illustrate where gaps in the evidence exist and how these deficiencies may be filled in the future.

Editor (s): Kathirvel Subramaniam, Kyung W Park, Balachundhar Subramaniam No. of pages: 521 Year of publishing: 2011 Description: This book is a comprehensive reference for anesthesia and perioperative clinicians involved in aortic surgery. With a primary focus on anesthesia for various aortic surgical procedures, including endovascular aortic surgery, the title also provides expanded coverage of CNS monitoring and protection, intraoperative transesophageal echocardiography, renal and spinal cord protection during surgery, management of aortic trauma, and postoperative care. Written by top cardiac anesthesiologists, surgeons, and intensivists, this indispensable reference provides everything you need to know about the burgeoning field of aortic surgery in one handy volume.

ISSUe - 22 2010

Surgical Speciality

Three-dimensional Echocardiography

Retinal and Vitreoretinal Diseases and Surgery

Global Surgery and Public Health: A New Paradigm

Editor (s): Thomas Buck, Andreas Franke, Mark J Monaghan No. of pages: 260 Year of Publishing: 2010 Description: Three-dimensional echocardiography is the most recent fundamental advancement in echocardiography. Since realtime 3D echocardiography became commercially available in 2002, it has rapidly been accepted in echo labs worldwide. All clinically relevant aspects of this fascinating new technology, including a comprehensive explanation of its basic principles, practical aspects of clinical application, and detailed descriptions of specific uses in the broad spectrum of clinically important heart disease, are covered in this book. In addition to an in-depth review of the most recent literature on real-time 3D echocardiography, this book represents an invaluable reference work for beginners and expert users of 3D echocardiography.

Author: Boyd S No. of pages: 450 Year of publishing: 2010 Description: As our understanding of the different retinal diseases, their management as well as new technology expands, there is critical need to put our knowledge for the benefit of the patients. The book Retinal and Vitreoretinal Diseases and Surgery, deals with the most sensitive, photoreceptive and innermost nervous tunic of the globe: the retina.

It provides updated information on all clinical conditions of the retina and vitreous in a comprehensive and lucid manner, along with high quality clinical photographs and illustrations, which include relevant information.

The book covers pathophysiology, clinical signs and symptoms, investigations, differential diagnosis, treatment, prognosis and step-bystep modern vitreoretinal surgical techniques.

Author (s): Catherine R. deVries, Raymond R Price No. of pages: 304 Year of publishing: 2010 Description: Until recently, surgical services in developing countries have been neglected, despite the critical role they could play in preventing disease and saving lives. Over the last few years, world leaders, public health professionals, and surgeons have collaborated to discuss public policies, resource utilization, healthcare reform, surgical safety, and workforce issues in order to bring these lifesaving services to those most in need. Global surgery and public health: a new paradigm offers the most current information as well as a systematic approach to considering surgery in the context of a broader umbrella of public health.

www.asianhhm.com

35

Technology, Equipment & Devices

Do we need artificial organs Along with the shift in emphasis to developing future innovations that enhance quality of life, there is a growing need for those devices that keep patients alive. Artificial organs and organ assist devices represent such life saving technologies.

Jörg Vienken Vice President BioSciences, Fresenius Medical Care, Bad Homburg, Germany

36

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

Figure 3

M

edical devices are by far the most innovative products of technology. The number of patent applications to the European Patent Office in Strassbourg / France prove the success of this realm. In 2006 alone, 15,723 medtech-related patents were submitted, exceeding the number of patents filed for other innovative sectors such as telecommunications or the automotive industry. The innovative power of medical technology has resulted in more efficient treatments and better therapies. In 2003, the British Medical Journal reported that “…advances in medical technology account for a third of the reduction in road traffic deaths.”.

In a recent issue of the respected New

ISSUe - 22 2010

Figure 1. Mother of Albrecht Dürer Germany 1514

England Journal of Medicine, Victor Fuchs wrote“…biomedical inventions, such as new drugs and devices as well as new procedures have been the primary source of increases in longevity since World War II. Two further figures might illustrate this notion. In 1900,

Technology, Equipment & Devices

Therapy of Kidney Patients - Hemodialysis

Figure 2

life expectancy for a 25-year-old individual was another 22 years, whereas the same holds true today for a 65-year-old . And, following C Franceschi from the department of gerontological research at Bologna University in Italy, it can be assumed that girls born in 2009 in the western hemisphere. will reach the age of 100 The improved quality of life achieved today can be impressively demonstrated by a look into the face of the mother of the famous German painter Albrecht Dürer. This picture painted in 1514, shows Dürer´s mother at the age of 63

(Figure 1). We should compare this face with ladies of today at the same age.

Longevity is, without doubt, associated with limitations, handicaps and co-morbidities. Projections from the year 2000 to the year 2040 foresee an increase in the number of disabled persons, for example, by 100 per cent in the USA. Further, among Americans 55-years of age or older, 3 out of 10 have difficulty in stooping or bending, 1 out of 10 has difficulty reaching or grasping, 4 of 10 usually sleep less than 7-8 hours in a 24h period, nearly 30 per cent have hearing impairment.

Number of Hemodialysis Patients - a 7% annual rise

Figure 4

Value-enhancing innovations for medical devices that ensure a higher life expectancy and a reasonable quality of life for both the elderly and the nearelderly are advanced by engineers and medical professionals. The worldwide market for medical devices reflects this notion and represents today a value of €260 billion . It will increase by 6-8 per cent annually limited only by restricted health care budgets which will, according to a guestimate of national health expen¬ditures in the USA, rise to an unprecedented 20 per cent of GDP in 2018. Consequently, evi¬dence-based analyses, known as comparative effectiveness research (CER), are backed by the economic stimulus bill, and take off now. Mary Woodard Lasker (19001994), an American health activist, and founder of the Lasker Award for Medical Research in the USA, commented in 1957 about such obviously traditional perspectives by saying: “If you think research is expensive, try disease!”

Along with the shift in emphasis to developing future innovations that enhance quality of life, there is a growing need for those devices that keep patients alive. Artificial organs and organ assist devices represent such life saving technologies. The treatment with the artificial kidney developed from an experimental therapy in the 1950s has reached the level of a routine therapy today.

Artificial kidneys and hearts (Figures 2, 3) represent one of the success stories in the realm of medical devices. Recordings of the numbers of kidney patients undergoing haemo¬dialysis worldwide show that around 1.7 million patients are currently kept alive by such a therapy (Figure 4). This figure increases exponentially with a worldwide growth rate of about 7 per cent – an astounding figure as the world population only grows by an annual rate of 1.1 per cent.

The perfection of the application of artificial kidneys for human therapies is supported by data from Japan where more than 67,000 patients undergo the treatment with this artificial organ for

www.asianhhm.com

37

Technology, Equipment & Devices

38

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

Left ventricular assist device (LVAD) 2010

Figure 5

shown by figures provided by the European organisation for organ transplantation ‘EUROTRANSPLANT’, located in Leiden / The Netherlands. In 2007, figures for fatal incidences in patients on the waiting list were 523 for kidney, 422 for liver, 218 for heart, and 122 for lung transplantation.

Consequently, the need for organs is not met by the transplantation of human organs currently. This need can only be, at least partially, compensated by the availability and the application of artificial organs.

What are the future perspectives?

Artificial organs, mainly the artificial kidney and the artificial heart will help keep patients with organ failure alive.

Production of such medical devices under the premises of economy-ofscale will help make artificial organs available for larger patient cohorts as already shown for the artificial kidney.

New developments on organ printing and thereby providing three dimenAu th or BI O

already longer than 10 years and the eldest patient on dialysis has a therapy age of 39 years and 8 months.

Artificial kidneys applied during haemodialysis represent a life saving therapy. Blood of uremic patients is cleansed in an extracorporeal blood circuit and patients have to undergo this therapy three times a week for four hours or longer. There has always been an argument that many countries cannot afford such treatments. Analyses of worldwide dialysis statistics have shown, that the provision of dialysis therapy in most countries is independent of the economic power (Figure 5).

A rule of thumb further assumes that about 1,000 patients per million inhabitants are in need of artificial kidneys, a figure that defines the need for countries where this therapy has not yet been realised to this extent.

Are there any current alternatives for the application of artificial kidneys?

Common under¬standing spontaneously refers to organ transplantation.

Kidney transplantation is a well-established surgical operation and patient survival after the transplantation has improved due to a better understanding of the mechanisms of transplant rejection and the advent of new immunosuppressive drugs which even allow for the transplantation of not perfectly matched donors. However, there is a considerable lack of donor organs, and patients around the world face terrifying waitlists for organ transplants. In the USA, more than 108,500 patients with malfunctioning organs are listed on the list for organ transplantation in 2010, including heart, kidney, liver, lungs, pancreas and cornea, exceeding the number of patients on the waiting list from 1990 by 5 times. The waiting time for a liver transplant averages 26 months; for a lung, it can be nearly three years. Similar data can be obtained for many other countries. They reflect a permanent need for human organs for transplantation. Due to the lack of human organs, patients die while on the waiting list, as

ISSUe - 22 2010

sional arrangements of functioning tissues and blood vessels are promising techniques for further improvements. Bioengineers currently work on regenerating organs from tissue by using stem cells and appropriate 3D-biodegradable scaffolds. An organ fabricat¬ed from the recipient’s own cells could be made to order and would not face the risk of immune rejection.

“These organs would be available on demand and thereby overcome donor organ shortage,” says Harvard Medical School’s Harald Ott. Future innovations for medical devices will have to centre on technologies that enhance quality-of-life for patients with organ failure. Non-invasive sensors for the analysis of physiological patient functions, miniaturised medical devices that are easy to wear or systems for personalised healthcare are examples for further developments.

References are available on www.asianhhm.com

Joerg Vienken is a chemical engineer with a doctoral degree in Biophysics & Engineering. He currently works as Vice President ‘BioSciences’ at Fresenius Medical Care in Bad Homburg, Germany with special and global focus on biomaterials, medical device technology, and artificial organs.

www.asianhhm.com

39

Facilities & operations management

Designing the Hospital of the Future in Times of Economic Uncertainty In these best of times and worst of times, design decisions need to be made based on credible data supporting their impact on both building performance and clinical outcomes.

Bill Rostenberg Principal, Director of Research, ANSHEN+ALLEN, USA

40

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

I

f Charles Dickens were alive today he might describe the current circumstances surrounding healthcare and medicine as both the best of times and the worst of times. In these best of times we live amidst unparalleled medical technology prolonging our lifespan, repairing injury and disease, and regenerating ourselves from fatigue and illness. In these worst of times – and contrasting with the everinspiring miracles of modern medicine – many individuals, businesses, municipalities and even entire nations now find themselves amidst global economic uncertainty. As worldwide financial partnerships continue to bring together individuals and communities across the globe, a monetary malady for one has a piercing impact on many others regardless of distance or nationality.

So how do healthcare leaders make informed decisions about designing the hospital of the future? Is it better to err on the side of financial minimalism, even if it means forgoing the possibility of enabling the next big cure? Or instead does one create facilities that mirror the seemingly limitless capacity of tomorrow’s science and technology in order to fully leverage the once-in-alifetime opportunity to build anew?

The answer is less about which of these two approaches to follow and more about how to make informed decisions regarding admittedly unknown futures.

Intelligent decision-making will be

ISSUe - 22 2010

aided by relevant data that substantiates the impact that our buildings have on both clinical and operational outcomes.

Such data can be found by examining five pairs of attributes that should form an integral part of any successful ‘hospital of the future’.

These attribute pairs are: Sustainability and Evidence Based Design Throughput and Safety First Costs and Life-cycle Costs Robust Flexibility and Economic Right-Sizing Technology and Humanity Sustainability and evidence-based design

Fortunately, acquiring pertinent data that informs decision-making is closely associated with two of the most significant drivers currently shaping the design of tomorrow’s healthcare facilities: sustainability and evidence-based design. While sustainability strives to improve building performance as it relates to our physical environment, evidence-based design strives to improve building performance as it relates to clinical outcomes. An example of sustainable design might include the use of radiant heating and cooling systems, which reduce the building’s energy consumption and carbon footprint as compared to other heating and cooling systems. Similarly, an example of evidence-based design might include

Facilities & operations management

Figure 1: Multi-scanner MRI suite at Cleveland Clinic designed for safety, efficiency and patient dignity. Anshen+Allen (A part of Stantec), Design Architect; Bostwick Design Partnership, Architect of Record. © 2010 Anshen+Allen

the use of HEPA filters to reduce nosocomial infection rates.

Inherent in both design processes – sustainability and evidence-based design – is the collection, analysis and interpretation of data. Energy usage, quantities of material waste and water consumption are common sustainable metrics. Infection rates, changes in patient lengths of stay (LOS), and frequency of injuries and errors are common evidence-based design metrics. While it may be easy to design a hospital that is either sustainable or exemplary with regard to evidencebased design, tomorrow’s hospital of the future must excel in both without compromising either.

Throughput and safety

As healthcare providers continue to be challenged by unremitting pressure to increase daily throughput, be it seeing more outpatients in clinics or conducting more procedures with fewer staff and faculty, the risk of medical errors, safety accidents and personal injury to both

staff and patients escalates proportionately. Therefore, design decisions affecting either of these issues should be made together.

For example, most new imaging devices – such as CT and MRI scanners – are capable of unprecedented scan speeds. CT scanners can perform a head to toe full body scan in less time than it takes the patient to get on and off the table. MR scanners can acquire more data in a few minutes than a radiologist can interpret in an entire day. However, along with this speed come potential risks. If adequate support space and staff are not provided (such as higher ratios of holding beds and radiologic nurses) the throughput capacity of the scanner will never be realized. If visibility of patients by technologists, nurses and physicians is not carefully planned, the potential for accidents related to electro-magnetic or radio-frequency interactions will be even greater as patient throughput increases.

Figure 1 illustrates a multi-scanner stateof-the-art neuro-imaging suite designed

to maximize visibility while also maintaining patient privacy and confidentiality. The design of this space exceeds many requirements of the American College of Radiology (ACR) guidelines for MRI safety.

First costs and life cycle costs

Using the previous example of MRI safety as a case in point, how does one decide on the cost-effectiveness of any design decision? How much of a cost premium for increased visibility is too much? How much space should be allocated for a procedure room, if a room larger than the code minimum can lead to both safer outcomes and the opportunity to perform more complex procedures?

Too often, first-cost decisions – such as maintaining the construction budget for a new building, and life-cycle cost decisions – such as reducing ongoing costs related to errors and injuries – are not the responsibility of the same individual. Thus it is essential that design

www.asianhhm.com

41

Facilities & operations management

Figure 2A: Section through Interventional floor at Palomar West Medical Center with wide span truss and living roof. Anshen+Allen (A part of Stantec), Associated Architect; CO Architects, Architect of Record. © 2010 Palomar Pomerado Health

decisions affecting first costs and life-cycle cost be made in unison. Data supporting first cost decisions, such as the cost of materials and labor are straight forward and relatively easy to obtain. In contrast, life-cycle cost data may be less obvious and more difficult to acquire. Life-cycle costs may be influenced by future building operational efficiency; staff efficiency; the various costs related to injuries and errors; and might include possible litigation costs. With the growing concern for hospital safety, such as new legislation in which reimbursement is withheld for “never events” (specific detrimental outcomes caused in the hospital), it is now even more critical to integrate the costs related to future life-cycle operations with first costs when making key design decisions.

Robust flexibility and economic right-sizing

Sustainable design philosophy suggests that buildings are right-sized for their intended use. For example, components of the heating, ventilation and air conditioning system should be optimally sized – neither too large nor too small – for the anticipated size of building for its intended use. Yet, evidence-based design and common wisdom tells us that the use of the hospital of the future will constantly change and that any disruption to ongoing services necessary to accommodate change should be avoided.

Therefore, two distinct approaches to flexibility must be incorporated into

42

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

the hospital of the future: right-sizing of building systems, and strategies for adding additional building systems capacities without disrupting ongoing services.

First, design decisions that provide future flexibility but do not inherently add cost should be incorporated in all cases. For example, the strategic coordination of building systems (structural columns, mechanical chases, stairs and elevators) that places ‘fixed vertical’ elements in such a way that they yield various opportunities for unencumbered internal renovation provides flexibility with little or no construction cost premium either initially or over the life of the building.

Next, a series of optional decisions – such as wide-span structural systems, increased floor-to-floor heights, excess Figure 2B: Floor plan of Interventional floor at Palomar West Medical Center with courtyards day-lighting interior of peri-operative suite. Anshen+Allen (A part of Stantec), Associated Architect; CO Architects, Architect of Record. © 2010 Palomar Pomerado Health

ISSUe - 22 2010

air, power or vibration-resistant capacities, or building shell space – should be carefully analyzed considering both their initial cost premiums and their potential lifetime savings. Only in this way can effective informed decisions be made to determine if these optional features should be provided. Such decisions should be based on more than just cost. The quality of care, staff recruiting and retention, as well as the mission and goals of the hospital may heavily influence such decisions. Figure 2 illustrates the design of a hospital that incorporates both approaches to flexibility: the strategic integration of building systems plus a wide-span structural systems.

Technology and Humanity

Living in these “best of times” amidst unparalleled medical technology it is easy to lose sight of designing humane healthcare environments. The hospital of the future should leverage the very best of our technology – medical technology, information technology and building technology – but also assure patients, families and care providers their dignity, privacy and respect. Daylight and views to outdoors are essential, but must be incorporated in ways that do not compromise efficient and safety-related clinical adjacencies such as increasing the travel distance between operating theaters and pre-operative and post-operative holding

Facilities & operations management

beds. Figure 2, described above, demonstrates large strategically placed courtyards yielding natural daylight in the center of the surgical suite while also maintaining immediate adjacency between the ORs and recovery beds. In addition, the structural truss supports a living rooftop above the entire peri-operative floor. Portions of the living roof are accessible to patients and their families and the entire roof is visible from the nursing units above.

Another important component of a humane environment is artwork. In addition to its value in assisting wayfinding by creating recognisable landmarks to aid in navigating through what are often large and complex places, artwork supports one’s psycho-social needs of individual identity and helps create a non-institutional ambience. The hospital of the future should have some predetermined portion of the construction budget allocated to art. Many projects receiving public funding are required per their funding requirements to allocate a predetermined amount of that funding for art. Figure 3 is a publicly funded hospital in which 2per cent of the capital construction budget was allocated to art.

Conclusions

BIO

Figure 3: Entry lobby with artwork at Laguna Honda Hospital.

Anshen+Allen (A part of Stantec) and Stantec, Architects.

Author

The successful hospital of the future must consider both the capabilities of tomorrow’s technology and the ambiguity of tomorrow’s economic uncertainty. In these best of times and worst of times, design decisions need to be made based on credible data supporting their impact on both building performance and clinical outcomes.

Cost-effective design does not mean simply building smaller spaces with fewer amenities, it means providing an environment that is both sustainable and based on clinical best-practice evidence; efficient and safe; economical to build and affordable to run and maintain; right-sized yet able to increase its capacities; and leverages the best that technology has to offer while always supporting human dignity, privacy and confidentiality.

Bill Rostenberg is a Principal and Director of Research, Anshen + Allen Architects (part of Stantec). Bill has written numerous books and articles about healthcare facility design worldwide. He is a founding fellow of the American College of Healthcare Architects (ACHA), and has been awarded Presidential Citations, from the AIA/AAH for Extraordinary Service to the Profession. He is a recipient of the AIA/AHA National Fellowship in Health Facility Design.

www.asianhhm.com

43

When the future is uncertain and the going is tough

Choose very carefully Hospitals-Management.com is the online platform of choice for hospitals & healthcare industry decision makers seeking to create fruitful partnerships and stay abreast of the day-to-day developments in the healthcare industry.

44

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

ISSUe - 22 2010

Suppliers who made the right choice Bloodline S.p.A. +39 0535 660411 contact@bloodline.it www.bloodline.it

Gouri Engineering Pvt. Ltd. +91 9820183890, +91 9820995109 gouriengg@vsnl.net www.gouriengg.com

Narula Exports +91-11-2522 3873, 4246 3995 exports@medikraft.com www.medikraft.com

Classic Scintific +91 2525 260707 response@classicscientific.net www.classicscientific.net

Hanlab Corporation 81-31-956-8587 simpson@hanlab.co.kr www.hanlab.co.kr

Aloka ProSound Co, Ltd + 81-422-45-6049 mail@aloka.com www.aloka.com

Creative Contract (M) Sdn Bhd +60 03 3323 2698 , +60 03 3323 2081 info@medicos.com.my www.medicos.com.my

Hardik International +(91)-(2827)-293301 sales@hardikinternational.com www.hardikinternational.com

Pangiran Budi Services 0060-07-6621905 sirferoz.usmc@docemail.com www.alibaba.com/company/10723891. html

AMANCIO +91 265 2791585 amancio@amancioindia.com www.amancioindia.com

Cryoflex - Poland Sp. z o.o. + 48 22 3313750 info@matrum.com.pl www.cryoflex.com.pl

Anaesthaids +91 22 5695 2983 / 84 / 85 anaesthaids@yahoo.com www.anaesthaids.com

Deepee Cooling Products Pvt. Ltd. +91 261 3240528 info@deepeecooling.com www.deepeecooling.com

Apel Co, Ltd +81-48-285-2309 sales@apel.co.jp www.apel-jp.com

Dometic S.àr.l Medical Systems 00352 92 07 31-1 medical.systems@dometic.lu www.dometic.lu

Apex Biotechnology Corporation +886 3 5641952 info@apexbio.com www.apexbio.com

Elekta AB +46 8 587 254 00 info@elekta.com www.elekta.com

APS-Medical +61-7-3888 2910 admin@apsmed.com www.apsmedical.com.au

Eurosets S.r.l. +39 0535 660311 info@eurosets.it www.eurosets.it

Aster Medispro Pvt Ltd + 91 80 41107321 info@astermedispro.net www.astermedispro.net

Evolution Medicals +91 121 2647112 info@evolutionmedicals.com www.evolutionmedicals.com

B. E. Smith Inc. 001-913-752-4528 ckrause@besmith.com www.besmith.com

Faber Medi Serve Sdn Bhd 603 -7620 0000 www.mediserve.com.my

Accurate Scientific Instruments +91 250 3200308, 65078576 accurate_scientificinstruments@hotmail. co.uk www.asilab.net Advanced Health Care Resources +91 11 40513538 ahcrpulse@gmail.com www.pulselith.com

Banyan Hope Sdn Bhd +603 2117-5360 info@banyanhope.com www.banyanhope.com Binary Spectrum +91 80 40576000 / 41152069 info@binaryspectrum.com www.binaryspectrum.com Bio-Care Medical Systems +91 9225126483 / 9822992871 cleela_nsk@rediffmail.com www.indiamart.com/biocare Biometric Cables +91 44 32 53 38 86 info@biometriccables.com www.biometriccables.com

Faith Biotech + 91 11 29819429 ba@faithbiotech.com www.faithbiotech.com Fotona d.d. + 386 1 500 91 26 info.medical@fotona.si www.fotona.eu Gambro Asia Pacific 00852 2 5762688/28397030 Inquiry.General@gambro.com www.gambro.com Global Medisafe Holdings Pty. Ltd. +61 2 4926 2811 marketing@globalmedisafe.com www.globalmedisafe.com

Hospaccx India +91 98452-08778 / 99028-61413 manish_rastogii@rediffmail.com www.hospaccxindia.com Hospital Designers & Developers India Pvt Ltd +91-120-4315155 hddipl@satyam.net.in India Medico Instruments +91 11 23861125 / 23867945 imi@indiamedico.com www.indiamedico.com Komal Health Care Pvt Ltd (India) + 91 22 2810 6666 sales@komalhealthcare.com www.komalhealthcare.com Lifecare Surgical +202 638 75 13 lifecaresi@lifecaresi.com www.lifecaresi.com Medi World +91 44 28492257 / 28143138 sampathkumar25@hotmail.com Mediaid (Singapore) Pte. Ltd. 00656296 2881 www.mediaid.com.sg Medima Sp. z o.o. +48 22 313 22 66 medima@medima.com.pl www.medima.com.pl Messe Düsseldorf Asia Pte Ltd (65) 6332 9620 hospimedica-asia@mda.com.sg www.mda.com.sg

PhenixVision +82-31-735-0942 shkim@phenixvision.com www.phenixvision.com Primus Gloves Pvt. Ltd. + 91 48 42 41 3063 , 2413076 marketing@primusgloves.com www.primusgloves.com Qiagen Gmbh +49 (0) 2103-29-16221 bd@qiagen.com www.qaigen.com Radicare (M) Sdn Bhd (603) 2260 2020 www.radicare.com Radpharm Scientific +61 2 6251 6533 info@radpharm.com.au www.Radpharm.com.au Richard Wolf GmbH (0 70 43) 35-0 info@richard-wolf.com www.richard-wolf.com Ron & Baker + 91 171 2521212 sales@ronandbaker.com www.ronandbaker.com Rx Professions Pvt Ltd. +91 040-32428185 / 40418186 info@rxprofessions.com www.rxprofessions.com Saeplast + 354 460 5000 saeplast@saeplast.is www.saeplast.com

MFD Diagnostics GmbH +49 (0) 61 31 - 14 40 – 200 b.lecher@mfd-diagnostics.com www.mfd-diagnostics.com

SEED Healthcare Solutions Pvt Ltd. +91 20 25651178/79 info@seedhealthcare.com www.seedhealthcare.com

MOCOM Srl +39 02 45701505 mocomcom@mocom.it www.mocom.it

Shimadzu (Asia Pacific) Pte Ltd. +(65) 6778-6280 rgpal@shimadzu.com.sg www.shimadzu.com

Modcon FZ LLC 0097 14 25 82 592 info@modcon.ae www.modcon.ae

Smeg SPA +39 0522 821527 instruments@smeg.it www.smeg-instruments.com

Solvay Pharmaceuticals GmbH +49 511 8570 www.solvaypharmaceuticals.com Sorin Group S.p.A. +39.02.63321 Martine.konorski@sorin.com www.sorin.com Srishti Software Applications Pvt. Ltd. +91-80-41109060/61/62/63 vivek@srishtisoft.com www.srishtisoft.com Synthes Asia Pacific +61 2 9449 0400 www.synthes.com TM of Toha Kunststofftechnik GmbH 0049-551-50450-0 www.toha-med.de TRC Refrigeration Corporation +91-22-25280149 trc129@rediffmail.com www.indiamart.com/trcrefrigeration U&C Batteries Pvt Ltd. + 91-40-27757161, 66405969 pcmrao@ucbatteries.com www.ucbatteries.com Unomedical a/s Phone: +45 48 16 70 00 Web: www.unomedical.com Venus Remedies Ltd. 00-91-172-2565577,2561244 www.venusremedies.com Viasys Healthcare Inc. (610) 862-0800 www.viasyshealthcare.com Waves Surgicals +91 11 23693185 / 23693187 wavessurgicals@yahoo.com www.wavessurgicals.com ZOLL Medical Corporation +1-978-421-9655 info@zoll.com www.zoll.com

If your interested to advertised please contact: advertise@asianhhm.com +91 40 30455000

w w w. h o s p i t a l s - m a n a g e m e n t . c o m www.asianhhm.com

45

information technology

Connecting Knowledge

How IT solutions can enhance collaboration within healthcare organisations Just providing clinicians with IT systems does not enhance their ability to collaborate. Clinician collaboration does not readily lend itself to the static methods on interlocution presented by many IT solutions.

Werner Van Huffel Industry Technology Strategist, Industry Market Development Manager, Healthcare and Social Services Public Sector, APAC region, Microsoft Corporation

A

s a Health Informatician the beauty of writing about this subject is the wealth of knowledge available in the literature regarding this area of study and implementation. In fact, the main problem I faced was using field experience to winnow away the chaff – mostly advertising

46

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

ISSUe - 22 2010

whitepapers – to get at the crux of the matter and answer two primary questions: What is' and ‘Where do you’ find knowledge in a healthcare organisation? and What does collaboration mean?

You would think that these are easy

information technology

questions to answer but I have found over time that they have an extensive number of solutions with which can be addressed – it all depends on your perspective and needs at the time you answer.

A small qualitative study was conducted into the views on knowledge and collaboration held by people working in health and IT (in the case of IT, both health and non-health individuals were interviewed). What I found was that even today – with the intrinsically embedded IT in health – people still confuse knowledge and collaboration. More worrisome were the findings that there was little understanding of the forces driving healthcare knowledge dissemination within a healthcare organisation's care network.

So, in order to address the ‘How’ in the title I need first address the ‘Now’. I have tried to make this paper as rounded as possible and so, in the spirit of “evidence-based medicine”, I am using peer reviewed material wherever possible.

What on earth is ‘Collaboration’?

For instance, Figure 1 (below) represents active (interpersonal) collaboration in action. In the same scenario a care team member may participate in passive collaboration through the action of someone or something unrelated to the immediate care team or knowledge-seeking activity. However, irrespective of whether it is active or

The word ‘collaboration’ has been bandied about for some time as marketing fluff, but what is it within a healthcare organisation in the real sense? When asked, both IT and clinical people tended to equate collaboration with working together – but when asked to give examples of what they meant by ‘[knowledge] Collaboration’ – the answers took on a different guise; one IT professional described collaboration as when ‘people get together to work on a document (say a discharge summary) together’, a clinician described it as when he ‘works with a lab in getting a test done’. One of the most interesting results from this simple study was the emergence (based on examples) of two themes of collaboration; ‘Active Collaboration’ and ‘Passive Collaboration’. In ‘Active Collaboration’ you go out and get the knowledge you want or need and in ‘Passive Collaboration’ knowledge is received tangentially while you are looking for it (possibly) via a different method to the one you were using.

The ‘Now’ of Connecting Knowledge

In 2007, an Informatics study, by Westbrook (WESTBROOK, et al. 2007), demonstrated the knowledge-seeking between roles of people involved in the provision of care in a healthcare organisation. Though conducted in Australia, the study holds true for healthcare organisations overall in the present process structure of care provision.

From this and many other studies into socio-technical aspects of healthcare IT, we can clearly see that knowledge effectively resides in the people that comprise the overall care team. But we know knowledge does not only reside with people. Knowledge can also be stored in such media as journal articles (Parker and Coiera 2000); it can be created by research; it can be derived from historical review and it can be kept as long as it is relevant. The reason this study, and others like it, are interesting to us is that, while it was conducted from the perspective of the clinical professional, it represents a great model from which to derive the ‘How’ while demonstrating the ‘Now’.

passive there are four generic attributes to any collaboration: If it can be accepted that collaboration is made up of these attributes then the area and value in which IT can enhance collaboration, thereby connection knowledge in healthcare organisations, is greatly increased.

Figure 1: Used with approval from Prof J. Westbrook (PhD)

1. There needs to be some form of agreed outcome related to the action of exchange.

Something to exchange

An agreed outcome

Some way to exchange

Entities to exchange with

2. Something needs to be exchanged, 3. What we are exchanging needs some way to be exchanged, 4. We (usually) need at least one other “thing” (person or machine) to exchange with

www.asianhhm.com

47

information technology

The many levels of IT enhancement of collaboration

There can never be a definitive guide to the possible ways to implement IT with respect to collaboration. The issues presented to IT by health fall into a sociotechnical category of ‘Wicked’ systems (Rittel and Webber 1973) while the way in which IT usage is distributed within healthcare organisations follows the curve of near-classical innovation diffusion (Rogers 2003). So, really, all we can do is look at one possible solution space. To make matters easier to represent we can simplify a typical knowledge-interaction scenario to the following: In this scenario we are primarily interested in solutions that allow care teams and individual cares to collaborate and how knowledge repository collaboration capabilities. It is only after we IT solutions for enhancing interclinician collaboration

Just providing clinicians with IT systems does not enhance their ability to collaborate (Coiera 2000). In fact, clinician collaboration does not readily lend itself to the static methods on inter-locution presented by many IT solutions. Interclinician collaboration is best done in an ad hoc manner. The best example of this that I have seen is in the area of Telemedicine and the use it makes of video-conferencing. But clinicians being able to talk to one-another via a web-cam, though interesting is not half as vital as them being able to just find

have dealt with these that we can look at consumer-provider (patient-clinician) collaboration solutions. Please note; even though healthcare is ‘patient-centric’ in everything it delivers and does, healthcare organisations are inherently ‘Clinician-

2

3

1 2

each other. This is where we see the IT solutions around the concept of “presence” being used to great effect. Presence is a uniquely technological solution to running around (either metaphorically or physically) looking for a colleague or care team member. What presence does is tag individuals, usually via their user name and role, and allows other (authorised) individuals within the healthcare organisation to observe their (personally allowed) availability. By combining the solutions of video-conferencing with presence capabilities, a uniquely IT enhancement to inter-clinician collaboration can be achieved.

IT solutions for enhancing knowledge retrieval and deposition

Figure 2: An example of a clinically relevant generalised search

48

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

centric’. This is not to say patients are not important, it is just that the reality of IT in care is in providing facilities to enhance provision of care and, for the purposes of this paper, it is the clinician who sits at the center of this provisioning.

We know, from both research (Chen, et al. 2003) and active experience, that there is a knowledge burden placed on clinicians – both to create new knowledge and retrieve established practices.

Here too IT solutions can enhance the inter-clinician collaboration in unique ways. The most basic form of current knowledge retrieval is they web-search.

However, a data-vomit of information,

ISSUe - 22 2010

while visually appealing to many, is next to useless to a clinician who may have only seconds to achieve meaningful use from the question posed. To this end, IT solutions are able to employ intelligence algorithms which are able to return more meaningful results.

However, as with all solutions within IT, such algorithms are only as good as the data available (deposited) and the knowledge used to create them.

To achieve a more consistent and viable knowledge base, IT needs clinicians to enter acquired knowledge accurately and with the least impact to work practices. How this can be achieved varies in as many ways as there are individual clinicians. For the purposes of maintaining the word count we will only look at the acquired knowledge that needs to be connected in a health organisation that relates to the recording of care directly by clinicians – the clinical notes.

The first thing to understand is that clinical notes are not a recording of diagnosis alone. They are the summation of the knowledge obtained by clinicians in the course of engaging in the provision

www.asianhhm.com

49

information technology

50

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

way, whether knowledge is recorded on a memory stick or paper or a Word document, it is always retrievable by a search system.

Conclusion

BIO

Collaboration in healthcare organisations is a vast area of concern and this article has only been able to [briefly] address the highest levels of the solution space. The area of IT solutions is so vast and moves so fast that what is described above is, in many respects, legacy before it is read about. For instance, as this article was being written a new method of

Author

of care for an individual (patient). Just providing the ability to record a diagnosis is not good enough in the provisioning of an IT solution. Such systems only provide a data point and have little or no relevance to connecting knowledge in healthcare organisations. What IT is able to do (but rarely implemented in this way to achieve) is to allow the clinician many modalities within which to enter information. For instance, one clinician may prefer to dictate their notes while another may prefer to scribble on some paper and yet a third may like to type. All knowledge thus created needs to be assimilated into a constant format for query and retrieval.

Most advanced IT solutions are able to employ voice recognition, optical character recognition and template driven capabilities to achieve a uniformity of stored information (usually as text with links to the original material). In this

ISSUe - 22 2010

interaction was being developed – that of the implementation of collaboration centered on immersive interaction with PACS systems. Though not strictly connecting knowledge and enhancing collaboration in the sense described above, it is only a matter of time before someone (either IT or clinician) finds a way to take this new solution and apply it to the issue of collaboration. The ability for IT solutions to enhance collaboration and drive knowledge connection is healthcare organisations is floating is a sea of opportunity – it all just depends on your perspective.

Werner Van Huffel is the Healthcare industry technology strategist in the Healthcare and Social Services team for Public Sector in Microsoft Asia Pacific. Based in Singapore, Werner specializes in Healthcare integration implementation and architectures and is involved in standards groups including HL7, CCOW, openEHR and others.

Events Email: eio-info@candc-group.com URL: www.excellence-in-oncology.org

Risk and Patient Safety 2010 Date: Nov 25 - Nov 26, 2010 Venue: Church House, London, England, United Kingdom Email: keren@healthcare-events.co.uk URL: www.healthcare-events.co.uk

Hospital Date: Oct 05 – Oct 07, 2010 Venue: Lenexpo Exhibition Centre, St.Petersburg, Russia Email: med@primexpo.ru URL: http://hospital.primexpo.com/

7th World Stroke Congress Date: Oct 13 – Oct 16, 2010 Venue: COEX Center, Seoul, Korea Email: stroke2010@kenes.com URL: http://www2.kenes.com/stroke/pages/home.aspx

Joint International Evidence Based Healthcare Conference 2010 Date: Oct 27 - Oct 29, 2010 Venue: Adelaide Convention Centre, Adelaide, South Australia Email: conference@aomevents.com URL: http://www.alloccasionsgroup.com/EBHC2010

HIMSS Asia’10 Date: Oct 28 - Oct 29, 2010 Venue: Daegu, South Korea Email: syeo@himss.org URL: http://www.himssasiapac.org/summit10/index.aspx

The World Health Care Congress Middle East Date: Dec 5 - Dec 7, 2010 Venue: Abu Dhabi , United Arab Emirates Email: Jon.Stock@worldcongress.com URL: http://www.worldcongress.com/events/HR10004/ index.cfm

Arab Health Date: Jan 24 – Jan 27, 2011 Venue: Dubai International Convention & Exhibition Centre Email: simon.page@iirme.com URL: http://www.arabhealthonline.com/

HC2011 Date: Apr 5 – Apr 7, 2011 Venue: Birmingham, UK URL: http://www.hc2011.co.uk/

National Healthcare Conference 2011 Date: March 24, 2011 Venue: Burlington Hotel Email: info@nationalhealthcare.ie URL: http://www.nationalhealthcare.ie/

CleanMed 2011 Hospital Efficiency 2010 Date: Nov 2 - Nov 3, 2010 Venue: Kuala Lumpur, Malaysia Email: enquiry@iqpc.com.sg URL: http://www.hospitalefficiency-asia.com

MEDICA 2010 Date: Nov 17 – Nov 20, 2010 Venue: Düsseldorf Trade Fair Centre, Messeplatz, 40474 Düsseldorf, Germany Email: info@medicacongress.de URL: www.medica-tradefair.com

Excellence in Oncology Date: Nov 18 - Nov 20, 2010 Venue: Hilton Hotel, Athens, Attica, Greece.

Date: Apr 6 – Apr 8, 2011 Venue: Sheraton Phoenix Downtown Hotel, Phoenix, Arizona Email: pdiamond@igc.org URL: http://www.cleanmed.org

World Congress of Nephrology 2011 Date: Apr 8 - Apr12, 2011 Venue: Vancouver, Canada Email: info@wcn2011.org URL: http://www.wcn2011.org/

European Medical Travel Conference 2011 Date: Apr 27 – Apr 29, 2011 Venue: Barcelona, Spain Email: chairman@emtc2011.com URL: http://www.emtc2011.com/

www.asianhhm.com

51

Connecting diagnostics, connecting information, connecting the dots

O

ver the past few years Inverness Medical has steadily expanded and we have added new products and healthcare services to our portfolio, resulting in a multitude of well known brands including BinaxNOW®, Clearview®, Determine® and Triage®. In order to realign with our strategy, to bring healthcare closer to the physician and patient, the company has decided to bring most of our products and services together under a single global brand, creating an identity that is easily recognisable to our customers - Alere “Alere” is a Latin verb meaning to nurture, to care for, or to support. It reflects our focus on delivering people-centered, smart and productive healthcare solutions. As a company focusing on improved quality of patient care, the name “Alere” clearly conveys our goals. The range of AlereTM innovative products and services will allow healthcare decisions to be taken at the point-of-care and cover a range of health areas including infectious diseases, cardiology, oncology, drugs of abuse and women’s health.

Over the coming months you will see brands including BinaxNOW®, Cholestech LDX®, Clearview®, Determine®, Panbio® and Triage® transition into a single global brand, AlereTM.

Cardiology Alere has recently announced the launch of three new next generation products; Troponin I - a single-analyte, improved sensitivity Troponin I (TnI) test, Cardio2 - a two analyte panel consisting of the new Troponin I and BNP as well as Cardio3 - a three analyte panel

consisting of the new Troponin I, BNP and CK-MB. These improved tests allow for earlier detection of even lower levels of TnI which improves outcomes and benefits the patient, the hospital, the physician office laboratory and the cardiologist.

These new tests represent the further evolution of Alere’s market leading Triage cardiac testing solutions. These test utilize enhanced TnI sensitivity enabling measurement down to the 99th percentile, a recommendation found in emergency department, cardiology and laboratory guidelines.

By offering this improved sensitivity troponin assay on panels that simultaneous test other cardiac markers at the Point of Care, these products will allow emergency physicians to make better chest pain/shortness-ofbreath patient disposition decisions much more rapidly.

When used in a rapid serial draw algorithm, the panel results can identify healthy patients earlier, allowing them to go home sooner and physicians to focus their time on only those patients in greatest need. All three products are designed for use on the Triage Meter.

“Alere continues to demonstrate its commitment to improving patient outcomes through the development of ever more powerful tools for the Point of Care”, said Tom Parenteau, Senior Director of Global Product Marketing. “We’re extremely excited to bring such innovations to the cardiovascular diagnostics market, ones which enable physicians to make faster and better informed decisions about their chest pain patients”.

The products bear the CE Mark, which expresses conformity with the requirements of the European IVD Directive and allows distribution within the European Union. The tests are now available for commercial sale in Europe, Australia and New Zealand and will soon be available in many other countries around the world. A timeline for US availability will be established shortly.

Blood-borne Pathogens Alere has also recently launched the new Panbio® Dengue Early Rapid immunochromatographic test for the early detection of dengue infection. Designed for

52

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

ISSUe - 22 2010

fatal if not identified and therapy administered in the early stages For more information about PanbioÂŽ Dengue from Alere, please visit: www.panbiodengue.com

HIV Diagnostics

use in conjunction with other dengue serology tests, the Dengue Early Rapid test can help to diagnose active dengue infection from the very first day fever appears. In facilitating early diagnosis, therapy and monitoring can begin much earlier, reducing the risk of severe complications such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS).

Detecting dengue NS1 antigen in serum, the Dengue Early Rapid test is able to provide a specific diagnosis of dengue infection in 15 minutes following an easy three step procedure. This is especially valuable in areas where diagnosis could be confounded by serological cross reactivity. There are four distinct dengue virus serotypes (DEN -1, -2, -3, -4) which are immunologically related and can all cause dengue fever. Although related, the four serotypes do not provide cross-protective immunity against each other, resulting in patients in endemic regions often having more than one infection during their lifetime.

The risk of DHF rises substantially with second or subsequent infections, further emphasizing the need for early diagnosis that enables early treatment and care.

Endemic in 124 countries, the dengue virus is carried and transmitted by mosquitoes. Typically, dengue fever is a non-fatal febrile illness characterized by fever, muscle pain, headache, and nausea and vomiting lasting 5-7 days. The more severe manifestations of the disease, dengue hemorrhagic fever and dengue shock syndrome, can however be

One major area of focus for us at Alere is HIV infection.

HIV remains an important public health issue that continues to demand constant evolution of testing technologies and testing algorithms, as well as sustained funding and involvement of laboratories.

Combined HIV antigen and antibody tests (4th generation) enable earlier detection of HIV infection than that afforded by antibody-only-tests (3rd generation). Rapid 4th generation screening tests designed for use at the point of care, have not been commercialized until now. The Alere Determine HIV 1/2 Ag/Ab Combo immunochromatographic rapid test enables simultaneous differential detection of the HIV-1 p24 antigen, as well as antibodies to HIV-1 and HIV-2 in human serum, plasma or whole blood.

Compared to 3rd generation assays, Determine HIV 1/2 Ag/Ab Combo improves upon the detection of HIV infection by detecting the presence of the viral antigen before the appearance of antibodies. Due to separate signals for HIV-1 p24 antigen and HIV antibodies, the test enables rapid detection of acute infection cases. Moreover, Determine is engineered in a robust and easy-to-use format for performance anywhere in the world, including areas where well equipped laboratory infrastructures are limited.

Advertorial www.asianhhm.com

53

54

A si a n H o s p i t a l & H ea lt hcar e M an age me n t

ISSUe - 22 2010

ClassifiedAds

Innovative Sterilisation Equipment Established in 1980, by a group of engineers and scientists, Gouri Engineering Private Limited has established itself as a reputed name over the years in machine- design, innovative products and technology, taking them from concept to commercialization for industry and research purposes alike.

One of the several accomplishments of GE in last three decades has been development of superior alternatives for imported products that are used for Infection Control. These include electrically operated fogging machines, pneumatically powered fogging machines, pneumatically powered surface disinfectors and other customized sterilization equipment, specifically developed considering the needs of the Pharma, Biotech, Life sciences, Tissue Culture, Aeroponic Agriculture & Healthcare industries.

Gouri Engineering has won the National Award for R&D from the Government of India and has been recognised around the world for its innovative and path breaking technology developments.

Gouri Engineering Pvt. Ltd

Plot No.49, Road No.3, Sector 1-S, CIDCO Industrial Area, Behind CIDCO Office, New Panvel - 410 206 Tel: +91 99300 67090 / 98201 83890, Telefax: +91 22 27455856 E-mail: innovations@gouriengg.com / gouriengg@gmail.com Visit us at: www.gouriengg.com

Manufacturers of World Class Critical Refrigeration Equipments Deepee offers better quality Critical Refrigeration Equipments since 1980 for Blood Banks, pharmaceutical, Biotech and clinical research companies and chemical research laboratories for safe storage of blood and its components, vaccines, biological tissues, samples, cell cultures, chemicals and other temperature sensitive drugs & materials. As a result of field trial & testing and engineering expertise DEEPEE has introduced most energy efficient refrigeration equipments with state of the art technology from + 22 deg. C. to -150 deg. C. DEEPEE manufactures Blood, Pharmaceutical and Laboratory Refrigerators, Cryoprecipitate Bath, Refrigerators and freezers for Mobile Application, Platelet Incubator & Agitator, Programmable Refrigerated Centrifuge, Snap(Blast) Freezer, Plasma Thawers, Plasma Freezer -40 deg. C., ULT Freezers -86 deg. C. and Cryogenic Freezers upto -135 deg. C. DEEPEE also offers custom configured equipments as per specifications and automation required by customer. We take pride in our workmanship and feel confidence you will experience years and years of trouble free round the clock operation.

DEEPEE COOLING PRODUCTS PVT. LTd C-1/6230, G.I.D.C. Estate, Road No. 62, Sachin-394 230.

Surat. Gujarat (INDIA).

Tel. +91-261-3240528.

E-mail- info@deepeecooling.com, deepee6230@yahoo.com

Manufacturers of World Class Healthcare Narula Group, established in 1953 is an ISO 9001:2000 & ISO 13485:2003 and CE certified company enhancing the healthcare facilities. We are the leading manufacturers, exporter of Hospital furniture’s, equipments, medical disposabels and having presence in overseas markets of SAARC, CIS, ASIAN, AFRICAN, Gulf, and European Continent.

Narula Exports has its credit in furnishing various hospitals on turn-key basis. We have been awarded various contracts of World Bank, UN Aided, and Red Cross Projects.

We are registered with United Nations Global Market Place (UNGM) and United Nations Procurement Divisions (UNPD) for the medical supplies of products.

Narula Exports

(An ISO 9001:2000 / ISO 13485:2003 Organization) Narula's Tower I - 25, Central Market, Punjabi Bagh West, New Delhi - 110026, INDIA Ph: +91 11 2522 3873 Fax: +91 11 2522 8702 Email: exports@narulaexports.com Website: www.narulaexports.com

www.asianhhm.com

55

Products&Services

Company

Page No.

Diagnostics Shimadzu ...............................................................................05 Alere....................................................................................OBC3 Healthcare Management Messe Dusseldorf....................................................................33 Srishti .....................................................................................49 Alere....................................................................................OBC3 Shimadzu ...............................................................................05 Acuis.................................................................................... IBC2 IQPC........................................................................................15 Technopak ..............................................................................27 Information Technology Srishti Software.......................................................................49 Alere....................................................................................OBC3 Medical Sciences Acuis.................................................................................... IBC2 Dometic . ................................................................................50 Greiner bio-one .......................................................................13 Shimadzu ...............................................................................05

SuppliersGuide

Technology, Equipment & Devices Greiner bio-one .......................................................................13 Mocom . .................................................................................39 Dometic . ................................................................................50 Dynamed ................................................................................21 Schneider...............................................................................IFC1 Company

Page No.

Acuis.................................................................................... IBC2 www.acuis.net Alere....................................................................................OBC3 www.alere.com Dometic . ................................................................................50 www.dometic.lu Dynamed ................................................................................21 www.dynamedindia.com IQPC........................................................................................15 www.healthcareinformaticsasia.com Greiner bio-one .......................................................................13 www.gbo.com Messe Dusseldorf....................................................................33 www. mda.com.sg Mocom . .................................................................................39 www.mocom.it Schneider...............................................................................IFC1 www.schneider-electric.com Shimadzu ...............................................................................05 www.shimadzu.com.sg Srishti Software ......................................................................49 www.srishtisoft.com Technopak ..............................................................................27 www.technopak.com

To receive more information on products & services advertised in this issue, please fill up the "Info Request Form" provided with the magazine and fax it, or fill it online at www.asianhhm.com by clicking "Request Client Info" link.

1.IFC: Inside Front Cover 2.IBC: Inside Back Cover 3.OBC: Outside Back Cover

www.asianhhm.com

1

www.asianhhm.com

2