asia’s first monthly magazine on The Enterprise of Healthcare
eHealth Magazine
volume 9 / issue 04 / april 2014 / ` 75 / US $10 / ISSN 0973-8959
Inside Blood Banks
The Red Market of India
RIS/PACS
Taking the Center-stage
Dr Naresh Trehan
Rock of Gibraltar ehealth.eletsonline.com
volume
09
issue
04
ISSN 0973-8959
Contents
Special Focus
12- MEDANTA- Abode of Rapid Strides in Healthcare Dr Naresh Trehan, Chairman and Managing Director, Medanta- The Medicity
in persion
16- NHM is so Ambitious that
you can never achieve it Dr AK Mahapatra, Director, AIIMS, Bhubaneswar, Orissa
cover story
20- Blood Market of India 23- Cumulative Approach
towards safe Blood Transfusion in India Dr Prashant Pandey, Consultant, Dept Transfusion Medicine and Blood Bank, Jaypee Hospital
26- Accreditation Ensures
Quality Dr BK Rana, Joint Director, NABH
Pathology, Laboratory Medicine, Medanta-The Medicity
AB Sivasankar, VP, Sales and Marketing, Telerad Tech Pvt Ltd
34- India has Decentralised
44- Telemedicine may slowly
tech trend
46- Difficult to be Paperless
Blood Banking System Dr (Brig) Anil Khetarpal, Artemis Medicare Services Limited
Trends, PACS will stay
without Integrated RIS/PACS Pradeep Achan, Co-Founder and CEO, Amrita Technologies
Vivek Kumar Verma, Business Head, Siemens Healthcare
48- Healthcare IT market will
38- Among All Emerging
28- Mission to serve the Needy
40- Quality Healthcare is High
30- Transfusion Center Delivers
42- RIS/ PACS is not Confined
Sudarshan Agarwal, President, Rotary Blood Bank
Novel Solutions Dr Vimarsh Raina, Director,
Replace smaller Clinics Sastradhar Reddy, Founder and CEO, MedPac Systems
Tech with Human Touch Madhav Chablani, Member ISACA’ External Advocay Committee
to Radiology
continue to grow in the Next Decade Dr Ashish Dhawad, Founder and CEO, Medsynaptic
50- PACS Evolution has
Broadened its Application K Raghava Ram, Director, Crane Global Solutions Limited
Specialty
52-
Each Child Deserves Attention Dr Vijay Yewale, President, Indian Academy of Pediatrics
54- Today toddlers Bounce
back from CHD Dr Vikas Kohli, Director and HOD, Pediatric Cardiology, BLK Super Specialty Hospital
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asia’s first monthly magazine on The Enterprise of Healthcare volume
09
issue
04
april 2014
President: Dr M P Narayanan
Partner publications
Editor-in-Chief: Dr Ravi Gupta
Editorial Team
WEB DEVELOPMENT & IT INFRASTRUCTURE
Health Sr Assistant Editor: Shahid Akhter Correspondent: Ekta Srivastava governance Sr Correspondent: Kartik Sharma, Nayana Singh Research Associate: Sunil Kumar education Sr Correspondent: Mohd. Ujaley, Ankush Kumar Correspondent: Seema Gupta
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ICE Connect Assistant Editor: Rachita Jha Correspondent: Veena Kurup Sales & Marketing Team Assistant Manager: Vishukumar Hichkad, Mobile: +91-9886404680 (South) Manager - Sales: Douglas Digo Menezes, Mobile: +91-9821580403 (West) Subscription & Circulation Team Sr Executive - Subscription: Gunjan Singh, Mobile: +91-8860635832 Design Team Assistant Art Director: Shipra Rathoria Team Lead - Graphic Design: Bishwajeet Kumar Singh Sr Graphic Designer: Om Prakash Thakur Sr Web Designer: Shyam Kishore Editorial & Marketing Correspondence eHEALTH - Elets Technomedia Pvt Ltd Stellar IT Park, Office No: 7A/7B, 5th Floor, Annexe Tower, C-25 , Sector 62, Noida, Uttar Pradesh 201309, email: info@ehealthonline.org Phone: +91-120-4812600 Fax: +91-120-4812660 ehealth does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. ehealth is published by Elets Technomedia Pvt. Ltd in technical collaboration with Centre for Science, Development and Media Studies (CSDMS) Owner, Publisher, Printer - Ravi Gupta, Printed at Vinayak Print Media A-29, Sector-8, Noida, UP, INDIA & published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP, Editor: Dr. Ravi Gupta © All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic and mechanical, including photocopy, or any information storage or retrieval system, without publisher’s permission.
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editorial
Indian Blood banks Organized and yet complicated India, a country which has an enormous growth in population and economy both, still suffers the shortage of blood leaving several questions. Unlike western countries, voluntary blood donations in the country reflect abysmal figures. Some modern blood banks in the country have arisen and have come a long way in filling this gap and improving the awareness and importance of voluntary blood donations. In this light, this issue is an attempt to highlight the current state of blood banking in the country with a focus on the operations of NABH, standalone blood banks & most modern blood bank. The objective of the story was to find out about perceptions of the medical professionals about the process of blood donation and blood banks. Today, efficient blood banking requires around 30-40 big regional blood centers, which facilitates world class, economical and provide safe blood components to meet the requirements of blood of the entire region. The need is to set up a nationwide network of regional blood centers that are capable of collecting, processing, testing, storing and distributing maximum number of units of blood per annum. Ever wondered, why India tops global list of 1st day deaths of infants? or why India accounts for 20% of all maternal deaths worldwide? Today we witness , almost 2 million children under the age of 5 dying every year and another 1 million being disabled for life. It is time to pause and ponder over the health of our children. What makes our children so vulnerable? We talk to the President of the Indian Academy of Pediatrics to know more about the initiatives taken to scale down this unacceptable figures that put us to shame. This issue also focuses on the most common birth defect – Congenital Heart Disease.
Dr Ravi Gupta ravi.gupta@elets.in
april / 2014 ehealth.eletsonline.com
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news
High Rate of Strokes Underline Need for Setting Up of Rehab Centers Developed countries have a system where stroke patients are sent straight from hospital to rehabilitation centres. Stroke rehabilitation centers typically provide the patient comprehensive rehabilitation including occupational therapy, physiotherapy and speech therapy under one roof, pointed out the expert neurologist. The three-day ISACON 2014, organised by the Kerala Association of Neurologists, focuses on prevention of stroke, advances in its medicine and rehabilitation of stroke survivors. P.N. Sylaja at the Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST) here, said SCTIMST is making an effort to train primary care-givers in rehabilitation of patients. “Time is a major factor. The brain gets damaged in about four and a half hours after the brain attack. So we need to start the treatment within this golden window period,” said V.G. Pradeep Kumar of Baby Memorial Hospital, Kozhikode.
Tripura Continues to Lead in Voluntary Blood Donation Tripura Chief Minister Manik Sarkar revealed that his state continues to be in the lead in voluntary blood donation in the country for a sixth consecutive year “Of the total requirement of blood during the current financial year (2013-14), 99 percent was collected through voluntary donation till last month. With the end of the year (financial year) in March, it would be 100 percent,” Sarkar said at a blood donation camp organised by the Agartala Press Club. According to National Aids Control Organisation, only five states in India have the distinction of over 80 percent blood collection through voluntary donation against the national average of 55 to 60 percent. The states are Tripura, Tamil Nadu, West Bengal, Punjab and Maharashtra. Saying that the voluntary blood donation movement became a festival in Tripura, the chief minister urged young people to generously donate blood to save lives.
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Few Takers for Healthcare Issues in this Massive Elections Health has failed to pick up as an election issue in India despite the country having overwhelming concerns over the quality of its delivery systems. While Congress sources said that its manifesto would promise universal healthcare and free medicine for the poor, a BJP spokesperson refused to commit anything about what the party promises to do on the health front. Last year’s economic survey pointed out that India has the lowest health spend - 4.1 percent - as a proportion of its GDP. Despite this, 70 percent of the population spends from its own pocket. Even the private plus government spending is abysmally low compared to other nations. While the United States spends around 15.2 percent of its GDP on health, France spends 11.2 percent and Britain 8.4 percent. Countries like Brazil and South Africa spend around nine percent. It is estimated that in India, spending on healthcare forces 39 million people each year into poverty.
India is a Healthcare Destination for Africans People from Africa come to Delhi not only for treatment; they also travel to other parts of the country as well. An official from Fortis Healthcare said the hospital chain also gets African patients at its Mumbai and Bangalore facilities, along with all its hospitals in Delhi and National Capital Region. Fortis has 65 facilities across the country. There is the flow of African patients in Ahmedabad in Gujarat and Aurangabad in Maharashtra. More than 50 percent of foreign patients coming to India are from the African region. We work closely with patients from their stay to visa to their medical treatment, we provide all services to get them best treatment available,” Edwige Ebakisse, director general, Emilie Health & Communication - a medical travel agency According to a report by the India Brand Equity Foundation, Indian healthcare revenues stood at $45 billion in 2012 and are expected to reach $160 billion by 2017.
news
Prescription Drug Abuse on the Rise in India: UN An independent UN body report says that prescription drug abuse is on the rise in India and that the situation is serious in South Asia where the soaring drug abuse problem includes abuse of pharmaceutical preparations comprising narcotic drugs and psychotropic substances. The International Narcotics Control Board (INCB), an independent UN body, monitors production and consumption of narcotics in the world. “Drugs enter South Asia’s illicit drug markets through different channels, including diversion from India’s pharmaceutical industry, illicit cultivation and/or manufacture within the region and smuggling from other countries, including Afghanistan (through Pakistan) and Myanmar,” the report said. Pharmaceutical preparations are diverted from the Indian land through illegal sources. India is trying hard but is not able to deal with this problem. These preparations are trafficked domestically or at international level, including through illegal internet pharmacies, the report said.
New Guideline for Thalassaemia in Pregnancy Announced New advice for clinicians on the management of women with thalassaemia in pregnancy, a condition that affects more than 70,000 babies worldwide each year, is published (28 March) by the Royal College of Obstetricians and Gynaecologists (RCOG) and launched at the annual RCOG World Congress in Hyderabad, India. Thalassaemia is a common inherited blood disorder caused by an abnormality with how the body produces haemoglobin, which affects the function of red blood cells in the body, leading to a red blood cell deficiency, or anaemia. While globally there are around 100 million individuals who are carriers, it is most common among communities with Mediterranean and Asian origins. There are an estimated 1,000 individuals affected by thalassaemia in the UK, with the Indian, Pakistani and Bangladeshi communities accounting for 79 percent of all thalassaemia births. The new guidelines stress the importance of a multi-disciplinary healthcare team, emphasising that women with thalassaemia should be assessed by a cardiologist or haematologist prior to and throughout their pregnancy to ensure maintenance of haemoglobin and to plan the pregnancy accordingly.
Credit to CGHS Beneficiaries in Empanelled Private Hospitals to Continue
There have been reports in the Media that private hospitals on the panel of CGHS are denying credit facilities to the eligible CGHS beneficiaries for delay in settlement of hospitals bills. 24 out of 407 Private hospitals empanelled under CGHS decided unilaterally to discontinue credit facility to the eligible categories of CGHS beneficiaries. Show Cause Notices stand issued to these Hospitals and the empanelment of five Hospitals has been suspended for a period of six months or till further orders, whichever is earlier. In this regard, the CGHS beneficiaries are advised not to be guided by misleading information as most of the private hospitals are continuing to extend the cashless facilities to the CGHS beneficiaries. The Ministry of Health and Family Welfare will ensure that the CGHS empanelled private hospitals continue to extend cashless /credit facilities to the eligible CGHS beneficiaries in compliance with the terms and conditions as laid down in the Memorandum of Agreement signed by them with CGHS.
High End TB Test now at Uniform Subsidized Rate Private labs in the country have introduced uniform reduced prices of a WHO approved Tuberculosis (TB) diagnostic test thus paving way for more patients access to one of the world’s most accurate and reliable TB tests. The gold standard for TB detection – the MGIT Liquid Culture will be available at a subsidized ceiling price of `900 (the maximum price laboratories can charge patients) at select labs registered with IPAQT (The Initiative for Promoting and Affordable Quality TB Tests), a coalition of over 60 private labs in India making WHO approved tests available at affordable prices to patients in the private sector. The cost varies between `1100 – `2000 in other private labs.
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special focus
MEDANTA
-Abode of Rapid Strides in Healthcare ‘ A world class healthcare facility at an affordable rate continues to be my mission,’ says Dr NareshTrehan, Chairman and Managing Director, Medanta - The Medicity. He discusses with Shahid Akhter, ENN, the gamut of technology and excellence in healthcare that makes Medanta a medical marvel and yet accessible to all
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You forayed into healthcare as a distinguished cardiothoracic surgeon and have carved a niche as a successful entrepreneur as well. Please tell us about your journey in these directions so far. After almost a decade of practice in the US, precisely, New York University Medical Centre, I returned to India in 1988 and helped in the establishment of Escorts Heart Institute and Research Centre (EHIRC) where I served as the executive director and chief cardiothoracic and vascular surgeon for two decades. For the next two years I served the cardio unit at Apollo Hospital and then I set out to realize my long cherished dream, Medanta – The Medicity. My forte is medicine and I am steadfast in my commitment as a doctor to deliver the best in healthcare. To wheel this idea, I hired the best of health professionals and opted for the latest in technology. It was and continues to be an expensive deal but I never compromised on quality. Have a look at the doctors that we have at Medanta and also the technology or the scientific advances that have been incorporated here. The equipments reflect my vision and the team of doctors have merged as an identity. Our priority is to deliver the best possible healthcare by serving the patients as best as we can and this is regardless of economic status or social class. People come to Medanta from all walks of life. Today, healthcare has emerged as mega business and corporate hospitals are emerging at an alarming pace. I don’t subscribe to this genre of business where the only consideration is supply and demand. Corporate hospitals have mushroomed and they work on a different parameter. To run our institution, we need revenue and this comes from the patients who are neither exploited nor fleeced. Money is an afterthought and it will come on its own.
For me it was a dream, rather a daunting compulsion to create a facility that could claim to be among the finest in the world. There are just a handful of institutions in the world that can claim to be like Medanta. Our next step would be to create a whole new standard of medicine for India.
How do you evaluate the progress at Medanta since its inception in 2009 ? Our growth has been phenomenal. Number of beds have increased from 400 to 2000. The array of equipments by way of volume and innovation has witnessed a sea of change. By way of technology, we stand at the highest level and this is an ongoing process.
“ In India, we perform more cardiac surgery than anywhere else in the world and we have better results than anyone else!� What is the concept underlying Medanta ? Any model that you emulate ? Besides the best of healthcare professionals, services and the maze of latest technology in medicine, Medanta also offers clinical research, education, development and training. There is a lot to be gained from traditional Indian herbal remedies and we continue to develop and explore newer therapies in medicine. We are keen to integrate modern and traditional forms of medicine. At Medanta you will find a lot in common with Mayo, Cleveland or Harvard and I aspire to go beyond. It will be a matter of pride to see India setting better benchmarks and offering the highest quality of healthcare by way of research, and teaching as
Alarming
Statistics Current projections suggest that India will have the largest cardiovascular disease burden in the world. Coronary heart disease is the most prevalent heart disease in India, contributing more than 95 percent of the total CVD prevalence. One fifth of the deaths in India are from coronary heart disease. By the year 2020, it will account for one third of all deaths. Sadly, many of these Indians will be dying young. Heart disease in India occurs 10 to 15 years earlier than in the west. There are an estimated 45 million patients of coronary artery disease in India. An increasing number of young Indians are falling prey to coronary artery disease. With millions hooked to a roller-coaster lifestyle, the future looks even more grim. Four people die of heart attack every minute in India and the age group is mainly between 30 and 50. Twenty-five per cent of heart attack deaths occur in people less than 40. Nine hunderd people under 30 die due to heart disease in India every day. Indian women account for 15 per cent of the global burden of heart disease which kills about 15 million people every year One in every 1,000 children suffers from congenital heart disease There appears to be a steady increase in hypertension prevalence over the last 50 years, more in urban than in rural areas. Hypertension is 25-30% in urban and 10-15% in rural subjects.
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special focus
Medanta – The Medicity A multispecialty medical complex, spread across 43 acres has 2000 beds, 50 operating theatres and over 350 critical care beds. Medanta offers the widest spectrum of clinical care, education and research Technology includes Cyberknife VSI, 256 Slice CT, Brain Suite, Hybrid Operating Suit, Da Vinci Robot, Artis-Zeego Endovascular Surgical Cath Lab, Linear Accelerators, Integrated Brachytherapy Unit, Alpha Operation Theatre, etc Fluoroscopic guided liver biopsies Video consultations from home Remote diagnostics at telemedicine centers Real time health monitoring through telemetry
well. We ensure that a patient is examined by all division heads, (depending on the complexity of the case). Any issue in any specialty is addressed by all chairmen to ensure that the best care plan is delivered to the patient.
What’s your vision for Medanta and how affordable it is for Indians ? The need of the hour is new and cost effective medicine that will impact the life of Indians at large. India is capable of delivering lower price due to abundance of cheap labour. Less than 10 percent Indians are able to afford the kind of medicine that we practice. When you compare costs between Medanta and US hospitals, we are charging just a small fraction. A great chunk of people in Asia and Africa can’t afford American medicine.
How do you see the development of cardiology in India and what to expect at Medanta ? Once upon a time, we used to prescribe medicines for valve and cornea heart disease. Those were the days
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“There is tremendous potential for telemedicine in a country like India where there are fewer doctors in rural and remote areas.’’ when we used to be helpless and a good many patients died. We knew about the availability of treatment but it was not available in India. A sense of frustration prevailed and this prompted me to train myself in the US as a heart surgeon. My mentor was Dr Frank Spencer who taught me at the NY University Medical Centre. In the recent past cardiac scenario has changed a lot and it is evident even beyond the metros and capitals. Heart attack is common and the treatment is simple but the problem begins when greed sets in and unnecessary tests or procedures are done. At times angioplasty may be necessary and at times not. Same with medicine – good and bad. The real problem in cardiology surfaces in cases that are complicated. At Medanta, the Heart Institute is a technological maze. The Heart Fail-
ure clinic is the first of its kind in this part of the world. The three dimensional cardiac mapping using Carto technique and myocardial scar identification by NOGA enable our electrophysiologists to perform the most complicated RF ablations with ease. Besides, we have early heart disease detection program and community outreach programmes.
How telemedicine can improve healthcare ? What initiatives Medanta has taken in this regard? Telemedicine has very huge potential but as of now it seems to be in a nascent stage. No less than 90 per cent of the diseases can actually be treated or diagnosed with the help of telemedicine or video conferencing. Now things are taking shape. With ever evolving technology, it would be
easy now to connect and incorporate telemedicine over Skype or with advanced webcams. This will immensely help in connecting with the rural areas.
Medanta is known for its medical research. Please tell us about progress in this direction ?
Dr Naresh Trehan is the most prominent heart surgeon in the country. His cache of awards, accolades and recognition is simply unending and includes the highest honours including the Padma Shri and the Padma Bhushan . More than 35,000 successful heart surgeries is just statistics to a person who is still passionate, dedicated and keen to see India at the helm of global healthcare. His vision finds space in Medanta – The Medicity, a world class health hub with spokes that are simply milestones.
We have created the infrastructure for research but a good deal of it is dependent on government’s rules, guidelines and regulations. These protocols are not just time consuming and at times there is a shift in the authority that approves it. For this reason, many drug development or procedure development are not happening in India. We need a regulatory body in place. India has huge potentials but as of today we are doing as little as 2 percent of research in the world. We have the resources, we have the patients and therefore the need too is here. We are keen to bring a change by initiating institutions which will be licensed to carry on research. My particular interest is in Ayurveda and modern medicine – something new, innovative and has potentials.
What are the roadblocks and challenges in Indian healthcare ? Where do I begin! Primary health care facilities, government hospitals, medical education, health insurance, preventive care, escalating disease burden, the issues are simply endless. As of today, healthcare is more of disease management. We need to build our system from ground up to create a new blue-print of India’s healthcare. We have over 800,000 ASHAs (Accredited Social Healthcare Activists) in India, but they are ill trained and don’t have any medical expertise. Their costs are a huge burden on the exchequer and nothing gets accomplished in return. All we need to do is to upscale their skills so that they can be the eyes and ears of the healthcare system on the ground. They need to monitor hygiene and find
We need to “ decrease the disease burden. If we cannot even provide sanitation, clean drinking water and mosquito control to our people, the disease burden gets doubled.” out who in the community needs medical help. This will be a big help. Indian healthcare is akin to a puzzle, rather a paradox, be it medical education or hospitals or any vertical of healthcare. On one hand we boast of the best of hospitals, medical tourism and so on but is it available and affordable to Indians at large ? The answer is no, despite our medical costs being around one tenth of what is charged in the West.
How good is Medical Tourism ? Your suggestion to make India a healhcare destination. Call it medical value based travel rather than normal tourism. We have all the ingredients – well trained and talented doctors in almost all verticals. Some of the most acclaimed doctors in the US are from India ! What we charge in India is just a fraction of what one is expected to shell out in the US or West. A coronary artery bypass operation would cost around USD 40,000 in America, in Europe it may scale down to USD 25,000 and at Medanta, it would close down to less than USD 4000. Next we have the technology – some of the best that you can see anywhere in the world. Add to this, the potential of tourism in India People have already started pouring in and in big numbers The government simply needs to create and maintain the upright image that often takes a beating on this or that reason.
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in persion
NHM is so Ambitious that you can never Achieve it There is huge shortage of doctors and whatever we have, they are not inclined to serve in rural areas. Dr A K Mahapatra, Director, AIIMS, Bhubaneswar in an interview with Mohd Ujaley says “our programmes such as National Health Mission (NHM) are so ambitious that you can never achieve the target, when you are not able to provide even a single MBBS doctor to PHC, how can you provide 6 doctors to CHC?” Last year, when I interviewed you, things were on nascent stage for AIIMS, Bhubaneswar but now they have taken a shape and various projects seem to be underway. What have been major changes since we met last? Lot of things have changed and improved since we met last. Academically, we have three batches of 210 students. There are now two undergraduate batches of 50 and 100 students respectively and 60 students have been admitted in BSC (Hons.) Nursing. We have occupied entire medical college building and today we have 70 faculty members which are largest amongst all the new AIIMS. Also, we have started outpatient service and on an average, we are examining 350-500 patients every day in the morning OPD. We have also started afternoon OPD for patients who need special care especially in the cases of high risk pregnancy, fetal malformation and also we have many special clinics such as sleep clinic, pulmonary clinic, hydrocephalus clinic, epilepsy
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clinics, thalassemia clinic, glaucoma clinic, oculoplastic clinic, and retina clinic. These clinics serve to the patients who required dedicated effort.
centre in Tangi which is a tehsil in Khorda district. Therefore our faculties and doctors have been regularly going to RHTC and UHTC.
Lot of people in Odisha believe that AIIMS Bhubaneswar should take lead in reforming healthcare in the state and there should be more interaction between state healthcare centres with AIIMS, Bhubaneswar. Are you sending students and faculty members to local healthcare centres?
There is acute shortage of super speciality care in the state, especially in the case when a patient has to go for chemotherapy and blood transmission. How AIIMS, Bhubaneswar is going to improve the condition?
AIIMS is Government of India entity and bound by centre rules but indeed our impact is in and around Bhubaneswar and may be in longer run we can help in improving the healthcare service in the state by providing our expertise to all the state’s healthcare centres but larger policy decision has to come from state government. As far as student and faculty interaction is concerned, we have started sending our faculties and students to rural health training centre (RHTC), Mendhasar and also urban healthcare
I agree with you that lot of work has to be done for super speciality care. In Odisha, we have Acharya Harihar Regional Cancer Centre in Cuttack, but they don’t have anything – no oncologist, no linear oscillator, and no simulator and there is no dedicated cancer service. So, if a person suffers from cancer, he has to go to Delhi, Mumbai or Chennai. In June, we started day care centre of 10 beds and the centre has admitted more than 500 patients till 24th of December for chemotherapy, blood transmission, and for minor procedure after chemotherapy. The nurses and doctors are kept especially
Dr A K Mahapatra Director, AIIMS, Bhubaneswar
academic committee and yet to start Post Graduate courses, so how do you look at it and what is your own assessment of the progress? I cannot compare a six month baby with a 60 years old man. In one year time we have achieved lot of milestones. Last time when you interviewed me, we had no governing body, no finance committee, no selection committee, and no institute body, today all our statutory bodies have been created. We have not been able to start Post Graduate courses because our academic committee is not formed and as per AIIMS act, all the matter pertaining to finance goes to finance committee and academic matter goes to academic committee, and administrative matter goes to governing committee, so we cannot start any extra academic activities beyond the undergraduate education without having an academic committee.
How long it is going to take to form the academic committee or start PG courses?
for cancer patients in two shifts. Also in afternoon clinic we are doing special training for the cancer patient and giving our services to RHC’s, CHCs and PHCs for the students training and community care. Recently, we have purchased equipment of worth 30 crores which includes 64-slice CT, 5 ultrasound machine, digital radiography, endoscopy, slit lamp etc. This investment which was not available to us three months back will definitely help in improving the service that we provide to the people of Odisha.
There are well wishers you say AIIMS, Bhubaneswar in coming year will be ahead of AIIMS, Delhi, but you do not have
Today we have 70 faculty members which are largest amongst all the new AIIMS. We have started outpatient service and on an average, we are examining 350-500 patients every day in the morning OPD. We have also started afternoon OPD for patients
I am not sure about it, last time when I talked to Hon’ble Minister, he said that as per Medical Council of India (MCI) guidelines, at least three year period is required to start a Post Graduate courses after establishment of the medical college. However, I referred to AIIMS, Delhi which was started in 1956 and in the same year post graduate courses were also taken. I think it should be possible to simultaneously start graduate and post-graduate courses where the infrastructure is adequate and today our infrastructure is far better than infrastructure AIIMS, Delhi had in 1960s. After four year of its establishment, the total number of faculty was only 25 so if you compare today’s AIIMS, Bhubaneswar it is at least 20 times better than AIIMS, Delhi of 1964. When my professor P.N. Tandon joined in 1965, there was nothing, in fact one table was shared between
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in persion
beautifully organized well planned HIMS system. In fact in SPGI, HIMS system started in 1995.
There is hug shortage of doctors and whatever we have they are not very inclined to serve in rural areas. In such a scenario, aren’t the prgorammes such as National Rural Health Mission (NRHM) too ambitious when it says there will be six doctors in every Community Healthcare Centre while there are no MBBS doctors even at some places in Primary Healthcare Centers (PHC)?
We are deficient by one million doctors. The latest census says that we are enrolling 46 thousand students but that is nothing when you compare it with the requirements two Head of Department (HOD). At one side of the table Baldev Singh, Professor, Neurology and on the other side P.N. Tandon, Professor, Neurosergary used to seat but they did not give up. The necessary things for our people are to be positive. We should look at the future in a bright and positive manner, since all our negativity does not help us, how it can helps society.
The private medical institutes like Amrita Institute of Medical
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Sciences and Research Centre is using modern information technology tools like HIMS in a very planned way but that is yet to come to AIIMS, why there is delay in using ICT? We have a small telemedicine entre here but ideally the policy and programmes of using information technology should come through Ministry of Health, Government of India. The government has created a committee under the chairmanship of M C Misra, Director, AIIMS, Delhi to look at the modalities of developing IT infrastructure across six AIIMS under which there is HIMS (hospital information system) which will include e-library, e-finance, e-education, ejournal, so far we have not been able to decide whether it should be open access system or close access system. We have met three times for the HIMS, and we are exploring what should be the ideal system. AIIMS Delhi does not have the HIMS, on the other hand place like Amrita Institute of Medical Sciences and Research Centre and Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPI) have
This is the huge concern for healthcare administrator in the country. We are deficient by one million doctors. The latest census says that we are enrolling 46 thousand students but that is nothing when you compare it with the requirements. America has got five times more doctors than the India. We are really suffering from lack of manpower. On other hand it is quite contrasting that our programmes such as National Rural Health Mission (NRHM) are so ambitious that you can never achieve it. None of these programmes have delivered the way they were planned. India had a National Tuberculosis Programme(NTP) in place from the sixties, yet more than 2 million people suffer from tuberculosis and half of a million die. The best way forward is that we should produce manpower without going too much into intricacies of MBBS. We need to accept the reality that our MBBS doctor will never go to village and we can never fill our PHC by well trained allopathic MBBS doctors. Kerala and Gujarat have achieved the target because they filled all the peripheral post by Ayurvedic, Unani and Yoga doctors. It is better to have something than nothing. NHRM says 6 doctors in CHC but there is not even a single doctor. You are not able to provide one doctor in PHC and telling six doctors in CHC, it’s nothing but a big joke.
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lood is the liquid of life for each and every life form in this planet. Every 24 hours, the human heart pumps 36,000 liters of blood over a distance of 20,000 km through the blood vessels, pumping approximately 70 ml of blood with each beat. The heart beats approximately 35 million times a year, pumping one million barrels of blood. A kitchen tap would require to be put on for 45 years to equal the quantity of blood pumped by an average heart in a lifetime. Many time one may have heard the statement that it was not the accident that killed him, but the transfusion. The unchecked buying and selling of contaminated blood continues to take lives of numerous people, however healthcare industry in India is booming in the rapid manner. While corporate are making the country the best destination for medical tourism, government is promising lot about the role of technology being introduced in the healthcare sector. But the simple thing of blood transfusion still lacks proper watch and standards to be established and followed around the country. A multibillion dollar business or profession spread worldwide, blood transfusion industry in real sense is becoming a production industry with all the components of business. While, somewhere in our minds we fear calling it a business, so as to not annoy the donors and general population though these stakeholders are churning out big sum of money from this. In India we have the decentralized system of the blood transfusion system, with differing standards of services and quality in every state and periphery. They vary from large blood component centers of international standards to small blood banks, using whole blood only. A majority of the blood banks belong to the latter category with limited facilities to be able to adequately address quality
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The Blood Market of India Donating blood is a philanthropic act whose impact is immeasurable. Indians are by nature charitable, but where blood donation is concerned, it has yet to catch the fancy of the common man. Ekta Srivastava, ENN, finds out more‌ issues in testing. Upgrading them as part of modernization is bound them to raise costs, making them economically unviable.
Blood Administration We have four types of blood banks/ centers from the administrative point of view in India. They are managed by the public sector, Indian Red Cross Society (IRCS), non-government organizations (NGOs, on not for profit basis) and corporate or commercial
sectors. Roughly, about 55 percent blood banks are from the government sector, 5 percent from the IRCS, about 20-25 percent are from the NGO sector and the rest are from corporate or profit-making sectors. If we look into the government sector, blood banks are run by blood bank in-charge or Blood Transfusion Officers (BTOs) who takes care of regular administration under the guidance of the Medical Superintendents or the Director of that hospital. Many a times, the
head of laboratory or pathology also takes charge of the blood bank. If it is a medical college (government or private), usually the head of the department of Pathology takes additional responsibilities of the blood bank. There are about 40 blood banks in the country which are separated from the Pathology department as independent Transfusion Medicine (Immunohematology & Blood Transfusion) department where trained technical personnel take care of regular administration. In case of IRCS blood banks, there is a committee which ‘officially’ manages administration through the blood bank in-charge or BTO. However, there is always some control from the local or state-level IRCS in the management. In the fourth sector, i.e. in the corporate sector, management is in better hands. Because they have to manage mainly with a small number of family replacement donations, professional hospital administrators or experienced businessmen manage blood banks behind the scene.
World of Illegal Blood Trading
According to AIDS Action, this illegal trade of blood is not just a third world problem. This is a global, multi-mil-
lion dollar industry with China, Russia, India, Bulgaria and Africa taking the lead in this illegal and unethical business of life. Like kidney transplantation, human bone and child trafficking rackets, blood trade too runs deep into the system. Without doubt, this trade cannot flourish and be widespread in the country without the involvement and support of local agents, mafia, police, politicians, and many more unknown entities. Few months back during one of my investigation, I found several agents and professional donors in and around government set-ups like AIIMS, Safdarjung hospital, Ram Manohar Lohia hospital and many more. Mainly the victims of this cycle are slum-dwellers, daily-wage earners, migrating population, rickshaw pullers, and push-cart vendors, shelter-less youth, street kids, or just someone in need of quick money, who are easily recognized by the agents or the brokers. Shockingly, when authorities are adamant on the fact that illegal blood trading has been completely vanished from the country through stringent counseling and other way, getting any blood group in just Rs 3000 to Rs 3500 is not an easy task. While, just looking after these youngster who are ready to give blood at any time and not even aware of the test that are required before the donation and the number of donation in the month, there are commercial
blood donors (CBDs). One, who are well aware of the requirement for donating blood on a periodic basis and have been doing this for a long time,. CBDs are mostly unskilled people who get into this trade and stick to it as a job. They operate through middlemen or agents in contact with the hospital, clinic or pathology laboratory. Each CBD is bled more than five times in a month, and some are donating a number of times a week.
Illegal about the blood trade • Professional donors sell their blood, which is of very poor quality and can transmit very dangerous diseases to the recipient. It is illegal to take blood from any professional donor. • The moment the minimum basic rules of blood donation are flouted, it ceases to be the humanecompassionate act. When any trade violates the gazette rules and norms, it is illegal. • Indian Constitution: Article 21 under part III of Indian Constitution spells out that no person shall be deprived of his life. Safe blood transfusion comes under legal protection as it is life-saving and also fatal. • Drugs & Cosmetics Act: Human Blood is covered under the definition of ‘Drug’ under Sec. 3(b) of Drugs & Cosmetics Act, which establishes regulations for blood banking and transfusions.
NGO’s plan of action The most common reason is philanthropy. If an NGO wants to do philanthropic work in the medical field, usually they want to start a blood bank. Probably, blood bank runs on philanthropic voluntary blood donation and these NGOs want to supply blood at a cheaper price. They initially fail to realize that it is a branch of medicine which needs sophisticated equipment and highly skilled manpower. Many non-medical trustees or promoters do not realize that supply of safe blood is more important than giving free blood. When the nitty-gritty of the Drugs and Cosmetics Act comes, they fall back on a few known medical personnel for help. Others want to create blood banks as a base to start commercial ventures like plasma fractionation, or as a source for hyperimmune serum and other blood components for business.
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• The Consumer Protection Act of 1986 also covers blood as a commodity. • Indian Panel Code chapter XIV, sections 269 and 270 provide for protection against spread of infectious diseases due to negligent and malignant acts. • National Blood Policy: Additionally all aspects of blood donation, collection, storage, use, etc come under the purview of the National Blood Policy that strictly bans sale and purchase of blood. With the Blood banks and hospitals across India reporting an acute scarcity of blood after a Supreme Court order to ban payment to donors came into effect on 1 January 1998, the blood trade which was already a flourishing business went underground. With no alternate arrangement in place yet, to ensure regular supplies of blood, the government is forced to ignore the many illegalities that dangerously flourish around blood banks here and elsewhere in India.
Why is the blood trade thriving in India? India’s annual demand for blood is about six million units but blood banks manage to collect only about three million units each year. Nearly a third of this comes from paid (professional) donors. The recent ban by Supreme Court in 1998, stopping payment for blood donors has failed to stop the trade in blood and has driven these businesses underground, far away from the eyes of law and healthcare authorities. Blood trade in India is widespread and needs a lot more than Government machinery to tackle it. Some legislation is simply waiting to be made and need that extra push from the informed public. It makes a difference when each of us tackles it in our individual capacities. Lets discuss what these medical professionals think is the best way to curb this blood trade menace.
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Cumulative Approach
towards Safe Blood Transfusion in India
By Dr Prashant Pandey, Consultant, Department of Transfusion Medicine & Blood Bank, Jaypee Hospital, Noida
Dr. Prashant Pandey
Consultant, Department of Transfusion Medicine & Blood Bank, Jaypee Hospital, Noida
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lood transfusion may lead to serious clinical consequences for the recipient, if the transfused blood is not safe. In a country like India with more than 1.2 billion population, inspite of continuous improvement in criteria of donor selection and better screening methods for transfusion transmitted viral diseases (TTVDs), the transmission risk of TTVDs still remains a major concern here.
Challenges so far The prevalence of infections like HIV, Hepatitis C (HCV) and Hepatitis B (HBV) amongst the general population
is noted to be 5.7 million, 12 million and 40 million, respectively. In India, the burden of Hepatitis B carriers is approximately 10 % of the global burden which is unquestionably high. Amid these high statistics of disease burden, the transfusion of safe blood is the biggest transfusion challenge in India. The other reason why the “safe blood transfusion” has become a big challenge in India is the consistent lack of repeat voluntary blood donations. Thus, it is not only the high burden of HIV, HBV and HCV in general population but also the absence of safe repeat voluntary blood donors in Indian society has made blood
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transfusion a challenge, especially in patients who require multiple blood transfusions at regular intervals. The prevalence of HCV amongst Thalessemia patients is estimated to be as high as 45% while two other studies from the Western India have estimated its prevalence as 16.7% and 17.5%, respectively. The prevalence of transfusion transmitted HBV and HIV has been estimated as 2% each.
Towards achieving the “near zero” risk of TTVDs In the last one decade, voluntary blood donation in India has improved significantly but still the proportion of repeat blood donation is very small. It is still posing challenges to achieve “near zero risk” of transmission of TTVDs only with ELISA (Enzyme Linked Immunosorbent Assay), an indirect method of testing of blood donors where we need to wait for the production of viral specific antibodies (or release of viral antigens). The production of the viral specific antibodies (or release of antigens) to reach the detection limit takes several weeks from the date of initial infection. During this period which is called as “serological window period”, the risk of transmission of viral infections is very likely. None of the biological system is 100% effective and could bring the transmission risk of TTVDs to “zero”.
ID-NAT – Need of the hour To reduce the transmission risk of TTVDs to “near zero”, nucleic acid amplification testing (NAT) techniques have been implemented in major countries worldwide. This has remarkably reduced the window period of detection of viral infections and is equally able to detect both window-period infections and chronic carrier with low viremia. The state when ELISA demonstrates negative result while NAT shows positive result is known as “NAT yield”. Today, there are very few blood centres in India that are regularly performing NAT testing and are sharing
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“Absence of voluntary blood donors has made blood transfusion a challenge, especially in patients who require multiple blood transfusions at regular intervals their data and experience of NAT testing at various scientific forums and meets worldwide. The NAT testing in India has been praised extensively in terms of interdiction of TTVDs in serological window period wherein the data has demonstrated a very high yield rate of 1 in 1528. The other important aspects which can further enhance the transfusion safety are the real-time reporting of transfusion incidents and to make a uniform policy for transfusion transmitted disease testing countrywide. India needs to have an effective hemovigilance program for the re-
porting of transfusion incidents and it should be made mandatory to all. Thus the four aspects which can help to achieve the “near zero” risk of blood transfusion are as follows: • To increase the repeat voluntary blood donation • NAT testing of blood donors • Real-time reporting of blood transfusion incidents • Effective hemovigilance program at country level The Department of Blood Bank & Transfusion Medicine at Jaypee Hospital has a state-of-the-art facility for the testing of blood donors with both serology basis enhanced chemiluminescence method and ID-NAT for the detection of viral genomes. We also have a huge in-house donor pool of eligible blood donors who have voluntarily donated blood at various occasions and will further help to enhance the safety of blood transfusion. To enhance the accuracy, safety and efficiency, the transfusion services at Jaypee Hospital has a global standard for labelling of blood components empowered with an Information Standard for Blood and Transplant (ISBT-128). It is the global standard for the terminology, identification, coding and labelling of blood products.
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Accreditation
Ensures Quality
Dr B K Rana, Joint Director, National Accreditation Board of Hospital and Healthcare Providers India (NABH), in conversation with Ekta Srivastava, ENN, talks about the process and benefits of getting NABH accreditation among the blood banks Could you please give us the brief overview of the blood industry in India? It is highly collaborative. Licensing process is in place under the Drugs and Cosmetic Act. Every blood bank opening up needs to be licensed and the reason about 2500 blood banks are operating under license. But health being a state subject, the licensing authority comes from the Centre and the states. There may even be variations among the states for providing the license. The services of the blood bank may also vary; licensing requirement may prescribe the size of the room, the number of nurses and doctors. The structures are there, but when we talk about the outcomes, there are errors going on in blood bank. Sometimes there is no proper cross match of the blood or correct identification of the patient or no proper testing. All these put together leads to the problem. For last seven eight years, we in NABH have been trying to put a system in place in addition to what the Drugs and Cosmetic Act licensing requirements have.
How much is the NABH accreditation important for the blood banks after getting license from Drug Controller? The licensing is the minimum requirement; without license you cannot operate a blood bank. Accredita-
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Dr B K Rana Joint Director, NABH
tion requirements are built on those requirements. Then we have defined the additional requirements at different levels, like the management level and how it functions, how the responsibilities are defined, how the authorities are defined for the management and the technical officials, quality management, overall management of the system and of the organization. We have defined the requirement for different steps and processes being followed up in different blood banks – how to identify and recruit the donors, taking them on board, checking the donor for adequacy of the donor etc. Once the blood is collected, it is tested stored. According to the Act, certain essential items which to be tested during testing process. Some blood banks do tests over and above these to further ensure that the blood is safe. Storage is also critical because all blood components need to be kept within a certified temperature ranges. Then checking the patients who come for blood, whether they are the genuine one or not. Then comes the transport; care has to be taken that the blood does not travel far once it is issued, and the place it is issued for has facilities to store that blood. These are the things that we put in the accreditation requirement over and above the Drugs and Cosmetic Licensing Act requirements.
What benefits does a blood bank get after getting NABH accreditation? It’s like a third party attestation that you are doing well. It has been seeing that blood banks that have gone for accreditation have improved their system; they have streamlined their processes, the requirements, and minimized their errors. These things definitely help, because the standards define everything. They say you need to have a competent doctor, staff and adequate infrastructure. Adequate infrastructure means you need have to
have room maintaining certain temperature and humidity, equipments need to be maintain and calibrated and should be working as they are suppose to work. This gives confidence to the staff, management of the blood bank that they have system in place which actually keeps a check on them. If something goes wrong within the system, they can check it and control it. So there are many things which will be beneficial for the organization after getting accreditation.
How many hospitals are under NABH accreditation? We have received 75 applications since 2007, out of which 60 has been granted accreditation. But it is not growing at a
tories, which anybody can start. Here, you have to have a license. When we analyze the situation and talk to the blood banks, the management says they need it to have some incentive for doing it. We have to make them aware of the incentives like errors are minimized, the staff is motivated, the performance goes up, and in time, and wastage will be minimized. There are challenges or perception with blood banks, that it is an organization where the motive is not to make money. It is a service and you are not supposed to sell it. There may be some challenges for blood banks to come up with money for the accreditation, but we are trying to overcome this. We had a talk with NACO
“Corporate have a different business strategy while the government has different one. While the government is providing service, corporate have to make money. They need to make money to survive, while the government uses the tax payer’s money” very fast pace. We need to have more awareness and industry also needs to make people aware that you need to reach certain benchmarks, certain improvements through a system.
What are the major challenges that the blood bank industry in India faces in getting accreditation? Over the years, we have found that while blood banks have money, they claim they have it for applying for accreditation. It is probably because they don’t have encouragement or they don’t find value in it or we are not able to promote it. Otherwise it’s not as haphazard as other industries like hospitals, diagnostics and labora-
and that Ministry of Health that they should support blood banks.
How will accreditation of blood banks help the general public? We need to come together to make people aware. It’s not only the blood bank that needs to be made aware of accreditation but the patient too should go to blood banks that have accreditation or certification. The message should go to the blood bank and the stakeholders that we should promote quality. I am not saying that accreditation is one of the tools for making quality, but my request is that we should be focusing on the patient safety. Ultimately, what we are talking about is the patient.
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Sudarshan Agarwal, President, Rotary Blood Bank and former Governor of Uttarakhand and Sikkim hate the ‘MyBaap Syndrome’ in the government functionaries and hope to get the best from the government. In an interaction with Ekta Srivastava, ENN, this former Secretary General- Rajya Sabha, speaks about the role of standalone blood banks
Mission to Serve the Needy B
lood donation is harmless, painless and absolutely safe and is, in fact, good for health. Established in 2002, Rotary Blood Bank is the country’s one of the largest and modern blood bank with state-of the –art technologies and service for the worthy cause of voluntary blood donation. For this endeavour, the blood is assisted by the combined efforts of all its divisions, which include technical branch, information technology, motivation branch, issue counter, accounts, administration, stores and the support staff. There is a shortage of over 1 lakh units of blood for patients in
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Delhi and NCR itself. Many accident victims, innocent children suffering from thalassaemia, pregnant women, cancer patients and other people in life threatening situations die due to shortage of blood. Rotary Blood Bank aims to meet the requirement of precious blood by organizing voluntary blood donation camps at education institutes, corporate offices and many other organizations and gatherings. RBB relies totally on voluntary donors and dispenses blood to those in need without asking for replacement donation. Voluntary blood donation is a selfless
service and an expression of love for mankind. Blood knows no caste, creed, colour, religion or race. The three suitably modified airconditioned vans fitted with couches to help conduct blood donation, wherever access to locations of organizations is difficult due to narrow approach roads or other administrative reasons. Additionally, the bank has a team of qualified and trained professionals who follow stringent screening procedures, careful documentation and Good Laboratory Practices for collecting, processing and testing blood.
Technology at Rotary Blood Bank
Blood has a Short Shelf Life
The RBB has invested in the sophisticated Blood Banking equipment and have qualified staff to run the Blood Bank. The single donation of 450 ml blood is separated into different components, benefiting as many as three patients. Blood is made up of different components and, invariably, a patient needs a transfusion of just a particular component. Utilizing whole blood is wasteful, and sometimes even undesirable. It is now the standard practice of all modern blood banks to separate blood into components and ensure the optimum utilization of this precious resource. Whole blood has cellular components comprising red blood corpuscles, white blood corpuscles, platelets suspended in plasma solution (liquid plasma consisting of water, electrolytes, albumin, globulin, coagulation factors and other proteins). It is needed when both red cells mass and total volume must be restored, as in massive hemorrhage.
All blood components have a short shelf life, creating the need for a constant blood supply. • platelets - up to 5 days • red cells - 42 days • plasma - up to one year
Red Cells The majority of donated blood goes to people with cancer, as well as people who have suffered traumatic accidents, burns or who undergo surgery.
Major Projects Thalassemia Thalassemic children have the same aspirations as any other child. All they want to do is play with their friends go to school and dream to be something big when they grow up. But what hinders their innocent goals is the fact that they are surrounded by needles when other children are surrounded by books and toys.
Young 25 Club It has been carrying out the crusade to create a regular and safe blood supply in Delhi and neighboring areas since 2002. Despite the fact that more and more people are now realizing the importance of donating blood, overcoming the acute shortage of blood requires stronger awareness measures. Young 25 Club is an initiative of the Rotary Bank with an aim to wipe off the scarcity of blood; to ensure
“I strongly believe that by devoting just a few minutes of your time you can make this possible. Let us together create a society where the life of every human being is important and where we can pride ourselves in being capable of saving the lives of fellow human beings
Plasma contains very important proteins, nutrients and clotting factors which help to prevent and stop bleeding. It is required in bleeding patients with coagulation deficiency problems secondary to liver disease, disseminated intravascular coagulopathy, Factor V or Factor IX deficiency.
Nature may have denied them what is rightfully theirs, but it is the lack of resources required for frequent blood transfusions and a dearth of quality blood that add to their misery. Even if doting parents manage to arrange blood for these children, their economic status may force them to discontinue treatment. Thus, many children from poor families die, and we do not even comprehend their loss.
Platelets
We Care
Platelets are used to help clot the blood and seal wounds in surgical and cancer patients. Leukaemia and chemotherapy treatments can reduce a patient’s platelet count. They are needed in cases of bleeding due to severe thrombocytopenia and prophylactic therapy.
At the moment, the only practical solution for survival of children with thalassemia major is multiple and frequent blood transfusion throughout life. Such a child needs one unit of blood every two to three months. This requirement goes up to two units of blood every three
Plasma
to four weeks. Rotary Blood Bank New Delhi has adopted children who are suffering from thalassemia. By doing so, the blood bank provides blood to these children free of cost.
availability of safe and quality blood round the clock; and to promote voluntary donation among the youth. The need of the hour is to create a motivated group of repeat donors who would pledge to donate blood regularly to overcome the severe shortage of blood supply. In India, people in the age group of 15-29 years comprise almost one-fourth of the country’s population. Young 25 Club aims to involve students/children in colleges, universities and educational institutes to motivate young volunteers as blood donors and to instill among them the value of saving lives by regularly donating blood.
Mission No one shall suffer in and around Delhi for want of Blood
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Transfusion center delivers novel solutions Dr Vimarsh Raina, Director- Pathology, Laboratory & Transfusion Medicine, ensures the quality blood bank at Medanta – The Medicity. In conversation with Shahid Akhter, ENN, he discusses the role of technology and the need for safety in channelizing the blood components Please tell us about the evolution of transfusion services in the Indian perspective? Blood banks are no longer dispensing windows for blood products created out of blood donated by healthy altruistic blood donors. A modern blood bank or transfusion service is an organized and yet complicated institution which not only converts voluntarily donated blood into blood components but is also having a very proactive role in therapeutics for critical illnesses like Myasthenia Gravis, Guillain Barre syndrome, Leukemia etc. A modern blood bank has a pivotal role in assisting the treatment of patients in multispecialty and super-specialty hospitals. No hospital handling critical and terminally ill patients can function without the support and services of an efficient transfusion service. It goes without saying that a modernized blood bank would have 100 percent blood component therapy, provide leuco-reduced blood products, have the safest possible chemiluminscense and NAT (Nucleic Acid
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Test)based technologies to ensure blood safety and also be able to provide blood support in situations where the patients are sensitized and hence may not be able to tolerate even the same blood group transfusions.
Blood banking in India is different from the US. What learning can we put to use from the West? In US, there is 100% voluntary blood donation at blood centers located in each city. After complete testing and component separation the blood is shipped to different hospitals based on requirement and from there, it is issued to patients. In India, there is a lot of impetus given to promote voluntary blood donations by various organizations, but still most of the blood supply comes from hospital-based transfusion medicine center, in terms of replacement donations, which is usually done by friends and relatives of patients. While some of the blood services in India may not be ideal, institutions like Medanta are proud to offer servic-
es and technologies which are at par with the best in the world. India has an annual demand of about 10 million units and a significant part of it comes from replacement (one time blood donors). The trend and public participation in enhancing voluntary, regular, repeated blood donations is very heartening, especially from the educated younger people, whom we see many times taking off from their busy lives to fulfill their social obligations like blood donation.
Blood grouping test is confined to routine ABO and RhD typing. What about others that are left out? Doesn’t this lead to complications? A good transfusion service is not confined to blood grouping and transfusion of same group compatible transfusions. A well established transfusion service would test each and every potential patient who may need transfusion support for antibodies by a group and screen approach. This ensures that not only would
we be able to provide blood efficiently and quickly at the time of an emergency but would also be able to pick up the difficult cases in advance and work them up for antibodies. Such patients would otherwise land up in extremely difficult and life threatening situations if the blood service is not able to provide compatible blood during an emergency.
Technological marvels and miracles are routine in healthcare? Have we made significant breakthroughs in Blood banking? In the last decade transfusion services has made more progress than any other branch of medicine. Due to the technological innovations in transfusion services we are able to perform solid organ transplants, such as kidney or liver transplants, between individuals from different blood groups. This is of great relevance to a nation like India where every year we have more than two lakh kidney failure patients needing a renal transplant but do not have access to a cadaveric donor or a family member who has the same blood group. In these situations a well equipped and experienced Transfusion Medicine Specialist can produce wonders by removing donor specific antibodies in the patient by doing plasma exchange prior to transplant. Some life threatening illnesses like Thrombotic Thrombocytopenic Purpura ( TTP ) which had a mortality of above 90 percent within with a week to ten days of diagnosis have a fantastic outcome today. Almost all patients diagnosed as TTP and who are treated by the transfusion medicine specialist with procedures such as Total Plasma Exchange (TPE) have a dramatic improvement and it is very gratifying to see the excellent outcome when you see a near dead patient walk out of your department hale and hearty within a week of the diagnosis.
“Providing the safest possible blood components is our main concern and duty. We add an extra layer of safety and security in blood testing. NAT (Nucleic Acid Testing), for instance, is used to ensure safety of blood components.�
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What strides have we made in stem cell harvesting, preservation and infusion? When we look at initial days, bone marrow was the only source for stem cell transplant. Today with Apheresis machines which are programmed for Peripheral Blood Stem Cell (PBSC) harvest, it has become relatively easy and less cumbersome doing a stem cell harvest followed by transplant. Compared to bone marrow harvest, PBSC harvest is easy to do, much more safe for the donor, we can harvest precise dose required for the transplant and also post harvest complications are bare minimum and comparable to a simple platelet harvest. These days the same PBSCs can be cryo-preserved for later use and with improved processing and storage techniques the patient outcomes have also improved. Stem cell infusion is given under very strict and personalized medical supervision. The patients who receive these infusion are under immune suppression and hence admitted in specialized rooms with HEPA filters and trained personal, round the clock. Utmost care is taken to keep the surroundings clean and sterile which has direct effect on the patient outcome.
What is the USP of the transfusion centre at Medanta? What sets it apart from others? The Transfusion Medicine Department at Medanta is unique in various aspects. We have a large team of highly qualified, dedicated and competent doctors who are available round the clock( 24 x7 x 365), are able to provide comprehensive services including • Blood component therapy and leuco-depleted products with log 4 reduction, which drastically reduces transfusion reactions in patients and prevents any graft versus host diseases (GVHD) and also to some extent prevents transmission of infections such as CMV.
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Specialised Programs Therapeutic Plasmapheresis Therapeutic Leukacytapheresis Therapeutic Throbocytapheresis Therapeutic Red Cell Exchange Stem Cell Harvest •
•
•
•
Providing the safest possible blood to patients by doing 100% NAT testing which markedly reduces Transfusion Transmitted Infections (TTI). Antibody screening for patients and providing corresponding antigen negative blood reducing incidence of hemolytic transfusion reactions. Therapeutic plasma exchange for various conditions including for ABO incompatible liver and renal transplant patients. Dedicated stem cell harvest and infusion team with inclusion of specialists from oncology, transfusion medicine and hematology.
What role does ICT play in the management of blood bank? ICT plays an important role in blood bank as it helps in improving efficiency levels and reducing chances of errors. Each donor is registered in HIS (Hospital Information System) at the time of donation and all the reports including blood group and infectious markers are updated. Once a donor is found to be reactive for any of the markers (HIV, Hepatitis B, Hepatitis C, Malaria and/or Syphilis), the HIS system will automatically block the same blood unit from getting issued. All the patient requests for blood are made through HIS and blood units are also issued through HIS. This helps in avoiding misuse of blood and a track can be kept for each and every patient.
What are the specialized programs in transfusion medicine at Medanta? Medanta is running Post graduate programmed in transfusion medicine popularly known as DNB (Diplomate National Board). Medanta is one of the few centers in the country to offer this course. Besides the department hosts regular seminars and courses for doctors across Asia for enhancing their skill sets.
How do you visualize the future of blood banks? I can see a paradigm shift in the blood banking. In all probability, in the near future blood (red blood cells) would no longer be coming from voluntary blood donors but would be a pharmaceutical product coming from dispensing pharmacies rather than the blood banks. Major advancements in nano technology and molecular medicine are expected to revolutionize organ transplant – both solid organ as well as bone marrow transplant and improve patient outcome. Blood banks would no longer be seen as just dispensing windows for blood products but would be playing a pivotal role in ensuring delivery of novel solutions such as dendritic cell therapies. The facilities and professionals in Transfusion Medicine would be playing greater role in health care than they are presently delivering, moving from support specialty to proactive participants in patient care.
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India has Decentralized
Blood Banking System With vast 39 years of experience as Head of Department, Pathology, in various army hospitals, Dr (Brig) Anil Khetarpal, Director- Blood and Transfusion Medicine, Artemis Medicare Services Limited, believes that India needs a central top of the knot regulatory body for the blood banks. In conversation with Ekta Srivastava, ENN Could you please give us the brief overview of the status of the blood bank industry in India? The blood bank industry in India is growing in a fast pace. Today people and society are aware of the fact that one can donate the blood if he is healthy and it will not cause you any harm. Secondly, India is a country where the longevity of the people are increasing , means that they are living for about 80-90 years of age, giving rise to lot of age related problems. Like Bypass surgery, lots of joint replacements, liver transplants and other things that happened in that age group, increasing the requirement for more and more blood. Now, beyond age group of 60 nobody can donate, but they are the main user of this. Cancer patients who are under chemotherapy also need a lot of blood. Every year we get outbreak of dengue patients where we need a huge amount of platelets. Ultimately, this consumption of the blood needs to get fulfilled by the society either voluntarily or by replacement to tackle such demand.
Illegal blood trading is also rising around the country in a big way. How do you think we can tackle this? We had a Supreme Court ruling in 1996, where it was decided that blood from the professional donor will not be
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Dr (Brig) Anil Khetarpal
Director- Blood and Transfusion Medicine, Artemis Medicare Services Limited
taken. And that is what we are sought of trying to aim at. When the donors come to us, we do lots of counseling, pre counseling before the blood is taken, to ensure that he is a healthy donor and genuine one. We thoroughly screen the donors, so illegal thing is the story of the past.
Few months back, during my some investigation I found these professional donors lying outside the government hospitals in Delhi and they are selling the blood say in `3000 and `3500 for a unit. These people will always make an attempt but it is up to the people taking care of the blood bank to ensure that these people do not become part of your donation process. This is what we are here to see. If you got stringent criteria of donor selection, there is no way that you will get mugged up by such people. Even if they try to come they will get rejected because the moment you start asking them question there will be the deviant. I think this is what all the blood banks should do; a perfect screening of the donors.
If a patient is a regular donor and suppose he suffered from some mis-happening, so still he/ she need a replacement donor? If he is a regular donor and he has donated it voluntarily. He is entitled to one unit of blood but if he has done replacement for somebody not donated then he needs to have replacement donor. There are two ways of getting blood either through voluntary donation or replacement donation. We are getting voluntary donation but majority are replacement donation.
What are the major challenges that blood bank industry is facing in India? One is the cost factor because once you have to increase the safety of the blood then you have to send it through various test processes. Cer-
tain people do only rapid test, which is less expensive, some are doing Enzyme Linked Immuno-Sorbent Assay (ELISA) which is more expensive then there is National Association of Community Health Centers (NACHC) testing where each NACHC testing cause additionally `1000. The more you try to improve the quality standard, more cost will be added. Same time, blood is something with which you cannot take chance, as you cannot afford to give infection to your own patients. This is a major problem with stand alone blood bank, which do not able to seek out to take care of the equality to that extent. Then there are three different agencies which are working for the blood banking management. First is Drug controller, which takes care of the licensing, second is the National Blood Transfusion Council under which there are many state blood
Please tell us the latest technology solution that the hospital has adopted .In what way they are helping in increasing the betterment of patients? Off late we have started with bone marrow transplantation and in last six months we have done more than 22 transplants. Previously, we took bone marrow from the bone but now we take it from the peripheral blood by apheresis, we have a cell separation machine where donor is attached to the machine, which is a six hour process. Then we are also in a position to give blood to the fetus, which is inside the mother’s womb. Sometimes this fetus become anemic due to RH disease, we provide the specialized kind of blood for such cases. This can be given under ultrasound guided manner. Other than that we are doing liver transplant especially for the patients
In last five years we have done almost 25,000 to 30,000 collections where only 2 samples are seen positive, these are the kind of screening we are doing councils, they provide the policies to the blood banking and tickle it down to the states. Third is NACO, which looks after the blood safety procedures. Now, issue with India is that we have very decentralized system, there is no one agency at the top who can take care of all the things. The reason you can see the mis- management in some of the periphery and stand alone blood banks. These Drug controller people are so over bounded with their work, they are not able to go and look after this wide area. Though there are rules and regulations given by the Drug controller but people are just following their own methods, making quality control different from one blood bank to other.
of medical tourism. Then anti-body screening that goes for grouping and cross matching, that we grouped the blood and cross match to the patient’s requirement. The benefit of this screening is that once you are undergone with this test then at the time of emergency, it just takes two minutes to give you the proper cross matched blood which will not get anti-body reaction from your body. Though it adds to the cost but we are doing this for the betterment of the patient’s life. Other then we are planning to use stem cell for regenerating in patients who have say liver sclerosis, chronic kidney disease, and respiratory problem, ulcers which are not healing and eye disease (which are age related) .
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Filming a Phenomenal Growth Story RIS/PACS have come a long way since they were a standalone solution to radiologist’s needs. Now they address the entire gamut of medical branches, helping in taking medicine to the poor andto promote medical tourism. Rajesh K Sharma of ENN takes a hard look at the sector
A
t the beginning of the century, the Indian healthcare story was a dismal one. It faced shortages of workforce and infrastructure. Total healthcare expenditure was just 4.3 percent of the GDP. But in the last decade, India’s health system has developed, aided by the government’s Millenium Development Goals (MDGs) that encouraged public sector efforts. The Eleventh Five Year Plan also brought about healthcare reforms. Encouraged by the government, even the private sector started investing in healthcare services. Many hospitals offering world class services sprung up, as did small and medium-sized ones that offered quality basic services. Around the middle of the new millennium, a revolution started brewing in India. This was the healthcare IT revolution. Hospitals and other healthcare institutes of various sizes began seeking the help of Indian IT, which had matured by then, in addressing their needs. They looked at IT beyond
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simply building a website and having a sophisticated payroll and ERP solution. The mundane tasks of the hospitals could also be addressed by IT.
HMIS Previously, big hospitals had sophisticated medical instruments and machines. They were out of the reach of the small and medium sized hospitals and clinics. Getting treatment at big hospitals was costly for the average Indian. But the growth of the healthcare sector had an emboldening effect, and owing to a growing prosperity and the confidence in IT, the smaller institutes started looking at IT to solve their issues. Hospital Management System (HMIS) successfully addressed their issues, integrating the various functions seamlessly and easing the medical, administrative, financial and legal burdens. A perennial issue of the hospitals was the radiology department, which usually had problems of storage as well as wastage. Radiology used up
lots of films for X-Rays and scans that need to be processed and stored, and had issues of availability. Patients, too had to carry around the films each time they visited a doctor, risking damaging the films.
RIS/PACS Radio Imaging Service (RIS) and Picture Archiving and Communication System (PACS) addressed the concerns of both, hospitals and patients. Used in advanced countries for a long time, RIS/PACS rode on the healthcare IT wave that swept India. Using a RIS/ PACS solution, a hospital or a clinic can take digital images of the patient and store them on a central server. This has reduced the redundancies of storage space required for the unprocessed and processed films. The patients too did not need to carry the films with them whenever they visited the physician. Though RIS/PACS involves huge one-time investment during installation, the benefits that it accrues in the
form of saving on films, storage, and improving the radiologist’s efficiency are immense. Hospitals and clinics are aware of these advantages and don’t hesitate while investing in a RIS/ PACS solution. The RIS/PACS sector has been incorporating the latest advances in technology, like cloud computing and telemedicine, improved digital imaging etc. From being used only in the radiology department, PACS has now extended its reach to other branches of healthcare that require imaging services. It has also helped in streamlining flow of information in a hospital. The economic boom has led to a mushrooming of hospitals and clinics of all sizes in India. Aiming to be world class, they try to incorporate the latest technology, which has led to many equipment manufacturers opening their shops in India. These manufacturers and resellers aim to cover all price points in selling their wares. Today, the RIS/PACS sector is highly competitive and closely fought. RIS/
“From being used only in the radiology department, PACS has now extended its reach to other branches of healthcare that require imaging services PACS manufacturers mix and match features to suit the needs of their clients. The growing use of RIS/PACS within the various departments in the hospitals has meant that even hospitals recognize the central role they will play in the future. The mushrooming of hospitals as well as recognizing the need for an
RIS/PACS solution by them has increased their demand that even the existing players cannot fulfill. The RIS/PACS market is expected to reach Rs 305.72 billion by 2018. This figure is enticement enough for the manufacturers to remain bullish. Teleradiology is being touted as a boon for Indian healthcare, since it can help take diagnostic care to remote locations. Government is promoting it, because it is easier to set up and is ably addressing the shortage of doctors in villages. RIS/PACS is playing a pivotal role in bringing diagnostic care to remote places through teleradiology. It has enabled city-based qualified and experienced doctors to attend to remote patients without leaving the cities. While on the one hand RIS/PACS is a boon to teleradiology and taking healthcare to remote locations, on the other hand, it has worked well the other way as well, as people from foreign places come to India for medical tourism. The government has recognized that India, with its abundant cheap labour and a highly educated middle class, is well suited as a medical tourism destination. People from foreign places come here for cost effective treatments. Radiologists use RIS/ PACS systems to do an early diagnosis of medical tourists via teleradiology. Patients convinced about the treatments later come to India. So, RIS/ PACS has an important role to play in bringing foreign capital to the country. eHealth first covered RIS/PACS in January 2008, when the India was relatively new to the technology. Since then we have featured this sector and the great strides it has made in the India healthcare market. India now is a playing field to many foreign as well as Indian RIS/PACS manufacturers. With RIS/PACS integrating the latest technological advances, the bouquet solutions available to those interested are immense. It is just a question of which to choose.
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Among all emerging trends, PACS will stay Vivek Kumar Verma, Business Head, RIS/PACS and Advanced Visualization, Siemens Healthcare talks to Rajesh K Sharma of Elets News Network (ENN) the growing adoption of RIS/PACS and advanced visualization in Indian hospitals What is the present state of RIS/ PACS segment in India? Are Tier II & III cities and smaller towns adopting these technologies? RIS/PACS primarily provides a platform for the automation and digitization of Radiology Patient Workflow, image viewing, archiving and distribution in a filmless environment.
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The RIS/PACS segment in South Asia is maturing gradually. Few government institutes and corporate hospitals are more focused on the Workflow Automation in Radiology Departments hence RIS/PACS implementations bring digitization into daily workflow. Tier II and Tier III are still to catch up for the RIS/PACS workflow,
but they have advanced in the adoption of advanced visualization for 3D pre-processing.
How important is pricing for RISPACS solutions, in the in Indian context? In Indian context, RIS/PACS have a major role to play in the overall digi-
How have advances like improved connectivity, cloud storage, Teleradiology impacted the RIS/PACS segment?
tization of the patient workflow in radiology departments to replace the paper-based manual workflow. South Asia being a price sensitive market, hospitals always look for cost effective solutions to improve their workflow efficiency. As we observed in the last couple of years, customers have invested more in advance visualization solutions than just simple RIS/PACS.
The advancement of Tele Radiology and cloud storage is highly dependent on the [increasing] connectivity and its [decreasing] costs. Hence, it is gradually helping in adoption of TeleReporting in emergency case.
Is RIS/PACS here to stay as part of the ongoing transformation of the healthcare segment?
How are government hospitals adopting these technologies vis-Ă -vis private hospitals? Large government institutes with dedicated Radiology Departments have been the early adopters of RIS/ PACS solutions and advanced visualizations, and are the trendsetters in the digitizing the radiology workflow. In recent times, private hospitals have
Vivek Kumar Verma
Business Head, RIS/PACS and Advanced Visualization, Siemens Healthcare
“Large government institutes with dedicated Radiology Departments have been the early adopters of RIS/PACS solutions and advanced visualizations, and are the trendsetters in the digitizing the radiology workflow also started adopting these solutions. Eventually, large hospital chains will push this sector’s growth.
What is the present scale of the healthcare technologies in the IT market? In Healthcare IT currently, global trends are adopting a client-server based advance multi-modality preprocessing, apart from archiving, distributing images and creating reports using RIS/PACS. This trend is being seen in India as well, as major institutes have adopted advance visualisation 3D pre-processing for faster and more accurate diagnosis for the increasing number of examinations done per day. Siemens has a client
server 3D advanced visualization and pre-processing solution called syngo. via platform. The syngo.via platform is helping the Radiology and Nuclear Medicine community to provide faster and accurate diagnosis and is leading the market in South Asia.
Are hospitals closer to improving their healthcare delivery by going all-digital and introducing RIS-PACS solutions? Hospitals have realized the need for workflow automation and are bringing in not only RIS/PACS solutions, but also, advanced 3D visualization pre-processing for faster diagnosis of routine and complex cases , as the key to improving the overall efficiency in patient care.
Among all the emerging trends, PACS is going to stay, but the speedy adoption of HIS (hospital Information systems), integrating RIS module into it has brought the PACS-HIS interface more in acceptance with reputed vendors. For hospitals with non-standard HIS, RIS integrated with PACS is still desired.
Please provide us an overview of the R&D at Siemens for the healthcare sector. Focusing on innovations in the Image Management and Reporting Solutions, Siemens is providing cutting edge solutions for various segments globally. As a result of R&D, the latest adoption of client server solutions for 3D pre-processing for multi-modality image reading and distribution is growing. Siemens is one of the leading companies in South Asia in healthcare imaging IT, covering RIS/PACS and advanced visualization for our customers.
What is your prediction for this market in the next decade in India? What are the growth contributors in the industry? Healthcare IT connectivity awareness is growing primarily due to IT awareness across segments with the mobile, tablet revolution in India, Tier II and Tier III markets also would adopt the benefits of RIS/PACS and advance visualization solutions for all segments including mobile applications.
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tech trend
Quality Healthcare is High-Tech with
Human Touch
Madhav Chablani, member of ISACA’s External Advocacy Committee and India Task Force talks about the expanding role of IT in healthcare, and its aim of unifying all aspects of healthcare to serve the patient better Growth of healthcare segment in the IT market Information is a key resource for National Healthcare Service, and from the time it is created till it is destroyed, technology plays a significant role. Information technology has advanced and is at the forefront of technology adoption in hospitals for providing highest level of patient care and safety, healthcare delivery and quality information to patients as well as all concerned external and internal players. With increasing information dependency and healthcare players not sharing information, the National Healthcare Service will be influential. Currently, all programs, directorates and states have their own IT solutions. These systems are not shared and complete information is fragmented. Coordination is lacking and is a major hurdle in providing quality information to improve decision making in healthcare sector. Standards for Information Architecture, Data Interoperability, National Disease and Service codes are lacking. Applications are not developed for National Healthcare Service but for the programs or enterprise. While designing a healthcare ar-
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formation, it is either not done or limited. The industry players are striving hard to achieve their strategic goals and realize healthcare delivery benefits through effective and innovative use of IT, while achieving operational excellence through reliable and efficient use of technology, at the same timecontaining IT-related risksto an acceptable level, and optimizing the cost of IT services and technology, and complying with ever-increasing relevant laws, regulations, contractual agreements and policies. It is becoming pertinent for healthcare organizations, for their IT governance and management needs and value delivery, to adapt business framework like COBIT 5 from ISACA.
Hospitals going all-digital and installing RIS/PACS solutions
chitecture, the focus should be on information exchange which flows down to all programs, directorates and state initiatives and systems that comprise the health system. While capacity building for healthcare IT change management is limited, for IT processes improvement and trans-
Technology is not a replacement for the human touch, but rather a powerful tool to increase quality and improve the patient care experience. Radiology has long deployed effective IT tools—RIS, PACS, voice recognition, 3D, enterprise storage and EMR— but now fiscal, political and demographic pressures are pushing departments, facilities and imaging centers to seamlessly integrate these
technologies to maximize productivity and patient outcomes. Another ingredient for thriving is a proactive technology vision and vigorous data mining and reporting. The epicenter is the radiologist, who needs the right information to flow instantly—as one open, unified,webbased view of the patient that includes images, relevant priors and current care data. But the whole operation must work with precision and speed. Ordering protocols must be set, scheduling must be efficient, patients need to move through the department quickly, comfortably and safely, and reports and images must be returned to referring physicians as quickly as possible. Tracking key metrics and adjusting to increase productivity and efficiency is becoming important. They are dissecting workflow, developing new processes and teaching employees to assist the department in reaching their pro-
multiple times, or re-identifying the patient, or dictating information the system already knows, or forwarding the images to multiple places. Also, the vendor’s product must be open to enable departments to plug in applications from other vendors or home grown applications seamlessly into it. It must be web-based, so that the radiologist can access his work from the hospital, home, imaging center, across town or across the world. One Patient means that the radiologist sees the “whole” patient. Hospitals and imaging centers consolidate images and reports across institutions and medical record numbers to present to the radiologist. The time is ripe for image exchange and single patient-jacket type offerings to put an end to the DICOM CD. It also means full digitization of a patient’s images—currently radiology and cardiology, but soon digital pathol-
ogists can form a virtual department that can read for many hospitals using sophisticated rules around turnaround time commitments, workload mix, specialty and credentials. The One Desktop, One Patient, One Community vision bringstogether many technologies that already exist, but also many thathave yet to become mainstream. I am convinced that effectively delivering in these areas will double the productivity that the radiology community is depending on to stay ahead in the constant demand of imaging.
The future of healthcare IT market and growth contributors Information is critical for informing the diagnosis and initiating therapy. We have to be ahead of the process and not behind it. We need to provide productivity and functionality that enable physicians to take care of pa-
With increasing information dependency and healthcare players not sharing information, the National Healthcare Service will be influential ductivity goals. Measure, learn, modify, and succeed.True, quality healthcare is high-tech with a human touch.
The role RIC/PACS plays in the transformation of healthcare I believe there are three main areas of initiatives that can enable this next significant leap in productivity, viz, One Desktop, One Patient and One Community. This brings together the information, workflow, and tools to allow radiologists to continue to practice high-quality healthcare with speed and precision, and IT solutions are the enablers of this vision. One Desktop means that the radiologist’s tools—RIS, PACS, voice recognition, enterprise storage, 3D and EMR—are seamlessly integrated so that the radiologist isn’t logging-in
ogy, visible light images, endoscopy movie files, all stored in a multi-purpose archive and plugged into the hospital’s EMR. One Community provides workflow tools to bring the healthcare community together. From the moment a physician orders an examination, the decision support that informs that order, the scheduling, the actual exam, the reporting system that effectively and quickly captures the radiologist’s diagnosis in text and discreet equality data using Natural Language Processing, and the channeling of the report, images, and any discrete results back into the originating physician’s EMR. Community workflow must bring radiologists together as well. With sophisticated dynamic workload allocation, radiol-
tients in a very efficient manner. Achieving maximum productivity among radiologists is a constant process that requires enterprises to juggle multiple inputs, include technology and processes. It is essential to plan each step and analyze its impact. A robust workflow image and information system portfolio provides a solid platform that not only provides features and functionality to maximize productivity, but also allows healthcare enterprises to further improve productivity We see too many independent vendors selling products that lead to loss of productivity for the radiologist, either because they don’t get integrated into the existing PACS or RIS, or require a different solution for almost every type of application.
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RIS/PACS is not confined to Radiology A B Sivasankar, VP, Sales and Marketing, Telerad Tech Pvt Ltd., talks about his company’s RIS/PACS solutions and also the industry outlook AB Sivasankar
VP, Sales and Marketing, Telerad Tech Pvt Ltd.,
How do you perceive the growth of the healthcare segment in the IT market? Healthcare IT in India is just starting to take off. This year, healthcare providers are expected to spend nearly $ 1 billion on IT products which will include hardware, software, internal and external IT services and Teleservices. Software, which consists of Hospital Information Systems (HIS), PACS, Electronic Health Records (EHR) and Mobile application services is expected to grow at 6 percent to reach around $ 101 million in 2014.
Please share your opinion on the importance of RIS/PACS in hospitals and their advantages over the traditional films. Just 25 to 30 percent of hospitals and diagnostic centers in India have RIS/PACS. Most medical institutes, even Post Graduate ones, do not have PACS. Creating awareness about the demerits of films and the cost benefits of using digital images, changing the physician’s views on digitization for better diagnosis, and a Government regulation for digitally storing patient’s medical records will go a long way in eliminating the tons of films used every day by healthcare providers and contribute to carbon credits. JCI accreditation and promotion of medical tourism will accelerate the adoption of PACS by hospitals. RIS/PACS will reduce
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costs and improve the treatment delivery.
How important is innovation in healthcare for customers in the growth markets? Innovation in healthcare adds a holistic dimension to business. Medical innovation contributes to society’s wellness, while increasing the innovator’s revenues. For example, by integrating audio and video platforms with diagnostic medical devices, telemedicine has given emergency medical facility access to remote villages lacking even basic healthcare infrastructure. It can also be used to train paramedics in remote places to handle emergencies. The technology is available, and the Government needs to extend its reach to benefit the rural population.
Please explain the benefits of remote radiology, and the void it fills in Indian healthcare. Radiologists are scarce in the country, and mostly absent in rural areas. Hence the absence of diagnostic centers there. Villagers must travel to at least a Tier II town for an Xray. Remote Radiology or Teleradiology helps to fill this vacuum. A techtrained radiographer can perform the X-ray and CT scans and send them via internet to radiologists who can remotely look at them. Patients, especially trauma patients, can avoid an unnecessary travel and it also increases the radiologists’ productivity and efficiency.
How important is pricing when pitching your products to clients? RADSpa is Radiologist Spa, in terms of user comfort. It is a product developed by radiologists, for radiologists. Hence it speaks the language of radiologist! Every version of the software undergoes iterations by our in-house radiologists before release.
Price is not the main factor but pricing is an important criteria! RADSpa can be positioned according to user needs. It can be a simple PACS for a single centre, enterprise for a large chain, in-premises deployment for a hospital, cloud version for Teleservices etc. It can also be hybrid in some cases. Hence, the price varies, and pricing is based on the actual need, with an option for upgradations at an incremental cost. So the buyer has a choice.
Are RIS/PACS here to stay as part of the ongoing transformation of healthcare?
Please tell us about your RIS/ PACS solutions.
How do you see the market in the next decade? What are the growth contributors?
RADSpa is a web based customizable Radiology Workflow software available anywhere, anytime and on any OS. It is also available on iPad. Some of its features are The Physician Portal allows referring physicians to view status of study, reports, images, ETA and search finished reports. It supports
RIS/PACS is not just confined to Radiology. Cardiology and recently Oncology also use PACS to regularly monitor the patient’s progress. Even non-DICOM applications like ECG, Treadmill etc., can be a part of RADSpa viewer. RIS/PACS is here to stay and soon, will encompass and integrate all departments in a medical facility.
The growth is expected to accelerate. Radiology market too, is growing. Many 3T MRIs, PET CTs are coming up across the country. Healthcare awareness, increased government spending for medical care, Insurance supporting investi-
“RIS/PACS is here to stay and soon, PACS will encompass and integrate all departments in a medical facility quick-view of images through WADO (Web Accessible DICOM Objects). It also allows context-based communication - offline comments - between radiologists, physicians and other users and is integrated with work-list and finished reports. Physicians and peer radiologists using RADSpa can grade each others’ reports and snip a part of report text for grade comments. The QA workflow supports adjudication in case of disagreement. While the grades follow ACR guidelines, they can also be customized. Reporting in RadSpa is completely web based. The report page displays the complete patient details.
gations will fuel the RIS/PACS market growth. These coupled with the drive towards film-less diagnosis has the potential for a higher CAGR from the present 15 percent in the near future.
With elections around the corner, what are your expectations from the government for this industry? Right To Healthcare (RTH) for every citizen, increased Budget allocation for meaningful, realistic healthcare spending, building infrastructure in Tier II and Tier III cities to enable rural population access to minimum healthcare.
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Telemedicine may
slowly replace smaller Clinics
Sastradhar Reddy, founder and CEO, MedPac Systems in conversation with Elets News Network’s (ENN) Rajesh K Sharma about his company’s RIS/PACS solution, the RIS/PACS market and his outlook for the future of the market How do you perceive the growth of the health care segment in the IT market? With an increasing population in developing countries and an aging population in the developed countries, the focus on productive heath care solutions has taken a paramount role. With the proliferation of portable devices like tablets and smart phones and increased data generation and dissemination, the health care segment is set to handle the challenge. Even less focused fields like Telemedicine and Teleradiology are growing due to improved Internet connectivity. Innovative personal devices which monitor personal health will grow in the future too.
Sastradhar Reddy founder and CEO, MedPac Systems
Please share your opinion on the importance of RIS/ PACS in hospitals and their advantages over the traditional films. RIS/PACS can reduce film costs and improve a radiologist’s productivity, as well as patient satisfaction. Webbased RIS/PACS can also be used for Teleradiology, improving the turnaround time as well as the quality of the report. Integrating RIS/
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PACS with EMR (Electronic Medical Records) or patient information systems (lab, pharmacy, nursing etc) will take patient care to a whole new level.
How important is innovation for customers in the growth markets? With computer platforms shifting from desktops to thin clients, mobiles and
tablets, health care solution providers have to constantly upgrade their solutions to meet the customers’ changing. The only way forward is to make their solutions platform agnostic; in other words, their solutions need to work on any desktop with any OS (Windows, Linux or MAC) or any mobile or tablet platform (Android or IOS).
How do you differentiate your products to your clients? Is pricing an important factor? The designing and implementation of PACS systems for a hospital depends on factors like the number of radiology modules required, the number of studies or examinations that a radiologist will do per day and also the number of years the reports are going to be stored in the hospital. The number of physicians and radiologists who will be using the PACS software concurrently is also a factor. One also has to ascertain whether the hospital plans to use the RIS/PACS for Teleradiology services as well. Depending on the above factors, we suggest RIS/PACS configurations to the hospitals, and the pricing is done according to the specific needs demanded by them.
Please tell us about your RSI/ PACS solutions Our RIS/PACS solution is called Pronto PACS. It is web-based and provides the user with a single solution platform on which the entire hospital can be run. The solution integrates HIS (Hospital information Systems), blood bank, RIS and PACS into a single platform, turning the hospital paperless and film-less. Since Pronto PACS is completely web-based, no software needs to be installed on the client machines, making life easier for the IT administrators. In addition, it is platform neutral and can be used on Windows, Linux or Mac desktops or Android or iPad tablets. Pronto PACS is a Linux-based and
built on Scalable Enterprise Linux Server platform. It is a web-based RIS/PACS solution with 3D PACS DICOM viewer. It is can store the medical studies and examination reports for years. We have an in-built storage monitoring module which monitors the health of the hard disks and RAID status, making data loss redundant. Being web-based, its administration can be done from a browser. It also supports reporting of Images from modalities like CT, MRI, CR, DX, US, XA, NM, PET, OPG, SC etc. In fact, studies from any DICOM compatible modality can be viewed in it. The DICOM viewer can auto detect the client platform and switch to HTML5 DICOM viewer on low power devices like
ing to the RIS/PACS technology. But with younger generation of tech savvy healthcare professionals entering this field, the adoption and deployment of RIS/PACS has been made easier. Another advantage of having RIS/PACS is that it can help in cutting down the increasing malpractice costs, since radiology records can be used as indisputable records, and don’t deteriorate over time.
What is your prediction for this market in the next decade in India? What are the growth contributors in the industry? Telemedicine may slowly replace the smaller clinics and in the future, we will have huge multi-super specialty
“Films are becoming more expensive, and film storage is a pain. This, coupled with the penetration of computing devices into healthcare has ensured that PACS is here to stay mobiles and tablets. The built-in Teleradiology module with jpeg2000 compression makes transfer of images on low bandwith networks a breeze. Our hybrid 3D PACS/Teleradiology Viewer makes 3D reconstruction even on a normal PC possible.
Are RIS/PACS here to stay as part of the ongoing transformation of healthcare? Films for traditional radiology are becoming more expensive, and storage them over time is painful and a drain on space and money. This coupled with the fact that the penetration of computing devices in healthcare is increasing has ensured that PACS is here to stay. The only barrier that remains is the initial cost of setting up a RIS/PACS solution, and the reluctance of the physicians in adapt-
hospitals for in-patients. I am expecting a huge consolidation of health care players and overall improvement in quality. With elections and a possible new government at the Center, what are your expectations from the government for this industry? I hope that the new government defines a patient medical record policy. A patient’s medical record ultimately belongs to the patient. But he or she is rarely able to access the records if they are ever kept. Mostly, they are never maintained. We need to have a policy wherein the records can be shared across various health care providers to better serve the patient. We also need a National Health Record database, so that researchers can access the data for their research to develop new drugs.
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Difficult to be Paperless without Integrated RIS/PACS Pradeep Achan, co-Founder and CEO, Amrita Technologies, in conversation with Rajesh K. Sharma of Elets News Network (ENN) in important role RIS/ PACS plays in delivering quality healthcare How do you perceive the growth of the healthcare segment in the IT market? The tremendous potential of Indian healthcare is being realized now, with the private hospital chains coming up demanding EMR driven systems to ensure efficiency and quality patient care. At the same time, state governments have been emphasizing the modernization and automation of public hospitals. We believe the Indian healthcare IT story is on a fast track, and will see significant growth over the next five years. While IT/HIS adoption is not new to Indian hospitals, what is changing is that hospitals now want systems built according to global standards, are integrated, and can scale up very quickly. Amrita Technologies has had many hospitals reach out to them for this. Hospitals have finally realized that to succeed, they need next generation systems to take advantage of advances in image technology and gigabit networks
By introducing RIS/PACS solution, hospitals are one step closer to being all�digital, thus meeting the need for improving the delivery of care to its patients. What’s your take on this? Pradeep Achan
Co-Founder and CEO, Amrita Technologies
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When Amrita Technologies launched its fully integrated healthcare suite in 2003, its intention was to fully integrate the front office, back office and
clinical functions at hospitals. An important aspect to this is an integrated and modular RIS/PACS solution. The days of printing X-Rays, MRIs on films with their associated delays of providing to the patient, transferring to the physician, storage, etc are long gone. Today, it is difficult to imagine going paperless without an integrated RIS/PACS solution.
How important is innovation for customers in the growth markets? Innovation is a “buzz” word that many companies simply pay lip service to. In the end, innovation becomes more of a mindset – an approach to functioning rather than a mandated process. Very simply, you need to innovate to survive. Healthcare IT companies come up with very good one time innovations, but unless it is a part of the mindset, it will not last. Many IT vendors have come and gone in the healthcare space in the last 5-10 years. This is not an area for making a quick buck – most enterprise healthcare projects are complex, dealing with disparate users, and take time to implement. Patience and innovation are key to staying and growing in this sector.
How do you differentiate your products while serving small and medium hospitals and clinics as well as big hospitals? Is pricing an important factor? Sector segmentation is quite important in Healthcare IT. They key difference in these segments is often the degree of automation that the hospital wants or is able to afford. Typically, the product used and services rendered are quite similar across hospitals regardless of size. Many smaller and medium hospitals in the past had not adopted PACS/RIS systems mainly due to budget issues as well as due to an
This is not an area for making a quick buck – most enterprise healthcare projects are complex, dealing with disparate users, and take time to implement ad-hoc, non-integrated approach to automation. Pricing is - and in my opinion - will remain a major driver in this segment. However, cloud based solutions may be able to fill in this vacuum, providing a fixed set of automated services catering to this segment alone.
Tell us about your RIS/PACS solutions. The Amrita MedVision application and the Picture Archive and Communication System (PACS) is a next generation system that helps you archive, retrieve, distribute, and viewing of radiographic images of patients. Amrita PACS is built with advanced integration frameworks to support new generation machine modalities – multiple slices, pet CT scans, etc. Also, it has been optimized for web delivery – today it is essential to cater to radiologists at different physical locations, and even when they are on the move sometimes. PACS offers a complete range of image management protocols and tools, for image storage, display, and distribution. By delivering images and information within the context of the EMR, the patient’s electronic medical record, PACS makes the images and reports available online. A doctor can
quickly display these images using the MedVision DICOM viewer at any time from across the hospital, including OPD, office, nursing ward, ICU, and OT, at the click of a button. The HMIS solution integrates with the Picture Archiving Communication System (PACS) and MedVision application. All images taken by the modality are captured and archived by PACS. These images can be accessed and viewed at any time by a doctor or a technician using the MedVision DICOM viewer.
So a clear statement, RIS/ PACS are here to stay as part of the overall and ongoing transformation of healthcare? Definitely. The hallmark of good quality clinical care is access to quality radiology investigations. As customers demand better quality of care, and hospitals invest in systems to streamline operations and avoid paper, RIS/PACS solutions will become an integral part of an HIS/HMIS offering.
What is your prediction for this market in the next decade in India? What are the growth contributors in the industry? India is on the cusp of an explosion in healthcare services. Hospital beds are expected to double in 5-8 years, and there is tremendous consolidation in this space. Running large and complex hospital operations with more demanding and knowledgeable patients and medical staff will drive the growth of Healthcare IT tremendously. Now, after the successful Maharashtra MEDD deployment (many of the Largest Hospitals and Medical Colleges in Mahastrashtra on Amrita HIS and RIS/PACS) many state governments are floating tenders and EOIs for HMIS and PACS solutions. As I said earlier, patience and innovation will be the key to growth in this space.
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Healthcare IT Market will continue to grow in the Next Decade Dr Ashish Dhawad, Founder and CEO, Medsynaptic talks to Elets New Network’s (ENN) Rajesh K. Sharma about the growth of healthcare IT market and the outlook for RIS/PACS solutions in that growth How do you perceive the growth of the healthcare segment in the IT market? Healthcare IT is a fast growing segment in India and is clocking one of the highest rates of growth across various sectors. A recent Frost & Sullivan report states that the Healthcare IT market will triple from current $ 381 million to $ 1.45 Billion by 2018. This shows how quickly the mindset of healthcare providers is changing regarding adoption and benefits of IT.
By introducing RIS/PACS solution, hospitals are one step closer to being all-digital, thus meeting the need for improving the delivery of care to its patients. What’s your take on this? PACS is a fantastic solution which not just improves workflow within the hospital and delivery of patient care, but also results in substantial return on investment for the hospital, by reducing films and other consumables. Any hospital which has more than three imaging modalities and moderate study volumes should definitely consider deploying a PACS or MiniPACS. To give an example, using Teleradiology via PACS helps provide critical results from anywhere, anytime during emergencies.
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Dr Ashish Dhawad Founder and CEO, Medsynaptic
How important is innovation for customers in the growth markets? Growth market customers love innovation. They are more open to trying out new technologies, as compared to developed market customers, who have already been using solutions for many years and tend to resist changes to established workflows. Many customers in growth markets are first time users of technology and can easily adapt to innovations.
How do you differentiate your products with your clients? Is pricing an important factor? Our biggest differentiator is our product innovation and the world class service that we offer. Obviously, pricing plays a role in decision making, but customers who value the quality of a product and responsive service consider pricing as secondary. Our continuous focus on improving our PACS and integrating with latest technology trends helps us highlight our USPs to the client and ultimately win projects.
Please tell us about your RIS/ PACS solutions. Medsynapse PACS is a true webbased solution unlike other solutions in market which are partially web-based. Using latest R&D, we continually keep improving Medsynapse PACS to offer better functionality and technology to our clients and that is why Medsynapse PACS has become popular in such a short time. We were the first in India to offer a true web-based PACS, VNA, integrated collaboration platform, mobile viewing, FFID technology etc. With the latest version we offer many new features like integrated web based MIP/MPR/3D and several other advanced processing tools, dashboards, MIS reports, advanced RIS and intelligent worklist to name a few. The latest version also offers
Medsynaptic PACS solutions Medsynaptic provides its PACS solution in two flavors, a regular PACS and a mini-PACS. Both of these are web-based, and can be accessed from anywhere. Both are described below:
MedSynapse MedSynapse is an indigenously developed web-based and cloud based system. It is USFDA & CE approved as well as HIPAA compliant. It offers multi-modality and multisite hospital connectivity. It has DICOM MWL support, provides consistent image quality and a fast and lossless image transfer. It has a Teleradiology module, VNA Compliant Archiving module along with advanced Reporting features like speech recognition included in it. Data mining capabilities, zero footprint viewer, RT support & MIS reports make it unique from other solutions.
miniSynapse miniSynapse is a web-based low cost and affordable solution designed for diagnostic centers and small hospitals. It is HIPAA compliant as well as USFDA/ CE approved and supports multi-modality connectivity. It comes with image processing tools that provide a consistent image quality. It has a Teleradiology module, an Archiving module and a Reporting module included in it.
the fastest full fidelity download speeds which is way ahead of the competition. A great innovation we have added is an HTML5 based universal viewer which can be accessed from any device or browser/OS.
So a clear statement, RIS/ PACS are here to stay as part of the overall and ongoing transformation of healthcare? Absolutely, RIS-PACS is here to stay and will in fact lead the transformation of healthcare, as imaging services form an important part of the overall hospital offering and collections. Plus, RIS/ PACS has clearly demonstrated a return on its investment for any hospital, as compared to other IT projects.
What is your prediction for this market in the next decade in India? What are the growth contributors in the industry? Healthcare IT market will continue to grow rapidly in the next decade as the healthcare industry matures in India and more hospitals realize
the potential benefits of deploying IT. The future is going to be digital and fully inter-connected, and healthcare won’t buck that trend. Increasing investments, new hospitals, insurance penetration, regulatory push and manpower shortages will drive this growth in future.
With elections and a possible new government at the Center, what are your expectations from the government for this industry? Like everyone, even the healthcare industry is waiting for a new stable government to start functioning. I hope the new government will bring in major reforms in the healthcare sector and give a new impetus to improve the growth prospects of the industry. Some specific areas where I would like to see action is a nationwide platform for health record, regulatory guidelines for image archival, incentives to hospitals for adopting healthcare IT and guidelines for interconnectivity between systems.
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tech trend
PACS Evolution
has Broadened its Application K Raghava Ram, Director at Crane Global Solutions Limited (CGSL) talks about the growing Indian healthcare market and how RIS/PACS solutions help in improving healthcare delivery How do you perceive the growth of the healthcare segment in the IT market? The Indian healthcare sector is growing at 15 percent CAGR, from INR 4711.68 billion in 2012 to INR 9483.30 billion by 2017. The rising population has led to a per capita increase in healthcare expenditure at a CAGR of 10.3 percent from INR 2583.63 billion in 2008 to INR 3470.82 billion in 2011. This is expected to rise to INR 5317.12 billion by 2015. This growth is due to greater access to high-quality healthcare and greater awareness of personal health and hygiene. The gaps in healthcare delivery are being filled by technologies like Tele Medicine, Tele Radiology, medical apps and various Government schemes. Investors are investing in healthcare areas like digital health knowledge resources, electronic medical record, mobile healthcare and hospital information system, which focus on the technological aspect of healthcare delivery.
Are hospitals closer to becoming all-digital by introducing RIS/PACS? RIS/PACS solutions help the doctors by putting information at the center of healthcare, facilitating seamless cap-
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K Raghava Ram Director at Crane Global Solutions Limited (CGSL)
ture, storage and retrieval of patient images and making them available enterprise-wide. The patient’s image is a click away for the doctors to view and arrive at a diagnosis. Also, while traditional films and scans may be damaged or lost by the patient, thereby impacting treatment, PACS saves all images on the PACS server, thus eliminating this risk and ensuring complete patient care. The solution completely unifies image management platform and au-
tomates task-based clinical productivity, supporting improved care delivery and optimized workflow.
How important is innovation for customers in the growth markets? Emerging innovations in healthcare delivery, particularly in developing countries, offer insights on how to tackle its rising cost. The innovations are uncovering the patterns for raising productivity, cost cutting, road to patient satisfaction, and visions for stakeholders and
leaders across health sectors-public, private, and social.
How do you differentiate your products to your clients? How important is pricing? We at CGSL offer products built on SAP, open source, IBM stack, Oracle stack and hybrid solutions, for different healthcare segment. Our solution’s core strength lies in its KPI (Key Performance Indicator)based approach and ability to interface with any third-party application or product used in the hospital. Our business alliances are our strength, which make our product different and unique. Pricing plays a major role in healthcare vertical. The mid-sized hospitals, which might be excellent in process and patient care, may not want to invest on IT, infrastructure vis-a-vis on medical equipments.
Please tell us about your RIS/ PACS solutions. Our product is database agnostic. It is built to leverage any levels of customization with minimal effort, thus minimizing the price burden of customer, while simultaneously accommodating the client’s requirements. Its lies in integrating RIS/PACS from different vendors or integrating HIS with RIS/PACS. It optimizes the complete workflow, decides on the best solution for achieving it, and develops and implement it. Archiving Solutions for Medical Industry is low cost, high performance and very reliable. It has a built-in redundancy, and is scalable, thereby addressing many price points and being a cost-effective solution. Our PACS solution is the first in the world to offer inbuilt video conferencing, chat, audio, share and FFID technology on an integrated platform. It has an inbuilt support for multisite centers with a global work list and central image store. It is VNA and VNC compliant and offers optimal
size images with best quality. It also supports DICOM Waveforms, DICOM Equipment, Mammo CAD, DICOM SR.
Is RIS/PACS here to stay as part of the overall transformation of healthcare? Yes, the growth in technology is enormous in RIS/PACS space.
What is your prediction for this market in the next decade in India? What are the growth contributors in the industry? Healthcare is one of India’s largest sectors, in terms of revenue and employment, and the sector is expanding rapidly. The continuous evolution of PACS technology has led to a broadening of its applications, from Tele-Radiology
imaging information technology. In addition, PACS market it is just not limited to radiology but also expanding to oncology, endoscopy and other specialties who are also adopting the systems.
With elections around the corner, what are your expectations from the government for this industry? Health system strengthening, human resource development and capacity building and regulation in public health are important areas within the health sector that the government should focus. The citizen also expects healthy living conditions, nutrition, safe drinking water, sanitation, education, early child development and social
“Emerging innovations in healthcare delivery, particularly in developing countries, offer insights on how to tackle its rising cost” to CAD (Computer-Assisted Diagnosis) and multidimensional imaging. It is evolving to provide access to image data outside the Radiology department to all branches of the hospital. Newer technologies like holographic media and GRID computing are likely to expand PACS-based applications further, improving patient care and enhancing overall productivity. The market for PACS is expected to reach INR 305.72 billion by 2018. This growth will come largely due to government investing in PACS, spurred by the push to digitize health records and the introduction of the software-as-a-service model, which significantly reduces the up-front cost of implementing PACS. The growth contribution is primarily by the government to encourage the digitization of healthcare systems, and technological advancements in
security measures from the government. 80 percent of the healthcare spend in India comes from private sector. A populous country like ours allocates only 20 percent of its annual budget towards healthcare, which is among the lowest in the world. The government should focus increasing the budget allocation for healthcare and making sure that all citizens receive healthcare services and benefits with the use of technology. With the technology enhancement in every vertical, the hospitals and healthcare providers should make HMIS mandatory for better patient care delivery process. The government run various health schemes to fulfill the objectives of taking healthcare to the citizens. Funds allocated to these schemes could be utilized for healthcare IT and infrastructure development.
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pediatric
Each Child Deserves Attention The Indian Academy of Pediatrics (IAP) is committed to the improvement of the health and well being of all children. Dr Vijay Yewale, President, Indian Academy of Pediatrics, in conversation with Shahid Akhter, ENN, outlines the efforts made IAP to improve childcare scenario in India
Indian Academy of Pediatrics (IAP) has come a long way. You celebrated Golden Jubilee last year. Please share IAP milestones, mission and vision ?
Dr Vijay Yewale President, Indian Academy of Pediatrics
Indian Academy of Pediatrics (IAP) took off in the year 1963 with around 150 pediatricians as its members. Today, we are 23,000 plus and still going strong. Our headquarter is in Mumbai and our members are spread across the country. Compared to other medical specialties and organizations, IAP is the largest and most representative association of pediatricians in India. Since inception, we have been focused on CMEs by way of lectures, symposia and conferences being organized across the country. In the undergraduate curriculum, pediatrics was found to be underrepresented and so we took steps to reclaim its importance and recognition as a separate discipline. At the core of our commitment lies our determination to improve the health and wellbeing of our children. The IAP strives for the achievement of the optimum growth, development and health in the physical, emotional, mental, social and spiritual realms of all children irrespective of the diversities of their backgrounds.
Globally, India stands 142 among 176 nations in maternal health. Why this dismal
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scenario and what steps have been initiated as a remedial measure? Maternal deaths are high for various reasons. Lack of quality emergency care is the most important among them. Add to this, poor accessibility to skilled birth attendants. Tetanus in newborns and several other reasons compound this problem. The government is addressing this issue and we have initiated Newborn Resuscitation Program – First Golden Minute Project, that will help in checking the infant and under 5 child mortality rate. The project aims to train about 200,000 health professionals in Basic Newborn Care and Resuscitation with ultimate aim to have one person at every delivery trained in neonatal resuscitation.
Any other program, joint ventures in association with IAP? Yes, we are associated with several programs, ventures and workshops.. Some of them are academic in nature, while other are workshops, training, etc. In collaboration with our Kutch branch we have started Infectious Disease Surveillance and AEFI (Adverse Event Following Immunization) reporting system for reporting serious AEFI. The Objectives of the project are to develop an early warning system for pediatric infectious diseases in India, to generate data on burden of infectious diseases in India and to generate data on serious AEFI. All the cases reported through various methods are collected in a single database in real time and reports are sent to all users on weekly basis. In case a disease outbreak is recorded on the system, email and SMS alert are sent to all users instantaneously. IAP Touch Workshop is about training of upcoming child health workers.
IAP’s current programmes and involvement? Our latest venture is in collabora-
Scary Figures l Today, almost
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2 million children under the age of 5 die every year in India and another 1 million or more are disabled for life. Out of every three babies in the world dying on the first day of their birth, one is from India In India, 24 out of 1000 newborns die within seven days of their birth India ranks 75 out of 77 middle income countries on the index Best Place to be a Mother (State of the World’s Mothers 2011) India ranks 142 among 176 countries in maternal health 57.9 % of pregnant women aged between 15-49 were found to be anaemic (NFHS-3) 50 % of women had at least 3 antenatal care visits (NFHS -3) 22.3 % of women consumed Iron Folic Acid (IFA) for 90 days or more (NFHS-3)
tion with Vodaphone. We have just launched the world’s largest vaccination reminder service for ImmunizeIndia. Through this drive, we aim to prevent 500,000 child deaths and disabilities by 2018. This is a free SMS service to receive reminders on immunization schedule for 12 years.
We have just launched the world’s largest vaccination reminder service for Immunize India Today, almost 2 million children under the age of 5 die every year in India and another 1 million or more are disabled for life. Vaccination reminder services in several countries have been effective in increasing compliance by 20%. With over 800 million mobile connections, almost every household in India now has a phone that supports SMS. A text message reminder service is therefore the most
cost effective method of reminding parents that a vaccination is due The IAP-ImmunizeIndia programme is a unique initiative that leverages the outreach of mobile technology and penetration of mobile phones across the country to raise awareness and deliver critical alerts about an essential health service. This reminder service will be available free of cost to parents across the country and they can opt-in to the service by sending a text message by SMS to the national short code 566778 from any mobile network in India, in the following format: Immunize <Space> <Baby’s pet name> < Space> <Baby’s date of birth> They will receive an immediate confirmation and text message reminders for 12 years, following the prescribed immunization schedule - 3 reminders are sent, at 2 day intervals, for each vaccination due.
How do you intend to achieve this herculean task ? To ensure an optimal outreach and registration for this program, the IAP in addition to its member pediatricians, will engage with other influencers that parents trust - doctors, nurses, midwives, school teachers, aanganwadi workers, priests, et al.
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pediatric
Today toddlers Bounce
Back from CHD Recent advances in medicine ensures that children born with a heart defect live healthy lives. Dr Vikas Kohli, Director & HOD, Pediatric Cardiology, BLK Super Speciality Hospital, in conversation with Shahid Akhter, ENN, focuses on the issue of Congenital Heart Disease (CHD) Please tell us about the congenital heart defects (CHD) today? The commonest birth defect seen in infants and newborns today are related to the heart. The abnormality is seen in almost 1 in 100 pregnancies. Congenital heart defects commences in the early stages of pregnancy, when the heart is developing. This includes abnormalities in the heart’s structure, electrical system and other abnormalities that affect the function of a baby’s heart. Usually it is genetic or chromosomal abnormalities that lead to heart defects. Risk factors may include smoking during pregnancy, maternal obesity, maternal diabetes and maternal infections such as rubella. Congenital heart disease is a general term for a wide range of birth defects that affect the normal workings of the heart. We are not too sure about the causes leading to congenital heart disease. Some know risk factors may include. l Down’s syndrome – a genetic disorder that affects a baby’s normal physical development and causes learning difficulties. l Mother having certain infections, such as rubella, during pregnancy. l Mother having poorly controlled type 1 diabetes or type 2 diabetes.
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What is a Heart Murmur ? After birth, the diagnosis usually involves a pediatric doctor hearing a heart murmur. A heart murmur happens to be an abnormal heart sound. Once this is suspected, a cardiologist performs an echocardiogram and a confirmation of whether the murmur is from an abnormality in the heart or is an innocent murmur can be made. Innocent murmur is a murmur which though present is not associated with a heart abnormality i.e. the heart is innocent and normal though there is a murmur. This is a fairly common situation.
How do you classify the heart diseases ? There are 2 main types of heart disease: one in which the baby turns blue and the ones in which the baby does not turn blue.
Blue Baby Almost all conditions in which the baby turns blue require surgical treatment. For others there may at times not be a requirement for surgery or it may be treatable by balloon angioplasty or device closure. Both these methods are non-surgical methods. All major defects require surgery to be done.
Hole in the Heart The more common defect of the heart involves a “hole in the heart”. An isolated hole in the heart (which could be a ventricular or atrial defect), will require treatment. The hole is between chambers carrying red and blue blood (red signifying with oxygen and blue signifying without oxygen). The condition of isolated hole in heart should not be confused with conditions where hole is present associated with many other abnormalities in the heart, which have varying treatment and outlook.
What forms of treatments are available ? Many conditions now can be treated without surgery. The closure of such defects can be done by an angioplasty technique similar to the one in adults to place stents. The common problems in children include a hole between the lower chambers (called VSD). The wall between the upper (ASD) and lower (VSD) chambers separates the red from the blue blood. A hole would result in extra blood flow to the lungs. This makes the child have more chest infections, child gains weight with difficulty and feeding also becomes a problem. On the other hand, the child could be blue when in addition to a hole in heart, there is a blockage of blood flow to the lungs (ToF). This is the commonest condition in which the baby becomes blue. Such conditions always require surgery to be done. Other defects in which the child becomes blue includes where the red blood from lung (with oxygen) drains abnormally into the blue blood, or the tubes coming out of the heart carrying red and blue blood get switched whereby the body
receives blue blood wrongly and the lungs get red blood. These conditions usually require a single operation and the child becomes normal. Finally, it is the condition when one of the valves or of the pump is not normal that the child requires more than one operation in lifetime of a patient and may affect the quality of life or the life span.
How Early Can the diagnosis be made ? With the current technology the diagnosis can be made of heart disease in the 18th week of pregnancy. This test is called fetal echocardiogram. Specialised heart ultrasound machines
cardiopulmonary bypass (heart-lung machine), and without the need to stop the heart. Defects amenable to such device therapy tend to be smaller (less than 20 to 25 mm [3/4 to 1 inch] diameter). Importantly, these lesions must be centrally located within the atrial septum. Defects at the very upper or lower edges of the atrial septum (called ostiumprimum or sinus venosus) are not good candidates for this procedure, because these defects usually involve other abnormalities of the heart valves, or venous drainage from the lungs. This determination can be made by the patient’s primary cardiologist.
“If an abnormality is noted, often it is a condition of the heart which does not require immediate treatment or surgery. Occasionally the abnormality may warrant intervention or surgery are used for this test with advanced features like STIC or FETAL NAVIGATION. Once the diagnosis is made the family can be counselled for future treatment. Or if the condition requires complicated treatment, the pregnancy can be terminated too.
What is Device Closure of a hole in heart ? This technique involves implantation of one of several devices (basically single or double wire frames covered by fabric) using heart catheterization methods in the cardiac catheterization laboratory, without the need for
l Congenital heart disease (CHD) causes the death of thousands of children in developing countries each year. Eight out of every 1000 live births around the world have some form of CHD. l Each year, approximately 1 million babies are born with heart defects worldwide.
The usual procedure is very similar to standard heart catheterization. Briefly, flexible long tubes (or catheters) are inserted into the veins and arteries in the groin. We use the knowledge that in all human beings, these vessels are directly attached to the heart, and this is the standard access technique used in all patients. Routine pressures and oxygen levels in all of the chambers of the heart are then obtained. Angiograms (pictures taken following dye injection) are performed to determine the size of the chambers, the size of the defect, and its location within the heart. Using a balloon catheter of a known diameter, the defect is then sized in comparison to the balloon, so that the device appropriate for that particular patient can be chosen. The device is then advanced into the heart through an introducer sheath (larger, less flexible tube).
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Odisha Telemedicine Program Biswa N Mohanty, Prof of Surgery & Chief Nodal Officer, Orissa Telemedicine Network, Deptt. Of Health & Family Welfare, Govt. of Odisha
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elemedicine as a tool to promote health care delivery and health education in the state of Odisha was accepted by Govt. of Odisha in the year 2001. The initial push was provided by Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow and Department of Electronics & IT, Ministry of Communications & IT, Govt. of India both in terms of funding and technical support. Subsequent support was offered by ISRO/Department of Space, Govt. of India, Bangalore. However Odisha Govt. took it up as a major health department initiative in the year 2005.
Methods The goal was three-fold (i) To make the Govt. and the medical professionals accept the new medical technology (ii) To enhance the quality of medical care in the state (iii) To offer postgraduate medical students a new direction of knowledge acquisition To meet the desired need, Govt. of Odisha established three medical college telemedicine nodes and 31 districtlevel telemedicine nodes to cover the entire state in a phased manner. Full time telemedicine technical personnel were engaged in all the telemedicine stations to man the telemedicine centers. Adequate fund was provided for maintenance of the state-wide network. CDAC, Pune was involved for installation of hardware, software and manpower training. A senior professor of a Govt. Medical College was identified as the state-level telemedicine nodal officer to look in to effective utilization of the network and to coordinate with funding & administrative agencies. Necessary
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Biswa N Mohanty, Prof of Surgery & Chief Nodal Officer, Orissa provision was made on a PPP mode to make benefits of telemedicine available to rural people.
Tele-Dermatology Session Monthly Telemedicine utilization data was generated from all telemedicine nodes, compiled and submitted to Govt. Every month a project review meeting was held under the chairmanship of principal secretary, health & family welfare department to find out the difficulties, assess the progress and offer solution to existing & upcoming problems.
Discussion Analyzing 12 years of data, it was noticed that 4511 patients with critical health problems have been benefited and 2478 topics have been discussed through Tele-CME programs for knowl-
edge boosting of the health professionals. Acceptance of the new medical technology by medical professionals is showing an upward trend. Tele-follow up sessions for patients of thyroid cancer have been quite useful. A total of 277 patients of operated thyroid cancer are on regular tele-follow up in the telemedicine center at Cuttack. A state-level telemedicine resource center is being established by Govt of Odisha within the premises of the premier medical college of the state at Cuttack at a cost of 5 crore (50 million) rupees for capacity building & optimal maintenance of the whole network. 37 posts of telemedicine technicians and a post of deputy system manager are being created by the Govt. to ensure effective utilization of the telemedicine technology.
Conclusion The acceptance of telemedicine technology both by the users and Govt. is on the rise. Still then challenges remain in setting up a successful & workable telemedicine program. There is a need in all institutions using telemedicine for critical evaluation of the ongoing programs. This should include periodic evaluation of benefits & cost of telemedicine, pros & cons to tele-health and other telemedicine issues.
In Focus
Driving innovations in
Medical Gloves In conversation with Ranju Kumar Mohan, Director, JK Ansell, Rachita Jha explores the latest technology and products introduced by the global leader in protection solutions for medical community especially surgeons in India Tell us about the journey of the company in India so far? We have long been a part of the growth story of medical safety and quality in protection products such as gloves in India. Gloves as a protection gear for medical professionals has been long ignored by many hospitals, however it has always been seen as a valued investment by surgeons. The value of premium high- end glove products is that it enables the surgeons to do their job better that a glove that fits perfectly, provides optimum tactile sensation, comfort and safeguards from infection. Our premium brands in medical gloves in India, namely GAMMEX and ENCORE have had their presence across the country for more than a decade. Our aim has been to introduce the latest technology under these brands to the industry. We began the journey of power-free gloves movement in this country and took the awareness revolution on the disadvantages and side-effects of powered gloves across hospitals. Exposure to starch used in powered gloves can lead to a number of undesirable reactions such as allergy systems. We are constantly on the innovation wheel to bring-in new products and exceptional features.
Please some of the key innovation in medial glove products pioneered by your company? Breaking the rules of one fits all, we
tile sensitivity for secure grip and superior barrier protection for the surgeon. The same is offered to various other specialties as well, and based on the different working conditions for the surgeon.
Tell us more about the latest under glove product launched by the company in India?
RanjuKumar Mohan Director, JK Ansell
have introduced glove products designed for each speciality field that the surgeon has expertise in. Under ENCORE we have a specialised glove designed for orthopedic surgery. The latex powder-free, epoxy brown, extra thick surgical glove offers increased protection during surgery. The textured surface delivers outstanding wet and dry grip to the surgeon and the brown colour reduces light reflection. Another field of micro surgery needs very fine glove with tactile sensitivity so that each movement is felt by the surgeon as normally gloves can be very thick and you may not get perfect surgery and consequence can be drastic. Hence a speciality approach has been applied to micro-surgery as well in which we offer gloves that has been tested for viral penetration, has polyurethane inner coating, high tac-
Puncturing of gloves during surgical procedures has been found to occur at rates of 11 percent to 43 percent worldwide. WHO recommends double gloving in countries with a high prevalence of HBV, HCV and HIV for long surgical procedures that has contact with large volume of blood or body fluid. The double colored gloves make the perforations easier to identify and significantly reduce perforation risk, in addition the innovative new Hydrasoft technology is designed to retain moisture and rehydrate skin despite continual glove wearing.
Please share your outlook on India as a growth market for medical and surgical gloves in the next financial year? Globally, India is gaining popularity in terms of medical tourism and in many cities and leading hospitals across the country and are catering to medical needs of international patient community. The quality standards in processes and procedures have become priority for majority of the private hospitals.
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in focus
Heart
Health for All
Sagar Hospitals has made expansion in South India to bring affordable healthcare services within reach of those living in south Indiaâ&#x20AC;&#x2122;s tier two and three cities. Ishiqa Multani,Vice President for Sagar Hospitals, in conversation with ENN elaborates more on the expansion of the hospital How has Sagar hospitals helped in the delivery of health care facility to the rural masses? The economic disparities, which exist in our nation continues to be an area of concern for us at Sagar Hospitals. Clearly, public sector hospitals are falling short when it comes to providing reliable and effective patient care, and we have taken a number of initiatives to address this growing problem. Sagar hospital has a public-private partnership with the government that utilises the Baypayee, Tamil Nadu Health Insurance and Yashwini health protection schemes to provide patients with subsidised care. As a continuous CSR practice, we regularly hold free health check camps, health awareness programs, in and around the state of Karnataka. For example, we recently offered free camps for ensure early diagnosis of heart problems and instill healthy lifestyle in people from the rural areas.
What steps have you taken to make healthcare affordable for the masses? For the last two decade, rising healthcare costs have hurt the competiveness in the healthcare space in India. A large section of people are driven into bankruptcy because of an illness or injury. We have tried to work some plans out for non-affordable class of patients who are not covered under
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any of the government schemes, for instance, we have introduced the’ Heart Health For All’ (HHFA) program at all our hospitals, thereby giving an opportunity to help patients and their families to come on a common platform and share their thoughts and experiences. Also, I would like to stress upon the point that only 12 percent of our population is covered under some form of health insurance including the government schemes. Out-of-pocket expenses go up to 86 percent. This is 66 percent high in comparison to a developed nation like USA where it’s only 20 percent. What the middle class needs is a better health security by putting in place comprehensive health insurance reforms that would hold the insurance companies accountable and provide more choice for the consumer.
What’s your intake on the important of the use of ICT in healthcare? How have you implemented ICT in your hospital? In a country like ours, where a large portion of population still resides in rural areas, ICT has the potential to impact the healthcare aspects. The ability to access healthcare services and demand for a system that responds to their (rural population) priorities and needs can be influenced by information and communication process, of course, catalyzed through an informed decision-making. A couple of months ago I read about the “Swasthya” This helps patients to keep a check on their vitals including ECG and keep track without an intervention from a physician end.We are looking at collaborating with the distributors and
work on something together to help make these devices available to the impoverished class. Sagar Hospitals has gone with flow in this ever-dynamic industry when it comes to investment in technology, be it clinical or non-clinical area. We have the basic like the advanced HIS system that connects all our units across. We also ventured into electronic medical record (EMR) way back in time. A unique technological feature that we implemented a couple of years ago,
crucial role in improving the total health of all Indians. As such, Sagar Hospitals has made expansion in South India a priority so that we can help to bring affordable healthcare services within reach of those living in south India’s tier two and three cities. Currently, Sagar Hospitals is focusing on expansions which will bring quality medical care to residents in south India’s tier two and three cities, we intend to start with Davengere before moving on to other cities as Hubli, Mangalore, Belgaum, and Bel-
“If patients are covered under insurance, the thought of undergoing a preventive check and treatment will not stop them from accessing the best care which to date remains a selling point for us, is the ability of our patient families to have an access to see and interact with the patient sitting anywhere in the world via web. Likewise, for our physicians, who would like to keep a tab on their patients shifted in the Intensive Care Unit, they can do so by accessing the data on real time basis.
lary. Apart from this, we have 3 projects in the pipeline, which we are almost ready to roll out on-by-one in the city of Bangalore.
What are your future plans of expansions?
Cultural variables, per se, play an important role that helps the counseling psychologists understand how culture relates to help-seeking, counseling process and the outcomes. Fortunately, for us, we have a wonderful, well-renowned team here at Sagar Hospitals that has been helping people who are in need of counseling. We have regular requests from schools, colleges and corporate to help them by conducting workshops sessions, seminar and counseling sessions for their people. The department for mental health sees closer to about 30 patients a day. We are contemplating on opening up a full-fledged behavioral sciences center here at the Banashankari Hospitals.
One of the greatest challenges that healthcare providers in India have faced is the geographic barriers, which can make it difficult for many of our nation’s citizens to access quality healthcare services, including the all-important preventive care which plays a
USP of the Hospital The USP of our Hospital remains our super specialty nature, with 25 plus super specialties. The focus specialties include cardiology and cardiothoracic surgery, Nero sciences, orthopedics, urology and wellness management/ preventive health checks. The hospitals uses a Hospital Information System (HIS) that keeps electronic records of patients and links the various departments. Shortly, we will have RFID technology deployed on the floor in our Banashakari Hospital followed by the others.
You have a dedicated department for mental health. How has been the response of the people towards psychological counseling?
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Ruby Hall Clinic, Wanowarie, Pune
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ith great pride and pleasure, I would like to inform you that the management of Ruby Hall Clinic presents yet another state of the art facility to the citizens of Pune which has recently started functioning in Wanowarie. Itâ&#x20AC;&#x2122;s a 120 bedded multispecialty hospital with the aim of adding comfort to care and well equipped to provide services to a high end clientele. Ruby Hall Clinic, in the past 50 years has set new bench marks for standards in the health care industry, the best of which have been adopted and incorporated in the new facility at Wanowarie. The facility is equipped
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with the best of infrastructure that has been made to adapt to continuously changingtechnology. The facility is equipped with cutting edge technology and has a certain sense of uniqueness over every other contemporary establishment. Apart from providing 24x7 emergency services with a fully geared up critical care unit, full-fledged diagnostic services of lab and radiology and regular out â&#x20AC;&#x201C;patient and in-patient care,and the highlights of our facility at Wanowarie are: l Modular state of the art operation theatres, designed to cater to the highest standards of procedures
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Day care chemotherapy unit Dialysis lounge l Worldâ&#x20AC;&#x2122;s 1st 15 inch cardiac catheterization lab with excellent image quality and lowest radiation dose l A stylish endoscopy suite l Physiotherapy and rehabilitation unit In our journey towards striving to be the best in patient care and to be the most sought after health care destination, we request your support to grow and meet client expectations to the fullest. To take this forward in a mutually beneficial way, we invite you to visit our hospital and see the facilities that your patients can avail of. l
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World Health Day 2014
Small Bite
Big Threat Dengue and malaria impacting socioeconomic growth
Vector- borne diseases, the theme for this year’s World Health Day (WHD) is timely. Affecting more than half the world’s population and accounting for 17% global burden, these diseases are difficult to predict, prevent or control. In India, the burden and risk of vector-borne diseases (VBDs) is massive. Adding to the complexity is that VBDs have intensified in their severity due to climate and environmental change, and globalization. The WHD campaign, ‘small bite: big threat’, therefore, is well-timed as it brings renewed focus on sustainable control, elimination and eradication of VBDs. The world’s fastest growing vector-borne disease is dengue, with a 30-fold increase in disease incidence over the last 50 years. Malaria is endemic in 16 states more than 80% of malaria burden and more than 90% of malaria deaths. In India, the burden is concentrated in the remote areas of the country with the poorest health systems where the population is most exposed. Weak collaboration across agencies, sectors, and levels of government, including the regulatory mechanisms are some of the key challenges. Now is the time for robust collaboration and action across all sectors and for targeted communitylevel sensitization. Dr Nata Menabde WHO Representative to India
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While countries in South-East Asia have made substantial economic progress, diseases such as dengue and malaria fuel a vicious cycle of poverty and have a significant impact on socioeconomic status of communities. “These are deadly but preventable diseases. The solution lies in a united and sustained effort from all of us. Ministries of health alone cannot control these diseases. Their control and prevention needs committed engagement from all sectors, strong political will and active community participation,” Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia.
Living in the midst of disease
The vector borne diseases are a menace especially in the developing world. Although the scenario is fast evolving and changing for the better, developing countries like India are the lands of paradoxes. While at one end ,there are centers of excellence that can match up with the best in the world, primary health care to all is still an issue. The good news is that these are preventable diseases but the bad news is that we are doing little about them. Prof Chintamani, - President, The Association of Breast Surgeons of India, Vardhman Mahavir Medical College Safdarjung Hospital, New Delhi
Greatest Contributors to human mortality
The most deadly vector-borne disease, malaria, caused an estimated 660 000 deaths in 2011. The Vector-borne diseases are one of the greatest contributors to human mortality and morbidity in tropical settings and beyond. The diseases that are spread by vectors kill a million people every year and more than half of the world is at risk for the same. It should be noted that the world’s fastest growing vector-borne disease is dengue, with a 30-fold increase in disease incidence over the last 50 years. Globalization of trade and travel and environmental challenges such as climate change and urbanization are having an impact on transmission of vector-borne diseases, and causing their appearance in countries where they were previously unknown. In our country, we have a large rural as well as slum population, which needs constant awareness in taking precautions and preventive measures for the same. We can protect ourselves and our families by taking simple preventive measures, including vaccination. Dr Dharminder Nagar, Managing Director, Paras Healthcare
Time to define strategy
It is an irony that over one million people in the world die every year due to vector borne diseases. It is quite considerable that the WHO is taking cognition and focussing on “Prevention of Vector Borne Diseases” on this World Health Day. We as a country like India, boasts of five-star healthcare facilities in metropolitan cities but the fact remains that infectious diseases like malaria and dengue are still one of the leading causes of mortality. Challenges of such magnitude need collective efforts of each citizen, the NGOs and the government bodies. The time has come to define a clear strategy with key milestones and well-defined monitoring parameters for implementation and mid-course correction for achieving targeted goals. Dr Vikram Singh Raghuvanshi, Chief Executive - Healthcare, Jaypee Hospital (Noida)
A major threat
“Vector-borne diseases are a major threat to the Indian public health. The need of the hour is to be aware of your surroundings and adopt an accurate strategy, starting from the diagnosis, treatment to the prognosis. With summers just round the corner, cases of mosquito- borne diseases like Dengue, Malaria and Chikungunya are bound to make a comeback if a decisive strategy is not put in place in advance, at the local and national level.” Dr Anurag Bansal, Medical Director, Quest Diagnostics,
Impacts Indian economy too
“India bears a significant burden of vector-borne diseases, contributing to 34 per cent of global dengue and 11 per cent of global malaria cases..On the other hand, rising incidence of non-communicable diseases will adversely impact the Indian economy,to the extent of 230 billion INR in a decade! Our Country is engaged in battling the dual burden of communicable and non-communicable diseases simultaneously, which developed countries have had to deal
with only sequentially! Therefore the theme for World Health Day 2014,”Vector-borne Diseases”, is as relevant for India as was last year’s theme of “High Blood Pressure”. NATHEALTH is committed to help address these critical needs.”… Anjan Bose, Secretary General,Healthcare Federation of India(NATHEALTH)
Health for all
It is a great opportunity to feel part of WHO day’s celebration. The theme is very apt for my country. We are a land of paradoxes; at one end of the spectrum are some of the richest people of the world while we are struggling to prevent vector borne diseases in this country. I dream of a future where the Alma Ata Declaration “Health for All” by 2000 AD would finally come true. Sukriti Rastogi Vardhman Mahavir, Medical College & Safdarjung Hospital, New Delhi
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advertorial product launch
Carestream’s New Bone Suppression Software Receives FDA Clearance, Now Available Worldwide Company’s Latest Imaging Software Offers IHE Dose Reporting Capabilities, Image Quality and Productivity Enhancements for CR, DR Systems
M
umbai, India, April, 2014 — Carestream’s newest image acquisition software that includes innovative features for its portable and room-based CR and DR systems is now commercially available worldwide. The software’s optional bone suppression feature, which recently received FDA clearance, creates a companion image (from the original exposure) that can improve visibility of lung nodules and other pathology by suppressing the appearance of posterior ribs and clavicles. Carestream’s current software already offers companion images that can enhance visualization of tubes, PICC lines and pneumothorax (an abnormal collection of air or gas in the pleural space that separates the lung from the chest wall). The software’s new IHE Dose Reporting capability will collect radiation dose information via the IHE (Integrating the Healthcare Enterprise) Radiation Dose Monitoring Profile from all CARESTREAM DR and CR systems and distribute it to a healthcare provider’s PACS. Carestream demonstrated its ability to collect and share radiation dose information during the IHE North America Connectathon held earlier this year. “Our new software collects radiation dose details from our CR and DR systems and sends this data to PACS systems that support the IHE dose monitoring profile,” said Helen Titus, Carestream’s Marketing Director of X-ray Solutions. “We are one of the first companies to provide radiation exposure data for CR and DR systems
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using the IHE profile. This information can then be linked to management systems that enable dose monitoring and reporting for each patient.”
Software Designed to Support Transition from CR to DR The new software will allow a single console to support one CR and one DR system—or two CR systems—from Carestream to help boost workflow, save valuable space and lower costs. Users will be able to identify CR cassettes or DR detectors, view patient demographics and review images from one console for both imaging systems. The software also will offer other workflow improvements.
“This new software will support both CR and DR systems to smooth the transition and expansion to digital radiography for hospitals and imaging facilities of all sizes,” Titus explained. The new software will be available for CARESTREAM DRX systems and CARESTREAM DIRECTVIEW Classic, Elite and Max CR systems. It will be offered as an upgrade to these CR and DRX platforms already installed at customer sites worldwide. Media Contacts: Nilesh Dattatray Sanap, Carestream Health India (P) Ltd, 022- 67248816 nilesh.sanap@carestream.com
SRS Global Industry Solutions & INDIAN MEDICAL ASSOCIATION (Goa State) Presents
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Accurate diagnosis – key to timely and appropriate treatment
E
ver wondered if you have ever felt transient dizziness or palpitations with sudden unexplained fainting or loss of consciousness? This could be grave conditions which can be related to your heart conditions and you could be suffering from slow or extra fast heart rhythms, termed as arrhythmia in medical terms. Arrhythmia refers to abnormal rhythms of the heart which in turn causes the heart to pump blood less effectively. The common symptoms of cardiac arrhythmia are dizziness, shortness of breath, lightheadedness, rapid heartbeat, heart palpitations, chest pain, blackouts, visual problems, and fainting.
Since different patients suffer from these symptoms at different frequencies; they are unlikely to be diagnosed by the conventional Holter monitoring that monitors the heart for 24-48 hours, or an ECG. The above mentioned tests allow the doctor to look at the heart’s activity at rest and at one point in time. But abnormal heart rhythms and cardiac symptoms may come and
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go. So to record your heart rate and rhythm during a symptom there is a device called as the External Loop Recorder (ELR). An ELR has capability to monitor a patient’s heart for a long duration (7-30 days), and hence has a higher chance of providing a diagnosis to patients with infrequent symptoms. The devices are generally placed on the patient’s
skin in the chest region. An ELR records arrhythmia episodes and wirelessly transmits them to the z-link monitor. This data is converted in diagnostic reports at the ECG Monitoring Centre and mailed to the physician via email. An ELR has emerged as the next big leap in medical technology by making a detailed monitoring of your heart conditions over a period of time easy and convenient like never before. This FDA approved and CE marked External Loop Recorder (ELR) System is an extremely patient friendly device and presents a comprehensive solution for apt detection and analysis of cardiac arrhythmias.
PL Medical Technologies Private Limited introduces a new revolutionary all-in-one home health and wellness monitoring mobile device – BPL LifePhone Plus, making better healthcare practices easy for the public, anywhere, anytime. The device will serve as a proven way to improve wellness at reduced costs through self-management and will facilitate a hands-on prevention solution among hospitals, physicians, caregivers and patients. The device will also be an add-on to the rural healthcare practitioners who extend their services in the remote parts of the country. Comprising of a personal healthcare device and a mobile phone app, BPL LifePhone Plus is an efficient healthcare solution that allows the patients to monitor their electrocardiogram (ECG), blood glucose, pulse rate, activity and the amount of calories burnt, and obtain feedback through remote monitoring from the physicians.
National Summit on
ICT in Healthcare cum Awards
Changing Dimensions of Healthcare in India 4th June, 2014 – Hotel Le Méridien, New Delhi Summit Objective To create awareness on benefits of eHealth Services (such as telemedicine technologies including teleradiology, telepathology and telepsychology). Impact long term strategic plan towards development of eHealth services and integration of eHealth technologies in Indian Healthcare System. Address major policy gaps and infrastructural issues in implementing eHealth services. Promoting e Health learning initiatives towards educating public health experts. Facilitating development of eHealth solutions such as, mobile applications and websites.
Awards Objective
Past Luminaries who addressed ASSOCHAM’s Healthcare Conferences
The ICT in Healthcare Awards would celebrate and acknowledge unique and innovative initiatives in Healthcare sector across the country. The applicants will be required to fill in a Self-Nomination form.
Sh. Gulam Nabi Azad Hon’ble Minister of Health & Family Welfare Govt. of India
Award Categories 1.
mHealth Project of the Year
2.
PPP Initiative of the Year in Healthcare
3.
Civil Society/ Development Agency Initiative of the Year
4.
Health Insurance Initiative of the Year
5.
Telemedicine Initiative of the Year
6.
Innovative Use of Technology by a Hospital
7.
Innovative Use of Technology by a Diagnostic Service Provider
8.
HIS & HMIS Provider of the Year
9.
Innovative Domestic player of the Year
10. Innovative international player of the Year
Sh. Pranab Mukherjee Hon’ble President of India Govt. of India
Sh. Sam Pitroda Adviser to Prime Minister, Govt. of India
Dr. Craig Venter Author of Human Genome Project
Interested participants please send your nominations to the undersigned. Attractive Speaking Slot / Branding Opportunities available Mr. Bharat Jaiswal (M): +91-971047550 (E):bharat.jaiswal@assocham.com
Mr. Vicky Pandita (M): +91-9999592906 (E):vicky.pandita@assocham.com
Mr. Vipul Sharma (M): +91-9013078036 (E): vipul.sharma@assocham.com
Mr. Ashish Andani (M): +91-8586839558 (E): ashish.andani@assocham.com
The Associated Chambers of Commerce and Industry of India (ASSOCHAM), ASSOCHAM Corporate Office: 5, S. P. Marg, Chanakyapuri, New Delhi – 110021, (P): 011-46550555, Fax No: 011-23017008/09, Website: www.assocham.org
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