Express Healthcare May, 2014 by Indian Express

VOL.8 NO.5 PAGES 92

Cover Story Is India emerging as OEM for IVD? Strategy Challenges in healthcare Knowledge Heart surgery in diabetes mellitus

www.expresshealthcare.in MAY 2014, `50

CONTENTS MARKET Vol 8. No 5, MAY 2014

Chairman of the Board Viveck Goenka Editor Viveka Roychowdhury*

Connect flourish

Chief of Product Harit Mohanty

and

BUREAUS Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das Bangalore Assistant Editor Neelam M Kachhap Delhi Shalini Gupta DESIGN National Art Director Bivash Barua Deputy Art Director Surajit Patro Chief Designer Pravin Temble Senior Graphic Designer Rushikesh Konka Artist Vivek Chitrakar Photo Editor Sandeep Patil MARKETING Regional Heads Prabhas Jha - North Dr. Raghu Pillai - South Sanghamitra Kumar - East Harit Mohanty - West Marketing Team Kunal Gaurav G.M. Khaja Ali Ambuj Kumar E.Mujahid Yuvaraj Murali Ajanta Sengupta PRODUCTION General Manager B R Tipnis

Dr Asif Gani,CEO, TransEarth Medical Tourism, gives insights to healthcare players on gaining and maintaining a good reputation online and the importance of social media in the process| P78

STRATEGY

KNOWLEDGE

CHALLENGES IN HEALTHCARE

HEART SURGERY IN DIABETES MELLITUS

BOLSTERING BLOOD BANKING STANDARDS IN INDIA

SCREENING OF IDA AND THALASSEMIA MADE SIMPLE

INTERVIEW: ANWAR FEROZ, ADVISOR, AAPI (US) & PRESIDENT, ASSOCIATION OF INDIANS IN AMERICA

INTERVIEW: DR SD GUPTA, CHAIRMAN, IIHMR

P25: EVENTLISTING

Manager Bhadresh Valia

P33: COVER STORY: INSIGHT

Scheduling & Coordination Rohan Thakkar

Changing landscape of diagnostics: Yesterday, today and the road ahead

CIRCULATION Circulation Team Mohan Varadkar

P56: ASK A Q

RADIOLOGY

INTERVIEW: DR BALAJI GANESHAN, SCIENTIFIC DIRECTOR, TEXRAD

CARESTREAM’S NEW BONE SUPPRESSION SOFTWARE RECEIVES FDA CLEARANCE

OMRON OPENS ITS FIRST AUTOMATION CENTRE (ATC) IN INDIA

DRÄGER CELEBRATES ITS 125TH ANNIVERSARY

ACTION KIDNEY, TRANSPLANT AND DIALYSIS CENTRE LAUNCHED

STTI ANNOUNCES GLOBAL ADVISORY PANEL ON FUTURE OF NURSING

SYSMEX CORPORATION BEGINS DIRECT OPERATION IN INDIA

TB PATIENTS IN INDIA FACE INCREASING THREAT OF DIABETES

INTERVIEW: HESTER C KLOPPER, PRESIDENT OF THE HONOR SOCIETY OF NURSING

INTERVIEW: SAMIT VERMA, CEO, AMPLIFON INDIA

INTERVIEW: DR RUPALI BASU, CEOEASTERN REGION, APOLLO HOSPITALS GROUP

LIFE

ASTUTE SURGEON

Express Healthcare Reg. No. MH/MR/SOUTH-252/2013-15 RNI Regn. No.MAHENG/2007/22045. Printed for the proprietors, The Indian Express Limited by Ms. Vaidehi Thakar at The Indian Express Press, Plot No. EL-208, TTC Industrial Area, Mahape, Navi Mumbai - 400710 and Published from Express Towers, 2nd Floor, Nariman Point, Mumbai - 400021. (Editorial & Administrative Offices: Express Towers, 1st Floor, Nariman Point, Mumbai - 400021) *Responsible for selection of newsunder the PRB Act.Copyright @ 2011 The Indian Express Ltd. All rights reserved throughout the world. Reproduction in any manner, electronic or otherwise, in whole or in part, without prior written permission is prohibited.

EDITORâ&#x20AC;&#x2122;S NOTE

Riding the IVD wave

pproximately 60-70 per cent of medical treatment hinges on diagnosis. Thus, it is no surprise that a June 2013 Frost & Sullivan report finds that the global in vitro diagnostics (IVD) market outpaces pharma industry growth in some segments. The report also forecasts that while the US and Western Europe are presently the largest IVD markets, APAC and Eastern Europe are projected to be the fastest growing. APAC currently makes up just around two per cent of the global IVD market in terms of revenues so there is tremendous scope for growth. Global IVD players have a dominant presence in most emerging markets and this will not change overnight. Faced with stagnating and even sliding growth in the matured markets these players are naturally flocking to newer markets. The IVD market is moving; from the culture-based tests, immunochemistry and clinical microbiology of the last decade, to the advent of scaled down point-ofcare models and molecular diagnostic assays in this decade. The next decade will see further automation while the main-streaming of personalised medicine will generate a need for more personalised diagnosis as well as the seamless integration of screening and treatment. Companion diagnostic test kits are already part of the repertoire of major pharma companies like Roche, Abbott and J&J who have built up in-house diagnostic divisions or acquired diagnostic companies in the last decade. So is there a challenger to this ranking in India? There is no doubt that market is ripe for a perfect storm. As our cover story reports, (Is India finally emerging as an OEM for IVD?, pages 26-29) home grown players have been content to play at the lower end of the market but there are signs that they now have the confidence to find their niche. Some companies have focussed on growing by acquiring (Transasia Bio-medicals has strategically acquired global companies clearly counting on leap frogging the technology curve) while others are focussing on the organic model. Besides bringing the best of the world to India, domestic players also need to produce indigenous IVD products so that they can offer cost effective alternatives, both for Indian patients as well as other emerging markets. The point-of-care segment too is a volumes driven market and needs a lot of customisation as per local levels of technical support, infrastructure and operator efficiency. As

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Today,there is a vast difference in the size and scope of the domestic IVD players in China and India as theyvie for a slice of the global IVD pie.Are our policymakers listening?

governments and insurers across the world seek to lower healthcare costs while at the same time providing universal access to healthcare, indigenous products (both medicines as well as diagnostic kits) are the answer to these two seemingly opposing goals. With the focus on patient outcomes only set to increase, the role of accurate diagnosis in increasing cost efficiencies will only make domestic IVD manufacturers more crucial to the healthcare ecosystem. But for this to happen, IVD manufacturers have to first have an ecosystem which allows them to thrive. Thus, there is need for a concerted effort on the policy front to press home our advantages. Luckily this is finally happening, albeit the success stories are still the exception rather than the norm. Tax structures across states need to be simplified; there needs to be a mandate to roll out more countrywide screening initiatives through PPPs with IVD players and healthcare facilities. These are all steps which the Chinese government has taken in the past decades. Today, there is a vast difference in the size and scope of the domestic IVD players in the two countries as they vie for a slice of the global IVD pie. Are our policy makers listening? The growth potential of the IVD sector is good for patients, because it has attracted more players and competition has pushed down costs while increasing access to a wider array of tests. Thanks to cut throat competition, diagnostic labs offer upto over 60 per cent discounts for certain packages. The growth is not restricted to the metros. Major players are expanding to the hinterland (See story 'Smaller cities: A new hub for diagnostic labs'; pages 30-32). Of course it is not all smooth sailing. With a fragmented market, there is always the possibility of inaccurate results, especially from smaller less established labs. Standardisation of rates and accreditation are thus the need of the hour. The next wave of diagnostics will need a combination of clinical knowledge, medical electronics, as well as IT skills to store and retrieve the massive amounts of data from diverse sources. We have these skill sets but vital links in the ecosystem need to the strengthened. As IVD manufacturers in India strive to catch the next wave, let's hope they can ride the wave rather than be washed up in its wake. VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

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LETTERS NEED FOR MORE BROADENED PERSPECTIVE

APRIL, 2014

Often the papers only publish the views, thoughts and interviews of the doctors in the healthcare segment. We all tend to miss the perspective of the other healthcare workers. For instance, I have worked as a dialysis technologist in both, acute and chronic environment. Our inputs and ground-level issues can create more awareness in the public about the healthcare scenario and throw more light on issues like staffing in healthcare, medical device industry, zero errors and patient safety, importance of patient-staff communication etc. Jerald Jude, General Manager Guru Enterprises, Bangalore

GOOD ARTICLE A very well written article (Refer to EH April article: Bridging the gap with MRI & USG). Congratulations. Dr Gagan Gautam Head of Urologic Cancer Surgery & Robotic SurgeryMedanta - The MedicityGurgaon, India

QUOTE UNQUOTE

“Healthcare is basically disease management. We should build our system from the ground level to create a new blue-print of India’s healthcare. We have over 800,000 ASHAs in India, but they are ill trained and don’t have any medical skills. Their costs are a huge burden on the exchequer. We need to upscale their skills so that they can be the eyes and ears of the healthcare system. ” Dr Naresh Trehan, CMD, Global Health (Medicity) (The Future of Healthcare: A Collective Vision)

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MARKET NEWS

OMRON opens its first Automation Centre (ATC) in India It is their fifth in the world OMRON AUTOMATION, part of OMRON Corporation Japan, opened its fifth ATC in India at Mumbai. Speaking on the occasion, Yutaka Miyanaga, Senior Managing Officer, Company President of Industrial Automation Company, OMRON Corporation, Japan, said, “This initiative is a part of our ‘Asia Hotspots’ strategy - one of its important tasks is to consolidate our foothold in India which is indeed a highly promising market for OMRON Automation.” The centre aims to showcase OMRON’s expertise in the ‘sensing and control’ technology so that the customers are able to test their new ideas, experience and understand how they can bring more improvements to their current manufacturing set up and can become more competitive in their respective fields in the industrial automation domain. According to Takehito Maeda, MD, OMRON Asia Pacific Pte, Industrial Automation Business, “The ATC is a step towards highlighting our solution centric approach and excellence in execution as a complete ‘automation partner’. It shall play a very important role in strengthening our contribution towards India’s manufacturing prowess and the society.” “In the industrial automation sector, it is extremely vital to provide a hands-on exposure to the associates so that

they are able to actually believe and then achieve what they have not been able to do so far through their manufacturing establishments. We are confident of achieving relevant traction in many industries through this initiative such as packaging, F&B, FMCG, pharmaceuticals, special purpose machines, automotive and textile by catering to the advanced requirements of the manufacturing segment like productivity, quality, efficiency and safety,” said Sameer Gandhi, MD, OMRON Automation, India.

Highlights of the centre: ◗ The centre has on display OMRON’s key portfolio of industrial automation range as well as the technical and

application support capabilities through actual demonstrations on machines and laboratories. ◗ The field of expertise includes SYSMAC Platform, Vision Inspection Solution, Robotics Solution and Machine Safety Solutions ◗ The SYSMAC platform depicts a high speed and high accuracy fully integrated platform by three “Ones” – One Machine Controller, One Machine Network, One Machine Software ◗ Delta Robot and the SCARA Robot together with Bottle Filling and VFFS (Vertical Form Fill Seal) machines are displayed in the machine demo area to explain the usage of SYSMAC to enhance a machine’s performance

Sigvaris appoints NovoMed as its exclusive distributor in India

◗ The centre also has a vision lab to allow testing of vision inspection functions by customers with all possible variations of lighting, lens and controllers ◗ Another notable area in the centre is the 'Tsunagi Lab' which provides the complete integration experience of OMRON to OMRON and OMRON to third party components so that the patrons are able to learn and handle the technologies which are in the scope of the total solution Spread over 3750 sq ft, the facility reportedly hosts more than 10 experts as software, hardware and application specialists dedicated to the ATC.

SIGVARIS, AN international medical device company and pioneer in compression garments including hosiery and socks officially appointed NovoMed Incorporation as its exclusive distribution partners in India. Sigvaris is a manufacturer of graduated compression stockings which are clinically proven to be preventive as well as therapeutic in the treatment of deep vein thrombosis (DVT), varicose veins, help improve circulation and revive tired, achy legs. DVT is a clot that develops in the peripheral veins of the limbs. It is often a precursor to a potentially fatal condition known as pulmonary embolism (PE) where the blood clot in the peripheral circulation breaks loose, travels to the lungs, lodges in the circulatory system and compromises heart and lung function. Speaking about the association, Nainesh Mehta MD, NovoMed Incorporation said, “We are proud to associate with Sigvaris who have attained global presence and recognition by staying true to their values of perfection, quality and precision.” Sigvaris stockings are made available all over India by NovoMed Incorporation.

EH News Bureau

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MARKET

Dräger celebrates its 125 anniversary th

Customer event in Kerala highlights milestones in corporate history DRÄGER, A COMPANY dealing in medical and safety technology successfully completed 125 years of operations. Chairman of the Executive Board, Stefan Dräger believes that this is “a good reason to pause and reflect on what makes Dräger special as well as a good reason to celebrate.” To commemorate the occasion, Stefan Dräger came down to India on April 10, 2014, and attended the customer event organised in Kerala. "In India we have been present for around 60 years. At the beginning we had local agencies for sales and service but later on we built up joint ventures and started our own production sites for medical and safety technology in this country. Since ten years now in medical and one and a half years in safety we have our own subsidiaries. During the last seven years Dräger Medical India has shown a very

good annual growth rate. We want to thank our customers, business partners and employees for their valuable contribution. We want to invite them to celebrate the 125th anniversary of our company with us and to acknowledge all those who have helped make us what we are today ,” said Stefan Dräger. Speaking on the occasion, Nikil Rao, Country Manager, Dräger India, said, “Over the last 125 years, Dräger has touched millions of lives with its cutting-edge technology and versatile range of products. With India being a focus market, Dräger aims to take this tradition of heart-felt dedication to the next level by addressing industry challenges and revolutionising the healthcare and safety sectors with continuous innovation.” Stefan Dräger, Chairman of the Executive Board, Drägerwerk Verwaltungs AG takes the guests through the Dräger Moments exhibit a selection of 15 key moments

EH News Bureau

Apollo Chennai conducts successful simultaneous kidney-pancreas transplant The surgery was conducted on a 52 year old kidney transplant beneficiary, who was also a diabetic A TEAM of surgeons led by transplant surgeon, Dr Anand Khakhar recently operated on a 52-year old diabetic patient with kidney failure from Pondicherry at Apollo Chennai. Reportedly, this is the first to be held in South India. The hospital claims that post the surgery, patient Parameshwari, who has been diabetic for over 20 years, can look forward to an insulin free life over a few months as her condition gets better.

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Simultaneous kidney pancreas transplant is an operation to place kidney and pancreas at the same time in a patient who has kidney failure and also suffers from diabetes, needing very high insulin dose to control sugars. Diabetic patients with kidney failure need kidney transplant to prolong their life. Steroids used as immunosuppressant’s make treatment of diabetes difficult and poorly controlled sugar levels will con-

tinue to affect the rest of the body including the transplanted kidney. However, performing pancreas transplant simultaneously eliminates these problems by optimally controlling sugar levels and protect the transplanted kidney form suture effects of diabetes. Additionally, it will also help reverse the effects of diabetes on other systems including peripheral neuropathy thus protecting the limbs. Commenting on the surgery,

lead surgeon, Dr Khakhar, MultiVisceral Transplant surgeon at Apollo Hospitals said, “On an average 700 pancreas transplant are performed annually in the US. However in India, it is still in infancy and it will pick up with increasing cadaver donor organ donation.” The recipient, known to have diabetes for over 20 years and developed kidney failure about six months ago needed 50 units of insulin per day. She has done

well, and is completely relived of her insulin intake and free from dialysis, as per a hospital release. Dr Preetha Reddy, Managing Director, Apollo Hospitals said, “We will be setting up multiorgan transplant programmes with same facilities to include pancreas, intestine, liver and kidney transplant at Apollo Hospitals Hyderabad and Bangalore.” EH News Bureau

MARKET

Action Kidney, Transplant and Dialysis Centre launched It boasts of being a complete cost-effective unit offering all aspects of kidney care under one roof SRI BALAJI Action Medical Institute recently launched the Action Kidney, Transplant and Dialysis Centre in New Delhi. The department boasts of being a complete cost-effective unit which offers all aspects of kidney care under one roof including electrolyte disturbances, hypertension and the care of those who require renal replacement therapy, including dialysis and renal transplant patients. The team of doctors at the centre will comprise Dr Rajesh Aggarwal, Dr Umesh Nautiyal, Dr Pawan Mehta, Dr GP Sharma and Dr Samir Khanna. The newly launched centre houses 36 dialysis machines, out of which 27 are assigned for patients, which are free from HIV, Hepatitis and related diseases, nine for the HIV and Hepatitis positive patients. In addition, there are nine dedicated ICU beds, a separate procedure and recovery room as well an independent waiting area for nearly 50 attendants. The patients are offered wi-fi services, independent TV and RO purifier facilities as well. Reportedly, the nephrologists at SBAMI will treat kidney disorders including acid-based disorders, electrolyte disorders, nephrolithiasis (kidney stones), hypertension (high blood pressure), acute kidney disease and end-stage renal disease. The specialised kidney care, transplant and dialysis centre will have several nephrological interventions available including the renal biopsy, intermittent peritoneal dialysis (IPD), continuous ambulatory peritoneal dialysis (CAPD) and care before and after renal transplant. EH News Bureau

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CIN: U33110MH1997PTC111307

MARKET

STTI announces Global Advisory Panel on Future of Nursing International nurse leaders convene at Basel, Switzerland, to advance global health THE HONOR Society of Nursing, Sigma Theta Tau International (STTI) announced the creation of the Global Advisory Panel on the Future of Nursing (GAPFON). The inaugural meeting of GAPFON — a panel of international nurse leaders — convened to establish a global voice and vision for the future of nursing that will advance global health. The panel was chaired by Johns Hopkins University School of Nursing Dean Emerita and Professor Dr Martha N Hill. “GAPFON will be a catalyst to stimulate partnerships and collaborations to advance global health outcomes. I am excited and honored to chair this initiative and look forward to working with nurses, other health professionals, and key stakeholders who are commit-

GAPFON will hold a series of regional meetings of leaders from key stakeholder groups, including representatives from multiple sectors around the globe, to obtain knowledge and social, economic, cultural, and political insight related to issues determined at this inaugural meeting ted to improving global health domestically and internationally,” said Dr Hill. The initial GAPFON meeting, a three-day high-level gathering that facilitated discussion to identify and discuss strategies to positively influence global health, recently took place in Basel, Switzerland. Key issues identified include the need for reform, advocacy, and innovations in leadership, policy, practice,

education, and work environments. “It is imperative that global nurse leaders work together to develop a unified voice and vision for the future of nursing worldwide,” said Dr Hester C Klopper, President, STTI. “The Global Advisory Panel on the Future of Nursing will be a vehicle for thought leaders to share information, develop and influence policy, and advance this profession to influ-

ence global health.” GAPFON will hold a series of regional meetings of leaders from key stakeholder groups, including representatives from multiple sectors around the globe, to obtain knowledge and social, economic, cultural, and political insight related to issues determined at this inaugural meeting. Data from these meetings will provide the basis for an action plan including policy implications.

Panel member Dr John Daly said, “The advisory panel and its agenda provide an unprecedented opportunity for global nursing leadership to make major strides in contributing to advances in global health.” Advisor to Her Royal Highness, Princess Muna El Hussein — the World Health Organization’s (WHO’s) Patron for Nursing Midwifery — and Senator, the Kingdom of Jordan, Dr Rowaida Al-Ma’aitah states, “I believe the time is right for a sharper vision and collective voice for nurses and midwives all over the world to influence the global health agenda. GAPFON is a powerful vehicle for paving the future of nurses’ influence in achieving global health outcomes.” EH News Bureau

HealthEminds launches web-based medical psycology and counselling service Dr Sunita Maheshwari and Ankita Puri are co-founders of this venture HEALTHEMINDS, an online medical start-up focusing on providing mental health therapy and wellness advice through an innovative, easy to use and engaging online platform, recently had launched their ‘Beta’ website: www.healtheminds.com. The website allows for an individual to access a panel of certified experts such as psychiatrists, psychologists, counsellors, life coaches, and have an online video consultation session from the comfort of their home. It is

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confidential, completely secure and with protection of the client’s privacy. HealthEminds already has a panel of 35 specialists trained on online video counselling available for consultation. Speaking on the occasion, Dr Sunita Maheshwari said, “We are proud to launch this web-based psychology counselling service. From our experience in telemedicine, we realised there is a crying need for confidential counselling without having to visit a doctor’s of-

HealthEminds has a panel of 35 specialists trained on online video counselling available for consultation

fice. This can improve the mental health of so many individuals who suffer daily from stress and depression, and do not know how or where to seek professional help.” “In India we have a gamut of issues such as performance and cultural stress, anxiety, marital issues, parenting, addiction, coping with loss of near and dear ones etc. Probably no less than in the west or maybe even more, as individuals cope with rapid urbanisation and loss of the traditional

support of joint families. However, most people do not have access to professional counselling to help them face such life issues. The biggest issues being stigma, taking out the time and the awareness that counselling can help. We at HealthEminds are setting out to change the dynamics and bring mental healthcare to every person’s home,” said Ankita Puri, Co-founder, HealthEminds. EH News Bureau

MARKET

Sysmex Corporation opens new office in Mumbai Starts its direct operations in India in the field of coagulation and biochemistry SYSMEX CORPORATION recently started its direct operations in India in the field of coagulation and biochemistry. This was announced by Anil Prabhakaran, MD, Sysmex India. A new office was inaugurated recently at Kanjur Marg, Mumbai at the hands of Hisashi Ietsugu, President, Sysmex Corporation, in the presence of Kazuya Obe, Senior Executive Officer, Sysmex Corporation, Iwane Matsui, Executive Officer, Sysmex Corporations, Frank Buescher, President and CEO, Sysmex Asia Pacific. A host of distinguished doctors and luminaries from the IVD industry such as Dr Velumani, CEO, Thyrocare labs, Dr Avinash Phadke, President SRL Diagnostics and Dr Phadke’s lab, Dr Shanaz Khodaiji, Consultant, Dept. of Lab Medicine, PD Hinduja Hospital, Dr Sushil Shah, Founder and Chairman, Metropolis Healthcare, and many more prominent dignitaries graced the occasion. The entire range of Sysmex coagulation analysers cater to small-mid-large sized labs from semi-automated single test analyser, with the newly launched CA-101 and CA-104, to the fully automated CA-600 series and the top-of the line CS-2000 series, all with varying throughputs, to cater to specific needs and offering best-in-class technology to perform clotting, chromogenic and immunological assays. The haemostasis reagent range covers routine and specialised coagulation testing for bleeding, thrombophilia and platelet function disorders in order to help the clinician make accurate and timely diagnosis. The biochemistry instrument portfolio includes the BX3010 and BX-4000 (table-top) and the JCA-BM6010/C (Floor model) automated chemistry analyser. They have superior performance efficiency to help

From L to R: Iwane Matsui, Executive Officer, Sysmex Corporation, Dr A Velumani, CEO, Thyrocare labs, Anil Prabhakaran, Managing Director, Sysmex India, Yoshimitu Kawata, Chief Consul at Consulate General of Japan, Mumbai, Kazuya Obe, Senior Executive Officer, Sysmex Corporation, Hisashi Ietsugu-President Sysmex Corporation, Suresh Vazirani-Chairman and Managing Director,Transasia Biomedicals, Frank Buescher, President and CEO, Sysmex Asia Pacific, Atsuhito Koyama, Chairman,Sysmex India

From L to R: Iwane Matsui,Executive Officer, Sysmex Corporation, Hisashi Ietsugu-President Sysmex Corporation, Frank Buescher, President and CEO, Sysmex Asia Pacific, Yoshimitu Kawata, Chief Consul at Consulate General of Japan, Mumbai during the ribbon cutting ceremony

labs achieve faster turnaround time with accuracy. The test menu is varied and all-encompassing to suit the individual needs of the laboratory. Reaching out to customers through a global network of operations, Sysmex India promises to exceed their expectations

by offering quality products and fine-tuned after sales support, real time monitoring of customer instruments through online support service for providing remote maintenance and quality control monitoring, and sharing the latest academic information and trends by organis-

ing seminars and symposiums. The corporate office is in Mumbai, with representatives in New Delhi, Bangalore, Chennai, Kochi, and Kolkata and shortly in Ahmedabad, Hyderabad, Pune and all the major cities in India. EH News Bureau

Strand Life Sciences MSMF partners BANGALORE BASED Strand Life Sciences entered into a partnership with the Mazumdar-Shaw Medical Foundation (MSMF) to set up the Strand at Mazumdar-Shaw (SAMS) translational lab in the Mazumdar-Shaw Centre for Translational Research (MSCTR) located at Bangalore. “With evolving healthcare systems, it is imperative that we are constantly innovating and developing capabilities that will provide personalised treatment and quality care to the people of India. We believe this collaboration will help us foster innovation and encourage indepth research in the genomics space and thereby provide better care for patients with cancer and other genetic diseases,” said Dr Kiran MazumdarShaw, CMD, Biocon. Strand will offer comprehensive genomic testing for cancer and other germline/hereditary conditions at highly affordable costs. In addition, the collaboration will also entail promoting research in the field of genomics, conducting medical and nonmedical programmes, seminars and talks shows, assisting clinicians and scientists in performing quality research, and towards making genomics research resources and data available to scientists. Dr Vijay Chandru, Chairman & CEO, Strand Life Sciences said, “The Mazumdar-Shaw Medical Foundation has shown great foresight and magnanimity in helping us work towards the goal of providing the leading edge of genomic medicine at affordable prices in India and elsewhere. This collaboration provides Strand with an opportunity to conduct and promote in-depth research in the field of genomic sequencing based diagnostics. EH News Bureau

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TB patients in India face increasing threat of diabetes Double burden of tuberculosis and diabetes- Findings from Prof M Viswanathan, Diabetes Research Centre and MV Hospital for Diabetes A STUDY conducted by MV Hospital of Diabetes, Chennai to determine the course of action for prevention and cure of diabetes In India trained special focus on the high prevalence of tuberculosis in diabetics and vice versa. The study was conducted by Prof M Viswanathan, Diabetes Research Centre among TB patients registered in selected five tuberculosis units in India for DOTS treatment. More than 800 TB patients were screened for diabetes using two hour OGTT test under this programme. The key findings of the study are 25.3 per cent of TB patients had diabetes and another 24.5 per cent had pre diabetes. Out

of 25.3 per cent, more than nine per cent were newly detected and 16 per cent were already diagnosed with diabetes. Nearly half of the subjects, who had TB and diabetes, had infectious form of pulmonary TB. In the follow up study conducted among these, TB patients showed that the presence of diabetes has adverse effects on tuberculosis patients in terms of tuberculosis treatment outcomes. A delay in a sputum conversion was observed among these patients compared to non-diabetic tuberculosis patients. Diabetics are more likely to have impaired immunity compared to normal people. This

defect in the protective mechanism makes them prone to acquire infectious diseases more easily than their normal counterparts. People having diabetes, living in a country where TB is also common, are three times more at risk of acquiring TB. The chance of reactivation of past TB is also common among the people with diabetes. With the increasing number of people with diabetes in India and being a country with a remarkable TB burden, it is necessary to look at the magnitude of people with both TB and diabetes. The findings of the above two studies and the growing

ical College and Research Centre, Geeta Niyogi said, “The state-of-art blood bank will cater highly to the locals in the north eastern suburbs and central Mumbai. Also, with the Asian Institute of Oncology existent in our hospital the blood bank would ensure further essential assistance.” Speaking about joining hands with Somaiya Hospital, Sanjiv Mehta, President, Rotary Club of Mumbai Queen's Necklace said, "We are happy that we could contribute towards making this a reality.

BHARAT HEALTH Organization (BHO) has launched their online portal on healthcare to connect doctors and patients and act as a one-stop solution for preventive healthcare. BHO’s network today covers virtually specialists doctors like general physicians, paediatricians, orthopaedics, gynaecologists, cardiologist, dermatologist, ENT, neurologist, ophthalmologist, oncologist, etc. The company is currently associated with more than 40 hospitals, diagnostics and clinics across India. “Technology enabled healthcare services is the need of the hour in the healthcare industry. With rising incidence of lifestyle diseases, it is significant for people of different age groups to undergo preventive healthcare measures. My repeated visits to the hospitals to treat an old injury gave me this idea to start this new venture. Our portal bhorg.com is live and at the moment we have 150 users for the same,” said Manas Garg, CEO, BHO. The patients can log into the website and take appointments with their respective doctors. Depending on the membership chosen, reportedly the patients can receive free consultation, treatment discounts, medicines at your doorstep, tax benefits, online health reports and much more. Currently the facility is available in Bangalore, Hyderabad, Delhi, Mumbai, Chennai, Kolkata, Gurgaon, Noida, Pune and 10 more cities. BHO is planning to expand its service to the rest of India within the next few months. The membership package ranges from free to Rs 6000 and can be chosen by the patients themselves. And the membership includes individual, family and child membership as well

EH News Bureau

number of people with diabetes in the community suggests the need of screening each TB patient for diabetes which would help in maintaining a better glycaemic control throughout the TB treatment regimen and assist in achieving higher cured rates for tuberculosis disease. The MV Hospital for Diabetes Chennai India celebrated its diamond jubilee (1954-2014) in Chennai and Dr K Roshiah, the Governor of Tamil Nadu launched the Diamond Jubilee Souvenir of the Institution and also launched Diabetes Control programme along with Red Cross Society. EH News Bureau

KJ Somaiya Hospital sets up blood bank for under served Collaborates with Rotary Club of Mumbai Queen’s Necklace to set up comprehensive facility SOMAIYA HOSPITAL, Sion has reportedly replaced its existing blood bank with fullfledged infrastructure and state-of-the-art technology. Rotary Club of Mumbai Queen’s Necklace has come forward with financial assistance for the endeavour with an aim to address the poor and needy patients. The revamped blood bank was inaugurated by Lata Subraidu, first lady Governor of District 3140 and Dr Sendurai Mani, Co Director at the Metastasis Research Centre, MD Anderson Cancer Center, Houston, Texas. With a capacity of 550 beds,

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Somaiya Hospital's blood bank would be among the biggest such facilities and includes an enhanced blood storage room to ensure safe storage of blood through plasma freezers, incubators and agitators. An initiative to develop a quality control room and component preparation room has also been incorporated in this project. Speaking on the occasion, Samir Somaiya, Chairman, KJ Somaiya Medical Trust said that the city of Mumbai is woefully short in infrastructure related to blood management and this shortage is impacting the overall standards of

medical care. Samir Somaiya aslo said, “Our dream is to ensure a centre where the best treatment, best education and best access to care are provided. We are in the process of building a vision to take a step forward in the pursuit of this dream. This facility will ensure the prominent arrival of a blood bank that is among the best. The Somaiya Trust has always tried to make hospital care available to all, irrespective of their financial condition or any other socio-cultural parameters.” Dean of KJ Somaiya Med-

BHO launches online portal for preventive healthcare

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Avon announces free breast cancer detection camp in Mumbai Free breast cancer detection camps for Avon representatives and family AVON FOUNDATION for Women is hosting a Breast Cancer Detection Camp in Mumbai for Avon representatives, their families and friends to create awareness and early detection of the disease. The first camp in the city, is being hosted at International Oncology Cancer Center, Dr LH Hiranandani Hospital, Powai, Mumbai. The Free Breast Cancer Detection camp will include vital check up of women and mammography if recommended by a cancer specialist. A team of experienced doctors from the hospital will be present to help and consult Avon representatives. Speaking on the occasion, Ujjwal Mukhopadhyay, MD – Avon Beauty Products said, “Avon believes that when women are empowered, fulfilling their dreams becomes a beautiful reality. We have hosted six camps last year and received encouraging response from the participants. We are moving across India to create awareness and help women change their lives.” Pradeep K Jaisingh, MD & CEO, International Oncology shared, “International Oncology provides comprehensive cancer care and women’s cancers are a big focus for us. This initiative by AVON and OutCancer is a tremendous step in the right direction and will go a long way in making a positive impact on breast cancer care in India.” Dr Neeraj Mehta, Regional Head, International Oncology explained, “This cause is very close to our heart and we have been making continuous efforts on this front to empower and educate women on health issues and are privileged to be able to provide support for the same.” EH News Bureau

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‘GAPFON seeks to provide evidence on the value of nursing’ The Honor Society of Nursing, Sigma Theta Tau International (STTI) recently announced the creation of the Global Advisory Panel on the Future of Nursing (GAPFON) to address key issues related to the global nursing sector. Raelene Kambli speaks to Hester C Klopper, President of the Honor Society of Nursing, Sigma Theta Tau International about how the panel will go about achieving their goals on the global front and what are their plans for Asia, especially for India What is the main objective of the Global Advisory Panel? What are the key issues the panel aims to address? On the global level, nurses are conspicuously absent from the table at places like the World Health Organization (WHO), the United Nations (UN), and other organisations where global health decisions are being made. At the same time, nurses are being marginalised by administrators focused on cost without considering return on investment. We know patient care improves with the overall nurse education level at a healthcare institution, as referenced in a recent study publicised by the New York Times. On the global stage and in other situations where nurses are marginalised, nurses need to be better at exerting their influence and voices rather than just accepting the status quo of exclusion. GAPFON seeks to provide evidence on the value of nursing, participate in and influence health policy and the global health agenda. What kind of partnerships the GAPFON is looking out for? GAPFON leadership is currently exploring alliances to determine best practices and memoranda of agreement for membership in GAPFON. It is seeking partners to lay the financial groundwork as

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well as key stakeholders and organisations to help partner with the future work of the panel. What are GAPFON plans for Asia, especially for India? Currently, GAPFON is beginning a roughly two-year formation phase. During this period, GAPFON will convene a series of regional meetings that will include nurse leaders from key stakeholder groups (including representatives from multiple sectors around the globe) to obtain knowledge and social, economic, cultural and political insight related to issues determined at the inaugural meeting. The GAPFON regional meeting locations, dates and objectives are being discussed and will be announced toward the end of calendar year 2014. The

GAPFON panelists are aware that nurses in Asia, and particularly India, make a tremendous impact on a vast population of constituents, and the panel is working to schedule one of the regional meetings in Asia. GAPFON is receiving inquiries and making every effort to include the right representatives in the regional meetings.

Indian nurses will be in a unique position to help identify areas of inconsistency and address them

India generates the maximum number of nursing staff that work aboard. How does the GAPFON plan to involve Indian nursing leaders to participate Global Advisory Panel? There is a huge gap in the understanding of global health from country to country. One of the critical issues discussed at the initial GAPFON meeting is the fact that nursing education programmes around the

world are not consistent where global health issues and messaging are concerned. For example, one panelist visited a US baccalaureate nursing programme. She asked the students if they knew what the UN’s Millennium Development Goals (MDGs) are, and they did not know the answer. As Indian nurses add their skills to the worldwide healthcare industry, they will be in a unique position to help identify areas of inconsistency and address them. As mentioned above, GAPFON is working right now to identify key leaders who should be involved in the Asia regional meeting, which will be scheduled before the end of 2014. The month of May is dedicated to the upliftment of the nursing sector globally. Any special plans in this regard? Because GAPFON is still in the very beginning stages of formation, this year we will rely on our participating organisations to celebrate nurses month, nurses week, and international nurses day with their respective members and affiliates. As we move forward, the month of May will provide GAPFON an annual opportunity to inform about, uplift, and celebrate the profession of nursing. raelene.kambli@expressindia.com

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‘We are world’s largest hearing service provider’ Samit Verma, CEO, Amplifon India reveals more about the huge gap for hearing aid services, needs for specialised clinics for hearing aid services, the company and its services, in conversation with Raelene Kambli Is hearing care still a less important aspect within the Indian healthcare sector? Hearing speech and sounds is crucial for communication development of a child as well as for other human abilities and social adaptation subsequently in life. Unfortunately, for various reasons hearing care has not drawn enough attention in India. There have been various studies in India on etiology and prevalence of hearing loss on regional basis which shows that the rural population is more affected than the urban population. Economic background, along with the lack of awareness, is partly responsible for lesser demand for hearing care. Most importantly, hearing care has not been accessible as it was available in select cities. Hence, people with hearing loss continue to manage with it without professional help. What role does specialised hearing care clinics play in meeting this gap? There is a dire need for specialised hearing care clinics with uniform standard care across India to provide right hearing care solutions. At Amplifon, our immediate aim is to reach out to maximum Indians through a widespread presence and only growing the footprint. In our clinic, we have expert audiologists and customer service officers who have experience in dealing with people across age groups with different hearing deficiencies. We provide hearing solutions and hearing aids from the world's leading manufacturers.

Amplifon is focused on improving the hearing of people through excellence in customer care and extensive counselling process. In case of children, detecting and treating the hearing loss early is a significant step towards improving the quality of your life. We make use of the latest clinical procedures and technological advancements. The latest digital technology means that our hearing aids are small, discreet and comfortable. And we offer a free lifetime aftercare service so that you always have the best possible hearing solution for your needs. What are the challenges faced by such clinics? The incidence of hearing deficiencies is on the rise in India with lack of awareness among people about specialised hearing care. The awareness about the specialised hearing care is at a nascent stage in the country and needs to increase at a rapid pace. Also, people are uncomfortable wearing hearing aids due to the cosmetic appeal and taboo attached to the hearing aids. We are reaching out to the public at large through media and camps to improve awareness and understanding. We have created special counselling tools inside the clinic for better appreciation of the solutions that we provide. How many such clinics exist in India? Who are the major players and what is their market size? Are these domestic players?

Amplifon is the world’s largest hearing service provider with over 5,500 clinics in 22 countries.We use the latest audiology equipment in diagnosing hearing loss Currently, there are around 2000-3000 such clinics in India but the quality of services delivered varies a lot. Most of these players have individual clinics. Only recently global players like Amplifon are in India. What are the kinds of

services provided by Amplifon clinics? Amplifon is the world’s largest hearing service provider with over 5,500 clinics in 22 countries. To create a difference and to provide a high quality hearing healthcare, Amplifon uses the latest and state-of-the-art audiology equipment in diagnosing hearing loss and for the fitting of hearing devices. This ensures that the most professional expertise and an excellent on-going client care program are provided. We are 100 per cent focused on one thing – provision of excellent audiology healthcare. We want all our customers to be completely satisfied with their hearing aids and to get the very best from them. After two weeks of fitting a hearing aid, Amplifon audiologists review it to check the aided benefits and offer five-point service for free for all the customers to ensure maximum benefits from hearing aids. At Amplifon, we believe in offering the widest variety of solutions to our customers. Our continuous endeavour is to provide end-toend solutions to every client. We are truly independent since we offer something quite different from many others in the industry, such as: Diagnostic audiological services (Adult): ◗ Pure tone audio logical assessment ◗ Speech audiometry ◗ Middle ear analysis using tympanometry and reflexometry ◗ Hearing aid candidacy evaluation using speech

discrimination tests ◗ Candidacy evaluation for BAHA Rehabilitation services (Adults): ◗ Rehabilitative counselling ◗ Hearing aid selection and demonstration of effectiveness ◗ Objective approach in hearing device fitting and fine tuning ◗ Clinical analysis of aided and unaided benefits ◗ Rehabilitation of cochlear implant clients including cochlear mapping ◗ Selection and fitting of assistive listening devices Hearing services (Children): ◗ Neonatal hearing screening using otoacoustic emission tests ◗ Pure tone audiometry/conditioned play audiometry ◗ Brain stems evoked response audiometry ◗ Hearing aid selection and fitting ◗ Candidacy evaluation for cochlear implants ◗ Parental counselling How is Amplifon different from the rest of its competitors? The Amplifon Group, with 60 years of experience, is a worldwide leader in hearing care service providing the most innovative hearing solutions. We aim at providing the best audiology and hearing care services available in the country via a team of highly qualified professional audiologists, trained as per international protocols. raelene.kambli@expressindia.com

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‘A long-term, sustainable roadmap to achieve Universal Healthcare coverage needs to be developed’ Dr Rupali Basu, CEO, Apollo Gleneagles Hospitals, Kolkata and CEO-Eastern Region, Apollo Hospitals Group shares her views on the current healthcare scenario in India and how the forth coming government needs to address these issues. In conversation with Express Healthcare Given that India is already in the grip of the election fever, do you think that the new government should increase healthcare spending in order to strength the health system within the country? Government of India – Ministry of Health and Family Welfare had rolled out universal health coverage (UHC) with the private sector carving out a role for itself in the long-awaited changes that are being introduced in the 12th five-year Plan period (2012-2017). The challenges of inadequate infrastructure, fund shortages and process inefficiency in the public sector have to be addressed by mainly forging partnerships with private healthcare providers. From the year, 2000 to 2010 – despite increase in country’s GDP growth, the healthcare expenditure has reduced from 4.4 per cent to 4 per cent (Ref: McKinsey India Healthcare: Inspiring Possibilities, Challenging Journey). The decline in out of pocket payment from 67 per cent in 2000 to 61 per cent in 2010 is still high considering other worldwide figure of 37 per cent (Ref: WHO – Global Healthcare Expenditure Database). It is important to plan for future considering the growth in urban and rural middle class and reaching out to them through extensive insurance coverage – moving

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it up to at least 75 per cent from 25 per cent currently. For population who cannot pay for healthcare costs would have to receive it subsidised through public provisions and government payments. Hence, government has to work in order to increase the reach of insurance coverage, be it a holistic healthcare provider and a payer. One good example of the same is RSBY. What are the salient issues in healthcare delivery model in India today and can the new government overcomes them? The healthcare delivery model for the country rests in following: ◗ Choice of roles – It is not possible to universalise the government’s role as payer or provider only in context of healthcare, just at this moment. A careful conscious and balanced choice is imperative to ensure the benefit reaches to appropriate class of population while supporting the growth of private institutions. ◗ Goals - A long term, sustainable roadmap for the journey to achieve the targets of universal healthcare coverage needs to be developed. These plans need to be specific to the requirements of each district of the country and customized to achieve their individual goals. The goals

It is important to plan for future considering the growth in urban and rural middle class and reaching out to them through extensive insurance coverage

of public, private and primary healthcare must be incorporated where use of technology will ensure better reach. ◗ Funding - The government needs to assume accountability for its own budgetary outlays, private investments and address how to reduce out-of-pocket spending. GDP spending in healthcare needs to be double digit by 2025; and government‘s contribution can be 50 per cent of it. ◗ Prevalence – of Non Communicable Diseases (NCD) shall bloat up in next few years. It would become important that care providers develop long term and holistic care models to ensure better lifestyle, improved diagnostics and increased precision in management of events and emergencies. ◗ Quality - Process efficiency and quality needs to drive the core objective of healthcare. It will be important to measure outcomes in terms of health indicators for the amount of resources allocated. ◗ Finally, utilisation of existing workforce in optimal way What about the manpower crunch in healthcare? How is the industry dealing with this issue? The need of skilled people in healthcare and the details of the need of healthcare

facility for the country have been worked out. The healthcare sector is experiencing significant and rapid change; but the dramatic change is yet to come. In an evolving and challenging environment, healthcare organisations need to ensure high levels of technical and professional expertise. The main crunch in this entire matter is skilled manpower. Human capital is distinctly different from the tangible monetary capital due to the extraordinary characteristic of human capital to grow cumulatively over a long period of time. The growth of tangible monetary capital is not always linear due to the shocks of business cycles. During the period of prosperity, monetary capital grows at relatively higher rate while during the period of recession and depression; there is deceleration of monetary capital. On the other hand, human capital has uniformly rising rate of growth over a long period of time because of the very nature of the foundation. This trained human capital doesn’t include only the doctors but nurses, technicians and health system managers. Current challenges: ◗ There is a limited structured programme for technical people. ◗ Most of the people have learned by trial and error by

MARKET standing behind a machine. ◗ Most of the training institutes don’t have any clinical field to teach/ demonstrate ◗ Poor quality of teaching (mostly confined to class room) so the performance is far from acceptable standard and sometimes even risky for the society ◗ Ever increasing gap from demand to production Industries participation in improving technical and vocational education for the state: ◗ Need more number of medical, nursing colleges for the country ◗ Retain good teaching faculty ◗ Universities need to get involved to launch more number of technical or vocational courses ◗ Even open universities can take special initiatives to start/ increase the number of study centers for the state.

The government needs to assume accountability for its own budgetary outlays, private investments and address how to reduce out-of-pocket spending. GDP spending in Healthcare needs to be double digit by 2025; and government‘s contribution can be 50 per cent of it Is the current number of medical colleges enough to fill the gap? The need of the training doctors for the country is enormous. Currently India has a shortfall of 7.5 lakhs doctors. In our country and compared to our population, the availability of hospital and doctors’ number is very less; this issue needs to be addressed immediately. Referring to World Health Organization (WHO)

recommendations, for every 1,000 people there should be one doctor. Our country will take another 15 years to achieve this standard. As the country needs 500 more medical colleges in the next five years both private and public sector should take responsibility together. The Government constructed medical colleges are limited currently and about 54 per cent of the medical colleges are in private sector today.

India needs to add 10,000 medical seats each year (2014-19) to get at least 50,000 medical undergraduates over five years. This can only be achieved by adding 100 new medical colleges every year for the next five years- that is the big task. Lastly, what is your opinion on VAT policy for hospitals and other healthcare providers? As a policy, the healthcare

providers are required to pay VAT on consumables, stents and implants. This increases the cost of the consumables and makes healthcare more expensive for the consumer. All these consumables, stents etc., are part of the continuous medical service and not an over the counter product that can be purchased and used as per the service providers will and is guided by the accepted medical practice as per the standard treatment guideline. Also, patient food is as per dietary recommendation of the physician and not a sale. It is incidental to the treatment and not a sale of goods. This also needs to be outside the purview of VAT. The principle of application of VAT in hospitals needs to be uniformed so that country looks at healthcare problems and solutions together.

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MARKET PRE EVENT

Dr L H Hiranandani Hospital to host IBOM 2014 Interactive sessions and didactic lectures by world experts on biological orthopaedic therapy to be held during IBOM 2014 DR LH HIRANANDANI Hospital will host the International Biologics Orthopaedic Meet (IBOM 2014) in Mumbai on May 30-31, 2014. The event which is scheduled to take place at Sofitel, Bandra Kurla Complex, Mumbai is a scientific meeting dedicated to the use of Biologics Orthopaedic therapy in orthopedics and sports medicine. This conference is organised in collaboration with Hiranandani Orthopaedic Medical Education (HOME), the orthopaedic research division of the Dr LH Hiranandani Hospital, and the Biological Orthopaedic Society, US. The objective behind this initiative is to create awareness on

biologics orthopaedic therapy, which is becoming a very popular treatment option in orthopaedics and sports medicine across the world. Sports medicine is a subspeciality of orthopaedics that aims at evaluating an individual’s sports capabilities. It analyses the strengths and weaknesses of an athlete or a sports person and offer solutions accordingly. The meeting includes educational lectures from eminent national and international experts who have spent considerable time in this field. IBOM will serve as a resource pool of prominent doctors from across the globe for advanced treatment options pro-

IBOM will serve as a resource pool of prominent doctors from across the globe for advanced treatment options in orthopaedics

vided to orthopaedics for best patient care. Doctors who will take part in IBOM are Dr Anant Joshi, Orthopedist; Dr Ashok Johari, Paediatric Orthopaedic and Spine surgeon, Lilavati Hospital; Dr Dinshaw Pardiwala, Director - Arthroscopy, Sports Orthopaedics & Shoulder Service and Head – Centre for Sports Medicine, Kokilaben Dhirubhai Ambani Hospital; Dr Hitesh Gopalan, Orthopaedic Surgeon at Medical Trust Hospital, Cochin; Dr Jaspal Sandhu, Dean, Faculty of Sports Medicine, Guru Nanak Dev University, Amritsar; Mandeep Dhillon, Professor, Department of Orthopaedics, Post Graduate

Institute of Medical Education and Research, Chandigarh; Dr Roshan Wade, Shoulder and Knee Arthroscopy Surgeon at KEM hospital; Dr Sanjeev Jain, Full time Orthopaedic & Joint Replacement Surgeon, Dr L H Hiranandani Hospital; Dr Sanjay Desai, Arthroscopist and Joint Replacement Surgeon; Dr Sachin Tapasvi, Joint Replacement Surgeon, The Orthopaedic Speciality Clinic; Dr Yajuvendra Gawai, Full Time Orthopedic Sports Medicine Surgeon and Joint preservation specialist, Dr L H Hiranandani Hospital; Dr Vaibhav Bagaria, Joint Replacement & Sports Injury Specialist.

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Rockland Hospitals launch preventive healthcare initiatives in Delhi Rockland is linking up with a large number of primary healthcare centres, RWAs and village heads in the Delhi NCR to educate people on the benefits of preventive healthcare THE ROCKLAND Hospitals Group organised ROCKATHON at Dwarka, Delhi recently to launch its preventive healthcare programmes. ROCKATHON is a first in a series of events to promote the concept of preventive healthcare through various forms of sports, life style correction and exercising. This is a part of the Rockland’s phase wise plans of ensuring prevention and early diagnosis in case of any form of sickness to ensure that the patients are

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This is a part of the Rockland’s phase wise plans of ensuring prevention and early diagnosis in case of any form of sickness to ensure that the patients are treated at the right time and right place treated at the right time and right place. Reportedly, Rockland is linking up with a large number of primary healthcare centres, RWAs and village heads in the Delhi NCR to educate people on the benefits of

preventive healthcare and early diagnosis of diseases. An increased level of stress and a sedentary life style is causing a number of health problems which adversely affect appetite, sleep quality and

eventually begin to affect the entire body. Even the young in their teens are getting affected by life style diseases. “Today's youth is technologically equipped and globally aware. But at the same time, in

the current scenario, it is easy for them to pick up bad habits at a young age. Many tend to develop habits like smoking, drinking, chewing tobacco, etc. To distract the youth from such harmful activities, it is necessary to make them aware about the harmful results of such bad habits. At the same time it is important to encourage them to practice sports and other physical activities,” said Pranav Srivastava, Director, Rocklandroup.

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ABMH organises QIPS-II, 2014 in Pune The second national conference was on quality improvement and patient safety ADITYA BIRLA Memorial Hospital recently organised the second national conference ‘ABMH QIPS 2014’ on quality improvement and patient safety at Aditya Birla Memorial Hospital Auditorium. Reportedly, the two-day conference witnessed more than 200 participants including speakers and delegates from all over India. Eminent CEOs, COOs, Medical Administrators, Quality Heads from hospitals like Apollo Hospital, New Delhi; Medishield Hospital, Mumbai; Fortis Hospital, Mumbai and Mohali; Seven Hills Hospital, Mumbai; Care Hospital, Hyderabad; SPS Apollo Hospital, Ludhiana; BJ Medical, BD Medical and NABH amongst others, discussed various factors to deliver quality and safety to patients. During the conference various approaches, practices and methodologies were shared amongst the delegates to bring about an improvement in healthcare delivery in their own hospitals, which in turn would result in rendering quality services for better patient care and safety. Paper and poster presentation sessions were also arranged which enabled the participants to showcase various initiatives undertaken by them to improve the quality of patient care at their respective hospitals. Emphasis on the following factors was given to deliver quality and safe care to patients. Some of the factors included: ◗ Legal aspects of patient safety – Focus on peer group review ◗ Innovative methods of quality improvement ◗ Clinical audit – How to get it in right perspective? ◗ Enhancing interdisciplinary collaborative care for superior patient safety ◗ Why accreditation at all? pros and cons ◗ Involvement of clinicians in

quality and patient safety ◗ Human factors in patient safety – Retrospect and prospect? ◗ Measurable goals in clinical practice – How to implement in real world scenario? ◗ Patient safety leadership walk rounds ◗ Antibiotic stewardship: Difficult challenge ◗ Infection control with limited resources – Role of innovative strategies ◗ Linked nurses – Key to infection control practices ◗ Nosocomial fungal infection ◗ Panel discussion ◗ The role of IT in quality improvement and patient safety ◗ Patient family education to improve safety outcomes “We are happy to organise this event the second time and it again turned out to be a grand success. This sort of conference helps us to review the current status of healthcare delivery in terms of pa-

tients’ safety and sensitise the healthcare professionals and policy makers on the innovative and evolving concepts and strategies to improve the quality of patient care and safety in India. We hope to take this event to the next level in our next conference to improve the overall healthcare delivery in India,” said Rekha Dubey, COO, Aditya Birla Memorial Hospital.

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7 Indian National Brain Bee concludes at SevenHills Hospital,Mumbai th

The event saw neuroscience-loving students engage in a four-round challenging competition GAYATHRI MUTHUKUMAR from Bengaluru won the 7th Indian National Brain Bee (INBB) finale held on Sunday. It is a quiz competition on neurosciences for students who have exceptional credentials in biology and have an interest to pursue careers in healthcare. It was held at SevenHills Hospital, Mumbai, and saw the participation of 12 students from across India in the grand finale. These Class 11 students are winners of the regional Brain Bee competitions held in their respective cities – Chandigarh, Kolkata, Mumbai, Noida, Delhi, Allahabad, Pune, Chennai, Ahmedabad, Cochin, Bengaluru, and Hyderabad. The event was judged by eminent neurologists from across the country, namely Dr Susheel Wadhwa, Narayan Hrudayala – Bengaluru, Dr Subhash Kaul, Head of Department of Neurology at Nizam’s Institute of Medical Sciences – Hyderabad, Dr Suvarna Alladi, Additional Professor of Neurology, Nizam’s Institute of Medical Sciences – Hyderabad and Brig SP Gorthi, Prof and Head of Department of Neurology Army Hospital R&R - New Delhi. Participants had gathered in Mumbai on Saturday, 19 April, where they were trained in different segments of neurology by the specialists. The Indian National Brain Bee champion – 2014 from Bengaluru walked away with a trophy, a laptop and a certificate of appreciation. She would also be sent on a paid trip to Washington DC to further participate in the 16th International Brain Bee finals, scheduled from 7-10, August 2014 along with the 122nd American Psychology Association Convention. The Brain Bee contest is conducted on a regional level and subsequently the winners in these levels contest in the national competition. The competition tests the knowledge of students about brain and in-

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The Brain Bee contest is conducted on a regional level and subsequently the winners in these levels contest in the national competition. The competition tests the knowledge of students about brain and includes activities that along with testing student’s knowledge would also engage them in learning about neuroscience cludes activities that along with testing student’s knowledge would also engage them in learning about neuroscience. Dr Harleen Luther, Senior Consultant – Brain, Spine & Peripheral Nerve Surgery, Dept of Neurosurgery, SevenHills Hos-

pital conducted the contest in Mumbai. Dr Luther said, “The purpose of Indian National Brain Bee-Championship is to motivate young students to learn about the brain and inspire them to seek careers in basic and clinical neurosciences

to help treat and cure diseases of the brain and nervous system. Witnessing this talent and competition at such a young age in India is a satisfying experience.” Anand Garg, CEO, SevenHills Hospitals, further added, “We saw young minds who are inspired to take up neurosciences as career paths participate in this unique competition. We are happy to organise this finale and hope the students enjoyed interacting with eminent neuro specialists from across the country. Also, good wishes to the champion for the International Brain Bee.” Over the last few years, India has seen some stellar performances from its national champions at the International level. Notably among these, the winner of the 3rd INBB from Mumbai had won the 12th International Brain Bee Championship held at San Diego in 2010, the first time ever since India’s participation at the international level since 2005.

EVENT BRIEF MAY 2014-FEB 2015 1

Green Lean Six Sigma Certification Training and other Hospital Management Workshops

GREEN LEAN SIX SIGMA CERTIFICATION TRAINING AND OTHER HOSPITAL MANAGEMENT WORKSHOPS Training calender: May 2014 to December 2014 Location: Mumbai, Delhi, Ahmedabad, Pune, Jaipur, Bangalore, Chennai and Hyderabad Last date to register: May 19, 2014 Summary:Green Lean Six Sigma in Healthcare Certification Training for: 1. Green lean six sigma in healthcare (yellow belt) 2. Green lean six sigma in healthcare (green belt) 3. Green lean six sigma in healthcare (black belt) This programme module is specially designed for hospital managers and other healthcare professionals and

shall focus on six sigma methodologies, lean concepts in healthcare systems and service delivery. Hospital management MDP workshops on: 1. Service management in hospitals 2. Healthcare quality (clinical audit) 3. IT in healthcare 4. Marketing of healthcare services 5. Healthcare quality (patient safety) 6. Quality management in hospitals These one-day MDP workshops envisages to build participants on various hospital management practices aspects as per the respective topics. Participant profile: hospital ceos /coos, management exec-

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14TH WORLD CONGRESS ON PUBLIC HEALTH IN 2015 Dates: February 11-15, 2015 Venue: Science City, Kolkata Summary: The 2015 Congress will offer unique

14th World Congress on Public Health in 2015

opportunities to discuss global and national public health issues among the global public health community and other key stakeholders. It will provide a unique opportunity to help catalyse change, bringing together and bridging perspectives from various disciplines of public health to infuence governments, organisations, agencies and institutions around the world to meet the challenge of improving people’s health . Contact IPHA 110, Chittranjan Avenue, Kolkata – 700073 Phone: + 91 33 32913895 Email: secretarygen@iphaonline.org Website: www.14wcph.org

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IS INDIA

EMERGING AS OEM FOR IVD? Though the in-vitro diagnostics market in India has seen double digit growth in the past few years, IVD equipment manufacturing is yet to gain pace to match the demands of the exponentially growing industry BY NEELAM M KACHHAP

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n-vitro diagnostics market and the clinical laboratory market have almost parallel growth path. Both these sectors have seen phenomenal growth in the past decade. However, while many entrepreneurs have invested in diagnostic laboratories converting them into profitable business spread across India IVD manufacturing has not seen similar enthusiasm. Only a handful of Indian manufactures dot the scene flooded by large foreign companies. However, there seems to be a ray of hope as few companies leading the path to success are inspiring confidence among newcomers.

The market The IVD market in India has seen double digit growth in the past few years. The Indian IVD market is pegged at $500 million, and is expected to surpass $1.5 billion by 2018 growing steady at a CAGR of 20 per cent according to a recent research report by MarketReportsOnline.com. However, Carl McEvoy, Partner, McEvoy & Farmer LLC , USA who specialises in market research for in-vitro diagnostics in emerging markets of Asia and Latin America, paints a different picture. “We estimate the market to be $760 million in 2014,” he says, providing evidence of the tremendous opportunity in India. The IVD market consists of both equipment and reagents for different segments such as immunochemistry, biochemistry, haematology, microbiology, blood gas and electrolyte, molecular diagnostics, urinalysis and coagulation analysis. “Of all the segments biochemistry occupies the largest share of the market,” says Suresh Chandrasekaran, General Manager - Marketing & Planning, CPC Diagnostics, Bangalore.

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2018 Molecular Diagnostics - 7%

2014 Immunochemistry: 24%

$500MILLION is the value of the Indian IVD market

$1.5BILLION is expected to surpass by 2018 growing at a steady CAGR of 20 per cent.

Growth drivers Increasing investment in the healthcare sector is responsible for the growth of this market. Patient awareness and government impetus have both put IVD on an accelerated growth path. According to Transasia Bio-Medicals, the increase in the diagnosis of chronic

REASONS FOR GROWTH ■

Urinalysis: 9% Microbiology : 4%

Biochemistry : 21% Haematology : 18% Blood Gas & Electrolyte : 13%

Increased healthcare awareness,

■ Desire to undergo preventive health checkups, ■ Availability of disease specific tests, ■ Corporate setups promoting health focus of employees, ■ And drift from manual to semi-automated

and automated equipment.

lifestyle and genetic diseases, aging population, and rising acceptance of personalised medicine drive the in-vitro diagnostic market growth. Fast-paced economy, public screening initiatives, and increase in the investment in healthcare infrastructures are the other major factors that contribute to the

IVD MARKET BY DEVICE & REAGENTS MARKET SHARE %

market growth. Transasia BioMedicals also explains that the Government is also supporting new initiatives for promoting the growth of the Indian IVD segment. Public-Private Partnerships (PPP) prevail in Tamil Nadu and parts of West Bengal (especially for radiology), now the Government is encourag-

ing the same in other states as well in order to pass on the benefit to the citizens. Moreover, the Government has encouraged Foreign Direct Investment (FDI) as well as indigenous research thereby promoting the sector. There has been a rise in the number of players entering the sector

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and offering quality products and after sales services.

Competitive landscape Of the total IVD market in India, top 10 slots are occupied by global IVD companies with only one Indian company featuring among them. The Indian IVD market is majorly dependent on global IVD companies. Global majors like Roche Diagnostics, Abbott, J&J, Siemens Healthcare Diagnostics and Beckman Coulter enjoy larger consumer base and mindshare in India. Companies from China and Japan have also started vying for a share of the pie with as many as five such companies opening its Indian subsidiary office in past few years. Mindray Medical and Sysmex are making its presence felt in India. Notable Indian companies like Transasia Bio-Medicals, Lilac Medicare , Agappe Diagnostics, CPC Diagnostics, Bhat-Biotech are also emerging as preferred partners for clinical laboratories.In terms of market share global companies rule 3/4th of the market in India. "Of the total IVD market in India, global IVD companies enjoy almost 75 per cent share, whereas local players have 25 per cent share,” informs Chandrasekaran. The total number of laboratories in India is not known, however, some experts estimated that India has more than 30,000 active clinical laboratories. Of these a very small number five per cent have achieved total automation, whereas 38 per cent have semi-automation and a large proportion 57 per cent still use manual methods.

Indian manufacturers turning a new leaf Traditionally, Indian manufacturers have not ventured into high-tech products but with local companies taking a lead this trend is changing. “IVD manufacturing in India is generally in areas of labourintensive products such as rapid tests and low-technology

items like packaging chemistry reagents,” says McEvoy. Chandrasekaran elaborates saying, “The earliest phase of manufacturing involved replication of technology of what was available in the western countries. Over a period of time, with the advent of sophistication in man power, availability of required raw materials and implementation of Good Manufacturing Practices, organisations have been able to venture into manufacture of high technology products.” “Many organisations have been able to sail into an odyssey into unchartered waters, like how CPC has been able to successfully launch the indigenous haematology analyser for the first time in India,” he adds. “Transasia is a notable exceptions with its partnership with Sysmex and their new group of international companies they have acquired over the past few years. The Tulip group with their new small molecular system is also an exception,” informs McEvoy. Reiterate his thoughts, Dr Shama Bhat, Chairman and MD, Bhat-Biotech India says, “Indian manufacturers do not have the technology and the segment is highly capital intensive. Now the trend is changing and companies like Transasia and several other companies like Bhat-Biotech have started making many instruments.”

Indian advantage Cost-effectiveness provides an edge to indegeneous products as the market in tireII and tier-III are more sensitive to cost. Transasia BioMedicals says that Indian IVD products are recognised for their quality. The latest technology is used for the development of the products. Indians enjoy the reputation of developing and offering advanced softwares and IT solutions. And so, we have an edge over others,as most of the analysers are technologically advanced, incorporating the lat-

est softwares. Moreover, the Indian IVD products are also recognised for their cost effectiveness.

Challenges The low number of Indian players in this market definitely point towards the hardships faced by the Indian manufacturers. From technological knowhow to precision engineering and poor regulatory and tax focus have all impeded the growth of Indian manufacturers in this industry. “India’s manufacturing is dramatically held back by poor infrastructure and a tax system that makes moving parts and final products between states time consuming and expensive,” explains McEvoy. “Credibility and ability to market our products are the main challenges. Even though the IT industry was able to overcome this stigma, we are still lagging behind in this respect,” says Dr Bhat. Explaining further Chandrasekaran says, “While India has made significant strides in the field of heavy engineering and automobiles in the past couple of decades, progress of indigenisation has been minimal in the field of medical electronics. One of the major reasons could be attributed to the scarcity of precision engineering components which are critical to the making of IVD instruments.” “Indigenisation always leads to technology being made affordable. This assumes great significance in the Indian context where a vast majority of the population does not have access to affordable healthcare. Expanding healthcare infrastructure being the topmost priority for government today, there should be incentives to organisations engaged in indigenisation which ultimately should motivate more companies to look at this as a lucrative option,” he adds. In addition, consumers expect more from their vendors today in terms of better features and prompt after-sales

service. For example an onboard laundry facility is a much desired facility for all biochemistry analysers as well as the presence of a refrigeration system, to ensures the storage of reagents in the analyzers overnight. In-build quality control feature is also much sought after. While all customers need efficient after-sale services and reduced down time; not all companies have the manpower or reach to deliver this. While product registration and certification is fairly easy in India, to operate in international markets Indian products have to pass through stringent international regulatory processes. This needs to be incorporated in the DNA of the product development process.

IVD manufacturing in India is generally in areas of labour-intensive products such as rapid tests and low-technology Carl McEvoy Partner, McEvoy & Farmer LLC, USA

Finding new buyers Indian manufacturers have gained ground on foreign shores with many exporting their products. “I believe the local companies are very aware of the world market and its opportunities,” says McEvoy. Indian IVD products receive a welcoming response from European, Asia Pacific, Russian and the Latin American markets opines Transasia Bio-Medicals. "Products manufactured in India have started gaining acceptance in the Middle East, South East Asia, Eastern Europe and African countries. Once we are able to prove that the products score equally on quality as much as the already available products, the products manufactured in India will have a greater acceptance in the global market,” explains Chandrasekaran. Market in India is far from saturation. IVD driven by informed consumers is unlikely to see a downswing. What is required is for the Indian manufacturers to rise to the situation and claim the market. Is it possible? Yes. However, only time can tell how this story will unfold. mneelam.kachhap@expressindia.com

Indigenisation always leads to technology being made affordable. This assumes great significance in the Indian context Suresh Chandrasekaran General Manager - Marketing & Planning, CPC Diagnostics, Bangalore

Indian manufacturers do not have the technology and the segment is highly capital intensive Dr Shama Bhat, Chairman and MD, Bhat-Biotech India

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cover ) ANALYSIS

Smaller cities: A new hub for diagnostic labs Opportunities are galore for the Indian diagnostic lab market within the tier-II and III cities of the country. More and more players are now vying for the piece of this pie, Raelene Kambli explores

he Indian in-vitro diagnostic lab sector known to be healthcare's high margin, asset-intensive business segment is on a constant growth path. The sector's current market share is around $400 million and is expected to touch $1,254 million by 2018. In the last three to five years itself, the sector is said to have maintained an average CAGR of 20 per cent year-on-year. Moreover, with the advent of new varieties of diagnostic tests incorporating latest technology, FY2013 marked a revenue growth of 25.8 per cent compared to FY’2012. Although, the surge in dollar against the rupee last year did act as a roadblock, nonetheless profitability earned by organised diagnostic players individually pumped in the revenues for growth.

Market players Majority of the market still remains fragmented. As per National Accreditation Board for Laboratories (NABL) figures of 2013, out of one lakh labs in India, 800 have applied for accreditation and 400 have received it. Nevertheless, large organised players like Super Religare Laboratories, Dr Lal Pathlabs, Metropolis, Thyrocare, Max Healthcare, Anand Diagnostic Laboratory and Apollo Clinics have been leading the industry. Seeing the immense opportunities within the Indian diagnostic lab market, international players such as Quest Diagnostics has also been making a mark in the north Indian re-

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gion. As far as the market shares are concerned, industry experts reveal that the top four brands contribute to volumes of more than 20,000 specimen per day, therefore their turnovers occupy 50-60 per cent of the total market share of the industry. SRL diagnostics itself claims for 50 per cent of the market share, whereas Dr A Velumani, Chairman MD, Thyrocare informs, “We have a mean daily work load of 210,000 investigations and our monthly turnover is Rs 25 crores.” He further goes on to say, “New players are many but to cross a 5000-specimen per day becomes a challenge in this most competitive business to business (BtoB)market. BtoB market gives volume while business to customers (BtoC) market gives value. The one who leans more towards BtoB have higher market share and we have almost 90 per cent BtoB business.”

Key drivers and trends Diagnostics is an extremely important component of the healthcare system. This segment enables accurate detection of health risks and diseases at earlier stages; it improves treatment and disease management as well. Indeed, it is the diagnostic segment that adds value to the healthcare sector at large. And with increased consciousness among people, the demand for in-vitro diagnostics has grown. According to a report titled, “India In-Vitro Diagnostics Industry Analysis till 2018 – Ac-

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Tier-II and III cities, present an attractive opportunity for large corporate players. These cities represent an area of under-served need, with a growing need for improved health infrastructure creditation and Automation to Drive Future Growth', the in-vitro diagnostics market in India is hugely driven by the increasing number of lifestyle diseases, inclining preventive healthcare practices, mounting disposable incomes, government’s initiatives and improving healthcare infrastructure. The report also reveals that this sector has showcased several emerging trends over the past few years. Some of the most definitive of these trends has been the advent of decentralised testing, mounting automation in laboratories, increasing consolidation and preference for early detection of diseases. Several pathological labs have resorted to invest heftily, and have been adopting fully automated systems for diseases diagnosis. In light of this, the accuracy of test results has increased, while the turnaround times have declined significantly. Additionally, the growth of portable diagnostics devices has propelled the market for point of care testing in India. Analysing the sector industry expert Dr BR Das, President-Research & Innovation, Mentor-Molecular Pathology and Clinical Research Services, SRL, observes some keys

trends within the sector: ◗ Increasing awareness about need and importance of diagnostic tests through mass media and the Internet ◗ Adoption of developed country (Western) clinical testing protocols across healthcare services ◗ Desire to undergo preventive health checkups and favourable government policies (preventive healthcare tests now allowed tax exemption under section 80D) ◗ Starting of stand-alone super-specialised testing (molecular diagnostics, molecular cytogenetics and mass spectrometry) laboratories ◗ Emphasis on development of new testing targets/algorithms, particularly in oncology ◗ Technological improvements (e.g. simpler automated workflows) that are driving the use of higher value tests (e.g., automated immunoassays, molecular diagnostics) ◗ Pricing pressure for tests due to competition from lower cost-pertest technologies ◗ Corporate acknowledging and promoting importance of health at workplace and at home. ◗ Emergence of the concept of cus-

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cover ) tomer relationship management in corporate IVD service set ups ◗ Increasing number of smaller labs applying for accreditation Additionally, Dr Velumani, points outs some trends observed on the clinical side. He says, “Laboratories understand that in biochemistry there are volumes, value and scalability and hence their focus has been shifting more towards biochemistry applications. Also, the preventive care segment has huge potentials and those laboratories which have the capacity are giving more importance to preventive care. On the other hand, automations are improving turnaround time and reducing analytical errors and hence more players are opting for costly automations as well.” Moreover, in an effort to match increasing demand, large players have endeavoured to increase pan-India presence, by building national networks, over the last few years. Simultaneously, the market has witnessed continuous mushrooming of diagnostics labs within the tier-II and III cities of India.

Tapping tier-II and III markets Presently, tier-II and III cities of India are witnessing a surge of activity where diagnostic labs are concerned. Major players, such as SRL, Metropolis, and Dr Lal’s Pathlabs are all setting up shops in the B-towns. Onquest Laboratories, Quest Diagnostics, Pathcare, Diagno Labs are midsized players also have a strong hold within these regions. Reasons being that tier-II and III cities, present an attractive opportunity for large corporate players. These cities represent an area of underserved need, with a growing need for improved health infrastructure.

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Starting of stand-alone super-specialised testing laboratories and emphasis on development of new testing particularly in oncology and many other reason are the key driver of growth for the Indian diagnostic lab market B R Das President-Research & Innovation, Mentor-Molecular Pathology and Clinical Research Services, SRL

Opportunities are In the last 10 years immense. There is there have been an unmet requireenough of populament of quality tion growth in these healthcare services cities and laboratoavailability in these ries have enough to cities. The major consume.Our wish players offer stateis to have a quality of-the-art services collection centre to meet this. with trained personMetropolis healthnel, to connect care intends to using broadband – establish around 15- next to each State 20 locations yearly Bank of India branch in India Dr Puneet Nigam Partner, McEvoy & Farmer LLC , USA

A Velumani CEO,Thyrocare

Major players, such as SRL, Metropolis, and Dr Lal’s Pathlabs are all setting up shops in the Btowns. Onquest Laboratories, Quest Diagnostics, Pathcare, Diagno Labs are mid-sized players also have a strong hold within these regions “Opportunities are immense. There is an unmet requirement of quality healthcare services availability in these cities. The major players offer state-of-the-art services to meet this”, feels Dr Puneet. Nigam (Chief of Lab services – Delhi), Metropolis Healthcare. Furthermore, several demographic factors, rapid urbanisation and saturation of progress in metro cities are some of the aspects that draw these players to venture into these semi-urban areas and smaller towns.

Market at a glance Speaking about the diagnostic operations happening in tier-II and III cities, Dr

Velumani informs, “Major players operate in the field of biochemistry, immunoassay, haematology and general pathology segment. Each segment has a couple of industry leaders who focus only on the top of the pyramid. The rest of the players occupy the rest of the pyramid. Big players play it for volumes while small players chase for value in these areas.” Apart from this, larger players are now raising funds to tap the market in these regions eg. Dr Lal's Pathlabs raised around Rs 44 million last year through private equity funding. This was one of the big ticket investment in healthcare services as well. As per Dr Lal's Pathlab, these funds will be

used to expand further in the tier-II and III cities. Metropolis healthcare too has aggressive plans to expand into the tier-II-III cities. They intend to establish around 1520 locations every year. Dr Velumani also reveals his plans for Thyrocare and says, “Villages become towns, towns become cities – in just 10 years. In the last 10 years there have been enough of population growth in these cities and towns and laboratories have enough to consume. Our wish is to have a quality collection centre with trained personnel, to connect using broadband – next to each State Bank of India branch in the country.”In addition, the Indian govern-

ment is also taking initiatives by entering into public private partnerships to create accessibility of healthcare services to the rural population of the country. While certain initiatives have been taken in healthcare services, PPP in diagnostics as an exclusive service are at a nascent stage. This is another opportunity that will open avenues for the industry players to target the lower income groups. Where opportunities are galore there will be challenges too. According to a report published by KPMG, some of the challenges faced by diagnostic lab players in the tier-II and III regions include: ◗ Difficulty in recruiting and retaining medical and paramedical talent ◗ Difficulty in patient recruitment and retention as business is based on credibility in local communities ◗ Profitability of centres in tierIII cities restrains large players from entering them i.e, challenges exist around scale and price points. Further, getting competent manpower, establishing supply chain and logistics, communicating the value of high-end services are some of the other challenges faced by large corporate players, discloses Dr Nigam.

Moving ahead Demand for diagnostic services is here to stay. Therefore, in-vitro diagnostic lab market is certainly going to flourish further. With more and more funds flowing into the sector, larger players as well as mid-sized players will be expanding their services pan India. More mergers and acquisitions will be on the cards. Moreover, increasing importance of accreditation of labs will also transform the sector into a more organised one. raelene.kambli@expressindia.com

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INSIGHT

Changing landscape of diagnostics: Yesterday, today and the road ahead

DR ARNAB ROY Senior Research Scientist, SRL, R&D

DR FAISAL KHAN Senior Research Officer, SRL, R&D

Dr Arnab Roy, Senior Research Scientist, SRL, R&D and Dr Faisal Khan, Senior Research Officer, SRL, R&D throw light on the progress achieved in the field of medical diagnostics in the last few decades, which has paved way for better treatment facilities and patient care

one are the days when diagnosis of a disease like cancer or tuberculosis would remain elusive for months or years together. Gone are the days when clinicians would keep speculating about the causes of a fever with no specific diagnosis. Gone are the days when the only modality available to diagnose a disease was a battery of routine blood tests and there was no way for a clinician to find out the changes occurring at a cellular and sub cellular level. Gone are the days when drugs would be given to patients without really finding out beforehand, whether or not the drug would really work on the patient. Gone are the days when the patient would have to go all the way to a pathology centre merely for checking blood glucose. The advancements in the field of medical diagnostics have revolutionised the entire gamut of detecting and identifying diseases. The concept of monitoring the efficacy of a therapeutic regimen through monitoring tests has got assimilated in mainstream clinical practice. Patients are not just tested any more to merely diagnose diseases but also undergo diagnostic tests, for determining the best suited therapy for each one of them. Besides, point-of-care testing devices like glucometers and pregnancy urine kits among many others have trans-

PCR microtubes

posed diagnostics from the laboratory, to the site of care of the patient. Indeed, in the past few decades, the arena of diagnostics has grown from strength to strength. This progress in medical diagnostics has made it possible to achieve milestones in the realms of personalised medicine, gene therapy, molecular pathology, companion diagnostics and point-of-care testing. However, Rome was not built in

a day!! Several years of relentless research and upgradation has gone into this change. Thus, on the occasion of World Health Day, it seems apt to take a trip down memory lane and look back at the journey of medical diagnostics. With the passage of time, the horizon of diagnostic modalities has widened from simple smear microscopy, histopathological examination and pathogenic

culture to serological assays, biochemical analysis, molecular pathology, monoclonal antibody mediated techniques and a wide array of PCR based methods; the change has been phenomenal. To better identify as to how the emergence of newer diagnostic techniques influences the patterns of disease detection; letâ&#x20AC;&#x2122;s consider the case of a few interesting disease areas. To begin with, letâ&#x20AC;&#x2122;s have a look at the

changes that have been witnessed in the diagnosis of TB. In the late 18th century, Robert Koch identified Mycobacterium Tuberculosis, stained this causative pathogen and visualised it under a microscope. In effect, this was one of the earliest applications of what later came to be known as 'smear microscopy.' This remained a widely used method in the diagnosis of TB for a long period of

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cover ) time. However, the acceptance of smear microscopy plummeted as several sputum-smear negative TB cases went undiagnosed and got reported as false negatives. This presented an unmet medical need for a more robust diagnostic option: A need that was satisfied by performing a pathogenic culture of Mycobacterium Tuberculosis; which remains the gold standard hitherto. In due course of time, serological tests also received wide acceptance as an adjunctive modality in the diagnosis of TB. However, in lieu of mounting evidence confirming misdiagnosis of TB with serological tests, regulatory authorities and international medical bodies issued recommendations banning the use of serological assays for TB diagnosis. The most noteworthy development in the area of TB diagnosis has in fact taken place in the recent past, with the introduction of a real time PCR based, US-FDA approved and WHO endorsed molecular assay called Xpert MTB/RIF. This molecular diagnostic method has substantially changed the paradigm of TB diagnostics in the last decade. As compared to the gold standard; it is quicker, has fewer infrastructural pre-requisites, is less technique sensitive and is highly automated which significantly marginalises the possibility of human error. Its diagnostic accuracy is comparable to the gold standard. It can be effectively employed for confirmatory diagnosis of pulmonary, extra-pulmonary, paediatric and MDR forms of TB as well as HIV-TB co-infections. A similar progression in diagnostic techniques can be traced by taking another example from oncology, that of acute myeloid leukaemia (AML). Traditionally, peripheral blood smears were examined to validate a presumptive diagnosis of AML by visualising leukaemic blast cells. Subsequently, this primary diagnostic method was followed by bone marrow aspiration smears for confirmatory diagnosis; which hold true even today. In addition to this, flow cytometry techniques have

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Flow cytometry techniques have been developed which detect the presence of several tumour markers in the blood sample of an AML patient been developed which detect the presence of several tumour markers in the blood sample of an AML patient. This technique is now widely employed in the diagnostic work up of AML not only for confirmatory diagnosis; but also for distinguishing between AML and acute lymphoid leukaemia and other lymphoproliferative disorders. Moreover, cytogenetics has identified a fusion gene called PML/RARa which has been recognised as the genetic signature of the disease and another fusion transcript AML/ETO which can help prognosticate a case of AML. In addition to the traditionally employed smears used for primary and confirmatory diagnosis, PCR based biomarker tests can detect tumour markers like FLT3, NPM1, CEBP-a and WT1. These tumour markers provide critical insight in predicting the prognosis of AML and have been recommended by international guidelines. The examples of TB and AML that have been presented here to cite the advancements in

the realm of diagnostics perhaps depict just the tip of the iceberg. A plethora of such other examples can be cited which would speak volumes about the changing landscape of diagnosis and its impact on disease intervention, therapy decision making and clinical outcomes. However, including multiple such examples is beyond the scope of this write up. Nevertheless, it would be useful to throw light at least upon one more crucial disease area; wherein diagnostics seem to have literally gone from bench to bedside. Of course, we are pointing towards diabetes, as a disease segment and the vast range of point of care testing (POCT) products for diabetes. Glycated haemoglobin can be measured with rapid automated POCT instruments for long term monitoring of blood glucose. Urinalysis dipsticks and blood betahydroxybutyrate meters are widely used for measuring ketones in blood and urine. Semi-quantitative visual dipsticks and quantitative automated methods of urine testing became are freely available for

bedside detection of urinary albumin at low concentrations and for the determination of the microalbumin creatinine ratio. This wide range of POCT products has gone a long way in easing the lives of diabetics for whom continuous serial monitoring is needed. Besides, POCT measures also ensure rapid and quick diagnosis, better patient compliance and reduce repetitive visits to a reference laboratory. POC diagnostic products are also widely popular in the measurements of electrolytes, blood gases and coagulation markers. Medical diagnostics is set to undergo a significant metamorphosis as the wheel of time continues to spin. The situation is thus pregnant with new avenues and vistas in diagnostics, which can result in remarkable changes in the detection, diagnosis and management of diseases in times to come. The vast body of scientific knowledge obtained through the study of the human genome and functional genomics has led to the discovery and clinical validation of a

plethora of diagnostic biomarkers. These biomarkers are being employed in screening, primary diagnosis, therapy decision making, therapeutic monitoring and prognostication. Biomarkers, as well as gene targeted therapy, represent the combined new frontier of laboratory medicine as well as of clinical management. Diagnostic algorithms assisted by computerised technology have enabled the assessment of large panels of molecular targets of a disease rather than testing individual biomarkers. Furthermore, the concept of bringing diagnostics to the bedside of the patient has gone a long way in easing patient care by accelerating treatment decisions and reducing costs. In the recent past, one of the key concerns of the healthcare sector has been increasing healthcare costs. However, under the umbrella of health care services, â&#x20AC;&#x2DC;diagnosticsâ&#x20AC;&#x2122; perhaps is the only segment that continues to remain the most cost efficient one. The demand supply equation is expected to further tilt in favour of the diagnostics domain as the demand for more and more rapid laboratory medicine services, increases within clinical practice. At this notable turning point, when the diagnostics industry is experiencing the flux of change and growth, the key to sustainable development lies in coaching and mentoring the next generation of laboratorians into seasoned lab professionals. References: 1.S. Dorman. Clin Infect Dis. (2010) 50 (Supplement 3): S173S177 2.P. Small and M. Pai. N Engl J Med 2010; 363:1070-1071 3.http://www.cytometry.org/public/educational_presentations/C herian.pdf 4.Kaleem Z et al. Arch Pathol Lab Med. 2003 Jan;127(1):42-8 5.Gregory T et al. Journal of Hematology and Oncology 2009, 2:23 6.Matteucci and Giampietro. Mini Rev Med Chem. 2011 Feb;11(2):178-84 7.A Wells. Rinsho Byori. 2012 Apr;60(4):312-20

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INSIGHT

Significance of second opinion in breast pathology

DR ANURAG BANSAL Associate Medical Director of Quest Diagnostics India

Dr Anurag Bansal, Associate Medical Director, Quest Diagnostics India opines that misguided diagnosis or treatment of breast cancer can be reduced and avoided by opting for a second opinion by a specialist pathologist

lobally, more than one million new cases of cancer are diagnosed in a year and approximately 23 per cent of all new cancer cases diagnosed are breast cancers1,2. With an incidence of 22.2 per cent, and a mortality of 17.2 per cent, it is pegged as the second most commonly occurring cancer in women in India3. Among males and females, breast cancer cases are expected to cross the figure of 100,000 in India, by the year 20204. In the US, about 89 per cent of women diagnosed with breast cancer are likely to survive for at least five years5. There are barely any similar statistics for India available, but rough estimates from the Population Based Cancer Registry (PBCR) and Hospital Based Cancer Registries (HBCR) reports state that this figure is less than 60 per cent. When detected at an early stage and aggressively managed using a multimodal approach, breast cancer displays significantly reduced morbidity and mortality 6,7. In India, a lack of an organised screening programme, scarcity of diagnostic aids, failure to act on symptoms, delay in consulting the specialist and lack of awareness of new screening tests may be some of the reasons that breast cancer does not get diagnosed and treated as effectively as in the US. To add to the complexity is the fact that breast cancer is not a single disease entity, but is a conglomeration of morphological subtypes with different clinical outcomes. Diagnosing and

staging accurately is another challenge faced by clinicians. Despite training and experience of pathologists, diagnostic discrepancies are bound to occur, as a result of inherent practice-related difficulties, as well as differences in the abilities and personal interpretations concerning tissue changes. Another important challenge is the interpretation of the ER-PR (estrogen or progesterone receptor) status and HER2/neu amplification and over expression. These tests help in the right classification of breast cancer and provide the clinician with information about how the tumour acts and what kind of therapy may promote a favourable response. Although there are several guidelines, these tests are performed and interpreted differently by different laboratories and clinicians resulting in further difference of opinion8. It has therefore been noted that breast pathology is one of the areas within surgical pathology that often yields differences of opinion.

As other fields of medicine have become increasingly subspecialised, so too has surgical pathology. There is an increasing trend toward sub-speciality diagnosis of surgical pathology cases in academic settings; that is, breast cancer case reports are often signed out only by pathologists with expertise in breast pathology to avoid any misdiagnosis resulting in wrong therapy. In the US, there is now a growing trend to obtain a second opinion from an expert breast pathologist and there are published studies highlighting the same. One such study showed that post second review, major changes that altered surgical therapy occurred in 7.8 per cent of cases, and in 40 per cent of the cases the second opinion provided additional prognostic information.9 In India, a study of this kind was done by a reference lab in its clinical laboratory in Gurgaon. A retrospective analysis of 51 breast cancer patients, who

were referred for second opinion between 2011 and 2013, was done to understand the level of diagnostic discrepancies. The specialist breast pathologists of the reference lab expert medical team conducted the consultative diagnosis for these cases. Out of the 51 cases, aged between 27 and 77 years, diagnostic insights provided by a specialist breast pathologist changed or impacted the therapy in almost 43 per cent of the cases. Out of the 43 per cent, the diagnosis was discordant from primary diagnosis in 27.5 per cent of the cases. In 15.6 per cent of the cases, the diagnosis from the breast pathologist provided â&#x20AC;&#x2DC;additional insightâ&#x20AC;&#x2122; that impacted the clinical management of the patient (selection of therapy and/or understanding on prognosis). In conclusion, a second opinion by a specialist pathologist can provide insights to the clinician to help guide diagnosis and treatment. With this team approach, more patients may be

spared the potential emotional, physical and economic toll that comes from late or misguided diagnosis or treatment of breast cancer. References: 1. Pakseresht, S., et al. Risk factors with breast cancer among women in Delhi. Indian J Cancer. 2009;46:132-138. 2. Jemal, A., et al. Global cancer statistics. Ca Cancer J Clin.2011;61:69â&#x20AC;&#x201C;90. 3. GLOBOCAN.(2008) [Online] Available from: http://globocan.iarc.fr/factsheet.a sp. [Accessed on: 21stAugust, 2013]. 4. Projections of Cancer Cases in India (2010-2030) by Cancer Groups. Asian Pacific J Cancer Prev, 11, 1045-1049 5.American Cancer Society. Breast Cancer facts and figures 2007-2008. 6. Yenidunya, S. et al. (2011) Predictive value of pathological and immunohistochemical parameters for axillary lymph node metastasis in breast carcinoma. [Online] Available from:http://www.diagnosticpathology.org/content/6/1/18. [Accessed on: 21st August, 2013. 7. Patil, VW.,et al. (2011) Triplenegative (ER, PgR, HER-2/neu) breast cancer in Indian women. [Online] Available from: DOI: 10.2147/BCTT.S17094. [Accessed on: 21st August, 2013]. 8. Kleer, CG. Pathology re-review as an essential component of breast cancer management. CurrOncol. 2010;17(1):2-3. 9. Staradub VL et al. (2002) Changes in breast cancer therapy because of pathology second opinions, Ann Surg Oncol. 2002 Dec;9(10):982-7.

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STRATEGY INSIGHT

Challenges in Healthcare

JYOTI R MUNAVALLI Research Associate, Maastricht University Medical Centre, The Netherlands

Jyoti R Munavalli Research Associate, Maastricht University Medical Centre,The Netherlands, Prof Frits van Merode, Professor of Logistics and Operations Management in Health Care, Dean of Sciences, Scientific Director India, Maastricht University Medical Centre, Maastricht, The Netherlands and Dr Shyam Vasudeva Rao, Co-Founder, President and CTO, Forus Health do a comparative analysis of the healthcare systems in different countries, identify the challenges in Indian healthcare and give recommendations to improve the system

PROF FRITS VAN MEROD Professor of Logistics and Operations Management in Health Care, Dean of Sciences, Scientific Director India, Maastricht University Medical Centre, Maastricht, The Netherlands

DR SHYAM VASUDEVA RAO Founder, President and CTO, Forus Health

n recent years, analysis of the proposition that ‘healthier means wealthier’ have abounded, with the vast majority of them concluding that health is a strong driver of economic growth. Therefore, the world is stepping towards universal healthcare, which provides accessible, affordable, appropriate and quality healthcare to every human. The healthcare sector is one of the fastest growing industries and it includes hospitals with primary, secondary and tertiary care, pharma, insurance, catering, housekeeping, management software and medical devices. Healthcare systems differ from country to country. What are the challenges in healthcare faced by developed and developing countries? Are they the same or different? Healthcare systems in the West are in a transition phase. The scientific medicine which uses technology has resulted in

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errors, accidents, infections and medical drug disasters that cause unnecessary pain and suffering. On the financial front, the uninsured population is accessing emergency services which are expensive. And for those who are insured, the choice of treatment is insurance provider dependent. Though a lot of money is spent on healthcare, the outcome is not quite satisfactory. Healthcare systems in Europe and the US are in the end-of-life-cycle state. Healthcare in the West has to be re-invented and India certainly shouldn’t follow them but learn from their experience. The nation’s economy is driven by its healthcare economics and therefore we need a sustainable and affordable healthcare system. First let us have a brief view on different healthcare systems.

Healthcare system in US Healthcare spending by the developed countries is always

US spends

17.9

per cent of its GDP on healthcare

France Germany and

are among the best healthcare systems in Europe

more as compared to the developing countries. The US spends 17.9 per cent of its GDP, highest in the world on healthcare, in which 45.9 per cent is from the public sector and 11.3 per cent is out-of-pocket spending. According to the World Bank data, the US health expenditure per capita in 2011 was $86081. The US spends a lot on healthcare due to higher prices for hospital visits, expensive drugs and costly diagnostic procedures. The administrative and operational costs also add an overhead to the overall expenses. A 2013 study found that about 25 per cent of all senior citizens declare bankruptcy due to medical expenses, and 43 per cent are forced to mortgage or sell their primary residence2.

Healthcare system in Europe Most European countries provide universal healthcare for its residents. Healthcare de-

STRATEGY

livery systems can be divided into two broad categories: National Health Services (NHS) on one hand and Social Security (based) Healthcare systems (SSH) on the other hand. In some countries, general practitioners are salaried employees of the local or the central government. The NHS is financed by taxes. The specialists in the larger hospitals are also employees of NHS. Those who are employed pay the premium out of their payroll, for others the government buys the premium. France and Germany are among the best healthcare systems in Europe, yet with complaints of long waits and too few beds3. According to the Organization for Economic Cooperation and Development (OECD), the European Union will see an increase of 350 per cent in health expenditure by 2050, whereas at the same time the economy is only set to expand by 180 per cent. Friedrich Breyer, a professor of economics at the University of Konstanz in Germany, calculates that in Germany alone, between 2020 and 2030, there will be a huge spike in the number of elderly people alongside an enormous drop in young and working age people. In consequence, the systems face the problem of rationing services in order to cut costs owing to an increasing demand and a decreasing tax base to pay for that demand.4, 5

Healthcare system in India India, along with modern medicine, also uses its traditional medical systems of Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH). According to the WHO report in 2003, these are used by 65 per cent of rural population for primary healthcare. According to the World Bank data, in 2011, Indiaâ&#x20AC;&#x2122;s health expenditure per capita was $59. The total healthcare spending in India is around 4.1 per cent of its GDP, lowest in the world1. Indian policies and framework on healthcare are very different

from the rest of the world. In India, the population distribution is 20 per cent urban and 80 per cent rural. 80 per cent of healthcare services are available to this 20 per cent of urban population. The country has both public and private healthcare providers. 25 per cent of the population is covered by public and private insurances and 71 per cent of the populationâ&#x20AC;&#x2122;s expenses continue to be out-of-pocket. As per WHO World Health Statistics 2011, 32 per cent is public and 68 per cent is private spending. Rising incomes have led to greater affordability of superior quality private sector healthcare facilities. The quality of healthcare in government-run healthcare centres is inadequate, forcing people to spend out of their pockets for private providers. Services provided in public hospital costs a fraction of the private hospitals but still patients prefer private hospitals because of the dismal sanitary condition, long waiting times, rude behaviour of staff, high infection rates and substandard clinical care at public hospitals. The lack of good administration and management, inefficient use of scarce resources and deficiencies in the quality of services create difficulties in accessing the public hospitals. Expensive drugs also add to the burden of this expenditure. As a result, many families slip below the poverty line. Though urban India has both public and private care centres, all are not affordable. In rural India, people have difficulty in accessibility and affordability of healthcare. Indian healthcare, on one hand, has world class hospitals, state-ofthe-art-technologies, qualified professionals and surgeons and on the other hand, the average patient faces problems like accessibility, high cost treatments and inconsistent quality. India today faces the double burden of diseases where its urban areas have to deal with the increasing incidence of lifestyle diseases (non-communicable diseases) while the urban poor and rural India have to tackle

INDIA spends

4.1

per cent of its GDP, lowest in the world on healthcare

25 per cent

of all senior citizens declare bankruptcy due to medical expenses,and

43 per cent

are forced to mortgage or sell their primary residence the threat of communicable diseases and infectious diseases. Further, the population growth rate of India has steadily gone down. The population aged above 60 years is projected to grow around 193 million. This change in the population pyramid will fuel the demand for healthcare, particularly because of lifestyle diseases.

Learning lessons Analysing the healthcare scenarios in different countries, we observe that nations spending the most on healthcare and those which spend less on healthcare face the problem of either accessibility

or affordability or both. One of the major concerns is the increase in the ageing population. Most of the countries have the same trend, increase of elderly population. According to the WHO, the world population over 60 years will double from 11 per cent to 22 per cent between 2000 and 20506. Due to this, more people suffer from chronic and expensive-to-treat diseases. This, along with technological advances, will cause healthcare costs to continuously rise. Moreover, the healthcare professionals are also ageing. The healthcare industry will very soon face even more shortage of manpower (primary care

physicians, nurses, surgeons). The mismatch between supply and demand will result in inefficient systems leading to high cost, long waiting times, improper staff utilisation (which adds to the cost) and patient dissatisfaction. Patient satisfaction has become an important parameter of quality management in hospitals. The increasing cost in healthcare is not only because of the technology used in treatment but also because of operational costs. To minimise the equipment costs, a trend of designing a low cost device has been already initiated. Along with this, are there any other way to reduce the cost?

Successful healthcare models The greatest challenge for healthcare in the West is affordability whereas in India it is both affordability and accessibility. A few philanthropists contribute to healthcare in India with their models, which make it accessible and affordable. One example is Aravind Eye Hospital (AEH) in Madurai, Tamil Nadu, India started in 1976 by Dr Govindappa Venkataswamy. AEH is one of the largest providers of eye care services and trainer of eye care personnel in the world with 1500 beds. It is inspired by McDonalds, the fast food chain which focuses on continuously improving and standardising their service processes and thus engineering and managing their company as an integrated system. AEH gradually shifted to become the Aravind Eye Care System. One unique quality of the hospital, that sets it apart from the other eye hospitals in India and the world, is that more 50 per cent of patients are treated free of cost yet the system is financially self-sustaining. Overall number surgeries conducted by AEH are 349,274 and on average its surgeons conduct 2000 operations/year (Source: AEH report 2011-2012). Aravind eye care model is a great case study on multiple areas like: strategy, marketing, design thinking,

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STRATEGY

leadership and operations. AEH is studied as a model in Bschools like Harvard, Stanford, Michigan, IMD –Lausanne and IIMs. It provides quality care at minimum costs because of their high level operational efficiency by managing the resources effectively7-10. Another example is Narayana Hrudayalaya (NH) in Bangalore, a multi-speciality hospital with the concept of a health city which means ‘one point for all healthcare needs.’ It was established by renowned cardiac surgeon, Dr Devi Shetty in 2001. This tertiary care hospital performs over 4,000 surgeries a year (approximately half on paediatric patients). It has a vision of ‘affordable quality healthcare for the masses worldwide’ and a mission of ‘making quality healthcare accessible to the masses worldwide’. NH has a vision to constantly improve their system towards a lean operations system, which aims to drive down unit costs through a highvolume standardised strategy. Its approach is towards providing affordable, quality healthcare for the poor through a combination of compassion, high-quality medical knowledge and skills, and an astute sense of making the business work for the poor. It continuously works on capacity utilisation and staff productivity, technological innovations and staff training. The higher patient volume helps to streamline the organisation’s workflows and processes as well as build systems with better efficiency and cost–effectiveness. NH has launched a micro insurance scheme for farmers called Yeshaswini and founded ‘Arogya Raksha Yojana’, to provide free OPD consultation, cashless surgical facility, and diagnostics at discounted rates.

The way forward AEH and NH are clear examples that innovation in the operation and process management can achieve a lot more than just innovation in medical technology. Healthcare is not limited to the disease and its

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treatment but extends to quality of care and patient satisfaction. To achieve quality care, the hospitals need to standardise their processes. They should be designed to deliver the desired outcome (target) as well as achieve cost effectiveness, value for money and quality improvement11,12. Along with standardisation, its integration with operations and process management is also important. The major problems in healthcare efficiency are uncertainty, inflexibility and complexity. Uncertainty results from mismatch in the demand and supply. Inflexibility is concerned with technical, economical and staff adaptability. Complexity refers to medical processes and their co-ordination. Efforts should be to make healthcare accessible and affordable to the base of the pyramid (BoP) of the population, yet sustainable. The demand for effective and efficient healthcare is a challenge which needs to be addressed quickly and the increasing demand should be met with adequate supply (healthcare providers). Therefore, we need a healthcare system which is accessible to the BoP, made affordable and redesigned for the end user (target costing), by utilising the operations management of TPS principles13 to increase system efficiency. This can be achieved by matching the demand with supply for which operations management becomes a necessity. The traditional healthcare management is based on past experience, feelings, intuition, educated guesses, linear projections and calculations based on the average values of input variables. What we need is evidence-based management where the healthcare system is really managed as a system and so are hospitals. Hospitals can often best be described as archipelagos. The ways in which the hospitals are organised add uncertainty and variability in supply and demand (on top of the ‘natural’ variability and uncertainty of demand). To increase both efficiency and quality, a system perspective of manage-

The study of different healthcare systems around the world shows that spending more money on healthcare does not necessarily result in an efficient healthcare system which is accessible and affordable ment towards the hospital will prove vital for the future. To achieve efficiency in the hospital, effective management is necessary. Efficiency cannot be achieved by an individual, only as a team in hospitals. The hospitals can become efficient by co-ordination, controlled decisions and planning as well as management of workflows. The problem of healthcare efficiency will keep growing with healthcare challenges. Therefore, it needs to be dealt quickly in the bigger interest of patients and the society. Efficiency is achieved by making the hospitals flexible. Sometimes, the smallest of changes may improve efficiency considerably. The workflows in the hospital need to be optimised to remove unnecessary, non-value adding tasks. These are the patient waiting for doctors or tests, doctor waiting for patient and test results, etc. the reduction of such wastes in the hospital will reduce the operational overhead cost. The TPS principle works towards system optimisation by eliminating wastes which are generated within the system.

Can our hospitals be transformed according to the TPS system? Can the major problem of variability and uncertainty be captured and optimised by this principle? This can be accomplished by redesigning and standardising the workflow process through the utilisation of IT and TPS principles in healthcare. This will reduce the waiting time, increase staff/equipment utilisation, improve efficiency and also contribute towards reduction of costs. So it’s time for hospitals to become efficient and effective. The study of different healthcare systems around the world shows that spending more money on healthcare does not necessarily result in an efficient healthcare system which is accessible and affordable. But, we need a healthcare system which is affordable, accessible and hence sustainable. The AEH and NH are the examples of this. Now it is time for our hospitals to take a leap from traditional management towards smart, innovative, sustainable and patient centred management.

References: 1.http://data.worldbank.org 2."Out-of-Pocket Spending in the Last Five Years of Life" Journal of General Internal Medicine, February 2013, Volume 28, Issue 2, pp. 304–09 3.http://www.forbes.com/2009/09/ 02/healthcare-spending-europebusiness-healthcare-gdp.html 4.http://online.wsj.com/news/articles/SB10001424052748704893604 576200724221948728. 5.Ageing in the European UnionThe Lancet 6.http://www.who.int/ageing/about /facts/en/index.html 7.Dr.Bhupinder Chaudhary, Dr.Ashwin G. Modi and Dr.Kalyan Reddy, “Right To Sight: A Management Case Study On Aravind Eye Hospitals”, ZENITH International Journal of Multidisciplinary Research Vol.2 Issue 1, January 2012, ISSN 2231 5780 8.Dr. Rani GeethaPriyadarshini , “A Case Study on Aravind Eye Care Systems”, November 6, 2011 School of Business, Coimbatore. 9.“Aravind Eye Hospitals: A Case in Social Entrepreneurship” - IBS case development centre, Asia-Pacific’s Largest Repository of Management Case Studies. ibscdc.org/Case_Studies/Entrepreneurship/…/Aravind Eye Hospitals-Case Study.htm1 10.Pavithra K. Mehta And SuchitraShenoy, “Infinite Vision - How Aravind Became The Greatest Business Case for Compassion”, ”, Berrett-Koehler Publishers, Inc. San Franciso, a BK Business book infinitevision.pdf. 11.Van Merode, G.G., H. Molema, and H. Goldschmidt, GUM and six sigma approaches positioned as deterministic tools in quality target engineering. Accreditation and Quality Assurance, 2004. 10(1-2): p. 32-36. 12.Merode, F.v., A prelude of the 2004 Antwerp Quality Conference: Targets and target values—integrating quality management and costing. Accreditation and Quality Assurance: Journal for Quality, Comparability and Reliability in Chemical Measurement, 2004. 9(3): p. 168-171. 13.Liker, J.K., The Toyota Way: 14 Management Principles from the World's Greatest Manufacturer. 2004, New York: McGraw-Hill. 330.

STRATEGY OPINION

Bolstering blood banking standards in India Industry players share their views on blood banking standards in India, operational challenges faced by blood banks and the role of technology in enhancing the existing standards, with Express Healthcare

Need for good monitoring mechanisms Dr Charu Pamnani Head - Laboratory Medicine and Quality, Wockhardt Hospital

ur guidelines are comparable to global standards; however, we fall short when it comes to good monitoring mechanisms. We also see a huge disparity between blood banks in the urban areas and those at district levels. Laws regarding blood transfusion services are part of Drugs and Cosmetics Act. Blood is under the regulatory control of Drug Controller (General) of India, the central licensing authority which is assisted by the State Drug Controllers. The National Blood Transfusion Council (NBTC) and State Blood Transfusion Councils (SBTC) are advisory in nature. Despite availability of consensus guidelines, inappropriate blood transfusions happen and not all collected units are converted into components, reporting of adverse events after transfusion is poor and donor deferral system is practically nonexistent. So, despite multiple agencies there is poor monitoring and control. We should consider a single autonomous agency manned by people with experience in transfusion medicine.

tremendously from technological advances. This is evident as far as blood safety is concerned. Nucleic acid test (NAT) testing has increased the sensitivity of detecting transfusion transmitted diseases and cut down the window period. Complete automation in red cell serology and interface with computers has cut down chances of human errors. Viral inactivation of blood and its components (there may still be few undetected and unknown viruses) by heating, ultraviolet irradiation, and use of alkylating agents and solvent detergents can further increase blood safety. Software-based blood bank management systems though not much in use now are the way forward. It will help with quick communication with donors, thus helping in increasing repeat voluntary donations. It can give stock updates ensuring utilisation of near expiry stocks. It also can make monitoring and auditing easier. In the future if we have a centralised distribution system, RFID technology can be used to track blood bags.

Role of technology

The biggest challenge is a steady supply of safe blood. Also, recruitment of voluntary

Transfusion medicine is a branch which has benefited

Challenges to be conquered

donors who are committed and will be repeat donors. Information, communication, and education to first time donors, so that they overcome their fears and prejudices cost a lot in terms of time, effort and funds, which are often scarce. There is unfortunately no centralised system to co-ordinate services and stocks so the deficit can be anywhere between 20-40 per cent. It also leads to wastage of blood or components in a few setups. The control on pricing deters the industry from implementing latest technologies as the cost implications would be high. We also need to find ways to increase longevity of blood and at the same time ensure that the clinicians are willing to accept that blood.

The future path Transfusion medicine would evolve into transplant immunology centres, which would test for HLA antigens and provide cross-matching facilities prior to transplant. Stem cell registries, cord blood banking, and tissue banking could be the way forward. Haematopoetic stem cells for bone marrow transplantation can be obtained from peripheral blood by apharesis.

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STRATEGY transmitted infections, leukoreduction to reduce adverse transfusion reactions attributed to leucocytes, bacterial detection using an automated culture system, technology for continuous temperature monitoring of blood during transport and cell separators to separate the desired blood components. In Dr LH Hiranandani Hospital, we have significantly brought down our transfusion reaction rate with the use of filter bags and pre-storage leukoreduction techniques.

Guidelines for blood banks Dr Lincy Jacob Consultant, Department of Transfusion Medicine, Dr L H Hiranandani Hospital

Hurdles to be handled

ational Blood policy recommends rationalisation and centralisation of blood transfusion services with 100 per cent blood collections from voluntary non-remunerated donors. Voluntary blood donation is the backbone of blood safety. While many countries globally have already achieved 100 per cent voluntary donation, our countryâ&#x20AC;&#x2122;s current voluntary donation statistics show that we are yet to close the gap from 83.5 per cent. Although the National Blood Transfusion

Council (NBTC) through the state blood transfusion councils (SBTC) promotes blood donor motivation, recruitment and retention programmes, it remains the individual effort of blood banks across the country to ultimately achieve this goal. In our organisation, we successfully converted from replacement to 100 per cent voluntary donations within a period of two years. Universal leucodepletion (ULD) of blood has been introduced in several countries to improve clinical safety of blood

components transfused. Adopting ULD of blood in our country would provide potential benefits to transfusion recipients; however cost-effectiveness remains an influential factor in policy decisions, with blood banks opting for selective leucodepletion instead. Since the Quality Council of India, through the NABH for blood banks, introduced standards for blood bank services in 2007, many blood banks in the country are pursuing accreditation to ensure uniformity of blood bank processes

and continuous improvement.

quality

Automation for progress Automation in blood banking has significantly minimised human errors while improving turnaround time of blood testing and issue. Advanced technology has further helped to improve the quality and safety of blood and blood components provided to patients. Today our country has Nucleic Acid Testing (NAT) technology to reduce window period of transfusion

Indian guidelines for blood banks Dr Anand Deshpande Consultant Tranfusion Medicine and Hematology, P D Hinduja Hospital & MRC Indian guidelines for blood banks

With major advancement in technology and emphasis on blood safety and assurance of quality, blood banks are faced with the constant dilemma of providing blood and blood components at an affordable cost. Due to this reason, maintaining uniform standards of quality and processes in blood banks remains a major challenge even today. Emerging pathogens in India add to the concern that current testing procedures alone may not be adequate to prevent transmission of potential human pathogens.

Challenges are aplenty but it is those challenges that push us to deliver the best. The immediate operational challenges that blood banks face are those of reporting to multiple authorities, pressure of delivering blood to each and every surgeon. And since in India voluntary blood donation is still at a very low percentage compared to international numbers, we face this humungous task of providing blood or platelets to the needy.

Evolving role of blood banks

here are different agencies that overlook the quality standards of blood banks in India and most blood banks do meet the minimum criteria of set quality controls. Also, unlike in the West, here we have three categories of blood banks i.e.

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corporate blood bank, government blood banks and standalone blood banks. Quality is maintained in all three categories to meet the requirements.

Technology for improving blood banking

standards Quality is directly proportional to technology. The advancement in technology does automatically improve the quality process as well. As I said, Indian blood banks are at par in delivering the best. For e.g. Hinduja Hospital, apart from the

following the standard norms of quality, also has a College of American Pathologists (CAP) accreditation which further states that we are at par with the international standards.

Operational challenges in India

A blood bank is the backbone of any hospital. Delivering safe blood at the time required is the key to any blood bank. We need more voluntary donors and repeat regular voluntary donors to come forward to enhance and ensure the safety of blood.

STRATEGY

lood transfusion service is a vital part of the National Health Service (NHS) and there is no substitute for human blood and its components. Increasing advancement in the field of transfusion technology has necessitated to enforce stricter control over the quality of blood and its products. In most of the developed countries, the blood banking system has advanced in all facets of donor management, storage of blood, grouping and cross matching, testing of transmissible diseases, rationale use of blood and distribution. The government has the full responsibility for the blood programme even though, in some countries, the management of blood transfusion services are delegated fully or partly to an appropriate non-governmental organisation (NGOs) working on a non-profit basis, eg. Red Cross Society. When a NGO is assigned this responsibility, the government should formally recognise it and give a clear mandate formulating the national blood policy. It is important to consider policy decisions enforcing appropriate regulations or necessary functions of health service to ensure high quality service and safe blood. In order to improve the standards of Blood and its components, the central government through the Drugs Controller General of India, has formulated a comprehensive legislation to ensure better quality control system on collection, storage, testing and distribution of blood and its components. Central government amended from time to time the existing requirements of blood banks in the Drugs and Cosmetics Act, 1940 and rules there under to meet the latest standards. Consequent to a public litigation case recently, Supreme Court of India directed central government to enact a comprehensive legislation on blood banks in collection, storage, testing and distribution of blood and its components. In this context, the office of Drugs Controller General of India made draft rules to further amend the existing law in the Drugs and

National Blood Policy and its importance Dr Lona Mohapatra HOD Lab Services , Rockland Hospital

they strive to protect patients' health and deliver safe blood and components to the right person at the right time. Laboratories are under constant pressure to do more with lessâ&#x20AC;&#x201D; including fewer skilled workers and scarcer financial resources. While technology has made many routine tasks easier to perform, the demand for blood continues to increase and the pace of processing blood for hospitals and healthcare providers continues to accelerate. In developing responsive solutions for modern blood banking laboratories, instrument makers must actively listen and thoroughly understand the challenges lab managers face. Only by doing so can they provide safe, efficient solutions based on solid science. When instrument manufacturers find effective solutions, that can make an enormous difference for laboratories. Over the past two decades, we've seen a continued shortage of highly skilled technologists and scientists entering the laboratory science workforce. Automation is becoming a standard part of blood bank laboratories because it can help eliminate the labor-intensive, time-consuming manual testing processes that require specialized skills and significant experience to master. Ultimately, automated testing can increase the lab's capacity, allowing it to serve more patients and operate more efficiently, and the difference can be dramatic.

Ensuring safety: priority number one Cosmetics Act, 1940 and rules there under to meet the direction of the Supreme Court.

National blood policy Government of India published in the year 2002 the National Blood Policy. The objective of the policy is to provide safe, adequate quantity of blood, blood components and products. The main aim of the policy is to procure non remunerated regular blood donors by the blood banks The policy

also addresses various issues with regard to technical personnel, research and development as well as to eliminate profiteering by the blood banks by selling blood. The policy also envisages that fresh licenses to stand alone blood banks in private sector shall not be granted and renewal of such blood banks shall be subjected to thorough scrutiny. The business of blood banking has become a complex balance of safety and efficiency. As

Significant progress has been made in blood safety during the past few decades3and it continues to be the number-one priority for blood banks and hospitals worldwide. Screening blood and its components to ensure that they are free of infections, disease and parasites and compatible with the blood type, antigens and antibodies of the patient who needs the transfusion are the highest concern for any blood bank. To meet rigorous compliance standards and provide blood and blood products that

Blood banking has become a complex balance of safety and efficiency are safe, most blood banks are turning to standardisation across instrument platforms and implementing new testing technologies like Column Agglutination (CAT). These new testing methods are easier to use, and help reduce error and variation among technologists and tests because they provide stable and clear endpoints that are highly precise, while delivering objective, consistent results.

Optimising performance: service solutions To operate at peak performance, today's blood banks also need expert services and support that complement this new generation of technological solutions. To maximise a laboratory's productivity, there is a growing need for technologies that reduce the potential for instrument downtime and prevent workflow interruptions to ensure that instruments are available when needed.

Protecting life: a shared commitment As the science of blood and blood component management continues to change, laboratories need vendors who can support their evolving requirements. That means not only innovating next-generation systems that are intuitive, flexible and designed to be an extension of the laboratory's team, but also showing the science behind the technologyâ&#x20AC;&#x201D;proving that a product lives up to its promises. New solutions must not only be produced, but backed up with evidence that gives blood bankers certainty about their results. Protecting the safety of the world's blood supply is a commitment from which any blood bank and any company that serves and supports blood banks, must never waver.

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STRATEGY I N T E R V I E W

‘Maternal and infant mortality is one of the area will have emphasis and focus on malnutrition’ After eight successful events across India, AAPI is planning to come to Mumbai in 2015 with its 9th annual conference, Global Health Summit. The association is also in talks with public and private institutions to run pilot projects at district levels across Maharashtra. Anwar Feroz, Advisor, AAPI (US) and President, Association of Indians in America shares details of AAPI’s future plans with Usha Sharma Is AAPI planning to launch its Maharashtra (Mumbai) chapter in 2015, tell us about its objectives? American Association of Physicians of Indian Origin (AAPI) US leads an international effort to collaborate with medical (physicians) experts from all over the world, including India, to discuss and develop solutions for the most common challenges in India to make quality healthcare accessible and affordable to all people of India. This is achieved via the Global Health Summits organised every year for the past eight years. AAPI

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has not yet decided on opening a chapter in Maharashtra. What are the new therapeutic areas that you plan to focus on in Mumbai and why? Our main areas of focus are diabetes, cardiovascular disease, maternal and child health, cancer, application of HIT. These are the areas which impact a large number of people. Non communicable diseases can be prevented and better managed by creating awareness, early intervention and education. Our local experts have guided us in

selection of these areas.

AAPI is investigating in enabled channels to expand its reach and deliver programmes at the district level. Cost and finding committed volunteers is one of the limitations

So far, how many private hospitals have tied up with AAPI and how closely would both the parties work? Are there any partnerships in the pipeline with hospitals and NGOs? We are in discussions with several leading institutions, both government and private. We have met with deans of all the leading medical colleges like GMC, Sion, KEM, Nair etc. and all have agreed to collaborate. Details have to be finalised. We are also in conversation with the Maharashtra University of Health Sciences. AAPI's pilot projects are at district levels. Tell us why aren't you getting into the zonal/taluka level? AAPI is investigating in enabled channels to expand its reach and deliver programmes at the district level. Cost and finding committed volunteers is one of the limitations. We would love to get to the taluka level. We believe in taking one step at a time and build upon our success. Tell us about your work to reduce malnutrition in the rural areas of the Maharashtra? Maternal and infant mortality is one of the areas

that will have emphasis and focus on malnutrition. There are several initiatives, and extremely good work is being done by several organisations like Indian Academy of Paediatrics, or the Federation of Obstetrics and Gynecologists, the Indian Medical Association, Governments of India and Maharashtra. AAPI will work together in lending its support, expertise and resources to compliment these efforts. How will the 9th annual conference on ‘Global Health Summit’ be different from its predecessors? Key areas of difference will be: clear focus, all plenary sessions, no overlaps or competing sessions as this will allow delegates to attend all key seminars and not miss any opportunities. Live streaming and e-enabled content. Pre and post GHS 2015 series of lectures to reach beyond the GHS 2015 sessions and provide the rich content to several thousand healthcare professionals who may not be able to attend the live meetings. Stronger collaboration between, professional societies, medical colleges, hospitals, government (both Union and State) and NGOs. u.sharma@expressindia.com

KNOWLEDGE INSIGHT

Heart surgery in diabetes mellitus

DR PRADEEP NAMBIAR Senior Consultant, Max Hospital, Patparganj Delhi, and Chairman, Cardiothoracic Surgery, Moolchand Hospital

Dr Pradeep Nambiar, Senior Consultant, Max Hospital, Patparganj Delhi, and Chairman, Cardiothoracic Surgery, Moolchand Hospital elaborates on the challenges in heart surgeries on diabetes patients and explains how the Nambiar technique can be beneficial in handling such tricky cases

iabetes Mellitus is the medical name for what is commonly known as diabetes. It is classed as a metabolism disorder in which the body has high blood sugar, the reason being, either the body cells did not respond properly to the insulin or because the insulin production was insufficient or both. Common symptoms of the disease are polyuria (frequent urination), polydipsia (increasingly thirsty) and polyphagia (hungry). People who have suffered heart diseases or a heart attack may have already gone through a lot of procedures to survive the attack and diagnose the condition. For example, many heart patients have to undergo Thrombolysis, a procedure that involves injecting a clotdissolving agent to restore blood flow in a coronary artery. This procedure is supposed to be administered within a few hours of the heart attack. If this treatment isn't done immediately after a heart attack, many patients may have to undergo coronary angioplasty or coronary artery bypass graft surgery (CABG) later to improve blood supply to the heart muscle.

The artery blockage can be treated with the help of medicines, stents or a heart bypass

surgery. The treatment depends on the severity and the number of blockages. Surgery

is suggested in case two or more arteries are blocked or if the left main stem is stenosed.

During a heart bypass surgery commonly, surgeons all over the world use arteries from the leg called the saphenous veins to bypass the blocked arteries and supply blood beyond the blockage. These leg veins block off in 10 yearsâ&#x20AC;&#x2122; time and the patient is required to go through a through a redo heart surgery with higher mortality risks. Besides, surgeons also follow the old school method of making big incisions in the middle of the chest with all its complications and the associated patient fear and apprehension. Robotic surgery because of its cost factor, availability and technical difficulty is still not increasingly followed in cardiac surgery even in the West. Considering all these complications, the Nambiar Technique is the answer to the situation with a minimal access coronary bypass. This technique could be a great procedure to be used on diabetic patients as well bearing in mind that it is less invasive and minimises the threat of infection and wound healing issues. It encompasses using a two inch left mini (thoracotomy) surgical incision in the chest wall

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KNOWLEDGE INSIGHT

Screening of IDAand Thalassemia made simple

DIVYA MUNSHI,, Product ManagementHaematology, Transasia Bio-Medicals

Divya Munshi, Product Management-Haematology, Transasia Bio-Medicals, highlights the utility of automated RBC indices, for screening and differentiation of IDA and beta thalassemia

n the Indian context, the two most common etiologies for microcytic hypochromic anaemia cases are iron deficiency anaemia and beta thalassemia (a genetic haemoglobinopathy). As per the WHO estimate, 80 per cent of children, 58 per cent of pregnant women, 30 per cent adults in India are suffering from iron deficiency anaemia (IDA) while 3.3 per cent of Indian population is affected by beta thalassemia. In regions like Punjab, Gujarat, Rajasthan, IDA and beta thalassemia co-exist with the former being prevalent and latter present in 6.5 per cent, 15 per cent and three per cent of their population respectively. This makes the task further difficult in the differentiation of borderline IDA and thalassemic cases. Utility of automated RBC indices, for screening and differentiation of IDA and betathalassemia: With the advent of automation in haematology, the first line of screening of IDA and thalassemia is possible through Complete Blood Count (CBC). An automated haematology analyser reports complete RBC count, Hb, MCV, MCH, MCHC which fall low in cases of microcytic anaemia. However, the key automated haemogram indices which help in providing first line of differentiation among such cases of IDA and thalassemia are RDW-SD, RDWCV in combination with MCV, Automated Reticulocyte Counts and IRF (Immature Reticulocyte Counts).

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Red cell Distribution Width (RDW) is a quantitative measurement of variation in red cell size provided as either Standard Deviation (RDW-SD) or Co-efficient of Variation (RDWCV). RDW-SD is measured by calculating the width in fl. (femto litre) at a relative height of 20 per cent above baseline of RBC curve. On the other hand, RDW-CV is measured by calculating ratio of 1SD of RBC curve to Mean Corpuscular Volume (MCV).

Calculation of RDW-SD and RDW-CV Both RDW-CV and RDWSD reflect the variability in erythrocyte size and thus measure anisocytosis, however, each of these parameters has its own clinical utility. RDW-SD is a direct measure across the RBC histogram, hence it is 'theoretically' a better and more accurate measure of RBC anisocytosis across the entire spectrum of MCV values. On the other hand,

RDW-CV shows better correlation as an indicator of anisocytosis, if the MCV is in the normal range and when the anisocytosis may be difficult to detect e.g early stage of IDA. While most analysers report, either RDW-SD or RDW-CV, some recent analysers provide 'Simultaneous reporting of RDW-SD and RDW-CV'. Simultaneous reporting of these two indices helps in screening and differentiating IDA and thalassemia.

Other than RDW, Ret counts and IRF (Immature Reticulocyte Counts) available on high end 5PDA systems and have been identified as a useful adjunct in diagnosis and management of the above mentioned pathological conditions. According to published reports, Ret counts and IRF have been found to be high in cases of beta thalassemia minor and iron deficiency anemia respectively.

Classification of Anaemia based on RDW-CV and RDW-SD in combination with MCV

Calculation of RDW-SD and RDW-CV

MCV High

MCV Normal

MCV Low

RDW-CV High

B12/ Folate deficiency, CLL, Cold agglutinins

Early Fe or B12 folate deficiency, Anaemic haemoglobinopathy, Sideroblastic myelofibrosis

Fe deficiency, Hgb-H, Red cell fragments

RDW-CV Normal

Aplastic anaemia

Chemotherapy, Non-anemic haemoglobinopathy, CLL

Heterozygous thalassemia, Chronic disease

RDW-SD High

B12 deficiency, Aplastic anaemia, Immune haemolysis

Acute/Chronic leukaemia, Transfusion, Homozygous haemoglobinopathy

Iron deficiency, Haemolytic anaemia

RDW-SD Normal

Liver disease

Secondary anemia

Early iron deficiency

RDW-SD Low

Chemotherapy (during treatment)

Heterozygous hemoglobinopathies- Thalassemia

Determination of the MCV is routinely used in the classification of normocytic, microcytic and macrocytic anemia. MCV when used in combination with RDW-CV and RDWSD, serves as the best criteria for the classification of anemia. As the MCV is an arithmetic mean, it may exclude partial microcytosis - even in the reference range. Only in combination with the RDW-CV and RDW SD, it may indicate dimorphic erythrocytes, for example, the initial stages of iron deficiency. The table highlights the importance of RDW-CV, RDW-SD and MCV in differentiation and prognosis of various anaemic conditions:

Case studies: Illustrating the importance of RDWCV and RDW-SD in differential screening The above mentioned two case studies clearly depict low MCV typical of microcytic hypochromic anaemia. In case

KNOWLEDGE

In regions like Punjab, Gujarat, Rajasthan, IDA and beta thalassemia co-exist with the former being prevalent and latter present in 6.5 per cent, 15 per cent and three per cent of their population 1, RDW-CV of 20.5per cent is indicative of red cell anisocytosis consistent with iron deficiency anaemia, later confirmed with iron studies. Whereas in case 2, RDW-SD of 25.6 per cent which is below normal indicative of a monotonous red cell population consistent with beta thalassemia minor, later confirmed with Hb electrophoresis. Given the prevalence of IDA and genetic haemoglobinopathies like thalassemia in India, availability of the simultaneous reporting of RDW-CV and RDW-SD on automated haematology analysers, goes a long way in screening these pathological conditions. Sysmex haematology analysers allow a â&#x20AC;&#x2DC;Simultaneous reporting of RDW-SD and RDW-CVâ&#x20AC;&#x2122; alongwith various specialised parameters like Reticulocyte and IRF which help in timely diagnosis of haemoglobinopathies. CASE 1 :Iron Deficiency Anemia

CASE2 BETA THALASSEMIA MINOR

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KNOWLEDGE I N T E R V I E W

‘IPAQT is now seen as a novel market-shaping business model to increase access to quality diagnostics’ As India grapples with its TB burden, accurate diagnosis remains a challenge and this is where the IPAQT initiative comes in. Madhukar Pai, Associate Director, McGill International TB Centre, Member, Governing Council, IPAQT, tells us more on the impact it aims to create in an interview with Shalini Gupta What was the driving force behind the IPAQT initiative? How did you get the various partners together to realise this goal? What were the challenges and the targets set? India is the highest TB burden country in the world. While the Revised National Tuberculosis Control Programme (RNTCP) is considered a success, only about 50 per cent of the TB patients are managed in the public sector. The remainder are managed in the largely unregulated private sector, mostly their first choice. Even as timely and accurate diagnosis is important for TB control, the private sector ecosystem is sub-optimal in this respect. There is overuse of unreliable tests, low availability and high cost of quality-assured diagnostics, lack of awareness about WHO-endorsed tests, and commercial incentives that result in cost inflation to patients. These factors result in high costs of care, delayed case finding, misdiagnosis and mistreatment, and emergence of TB drug resistance. In May 2012, after concerted efforts by various stakeholders, the Indian government banned the use of sub-optimal serological, antibody tests that accounted for a big fraction of TB tests in the private sector [See story http://pharma. financialexpress.com/latestissue/669-beyond-the-ban]. This provided a window of opportunity to promote the use

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of WHO-endorsed quality tests such as GeneXpert, Line Probe Assay and liquid cultures. However, the high prices of WHO endorsed tests (~ USD 60 to 100) in the private sector put them beyond the reach of the majority of TB patients. So, it was challenging for the market to replace the banned tests with higher quality, WHO-endorsed tests. To address this market problem, the Clinton Health Access Initiative (CHAI) conducted an in-depth market analysis to make a case on the commercial potential of the Indian TB diagnostics market which was largely untapped and highlighted to suppliers of WHO-endorsed tests that high price was one of the biggest barriers to market penetration. CHAI engaged in negotiations with these suppliers (namely Cepheid Inc for GeneXpert, Biomerieux for Hain LPA and BacT/Alert, and BD for MGIT Liquid Culture) to make these quality tests available to the private sector at the same input price as the public sector. Instead of premium pricing, diagnostic companies were encouraged to consider the high-volume, low-margin model that is more appropriate for TB patients in the Indian context. Furthermore, in order to reduce the mark-ups in the supply chain, CHAI helped organise a group of major laboratories into a partnership called IPAQT. IPAQT would deliver these tests at almost half the prevailing market

IPAQT hopes to create a sustainable “win-win-win” situation where patients, the RNTCP, laboratories and test manufacturers all benefit prices by offering tests to the laboratories at lower input prices and capping the laboratory and provider margins per unit. The objective was to create a system wherein all the private intermediaries in the value chain gain in terms of greater absolute profits due to higher volumes, and hence would actively invest in driving

widespread uptake of the WHO-endorsed tests to achieve higher volumes and therefore financial returns and health impact. Furthermore, participating laboratories have committed to abide by certain guiding principles, which inter alia include, offering the tests at or below agreed upon ceiling price to the patients (which have to be transparently advertised), discontinuing use of suboptimal blood TB tests, and notifying all TB cases to the RNTCP so that a linkage to quality treatment could be established. Adherence to these guiding principles is monitored. So, IPAQT hopes to create a sustainable “win-win-win” situation where patients, the RNTCP, laboratories and test manufacturers all benefit. How long has the initiative been operational in India now? What are the milestones achieved so far? The partnership, named “Initiative for promoting Affordable and Quality TB Tests” or “IPAQT”, came into being in April 2013 when the first set of private laboratories purchased GeneXpert and Hain LPA at negotiated prices. The number of GeneXpert tests and Hain LPAs used in the private sector in IPAQT’s first year (April 2013 to March 2014) is over 40,000 tests, up from less than 2000 tests during the whole of 2012.

What is the current price at which they are available as a part of IPAQT? Are the prices slated to come down any further? When the price of the GeneXpert cartridge is set at $10, how come the tests cost Rs 2000? WHO-endorsed tests are available at IPAQT labs at prices 30-50 per cent lower than at non-IPAQT labs. The four WHO-endorsed tests are priced at: ◗Xpert MTB/RIF – Rs 2000; ◗Hain Genotype MTBDRplus line probe assay –Rs 1600; ◗MGIT Liquid Culture – Rs 900 (for detection); ◗BacT/Alert Liquid Culture – Rs 900 (for detection) Patients and physicians can find out where to get these tests on the “Find a Lab” section of the IPAQT website (http://www.ipaqt.org/test-finda-lab/). Yes, the public sector price for a GeneXpert cartridge is $9.98. But this is just the cost of the reagents. It does not include transport and shipping costs, import duty and customs, distributor costs and margins, sales taxes, and costs incurred by the labs (e.g. amortisation of the equipment, lab overheads, personnel), and lab profit margins. When IPAQT was launched, the price of GeneXpert was Rs 1700, but had to be increased to Rs 2000 in 2014 because of significant devaluation of the rupee against the US dollar.

How subsidised are the tests?

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KNOWLEDGE I N T E R V I E W

‘Healthcare organisations should have trained healthcare administrators with modern management skills’ Dr SD Gupta, Chairman, IIHMR talks about the recent Research University status given to Indian Institute of Health Management Research (IIHMR) Jaipur by the Government of Rajasthan, the huge demand for healthcare management professionals in India and IIHMR’s endeavours to meet the demand, in an interaction with Lakshmipriya Nair Scarcity of manpower is a major problem in Indian healthcare. What are the three immediate steps that should be undertaken to deal with this issue? The three immediate steps would be: ◗ Manpower should be equally distributed in rural and urban areas. ◗ Private sector should be encouraged to train more healthcare professionals. ◗ Replacing the technical manpower with health care managers to enable them to work as professionals in hospitals. What kind of shortage are we witnessing in the managerial and administrative segment of Indian healthcare? What would be the right way to handle this shortage? At present the healthcare system is managed by doctors who do not have administrative capabilities and skills. The healthcare organisations should have trained healthcare administrators with modern management skills to improve the healthcare services. This would also require change in government policy. Which government policies are needed to reform the management side of Indian healthcare? India today faces the dual burden of infectious diseases and chronic diseases. Prevention and public health functions need more focus than

clinical care. It is imperative that factors like nutrition, hygiene, water supply and sanitation, food adulteration, quality of drugs, environmental protection, and health programmes in schools and occupational areas are addressed. What are the lessons for India in hospital management from the global experience? Technology is increasingly playing a role from patient registration to data monitoring, from lab tests to self test tools. Devices like smart phones and tables are starting to replace the conventional recording systems. These need special emphasis in the hospitals of our country. What are the areas of hospital management that need special focus while looking to train professionals in India? Modern hospitals need a multi-dimensional and multidisciplinary approach to put various services together for its effective and efficient use. Developing management competencies, leadership skills are core to our institute’s mission. Which are the organisations that you are seeking partnerships with? How would they help in improving IIHMR's offerings? Working together as partner, disseminating

IIHMR’s close affiliation with the Johns Hopkins University has been multifaceted from the beginning information and sharing knowledge at the national and global levels are the ethos of the institute. Emphasis has been given to networking with prestigious universities like Johns' Hopkins University, US; Gulf Medical University, UAE; Mahidol University, Thailand and international organisations such as World Health Organization (WHO), UNICEF, SEAPHIEN, The Union-Paris, Sup biotech Paris etc.

How has hospital management changed over the years? What are the current trends globally in this sector? Managing large hospitals has become an increasingly specialised job as the organisation structure in these hospitals is getting complex. Coordinating the work of senior consultants, keeping a check on lapses and irregularities as well as preventing and controlling workers’ unrest require specialised managerial skills. Moreover, hospital managers have the responsibility to not only protect the interest of the clients but also to safeguard the hospital staff against getting involved in avoidable legal disputes. With the advancement in medical technology, interventions on patients are increasing. This results in high chances of transmission of hospital acquired infections. The pressure on a hospital to improve the quality of care is not only from the clients but also from other institutions like insurance companies and thirdparty administrators (TPAs). How does IIHMR help its students to be at par with the changing trends in the world? It aims at developing trained professionals with requisite skills in planning and operating management techniques, diagnosing and solving management problems and acquiring consultancy skills. It intends to prepare the students

to serve in hospitals and healthcare institutions of developing countries, both in the public and the private sectors, and to meet the rising demand for quality care. How far does the tie up with John Hopkins University help in the endeavour? IIHMR’s close affiliation with the Johns Hopkins University has been multifaceted from the beginning. The association with this esteemed university from the US has actively contributed in the areas of research, academics, capacity building and training. This unique affiliation has resulted in raising the benchmark of quality for IIHMR University in the field of academics through the JHU’s No. 1 programmeMaster of Public Health. Tell us about the recent University status granted to IIHMR by the Rajasthan government? What are the criteria that needed to be fulfilled to be granted this status? IIHMR has been granted the status of a research university by the Government of Rajasthan and is permitted to conduct only postgraduate courses for promoting public health education in this part of the world. The criteria included world class infrastructure intellectual capacity, financial soundness and its capacity to carry out research. Continued on Page 49

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KNOWLEDGE Continued from Page 46 Further, price reductions may be possible, if the Government of India exempts all WHO-endorsed TB tests from import duties. This is something that civil society and stakeholders have been expecting. Since TB kills nearly 900 Indians every day, all TB products should be exempt as ‘life-saving’ drugs/devices. How many labs in India are currently offering these tests? By how much has the number increased since the beginning of the initiative? What quality standards do the labs need to meet in order to offer the tests? Also, since reference labs under the RNTCP programme are also offering the tests are they also adhering to these standards? Since its inception in 2013, when 15 labs came together to partner with the project, IPAQT has grown to include 65 member laboratories (as of April 2014), which includes five of six national laboratory chains, 22 hospital labs, and over 25 regional laboratory chains; these member labs collectively account for over 3500 collection centres, covering approximately 70 per cent districts in India. To be eligible to join IPAQT, labs have to fulfill certain accreditation and quality standards. For the Hain Line Probe Assay and liquid cultures, only laboratories with Microbiology departments that are accredited by the National Accreditation Board for Laboratories (NABL) and/or College of American Pathologists (CAP) and/or RNTCP are eligible to join IPAQT. For GeneXpert, any kind of NABH, NABL accreditation and/or CAP and/or RNTCP accreditation is sufficient. Also, all member labs have to agree to external quality assurance (EQA). RNTCP accredited culture and drug-susceptibility testing labs also have to meet stringent quality standards and participate in EQA. The number of GeneXpert tests and Hain LPAs used in the private sector in IPAQT’s first year (April 2013 to March 2014)

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submitted for smear microscopy or a single sputum specimen for Xpert MTB/RIF testing in a quality-assured laboratory. Patients at risk for drug resistances, who have HIV risks, or who are seriously ill, should have Xpert MTB/RIF performed as the initial diagnostic test. Blood-based serologic tests and interferon gamma release assays should not be used for diagnosis of active tuberculosis.” Since Xpert MTB/RIF is more sensitive than sputum smears (sensitivity of Xpert is about 98 per cent in smearpositive TB cases, and 67 per cent in smear-negative cases), if it is used on new patients with TB symptoms, then it can pick up more cases of TB than smears, and do it within a short time (results are available the same day). If Xpert MTB/RIF is used on retreatment or treatment failure cases, then it can rapidly diagnose MDR-TB by detecting rifampicin resistance within the same day. Resistance to rifampicin is a very good marker of MDR-TB. So, Xpert MTB/RIF can help to immediately start MDR-TB therapy, while waiting for confirmation using liquid culture and drug-susceptibility testing.

for low case notifications range from labs and doctors not recording patient information, private laboratories and hospitals not being aware of the notification process (who to notify to, format and frequency etc.). Lastly, the government systems are not fully established and enabled to receive case notifications through automated methods (e.g. remote connectivity software that can be connected to GeneXpert machines and computers). Even though the IPAQT charter requires all member labs to notify positive TB cases to the respective district TB officers, all stakeholders are experiencing operational challenges - the private sector (labs and providers) are unsure about how best to collect patient data while respecting privacy, and to notify, and about what happens to the patient data after notification. On the other hand, RNTCP is grappling with the question of how best to follow up on the notification data received so as to not alienate the private sector. The methodology for notification from private sector ranges from paper forms submitted to the DTO on a daily basis, to weekly emails. In a subset of 14 IPAQT labs where 9,506 samples have been tested, 2,868 positive TB cases and 711 MDR-TB cases have been detected. Efforts are ongoing to install remote connectivity software to all IPAQT labs, and to link them to the RNTCP notification portal called Nikshay http://nikshay.gov.in/User/Logi n.aspx. Hopefully, these efforts will result in many more private cases being notified.

How many fresh cases of TB, MDR and others have been detected so far through IPAQT? Have these cases been notified to RNTCP, what is the process for that? Despite notification of TB patients diagnosed in the private sector being made mandatory by the government in May 2012, currently very few TB patients diagnosed in the private sector are notified to the government. The reasons

How do you see such public private models further being able to create more impact? What advantages do they offer and what remain the challenges? Could they be for profit going forward? Ultimately, TB patients need a complete solution to their problem, regardless of whether they seek care in the public or the private sector. Therefore, it is important for the private sector to work hand

Efforts are ongoing to install remote connectivity software to all IPAQT labs, and to link them to the RNTCP notification portal called Nikshay http://nikshay.gov.in/User/Login.aspx. Hopefully, these efforts will result in many more private cases being notified is over 40,000 tests, up from less than 2000 tests during the whole of 2012. This is much higher than it was before IPAQT was formed. What are the current awareness levels on the availability of these tests? What is being done to increase the awareness and hence expand the reach and impact of the programme? Are doctors recommending any other tests apart from the WHO approved tests? If yes, why? Low awareness of quality TB tests amongst private providers remains a key barrier to their widespread adoption. Although serological tests were banned by the government, the awareness about the ban at the grass root level is limited. Also, since the ban on serology, other sub-optimal tests such as inhouse polymerase chain reaction (PCR) and interferongamma release assays (IGRAs) are popular in the private sector. In-house PCR can produce highly inconsistent results across labs, while IGRAs are blood tests that should be restricted to latent TB diagnosis (they are discouraged by WHO and RNTCP for active TB diagnosis). CHAI conducted a survey among 1244 providers across 15 Indian states in early 2013 where diagnostic and treatment behaviour of privately practicing physicians was assessed. This survey revealed that ~85 per cent of the questioned providers were not aware of WHO-endorsed molecular tests. In addition, current market structure and dynamics thereof imply that all

private intermediaries including private providers, collection centres and reference labs make higher per unit margins on ineffective tests such as IGRAs and inhouse PCRs. Hence, they have a very strong incentive to keep promoting the use of such tests over the quality, WHOapproved tests. Thus, marketing efforts of the labs alone are not sufficient to achieve improved awareness and prescription of quality TB diagnostics by private providers. These efforts need to be supported by targeted activities by CHAI and other partner NGOs. Over the last six months, CHAI has conducted a series of Continuing Medical Education (CMEs) sessions to sensitise providers on appropriate diagnostics and correct treatment as per International and Indian standards of TB Care; these are supplemented with collaborative activities of other NGOs. The team is also exploring the possibility of having a field force in certain cities to sensitise private sector providers on a one-on-one basis. How could using these tests for fresh cases as opposed to only for retreatment cases (as in RNTCP labs) help increase the rate of diagnosis of TB? Is there currently a protocol on which patients should be suggested a particular test? According to the International Standards for TB Care (3rd Edition, 2014): “All patients (including children) who are suspected of having pulmonary tuberculosis and are capable of producing sputum should have at least two sputum specimens

KNOWLEDGE in hand with the RNTCP, and improve the overall quality of TB care in the country. IPAQT has shown that the private forprofit sector (laboratories as well as diagnostic companies) is interested and willing to consider novel business models that can increase their volumes (hence make economic sense, and are sustainable), as well as contribute to a national public health effort. IPAQT is now being seen as a novel market-shaping business model to increase access to quality diagnostics to patients in the private sector. While IPAQT has demonstrated that it is possible

to engage diagnostic manufacturers and laboratories to serve a public health need, it faces many challenges. To reach scale in a country of India’s size, will require many more labs to come forward and join the initiative. It will require doctors in India to prescribe only WHO-endorsed, high-quality TB tests and adhere to national and international standards for TB care. It will require RNTCP to accept notifications from IPAQT labs and set up systems to link MDR-TB cases to free second-line treatment. Even if the above were to be met, prices of TB tests are still

too high for the base of the pyramid (BOP). We need new TB tests that are as accurate as the currently available WHOendorsed tests, but much cheaper. Such technologies are under development or evaluation, including products from India, and will have a big potential market. We recently estimated that a $5 molecular rapid test for TB that can replace sputum smears will have a potential annual market of $154 million in 22 high burden countries. http://tbevidence.org/wpcontent/uploads/2014/02/KikEJR-2014.pdf

Is IPAQT also looking at other countries with high TB burden to implement such a model or to tweak it? What goals have been set for this year for India? While there is merit in replicating the IPAQT model in other countries which are characterised by high disease burden and large private sectors, the immediate goal of IPAQT is to reach some scale in India and demonstrate that the model is feasible and has impact. India has about 400 NABL accredited labs and IPAQT is hoping many of them will join the initiative and support TB control in India.

Accurate diagnosis alone is not enough – we need to make sure that all diagnosed cases get notified and treated with appropriate drug regimens and treatment completion is ensured. So, CHAI is working with the RNTCP and has identified laboratories in a few geographical areas to develop systems and processes for accurate patient data recording, and development and strengthening of the RNTCP systems for the notification process and linkages to MDR-TB treatment in the public sector.

health sector. We are moving ahead with expanding and strengthening institutional network, as well as building new partnerships and collaboration with the national and international organisations

for more efficient and effective healthcare delivery. We reaffirm our commitment to improving the health standards of the people with the collective efforts of the government, partner institutions and

development organisations. As ever, I am an uninhibited optimist and believe we will make it to the new orbit with our committed faculty, research and support staff.

kept under control, it can unleash a blast of complications that affects almost every organ in the body which includes the heart and the blood vessels, the eyes, the kidneys, the nerves, the gums and teeth. People with uncontrolled diabetes mostly face heart and blood vessel diseases. In 2004, almost 68 per cent deaths pertaining to heart diseases because of diabetes were registered among people aged 65 years or older, with stroke being noted in 16 per cent of death certificates. Diabetes can also cause poor blood flow in the legs and feet (peripheral artery disease). The sickness and the mortality rates during surgeries or any kind of required incisions are bigger in diabetic patients as compared to the non-diabetic patients of similar age group for various reasons. Macro vascular disease is extremely common in the patients with Type I and Type II diabetes. Over and above that,

patients over the age of 50 years have impaired renal functions and are prone to fluid and electrolyte imbalance, dehydration and obtundation. During the post-operative period, diabetic patients have more incidences of infection at the site of operation and are also prone to urinary tract infection, pneumonia and various kinds of infections. A diabetic patient’s wound healing is mostly weakened in the setting of persistent hyperglycaemia as a result of modified fibroblast function. All these defects pooled with the infections may result in incision dehiscence, which frequently leads to a difficult and prolonged hospitalisation and frequent readmissions. Consequently, the diabetic patient spends 30 per cent to 50 per cent more time in the hospital than the non-diabetic following surgery, even if the surgery proceeds without incident. Heart disease today is accelerating at an alarming pace in

our country and is proliferating among the current generation because of stress, food habits and most importantly diabetes. India is the diabetic and heart attack centre all over the world and aggravating the situation, it has also been witnessing an upsurge in the coronary artery diseases. These are arteries which carry blood to the heart muscles. In heart disease cases, the coronary arteries get blocked leading to chest pain and heart attacks and damaging the heart muscles. It also reduces the functioning and pumping power of the heart. The Nambiar Technique successfully demonstrates how even diabetic patients can elongate their life span and increase their chances of leading a normal life. It is advisable to keep diabetes in control by maintaining a disciplined lifestyle and regulating one’s diet and fitness with proper medication and your doctor’s supervision to avoid risking heart disease.

shalini.g@expressindia.com

Healthcare organisations... Continued from Page 47 Any new courses in the offing by IIHMR? How would it help to mitigate the scarcity for hospital management professionals?

We continue to strive for excellence with our vision to become a world class university of learning and scholarship in management education, research and capacity development in the

lakshmipriya.nair@xpressindia.com

Heart surgeryin diabetes... Continued from Page 43 through which the bilateral internal thoracic arteries (BITAS) are harvested under direct vision without robotic/thoracoscopic assistance on a beating heart. Multivessel total arterial revascularisation is then done using the left internal thoracic artery (LITA) - right internal thoracic artery (RITA) Y composite conduit by the off pump methodology. In this surgery, instead of using the saphenous veins from the legs, the doctor uses the mammary arteries from inside the chest to bypass the blocked arteries. This minimal access or keyhole surgery has revolutionised the field of heart surgery. The technique has wonderful advantages like the mammary internal arteries lasting more than 30 years. It also keeps away the complications of splitting the chest open. This surgery enables the patients to be discharged from the hospital in three days and be

back at work in 10 days from discharge whether one is an executive or a manual labourer. There are three types of diabetes viz. Type I diabetes in which the body does not produce insulin. People with this type of diabetes need to take insulin injections throughout their life. The second type of diabetes is the Type II diabetes in which the body does not produce adequate insulin for the body to function properly or the cells in the body do not respond to insulin properly. This type of diabetes is however progressive and it worsens gradually. The patient has to take insulin may be in the form of a tablet. The third type of diabetes is called gestational diabetes which affects mostly females during pregnancy. High levels of glucose in a woman’s body render the body unable to produce enough insulin to transport all the glucose into her cells which results in gradually rising levels of glucose. If diabetes is not

EXPRESS HEALTHCARE

May 2014

RADIOLOGY I N T E R V I E W

‘TexRAD is a novel measurement tool that enhances the ability of diagnostic imaging’ A UK-based company has found a way to maximise the information that can be obtained from the diagnostic images without subjecting the patient to additional procedures. TexRAD is a software application that analyses the textures in existing radiological scans to assist the clinician in assessing the prognosis of patients with cancer. M Neelam Kachhap interacts with Dr Balaji Ganeshan, Scientific Director, TexRAD to know more about the possibilities of this software What is medical image processing? Medical image processing is the branch of medical imaging associated with quantitative analysis and visualisation of medical images of numerous modalities such as Positron Emission Tomography (PET), Magnetic Resonance Imaging (MRI), Computed Tomography (CT), or microscopy to extract, enhance and display information that could be used by medical imaging professions (engineers, physicist and clinicians - radiologists) to diagnose, monitor and treat medical disorders. What led you to analyse textures of radiological images? Heterogeneity of the tumour microenvironment (e.g. tumour blood supply) is a well-recognised feature of malignancy that is associated with adverse tumour biology. A heterogeneous blood supply will also impact on treatment response due to poor delivery of chemothera-

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May 2014

peutic agents to areas of low vascularity. Hence, a non-invasive imaging method for assessment of tumour heterogeneity could potentially provide a biomarker for prognosis and treatment response. Visual analysis of diagnostic images is largely based upon evaluating morphological information such as size and shape. Image perception and identifying relationships between perceived patterns and possible diagnosis heavily depend on radiologist’s knowledge, analytical skills, memory, intuition and diligence. However, the human visual system has difficulties in discriminating textural information such as coarseness and regularity that result from local spatial variations in image brightness. Furthermore, quantitative information from images is becoming increasingly important within radiological practice as it makes the process more objective. This however is not possible through visual analysis and therefore requires computer-

based algorithmic processing. Texture analysis is a vital component of medical image analysis because it is difficult to classify human tissues via visual assessment based on shape or grey-level information. Also, improvements in texture analysis techniques would increase the extracted information enabling better quantification of differences in appearance inaccessible to the naked eye.

TexRAD employs filters to specifically highlight these coarser features and uses histogram analysis to quantify the filtered images

How was TexRAD born? Most initial texture analysis work (prior to TexRAD) was focussed on tissue segmentation and identification of tissue as benign or malignant. There was very little work on assessing prognosis, disease-severity and treatment-response/prediction, which was more challenging and less developed. This was in fact the basis of my PhD research at the University of Sussex which started in October 2004 to develop a texture analysis algorithm for patient risk-stratification (‘personalised-medicine’), which

could be used as an adjunct (confident decision-making) in routine clinical (radiological) practice. The texture analysis algorithm developed was novel in its approach within medical imaging and a patent application was made in 2007 to protect the invention (currently granted in a few jurisdictions). This generated some initial interest among few prestigious institutions in UK and Europe which led to us developing a research software prototype of the texture analysis. Further interest and scientific publications demonstrating its usefulness in cancer imaging and lack of a commercially available texture analysis software platform led to the spinning out of the company (TexRAD www.texrad.org was incorporated in February 2011) with a number of partnering companies, university and individuals: ◗ Imaging Equipment (Distributor of radiopharmaceuticals Nick Stevens – Managing Director)

RADIOLOGY ◗ University of Sussex

on CT has shown the ability to identify poor prognostic (reduced-survival) lung cancer patients (at the time of staging) and haepatocellular carcinoma patients from good prognostic cases, potentially assisting the clinician to optimise treatment strategies for better patient outcome.

(Dr Ian Carter – University Director) ◗ Dr Balaji Ganeshan (Scientific Director, Inventor, Senior Research Associate at the University College London) ◗ Cambridge Computed Imaging (medical software developing company – Mike Hayball, Technical Director) ◗ Miles Medical Pty (Prof Ken Miles – Consultant Radiologist & Nuclear Medicine Physician, Co-inventor, Professor of Medical Imaging, University College London) The current academic base for TexRAD is at the Institute of Nuclear-Medicine, University College, London. What does the TexRAD software do? How does it do it? TexRAD is a novel measurement tool that enhances the ability of diagnostic imaging (CT, PET, MRI) to contribute to treatment decisions for patients with cancer and other diseases. To date, diagnostic imaging systems have generally enhanced fine detail with the aim of optimising anatomical resolution. However, experience from the automated identification of military targets has indicated that important discriminatory information is to be found within coarser variations in image brightness. If pronounced, these variations can be perceived as abnormalities of texture. TexRAD employs filters to specifically highlight these coarser features (radii 2 -12mm) and uses histogram analysis to quantify the filtered images. How is this information used for risk assessment of a cancerous tissue? Clinical research applying TexRAD to a range of tumours (lung, oesophageal, colorectal, breast, prostate, renal cell cancer) has identified biological correlates of known prognostic significance and shown the ability of cross-validated threshold texture values to stratify patients by prognosis and/or treatment response.

What has been the customer experience with TexRAD? Are any hospitals in India using this software? We have been working with prestigious clinical and research institutions around the world and the interest and feedback has been encouraging. The interest in TexRAD has been gaining a lot of momentum as a novel research tool (to enhance research output and establish novel clinical applications) leading to the development of a potentially useful clinical tool. This is evident from the increasing number of high-impact research papers and conference publications from the TexRAD user community, an indication of the acceptance of TexRAD within the scientific community. (http://www. texrad.org/index.php?option=com_content&view=article&id=4&Itemid=5) Additionally, the very recent research work undertaken by Tata Memorial Hospital has recently shown the potential application in cervical cancer prognosis and response assessment.

What are the other ways in which this software helps oncologists/researchers? Modelling studies have demonstrated that the use of TexRAD to analyse medical images for quantifying tumour heterogeneity acquired in routine clinical practice can potentially impact clinical decision and assist the clinicians (e.g. oncologists), making, for example, suitability for cancer chemotherapy (use the TexRAD information as an adjunct/additional prognostic factors in Adjuvant! Online), improving the ability to accommodate patient preferences and to save costs

of inappropriate treatment that might have been selected using existing methods. Why is information on tumour heterogeneity crucial to oncologists today? This software is particularly generating a lot of interest in doctors working with thoracic malignancies, renal cell carcinoma, haepatocellular carcinoma. Why? These malignancies are some of the most common cancers worldwide, and in India. Their prognosis is also poorer. With early risk-stratification and optimised treatment, the overall outcome for

patients with these cancers can be potentially improved. Imaging generally forms part of the first diagnostic test in detecting these cancers. Hence there will be great value if novel imaging biomarkers can be developed for early risk-stratification. Research using TexRAD on CT has shown the ability to sub-select metastatic renal cell cancer patients who will respond well to a specific type of targeted therapy (anti-angiogenic drugs which are not only expensive but toxic) from those who will not; for whom another form of treatment may be beneficial. Research using TexRAD

Anything else you would like to add. This high level of performance verification undertaken for TexRAD is unusual, if not unique, amongst imaging biomarkers. TexRAD does not require specialised imaging protocols to be added to existing imaging and the barriers to uptake are therefore likely to be low. TexRAD has comparable or superior prognostic performance and lower cost than serum or pathological biomarkers. TexRAD is therefore well placed to fulfil the need for readily available prognostic biomarkers to underpin stratified medicine. mneelam.kachhap@expressindia.com

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May 2014

RADIOLOGY HIGHLIGHTS

Carestream’s new bone suppression software receives FDAclearance Available worldwide, the imaging software offers IHE dose reporting capabilities, good image quality and productivity enhancements for CR and DR systems CARESTREAM’S NEWEST image acquisition software includes 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 visualisation 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 Integrating the Healthcare Enterprise (IHE) dose reporting capability will collect radi-

Carestream Chest Bone Suppressed

ation dose information via the IHE 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

Carestream Chest Simplified View

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 using the IHE profile. This information can then be linked to management systems that enable dose monitoring and reporting for each patient.” 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 work-flow, 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 work-flow 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. EH News Bureau

HCG launched advanced radiotherapytechnologyin India The first Agility Synergy was launched by Professor CNR Rao HCG-M S RAMAIAH Cancer Centre, a unit of Healthcare Global Enterprise, launched the first 'Agility Synergy' in India, an advanced radiotherapy technology, inaugurated by Professor CNR Rao. Agility is a multileaf collimator (MLC) manufactured by Swedish medical equipment company Elekta. Professor Rao, on the inau-

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May 2014

guration of the technology, said, “It gives me immense pleasure to inaugurate the first “Agility Synergy” in India. Research and technology has played a very crucial role in the advances in cancer treatment. I’m pleased to know the gold standard in precision cancer treatment is now accessible in India.” Dr BS Ajaikumar,

Chairman, HCG Enterprise, said, “HCG has been at the forefront in the fight against cancer by introducing new technologies and improving medical outcomes. With the introduction of Agility – Synergy, for the first time in India, patients will immensely benefit from the most precise cancer care treatment available.” Reportedly, the benefits of

Agility Synergy are as follows: ◗ Increases the speed of delivery and allows higher dose rates to be used for more effective modulation ◗ Shortens treatment times considerably ◗ Continuous monitoring and control throughout treatment for confidence in beam shaping and treatment delivery

◗ It reduces unwanted dose to organs at risk and healthy tissue ◗ It reduces off axis dose when performing off-axis beam shaping ◗ Low integral dose reduces the risk of inducing secondary tumours. EH News Bureau

RADIOLOGY

GE Healthcare unveils Discovery IQ,first ever PET/CTdesigned in India

Philips Medical Systems stops CTmanufacturing temporarily

Reportedly, Discovery IQ PET/CT is 40 per cent more affordable than currently available PET/CTs

Its Cleveland, Ohio manufacturing facility has stopped production since January 2014

GE HEALTHCARE unveiled Discovery IQ, an advanced Positron Emission To m o g r a p h y/C o m p u t e d Tomography (PET/CT) molecular imaging system designed in India for the world. The new Discovery IQ is the result of $15 million (Rs 90 crores) investment, and three years of close collaborative development with Indian nuclear medicine physicians and oncologists, according to a company release. Reportedly, the new GE Discovery IQ PET/CT comes with advanced early disease detection capabilities as well as measurements to understand patient’s response to cancer treatment. “Three years back, we promised to develop an advanced yet affordable PET/CT to improve access to early cancer detection. We are proud that we have realised that commitment today with the launch of Discovery IQ - an advanced PET/CT that is 40 per cent more affordable and can usher in personalised treatment for the patient. We are thankful to the Indian healthcare providers for their close collaboration and insights into their needs that helped develop this important weapon against cancer,” said Terri Bresenham, President and CEO, GE Healthcare South Asia. “Molecular imaging is the epitome of healthcare imaging technologies. GE is very pleased to demonstrate to the world India’s capabilities in developing the most

GE’s new Discovery IQ is scalable to fit the needs of the many Indian healthcare providers and is built on a platform that is upgradable on site to meet the increasing demands of a hospital sophisticated medical technologies.” she added. GE’s Discovery IQ, is a step GE has taken to help improve affordability and accessibility to this critical tool that can enable early detection and treatment of cancer. GE’s new Discovery IQ is scalable to fit the needs of the many Indian healthcare providers and is built on a platform that is upgradable on site to meet the increasing demands of a hospital, making it a secure and affordable long term investment to provide continuous, superior care over the years. “We know that cancer patients don’t always respond to their initial course of treatment,” said R Sureshkumar, General Manager, PET/CT Product Development, GE Healthcare. “If we can give clinicians a more accurate and reliable solution to determine early whether the treatment is working or not, they will be able to tailor a regimen of therapies according to individual patient response and needs.” One of the key innova-

tions that comes with GE’s Discovery IQ is Q.Clear^ technology that can provide up to two times improvement in PET quantitative accuracy (SUVmean) and up to two times improvement in image quality (signal-tonoise ratio). Reportedly, the reconstruction technology shows the advantage of full convergence PET imaging without any compromise between quantitation and image quality. “With affordable Discovery IQ PET/CT from GE Healthcare, PET/CT can become an integral part of cancer care management for every cancer centres in India. Clinicians will now have ready access to tools that will allow evidence based and cost effective treatment. Together with our customers, we are focused on improving access, quality and affordable cancer care for the patient”, said R Balamurugan, Director, Oncology, GE Healthcare South Asia. EH News Bureau

M Neelam Kachhap Bengaluru PHILIPS MEDICAL System has suspended production of CT scanners at its Cleveland, Ohio manufacturing facility since January 2014. This will result in delay of shipping of products from this facility which manufactures computed tomography and nuclear medicine equipment. The stoppage would affect the delivery of Philips CT products like the Ingenuity products, Philips Brilliance CT Big Bore and the iCTs. "In our healthcare facility in Cleveland, Ohio, certain issues in the general area of manufacturing process controls were identified during an ongoing US Food and Drug Administration (FDA) inspection. To address these issues, on January 10

This stoppage will result in the loss of EBITA of approxi mately euro 60 to 70 million in the first half of 2014

(2014) we started a voluntary, temporary suspension of new production at the facility, primarily to strengthen manufacturing process controls," an official statement from Philips said. In the past few years this computed tomography and nuclear medicine headquarters of Philips Medical System has received warning letter from the US Food and Drug Administration (FDA), for issues related to quality control, among others. The current and prospective customers looking to buy these products may be affected by the current situation. However, the customers in India have not received any advisory from the company on current issues and expected resolutions. A Krishnakumar, CEO, Philips India did not reply to e-mail queries and was not reachable for comments. The company estimates that this stoppage will result in the loss of EBITA of approximately euro 60 to 70 million in the first half of 2014. As of now, Phillips claims that it will rectify the situation by the second half of 2014, and start delivering CT scanners thereafter. However, the company will need time to rectify its manufacturing processes and practices to the standards and quality required by the FDA.

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May 2014

IT@HEALTHCARE I N T E R V I E W

‘The hospital-in-a-box solution allows for quick installation- hospitals can be up and ready in a week’ Sid Nair, VP, Healthcare & Life Sciences, Dell Services tells Viveka Roychowdhury that healthcare IT outsourcing in Indian hospitals has to increase so that hospitals can increase productivity and efficiency as well as focus on their core objective- giving quality care to patients As head of Dell's global $1.5 billion healthcare and life sciences services business unit, what is the strategic vision behind the recently launched cloud-based solution for India's healthcare market? The Cloud solution is the execution of one of the key strategic priorities that the Healthcare and Life Sciences (HCLS) organisation outlined at the beginning of our new fiscal - international market expansion. This solution is also an integral part of Dell’s vision of building future-ready IT platforms to provide cuttingedge technology and services that enable innovation in Health IT. The cloud-based solution extends Dell’s Cloud strategy of providing choice and flexibility to customers to drive tangible business results through cloud computing. It’s an exciting time for us to be part of the Indian healthcare industry. Currently at $128 billion, healthcare is one of the fastest growing industries in the country, with a CAGR of 15 per cent.

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The hospital-in-a-box solution seamlessly and cost effectively delivers integrated clinical and financial systems for healthcare providers in India. We are extending Dell’s proven capabilities and global healthcare leadership to India and have brought in the best-of-breed combination of HIS and ERP to help providers achieve their goal of providing efficient, information-driven healthcare in an affordable way. We will continue to bring to India unique solutions that will allow healthcare providers to focus on their number one goal-enhanced patient care. The Software as a Service (SaaS) based solution allows healthcare providers to quickly respond to increasing demands of infrastructure and storage, and train staff without huge capital investments and recurrent readiness costs. End-users (physicians, nurses and back office staff) can get instant access to cloud-based applications and reports through the use of a simple conventional browser.

Our pay-asyou-go pricing model brings down the total cost of ownership by 50 to 60 per cent and helps in increasing operational efficiency

They can also remain connected via smart phones and other hand-held devices, ensuring secure and anytime, anywhere access to information. The hospital-in-a-box solution allows for quick installation- hospitals can be up and ready in a week. The solution is truly one of a kind in terms of its capabilities, delivery model and pricing. We believe it will be a game changer for the Indian healthcare provider market where hospitals are constrained by huge upfront capital investments, and higher cost of licensing, maintenance and support. What is the cost of deployment? What is the projected value proposition? Any examples of successful implementation? The solution caters to different provider segment in the gamut of healthcare delivery including single clinics, chain of clinics, midsized hospitals, large hospitals and groups. So the cost of deployment varies based on size of delivery

organisation, scope, and users. The solution is strategically designed for Indian requirements -- to keep the huge upfront cost and recurring operational cost at bay. In the Indian healthcare provider industry many of the small to midsized players shy away from modern technology adoption due to huge cost of infrastructure, hardware and software. Our pay-as-you-go pricing model brings down the total cost of ownership by 50 to 60 per cent and helps in increasing operational efficiency and productivity. We have piloted the solution in a few hospitals so far and the response has been very positive. Who are your technology partners for the cloud based solution? Our partners for this solution are Ubq Technologies and Ramco Systems. They will help us deliver an end-to-end proposition to providers. Ubq's Hospital Information System (HIS) solution, medics, will serve as the front-end application for

IT@HEALTHCARE patient-centric activities and will integrate with Ramco ERP on Cloud to provide customers seamless enterprise-wide application on the cloud. What is the projected growth for the different customer segments served by your vertical? The global healthcare IT services market is expected to grow at an approximate five per cent CAGR over the next five years spanning the hospital, health insurer and life science sub vertical markets. As a market leader in providing transformational services to healthcare and life sciences customers, through 15,000 employees worldwide, we are expecting to grow above market rates. Industry analysts continue to recognise our leadership in healthcareGartner has ranked us as #1 healthcare IT provider for the third consecutive time this year. Everest Group has recently positioned Dell’s healthcare IT services in the Leader category for Healthcare Payer IT and as a market Star Performer for Payer Information Technology Outsourcing (ITO) on the PEAK Matrix. Amongst Dell’s priorities for this year is expansion into certain geographies and a new dedicated focus on the mid-market segment in these markets. Can you give more details? We are focusing on expanding beyond our current priority markets which include the US, the UK and the Middle East. We are reaching out to emerging markets with targeted healthcare solutions, like this cloud solution, in India, China and Latin America. Governments across the globe are focused on reducing cost of healthcare while patients are demanding more from the system. What transformative changes do you see in the sector? We believe that a number of industry transformation

The need of hour for the current Indian healthcare market is to reduce complexity through integration, creation of a unique patient experience, addressing patient mobility and bringing standardisation by adopting seamless automated workflows to ease the pressure on care providers with all around accessibility

trends will fundamentally change the healthcare market over the next few years: ◗ Capitation – To improve quality and reduce costs, healthcare payment reform is driving the movement from ‘pay for volume’ to ‘pay for quality’. Health insurance payers are moving towards paying a flat fee for each patient it covers to healthcare providers as a way to reduce costs and improve performance by shifting the risk to healthcare providers. ◗ Consolidation – Increased amounts of consolidation is occurring as health systems/hospital chains try to take advantage of economies of scale and expand into new markets/regions by acquiring smaller hospitals. In addition, payers and provider health systems are beginning to merge as they see opportunities to reduce risk and maximise reimbursement under a single organisation. ◗ Coordination – Greater emphasis is being made to care for patients outside of the hospital to reduce cost and burden on healthcare resources. ‘Avoidable’ Emergency Room cost is estimated at $6 billion a year when patients could be potentially seen by their local primary care physician. By creating better care coordination across the care continuum, the healthcare industry hopes to deliver the right

care to the right patient at the right time. ◗ Competition –Increasing competition between providers and payer organisations as they compete for patients is changing the way many organisations think about their business strategies as they try to focus the patient at the centre of how they operate. ◗ Consumerism – Patients are becoming more conscious of their health and are wanting to lead healthier lifestyle and in turn demanding more and more information. Both providers and payers are also looking to utilise the ever expanding data that is available, to provide personalised medicine and manage overall population health as way to improve quality and reduce cost. How is Dell positioning itself to help healthcare clients transform themselves to be in tune with these changes? Dell transforms care by connecting people to the right technology and processes, creating information driven healthcare and accelerating innovation. Dell supports the entire spectrum of care delivery: hospitals, health systems, physician practices, health plans and healthcare supply chain organisations. Dell’s healthcare strategy centres around our fundamental understanding of our customers, combined with deep IT domain

capabilities across our infrastructure and cloud, applications and business processing outsourcing services. Our deep vertical expertise allows us to provide our healthcare customers with innovative solutions that address key challenges in their respective markets. Our healthcare team has continued to expand key solutions that aim to improve quality and help reduce healthcare costs; including our Dell Clinical Cloud Archive, Electronic Medical Record Support, Payer Health Insurance Exchange and Predicative Analytics. What is your advice/ recommendation for Indian healthcare delivery players on the best plan to leverage IT and feed their growth strategies? If you look at the Indian population of ~1.2 billion and the average beds availability, you will find a large gap that has to be filled. India needs to be able to add around 80,000 beds every year for another 10 years to be self-sufficient in terms of availability of beds. This can be viewed from two angles. The first is business expansion where there will be organic and inorganic growth in this segment with new players joining in, mergers and acquisitions and FDIs. This business expansion is a long-term strategy which needs to be closely associated with IT requirements to fill the gaps to provide wheels for

smooth expansion. The healthcare IT outsourcing in Indian hospitals so far has been minimal with mid and large organisations preferring to keep their IT in-house. This leaves them with little time and resources to focus on their core objective- quality care to patients. This needs to change so that hospitals can utilise their skilled resources which is a major cause of rising operational cost for patient care where they belong. The second point is huge amount of patient records and its digitisation due to beds additions and expansion. Currently, mid to large organisations spend about 55 per cent on hardware and another 25 per cent on software. With the current pressing economic conditions where revenue margins are low, this amount is going to be unsustainable in near future. With one to two per cent of IT budget, the adoption of new technology will be near impossible and the entire budget will be used up just for support activities. The need of hour for the current Indian healthcare market is to reduce complexity through integration, creation of a unique patient experience, addressing patient mobility and bringing standardisation by adopting seamless automated workflows to ease the pressure on care providers with all around accessibility. As mentioned earlier, Dell is committed to bringing business transformation with affordable cutting edge technology to healthcare providers that can help them increase productivity and efficiency. With the cloud solution we are presenting an ideal solution to Indian healthcare industry. We are confident that with the solid value proposition that this solution offers, healthcare providers will adopt this solution for betterment of healthcare delivery in order to create a unique patient experience. viveka.r@expressindia.com

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May 2014

ASK A QUESTION What is the importance of feasibility survey of a hospital? SATISH SHAH, Ahmedabad

The hospital project feasibility may form the basis of an important investment decision and in order to serve this objective, the document/study covers various aspects of project concept development, start-up, and production, marketing, finance and business management. The document also provides sectoral information, brief on government policies, which have some bearing on the project itself. Feasibility study captures all the important factors that can play an instrumental role in the success of a project. What are the crucial factors and steps in decision making for investment? ROUNAK SHRIVASTAVA, Gurgaon

Before making any investment decision, it is advisable to evaluate the associated risk factors by taking into consideration certain key elements. These may include availability of resources, academic knowledge, past experience and specific managerial and medical healthcare skill. At times, evaluation and analysis of strengths, weaknesses, opportunities and threats (SWOT) for a particular project serves the purpose of a basic tool in investment decision making. Can you brief me about the architectural services of any project? MOHAMMAD ASLAM, Aligarh Conceptual drawings: Based on client requirements of specialities, plot size and layout and other parameters, we present a conceptual plan for the hospital; will show the proposed structures with block relationships of the

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May 2014

departments, area, shape and location within the building. Detailed architectural services: Covering complete design of the building, internal space and facility planning and ancillary and support services. Interior design: Complete design of the interior spaces, including public areas like lobbies, cafeterias, waiting areas, and semi medical and medical areas like OPD, inpatient wards and special rooms, operation theatres, pathology, etc. Structural design: Design of the structural framework for the entire building conforming to the specific needs of the intended space, including the detailed construction drawings for the work to proceed on site.Design of services like electricals, plumbing systems, HVAC systems, fire fighting systems, data and voice networking, building management systems, UPS systems, sewage treatment plant and rain water harvesting.

to reach patients at the point-ofcare and ensure that staff manages the entire patient population effectively and efficiently.

What is the importance of quality care management control programme in hospitals? DR NISHA KURESHI,Valsad

What are the basic job specifications of executivemarketing and human resource?

All the regulations for quality management in hospitals prescribe policies, procedures and responsibilities for the administration of the hospital quality management programmes including policies addressing medical services quality management requirements, quality healthcare and medical records documentation controls. These quality control systems allow a care team to know the status of each of their patients regarding required preventive, screening, and chronic disease management services based on practice-specified care guidelines. These quality management controls act as a tool

A marketing executive should have good energy, good teamwork skills, communication skills, adaptability, creativity and commercial awareness along with numerical skills and IT skills. Human resource executive should have strong effective communicator in writing and in interpersonal communication; highly developed, demonstrated teamwork skills; expert in employment law and employee relations and communication; familiarity and skill with the tools of the trade in human resources including HRIS, Microsoft Office suite of products, file management and benefits administration.

What are the main responsibilities of operations-manager? DR VIKAS BHALLA, Mumbai

◗ Maintaining community relations. ◗ Maintaining physician relations and hospital planning. ◗ Managing executives and other administrative personnel. ◗ Evaluating programmes, budget planning, cost containment. ◗ Maintaining or improving customer satisfaction ratings, assessing service quality. ◗ Continuous improvement initiatives. ◗ To oversee number of areas such as: nursing, medical records, information systems, human resources, finance, facilities and material, patient admissions.

MALINI SHAH, Varodara

TARUN KATIYAR Principal Consultant, Hospaccx India Systems

Express Healthcare's interactive FAQ section titled – ‘Ask A Question’ addresses reader queries related to hospital planning and management. Industry expert Tarun Katiyar, Principal Consultant, Hospaccx India Systems, through his sound knowledge and experience, shares his insights and provide practical solutions to questions directed by Express Healthcare readers

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IgE & IgG antibodies to Food.... Hypersensitivity to Food

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ELISA test for semiquantitative determination of specific IgE

Test for determination of IgG to 59 common Indian foods

Carefully selected allergens having prevalance in India. Food and Inhalation panel

Serum or plasma can also be used as sample.

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Qualitative test for determination of IgG antibodies to 59 common Indian foods. Requires only a finger prick blood sample.

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LIFE

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Throughout his career Padma Shree Dr Narendra Kumar Pandey, has worn many hats but his latest – as Chairman & MD, Asian Institute of Medical Science – excites him the most. M Neelam Kachhap listens on as Dr Pandey recounts his life’s journey and its many learnings

ARD WORK and determination can turn any dream into reality. That’s what Padma Shree Dr Narendra Kumar Pandey (63) has always believed. How else would the dreams woven by a small child on a dusty, oblivious village road mature into an illustrious career in medicine? Dr Pandey’s journey started from the heartland of Bihar and traversed through larger cities in India and the UK before stopping in Faridabad near Delhi where his dream took shape of a 350-bed super speciality tertiary care hospital called Asian Institute of Medical Science (AIMS). Currently, he serves as the Chairman, MD and HOD of Surgery at the Institute which he runs with grit and determination; providing accessible, affordable and best available healthcare services in India. He is joined in this endeavour by his two sons and daughters-in-law; together they envision to make AIMS the most trusted healthcare partner in India.

Dr Pandey’s life is the story of a person with an indomitable spirit who believed in taking small steps to success than a short-cut. It has been a long, meandering road to success for him but there is no stopping Dr Pandey, as he has already chalked a new path with new goals to further the cause of affordable healthcare in India.

Early life Born and brought up at Bishnupura in Saran district of Bihar, Dr Pandey is the eldest of the three boys of the village Head Master and his wife, Late Jagat Pandey and Vidya Pandey. “My village was connected with a dusty road and infrequent buses, not more than two to three in a day,” recollects Dr Pandey in a pensive mood. “Every time it rained there was holiday at school because it hardly had a roof. My uncle was a teacher so there was always a lot expectations and pressure to study and do well,” he says of his early childhood. He recounts his carefree childhood days which changed when his father joined the Ministry of

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AWARDS AND ACHIEVEMENTS

LIFE

Home Affairs and got posted to various locations, including Assam forward area during 1962 China war. This was the time when he realised the responsibilities of the family and focused on his studies. Always a bright student, Dr Pandey was also active participant in co-curricular activities and sports. “I was supposed to be a good debater. Once I got selected for the district debate to be held at Ranchi, however, it turned out to be much embarrassing as I could not speak a word when I went on to the podium,” recounts Dr Pandey. However, in his later years, he went on to be a much sought after orator and guest lecturer for many national and international conferences.

Shaping his career Being a good student he had many career options but he chose medicine. “In the 60s, choice of career was either medicine, engineering or perhaps the civil services,” explains Dr Pandey. “I was always intimidated by physics, so I picked up medicine to avoid studying physics,” he adds. One of his father’s friend was a general practitioner who also inspired Dr Pandey to take up medicine and he got into Patna Medical College. Later on, he specialised in surgery and it was an intentional choice, he asserts. “During my final year at medical school I was drawn towards surgery. I noted that it was an area where the doctor could really do something and cure the illness,” he says. He remembers his time at the Patna Medical College very fondly. “College days were fun,” he says with a smile. “Patna Medical College is situated on the banks of river Ganga, so our boating club was very active during winter. I would row upstream for two to three km,” he claims. Dr Pandey also recalls spending time in the college canteen. Towards the end of his college life he remembers a lot of extra classes and the excellent guidance provided by his teachers. “We had some wonderful teachers like Prof Saran,

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Prof Govind Achari, Prof VN Singh, Prof SK Sinha and our anatomy head Prof Manik Singh,” he shares. He recounts that Prof Manik Singh was hilarious. Dr Pandey got his MBBS degree in 1974 and proceeded to do his internship from the Patna Medical College. “My first job was at a block hospital in Danapore, District Patna and I did it for over a year,” informs Dr Pandey. Here Dr Pandey’s surgical dreams met with the harsh realities of the Indian district hospital. The lacuna in the Indian healthcare delivery at the time left him isolated and he started feeling detached from his dream of becoming a world class surgeon. “The work was not what I had expected. It mainly consisted of some relief distribution and mostly focused on vasectomies and its target,” Dr Pandey recounts. This was the time when the government had initiated a widespread compulsory sterilisation programme to limit population growth in India. “At the time one’s performance was linked to vasectomies and number of tubal ligation. We worked under tremendous pressure. This was my phase of detachment with my job and a turning point as I decided not to continue doing the same for years to come,” he remembers. Luckily, he got an opportunity to move to London which he readily took up. Dr Pandey was by then married to Padma Pandey whom he had met at a common friend’s house. She was was studying MSc at Patna Science College at the time.

Higher studies and life at London By 1976, Dr Pandey moved to UK for further studies. Dr Pandey honed his surgical acumen at various hospitals in England. He got to work with eminent surgeons which gave him an opportunity to learn the intricacies of surgery. “I repeated the internship in A&E, Surgery and Orthopaedics at Ashford hospital, London, Aberystwyth District General Hospital at Devon in UK and at the district hospital, Barnstable. I did my FACS

Distinguished Service Award by Delhi Doctors Association in 1997

Dr BC Roy National Award for the development of Minimal access Thoracic Surgery 2005

Betadine Achievement Award – Association of Surgeons of India (2010)

Doctor of Science AwardTeerthanker Mahaveer University (2013)

Padma Shree in Medicine 2014

from The Royal College of Surgeons of Edinburgh in 1982 and spent considerable time working in different eminent hospitals in London like the Hammer Smith Hospital, Kings College, Charing Cross Hospital and Middle Sex Hospital,” he says. Recounting his learnings at UK he says, “My shift to UK brought my focus back to the practice of surgery. It gave me chance to learn art of surgery from many eminent teachers, Sir APM Forrest, Prof Mansel, Prof Blumgart at Hammersmith, Prof Russell at the Middlesex. They were true gurus in the field of liver, pancreas surgery etc. Sir Alfred became a pioneer of minimal access surgery.” “The time in London also bettered my communication skills, helped in leadership training. This made me more confident, a better surgeon and also taught me how to lead team of healthcare professionals,” he adds. Dr Pandey had an opportunity to settle down in the UK, however, he decided to come back and serve his country.

Working in India

PERSONAL NOTE ◗ Born on January 1, 1951 at Bishnupura in Saran district of Bihar ◗ Completed MBBS in 1974 from Patna Medical College ◗ Married Padma Pandey in 1975 and has two sons and four gandchildren ◗ Anupam Pandey and wife, Neha Pandey look after the administration of AIMS while Dr Prashant Pandey and wife, Dr Smriti Pandey take care of the clinical administration of the hospital. ◗ As a student he enjoyed sports and played the indigenous Guli danda to football and Cricket. ◗ In medical college played table tennis and captained college team at Inter medical college, T.T. competition in 1972 at All India Institute of Medical Sciences, Delhi.

Dr Pandey came back to India in 1984. Having once worked in the government sector he wanted to give the private sector a try. He joined Escorts Hospital now known as Fortis Escorts Hospital, Faridabad in 1985 as a consultant. By the time he left the hospital in 2007, he was serving as the Executive Director. In the mean time he was also the member of the Board of Directors of Escorts Heart Institute and Research Centre, now known as Fortis Escorts Heart Institute Delhi, and remained with them till 2007. He left the hospital to pursue his dream of building his own hospital.

A new chapter Dr Pandey invested all his life savings into building his dream project, AIMS. “We started the construction of AIMS in 2008 and opened the 350-bed tertiary care facilities for patients in 2010,” Dr Pandey says. He adds that setting up this tremendous facility with super speciality was truly a

phenomenal experience. The hospital has been accredited with NABH and NABL and is equipped with state-of-the-art technology. The hospital provides preventive, diagnostic, therapeutic, rehabilitative, palliative and support services, all under one roof and is designed to meet patient care and research requirements of today. Dr Pandey has ambitious plans to add more hospitals under the brand as well as venture into allied business like clinics and wellness centres. “We are looking at the growth plan of AIMS, our Asian Clinic in Greater Kailash, South Delhi is already functional. We have planned to set up these clinics at different locations in NCR,” he informs. “We hope to start two or three 100-bedded secondary care facilities in NCR. We are also exploring to start a specialised mother and child care centre in NCR,” he adds.

Awards galore An astute surgeon, Dr Pandey toiled to make a name for himself and has been awarded generously. A fellow of both the Royal College of Surgeons of Edinburgh as well as the Royal College of Physicians and Surgeons of Glasgow, he is also recognised for his pioneering work in minimal access surgery. He is a name to be reckoned with in the field of surgery and has served at most of the professional associations. “I am associated with various professional bodies,” he informs. “I am the National President of the Association of Surgeons of India; President, International College of Surgeon, Indian chapter. I had privilege of being joint editor India Journal of Surgery for six years, member, Committee on health, Confederation of Indian Industry. Member, Senate Theerthanker Mahaveer University, member, Moradabad Board regent – Indian Institute of learning and advance development,” he explains.

An educationist Dr Pandey has a fond association with the National Board of Examination (NBE) India. “I

LIFE

served as an examiner, inspector and as a member of the Committee set up by NBE for preparation of the programme and guidelines for orientation course designed for examiners and inspectors,” he tells. As Coordinator - Fellowship Program he coordinated post DNB Fellowships in 13 specialities, under the direct supervision of the President of NBE. This involved organisation of syllabus, question data bank, planning and execution of various entry and exit examinations for fellowship as well as identification of various centres to run the programme. “I managed to introduce centralised admission procedure for fellowship examinations,” he says. His ability to interact effectively and efficiently with faculty members of various specialities helped smooth functioning of the programme. He was also able to help in upgrading the syllabus for DNB in surgery under the direct supervision of the President of NBE with the objective to cover all newer aspects of development in surgery in curriculum as well as introducing objectivity during training. He introduced the logbook with methodology to grade the level of hands on training in surgery. “I was appointed examiner for the Royal College of Surgeons of Edinburgh, both for MRCS and FRCS exams and continued as such till 2000. I had the privilege to examine various centres along with peers in the surgical field, in both India and the UK,” he says. He has also been a faculty member for workshops, symposia and other such programmes being organised by the college at various places in India on postgraduate examination in general surgery as well as on medical education, training and assessment techniques from time to time. “These examinations are an important activity of the Glasgow College and this assignment, given by the Board of Examiners for Surgical Examinations of the College, testify international recognition of my contribution to medical education,” Dr Pandey explains.

Dr Pandey with his son, (left) Anupam Pandey and his wife Neha Pandey and (right) Dr Prashant Pandey with wife Dr Smriti Pandey

Dr Pandey with his family during a holiday

We are looking at the growth plan of AIMS, our Asian Clinic in Greater Kailash, South Delhi is already functional. We have planned to set up these clinics at different locations in NCR. We hope to start two or three 100-bedded secondary care facilities in NCR and are also exploring to start a specialised mother and child care centre in NCR He also organised a number of conferences, workshops, scientific meetings and other similar medical education pro-

grammes for The International College of Surgeons, The Association of Surgeons of India.

Road ahead Talking about his life, Dr Pandey says, “I have absolutely no regrets in life. Al-

though I feel that I should have started on my own much earlier to set up an institute like AIMS.” He also has no plans to retire. “I have no plan of retirement in the near future as I have a long list of things to do. Primarily, improving healthcare, particularly in Tier 2 cities. This will keep me occupied in future,” he says. “I am still in active clinical practice however, I do spent almost half of my time in administration. But I would wish to continue to be in touch with my patients,” he concludes. mneelam.kachhap@expressindia.com

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and

Connect flourish Dr Asif Gani,CEO, TransEarth Medical Tourism, gives insights to healthcare players on gaining and maintaining a good reputation online and the importance of social media in the process

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N THE rapidly changing world, the advent of social media has empowered consumers including the patient fraternity. This has fundamentally changed the patient-doctor relationship. With access to the Internet, a large scale wealth of medical information is within easy reach of the public. An average patient today is more informed, often even before he meets the doctor. Post-consultation or treatment feedback on a social media website can build or tarnish the image of a doctor. The doctor-patient relationship which was sacrosanct is now under the scanner and patients have a growing option to post their reviews, feedback and opinions on various social media, consumer and patient review sites.

Online reputation management Reputations and more are established and demonised in the matter of a few minutes. It is a world full of sneezers and one good or bad word is sneezed rather vividly. No amount of PR or advertising budget can salvage a bad reputation. Like it or not, accept it or not, it is a cynical world we are living in. Or better still, we have become cynical. A couple of years ago, there was an awe and shock reaction when a super-speciality hospital in India, was inaugurated amidst much fanfare. Film stars and politicians were getting their health check-ups here, there were stories about how doctors were hand-picked from the West at mind-boggling salaries that would put CEOs of companies to shame, so on and so forth. There was the aura, the marketing drive, the zeal of the proponents. And then the bubble was pricked.

DR ASIF GANI CEO, TransEarth Medical Tourism

There were whispers of inflated costs, a surgery gone kaput, over-worked doctors rushing into the operation theatre, sub optimal nursing care, callous administrative officials. “These people are nothing but greedy mammons,” scoffed a friend. His mother, he says had walked into the hospital for a minor procedure but was now in the throes of a multiple organ failure. However, the hospital was quick to control the negative feedback. Its online presence was strong and hence balanced the negative talk with positive buzz. Let me quote a routine example. One is frantically looking at a major surgery for a relative. One looks around for opinions, second opinions and third opinions from doctors, relatives and friends. Finally, one stops at a particular surgeon and a particular hospital. And the surgery goes off well. There are raves. Not by the hospital machinery but by the relative and the patient himself, on the Internet. The actual experience is recounted. Thousands of people read the review and are influenced by it. This is known as the sneezing effect. Like it or dislike it, doctors and hospitals are up for reviewing and rating. Pre-surgery opinions are extremely important. We all

need second opinions from doctors, relatives and friends. Here relatives and friends play an important role. The Internet has expanded the scope with its vast number of users and has provided this opportunity in ample proportions. Today, the trend is to verify each and everything beforehand. Information about every person, product, place, or service is just an Internet search away. People, at large, prefer to know how well something is doing or rather acquire more information about a person or thing prior to indulging in or with it. Type in what you would like to know and hit the search button – pop comes all the information and reviews. Everyone and everything is being reviewed.

Importance of social media Today, social media is an important medium that thrives on social inequity, creates a revolution amongst people, allows the consumer to make brands listen to him, rediscover long lost pals etc. In short, the dotcom which busted a decade ago has returned with a vengeance in a more humane form. Today, the Internet has diversified itself. Yesterday, the dotcom defined it – today, when we say dotcom we usually refer to e-commerce sites – Consumer Review and Social Media platforms have acquired a definition of its own. According to a study published in the academic journal Memory and Cognition it has found that users are more likely to remember a Facebook status update than lines read from a physical book. Custodians of brands are concerned about what is being

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LIFE

said online and offline about their brand. The online focus of customer management has increased manifold. Brands are watching and reading what is written about them on various consumer review and social media sites like Facebook, Twitter and MouthShut. The brand/consumer relationship has shifted from a one-way delivery channel to more of a conversation. These days, consumer blogs and posts are actually getting responses. The name of the game is now engaging with a customer base. Brands no longer rely completely on customer care departments and their own websites. They know that to tackle one bad review, one bad comment on their product they have to search the entire web. Agencies are now being appointed to see what’s written about brands online and resolutions are sought. According to a survey conducted by Zarca Interactive, a US-based market-research company: ◗ 66 per cent people who are online, read online reviews before deciding on a doctor ◗ 76 per cent feel reviews impact their decisions ◗ 84 per cent trust actual user review more than domain expert reviews One of the most searched and reviewed categories on the Internet is medical service providers and doctors. It is only wise to be aware of the fact that you are being watched by people who might want to consult or get operated by you or at your hospital and reviewed by people who are availing your services. Gone are the days when people literally walked up to friends and colleagues for feedback or called others up on the phone. Any information pertaining to you and the hospital where you practice is freely available at just a click. In short, the experience of few people serves as an extended relatives opinion for all others.

Dos My dear colleagues, it would

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66 per cent

people who are online, read online reviews before deciding on a doctor

be great if you become more internet-savvy and pay attention to details like these. You are under the telescope – you are written about and read about. Basically, you are being talked about. In other words, please connect and flourish. People are talking about you - sniggering at times, cheering at times. Don’t let wrong or unpleasant reviews about you mislead probable patients and ruin your potential patient base. Be prolific in countering negative remarks. Apologise wherever necessary. Convert negative feedback into positive buzz. An increasing number of people are using social media websites to seek medical advice and find a healthcare

76 84 feel reviews impact their decisions

per cent

professional. By joining various patient review and social media websites - and staying active online – you will reach potential patients and let them communicate with you directly. Strong social media marketing helps you: ◗ Brand your practice and hospital ◗ Post updates, news, and information instantly ◗ Communicate with your patients in real time ◗ Form a strong patient support group ◗ Respond to comments - and address negative comments before they become an issue

Connect and flourish Make sure your high qual-

per cent

ity medical services are becoming the talk of the town and an increasing number of people are stepping into your clinic and hospitals. Great reviews and ratings about you as a doctor can have a major impact. It can spiral your practice upwards and generate leads. Have your visibility online, but only a positive one. Get web friendly with good reviews. Great reputation is what matters most for medical practitioners. With new technology emerges a new challenge. As surgeons and physicians we need to adapt ourselves. We cannot be living forever in the ancient age. Gone are

trust actual user review more than domain expert reviews

the days when domestic and overseas patients would see the website of particular hospitals and come down for treatment. Today, they check online reviews about the hospital and doctor. Just as we embrace new technology, we need to adapt to new social media challenges and convert half-possibilities into fullblown opportunities. Through this article I would encourage you to 'Connect and Flourish', best leverage positive consumer reviews thereby generating potential leads, outflanking competition, improving brand perception and accelerating growth.

LIFE PEOPLE

Scott McCool is Polycom’s new CIO McCool has more than 25 years of experience in building and managing IT organisations POLYCOM ANNOUNCED that Scott McCool was promoted to the role of Group Vice President of Information Technology and Chief Information Officer. He is now responsible for Polycom’s global Information Technology (IT) organisation and prioritising the company’s IT spend to investments that deliver the greatest value. McCool reports to Chief Accounting Officer and interim Chief Financial Officer, Laura Durr, who is responsible for managing all financial, accounting and IT functions at Polycom, and is focused on driving efficiency as Polycom looks to accelerate its momentum in the market. McCool has more than 25 years of experience in building and managing IT organisations. McCool joined Polycom in July 2013 as the company’s Vice President of Information Technology and Chief Information Security Officer.

McCool joined Polycom in July 2013 as the company’s VP of Information Technology and Chief Information Security Officer

Durr said, “McCool brings significant experience in technical leadership roles, having managed technology solutions addressing complex business problems for a broad range of organisations, ranging from Fortune 500 companies to government agencies, large private companies and more. Scott is a great leader who is helping to drive Polycom’s future forward as we refine customer solutions designed to improve operating performance and profitably grow the company.” “Polycom’s global team of IT professionals consists of the industry’s leading collaboration experts. They are passionate about developing new and innovative ways to leverage video, voice and content collaboration solutions, alongside our other IT investments and business processes, to make Polycom more competitive in the market, more efficiently operated, and a more engaging place to work,” said McCool. “It is a thrill to have the opportunity to lead that team and to help deliver that expertise and experience to our customers as they seek to build their own collaborative environments.” Prior to joining Polycom, McCool directed global infrastructure engineering at Brocade, launching innovative designs and leveraging Brocade IP, storage networking and software-defined networking (SDN) solutions. Scott holds a Master of Science in Computer Information Systems, a Master in Business Administration, and numerous IT certifications.

Gary Reiner and Cory Eaves join CitiusTech’s Board of Directors They join the Board from General Atlantic, CitiusTech’s new investor CITIUSTECH has announced two key additions to its board of directors: Gary Reiner and Cory Eaves both from CitiusTech’s new investor, General Atlantic (GA). Reiner, an operating partner with GA, was formerly the Chief Information Officer at General Electric. Cory Eaves, is a Managing Director and head of GA’s Resources Group. CitiusTech announced that General Atlantic has become a large minority shareholder in March. Rizwan Koita, CEO, CitiusTech, said, “I welcome Gary and Cory to the CitiusTech board. Their deep experience in technology, operations and healthcare will go a long way in helping scale CitiusTech’s presence across new markets and offerings.” He added, “We look forward to a deep and longstanding relationship with the GA team, and are excited about the immense growth opportunities that lie ahead of us.” As a GA operating partner, Gary Reiner provides strategic counsel to GA and its portfolio companies. Reiner also serves on the board of directors of Hewlett-

Gary Reiner provides strategic counsel to GA and its portfolio companies Packard, Citigroup, Box, Appirio, Mu Sigma and Amedes Group. Previously, as senior VP and CIO, GE, Reiner led M&A, Sourcing, IT, Operations and Quality. Earlier, he was a partner with Boston Consulting Group, where he drove strategies and operations improvements for hightechnology businesses. “CitiusTech has created a strong niche in the healthcare market today through deep domain expertise and the ability to build exceptional technology solutions for the healthcare market,” said Reiner. “I’m really looking forward to working with Rizwan and his excellent management team.”

Cory Eaves leads GA’s Resources Group, a team of functional experts who support GA’s investment team and portfolio companies. He has over two decades of operational experience, including previously serving as chief technology officer of SSA Global, one of the world’s largest enterprise software providers and a prior GA portfolio company. Before joining GA, he served as Executive Vice President, Chief Technology Officer and Chief Information Officer at Misys plc, a global provider of software and services to the healthcare and financial services industries. He was also a member of the Board of Directors for Allscripts, a provider of practice management and electronic health record technology. “The healthcare technology industry is an exciting place to be, with tremendous opportunities for growth and innovation through next-generation technologies like mobility, cloud computing, predictive analytics and big data,” said Eaves. “I am pleased to be joining the board of such an exciting growth company.”

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Dr Gullapalli N Rao to Lead International Academic Body The LVPEI Chairman has been elected as President to the Academia Ophthalmologica Internationalis (AOI) DR GULLAPALLI N Rao, Founder and Chair, LV Prasad Eye Institute (LVPEI) has been elected as President to the Academia Ophthalmologica Internationalis (AOI). The Academia is a 73 member body of the most eminent academicians in ophthalmology in the world, each holding a chair of this prestigious body. The 73 chairs represent professors from many top most universities of the world and Dr Rao is the first ever non-university based academician and the first one from outside US, Europe and Japan to be elected President of this body.

Dr Rao was elected to the chair of AOI in 1998 and became the second Indian ever to receive this honour after his teacher, Prof LP Agarwal, former Director of the All India Institute of Medical Sciences (AIIMS). On being elected President of the Academia, Dr Rao succeeds Prof Paul Lichter, Director Emeritus of Kellogg Eye Institute at the University of Michigan in the US and Prof Peter Watson of Cambridge University in UK. The announcement was made during the World Ophthalmology Congress in Tokyo, Japan. Speaking on the occa-

sion, Dr Gullapalli N Rao said, “This is among the highest honours conferred in the field of ophthalmology and is a huge responsibility. I am extremely privileged to have been given this opportunity, and grateful to everyone especially in LVPEI for helping me in this journey, without which this wouldn't have been possible.” Dr Rao was earlier Chair of the Board of Trustees and CEO of International Agency for Prevention of Blindness (IAPB) in which position he is credited with playing a critical role in initiating and advancing the 'Global VISION 2020: The

Right to Sight program' the prevention of blindness programme globally in partnership with the World Health Organization (WHO). He was also the recipient of numerous awards from many international organisations and delivered many named lectures in international conferences and universities around the world. He published nearly 300 peer reviewed scientific papers and held editorial positions in many international journals. He is also a member of the jury of the prestigious 'Annual €1.0 million Champalimaud Award for Vision' and on the boards of

many national and international organisations worldwide. An entrepreneur of solutions for eye health, Dr Rao is renowned for the creation of sustainable, high quality, comprehensive eye care delivery and as the father of the vision centre model.

TRADE & TRENDS

Welch Allyn partners with Bansal Hospital,Bhopal Bansal Hospital is the first hospital in India to have the Connex® Integrated Wall System, a next generation vital signs management and physical assessment solution

Bansal Hospital: A world class hospital where the best infrastructure meets the best doctors to deliver cutting edge technology with care

WELCH ALLYN, a leading global manufacturer of point of care products and solutions and Bansal Hospital in Shahpura, Bhopal, have partnered for the hospital’s first installation of the Welch Allyn Connex® Integrated Wall System. The Welch Allyn Connex® Integrated Wall System is a next generation vital signs management and physical assessment solution that offers everything a busy medical facility needs to easily and efficiently examine patients and make critical decisions with the most accurate information available. Recently introduced in select markets, the Connex® Integrated Wall System allows providers to electronically capture accurate patient vital signs and perform basic diagnostic examinations with features that include an integrated otoscope and ophthalmoscope; adult, paediatric and neonatal non-invasive blood pressure modes with extra cuff storage; a choice of Masimo® or Nellcor® pulse oximetry; and a choice of

EXPRESS HEALTHCARE

May 2014

Ideal for connected facilities, the Connex® Integrated Wall System significantly reduces time spent on manual transcription and instances of human error with automatic data transfer to an electronic health record SureTemp® Plus oral thermometry and/or Braun® ThermoScan® Pro 4000 integrated ear thermometry with a built-in probe cover holder. Devices are attached to a conveniently-placed wallmounted unit, reducing wear and tear and eliminating lost, stolen or misplaced equipment. A large, touch screen display on the integrated monitor provides easy-to-read results that can be shared with the patient instantaneously for improved communication and compliance. And, the wall system can be configured for spot-check, monitoring

with intervals or triage modes. “It’s a huge step forward for us to have such device on our VIP Suites and in my OPD room. This is the only device we’ve found that integrates best-in-class physical assessment devices and an advanced vital signs management in one system. You have everything at hand , patient data is immediately sent to EMR, with no cables or roll stands around saving a valuable floor space,” said Dr Skand Trived, Executive Director, Bansal Hospital. Ideal for connected facilities, the Connex Integrated Wall Sys-

Dr Skand Trived improving patient care at Bansal Hospital with Connex Integrated Wall System.

tem significantly reduces time spent on manual transcription and instances of human error with automatic data transfer to an electronic health record (EHR.) And, patient vital signs can be viewed anytime, anywhere on a network. The customisable wall system supports both Welch Allyn and its manu-

facturing partners’ technology. Its open architecture makes it a great investment, as upgrades and new technology can be added as they become available. For more information about Welch Allyn and its complete line of connected products and solutions please visit www.welchallyn.com

TRADE & TRENDS

Eppendorf launches Elpas Infant Protection from electronic microinjectors, FemtoJet 4i and FemtoJet 4x Tyco Security Products These electronic micro-injectors claim to deliver high levels of reproducibility and precision

Elpas Infant Protection permits regular movement of mothers, staff and visitors in and out of the maternity ward ELPAS INFANT Protection from Tyco Security Products, helps hospitals prevent baby abductions and unintentional baby mismatching in maternity environments from the time of delivery upto discharge. Elpas Infant Protection permits regular movement of mothers, staff and visitors in and out of the maternity ward, while preventing the removal of protected infants from the ward unnoticed or without supervision. In addition to monitoring the physical whereabouts and safety of the infants, Elpas Infant Protection can log the authorised transfer of the infants throughout the hospital, preventing any illicit attempts to move infants from wards and treatment centres.

How BabyMatch Works At the time of birth, the infant is issued an Infant Protection Bracelet, which is placed on the baby’s ankle and later can be adjusted should the baby lose weight before discharge. Should an attempt occur to move the protected infant from the secured area without approval or authorized escort, the Bracelet will trigger the system to alert personnel of the occurring security threat. Elpas BabyMatch has useful feature-benefits such as tamper protection, exit protection, alert and paging options and flexible escort options. It involves easy to use software and supports incident logging/ reporting. It is CE, FCC and IC compliant.

EPPENDORF HAS introduced its latest electronic microinjectors, the FemtoJet 4i and FemtoJet 4x. The new systems are suited for all research laboratories wishing to inject small to intermediate volumes, from femtoliters to microliters, precisely and reproducibly. Reportedly, with simple operation and a wide range of functionalities, the FemtoJet 4i and FemtoJet 4x make otherwise intensive processes convenient and easy to undertake, with limited amount of input and training. With a built-in compressor, the FemtoJet 4i is ideal for injecting small volumes of up to ~100pL into adherent and suspension cells. For users wishing to inject larger volumes or longer series at higher pressures, the FemtoJet 4x employs an external pressure supply to

New FemtoJets have exceptionally low noise emissions and a small footprint and also benefit from Eppendorf’s premium levels of design

deliver the precise and continuous pressure required. The systems can also be easily coupled with the existing Eppendorf InjectMan 4 and TransferMan 4r, for rapid and efficient microinjections into delicate cells. This not only simplifies researchers’ daily tasks, but speeds up workflows. A company press release claims that the new FemtoJets have exceptionally low noise emissions and a small footprint and also benefit from Eppendorf ’s premium levels of design, making them ideal for use in busy laboratories. When researchers wish to carry out gentle microinjection procedures, including pronuclear injection and serial injections, the new FemtoJet 4i and FemtoJet 4x provide an ideal solution.

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May 2014

TRADE & TRENDS

Draeger Medical India launches OR light on wheels Polaris 100 and Polaris 200 is now mobile and its height is adjustable LÜBECK- WITH the Polaris 100 and Polaris 200 Mobile, OR teams have for the first time launched mobile OR lights which can be adjusted in height depending on the situation in the OR and according to the surgeons requirement. The mobile Polaris 100 and Polaris 200 lights can be used in addition to ceiling-mounted OR lights when the surgeon needs an additional light source for more complicated surgeries. In the case of several adjacent treatment areas, for example in emergency rooms, the physician can move the Polaris 100 or Polaris 200 between the treatment areas and use it on site as a single light for minor surgeries.

Easy to transport In its transport position, the light has a height of approximately 6 feet (1.85 m) so that clinical staff can easily push it through standard doors. In its operating position, the physician has a working height of up to six feet seven in. (2.17 m) under the light body at the operation site or in the treatment room. The mobile Polaris 200 has an illumination intensity of 160,000 lux. The built-in battery allows for mains-independent operation for at least three hours with full light intensity. A visual and acoustic warning informs the OR team when the battery charge falls below 25 percent. Dräger Medical GmbH is the manufacturer of the Polaris 100 and Polaris 200. For more information, please visit http://www.draeger .com/sites/en_in/Pages/Hospital/Polaris-100-200.aspx?navID=1265

Dräger. Technology for Life® Dräger is an international leader in the fields of medical and safety technology. Our products protect, support and save lives. Founded in 1889, in 2012 Dräger generated revenues of around euro 2.37 billion. The Dräger Group is currently present in more than 190 countries and has about 12,500 employees worldwide. For more information, please visit http://www.draeger.com

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May 2014

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Maximize hospital efficiency and business performance! Download ‘7 reasons your hospital needs StruxureWare for Healthcare’. Plus, enter to win Samsung Galaxy Note 3! Visit www.SEreply.com Key Code 52564y ©2014 Schneider Electric. All Rights Reserved. Schneider Electric and StruxureWare are trademarks owned by Schneider Electric Industries SAS or its affiliated companies. All other trademarks are property of their respective owners. www.schneider-electric.com • 998-1184569_GMA-GB

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