HEALTHCARE BUDGET ‘09- Expectations versus Allocations: August 2009 Issue

V OL U ME 4 | I SSUE 2 | FEBRUARY 2 00 9

ISSN 0973-8959

Carestream Health India appoints new MD

MAQUET launches solution for digital OR-Integration

A Monthly Magazine on Healthcare ICTs, Technologies & Applications Volum e 4 | I s s ue 8 | AU GU ST 2009 | I N R 75 / U SD 10

TECH TRENDS The Operating Theatre of the Future Divya Chawla, Principal Correspondent, eHEALTH PAGE 14

SPOT LIGHT Enhanced IT Implementation in Healthcare Dr Ashish Dhawad, CEO, Medsynaptc Pvt. Ltd. PAGE 20

IN CONVERSATION LifeCell to bring NxG Stem Cells Technology to India Mayur Abhaya, Executive Director, LifeCell International PAGE 22

PERSPECTIVE ‘Enterprise Apex LIS has improved efﬁciency and turn around time’ Girish Mehta, President and CEO, Piramal Diagnostics Services PAGE 26

APPLICATIONS Enabling Integrated Healthcre Seetharam Malur, Director, Idea Object Software Pvt. Ltd. PAGE 30

8 COVER STORY

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CONTENTS w w w . e h e a l t h o n l i n e . o r g | volume 4 | issue 8 | August 2009

COVER STORY Healthcare Budget: Expectations versus Allocations

TECH TRENDS

The Operating Theatre of the Future

SPOT LIGHT

Enhanced IT Implementation in Healthcare Dr Ashish Dhawad, Chief Executive Officer, Medsynaptic Pvt. Ltd.

IN CONVERSATION

LifeCell to bring NxG Stem Cells Technology to India Mayur Abhaya, Executive Director, LifeCell International

Healthcare Budget 2009

PERSPECTIVE

‘Enterprise Apex LIS has improved efficiency and turn around time’ Girish Mehta, President and CEO, Piramal Diagnostics Services VasuKumar Nair, Director, 21st Century Health Management Solutions

APPLICATIONS

Enabling Integrated Healthcare Seetharam Malur, Director, IdeaObject Software Pvt.Ltd.

EXPERT CORNER

A Puzzling Bladder Condition

Dr Nagendra Mishra, Consultant Urologist, Jivraj Mehta Hospital, Ahmedabad

DEVELOPMENT DIMENSION

Connecting Leaders and Information Technology for Health Transformation Sally Glass & John Galss, Founders, CHIK Services Pty Ltd., Australia

EVENT REPORT

Seeking Credibility for ‘A Credence Good’ Conference on ‘Accreditation of Hospitals’ organised by CII in New Delhi on July 4, 2009

REGULAR SECTIONS

New-age Operating Theatres News Numbers

August 2009

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EDITORIAL GUIDELINES eHealth is a print and online publication initiative of Elets Technomedia Pvt. Ltd. - an information research and media services organisation based in India, working on a range of international ICT publications, portals, project consultancy and highend event services at national and international levels. eHealth aims to be a rich, relevant and wellresearched information and knowledge resource for healthcare service providers, medical professionals, researchers, policy makers and technology vendors involved in the business of healthcare IT and planning, service delivery, program management and application development. eHealth documents national and international case studies, research outcomes, policy developments, industry trends, expert interviews, news, views and market

intelligence on all aspects of IT applications in the healthcare sector. Contributions to eHealth magazine could be in the form of articles, case studies, book reviews, event report and news related to e-Health projects and initiatives, which are of immense value for practitioners, professionals, corporate and academicians. We would like the contributors to follow the guidelines outlined below, while submitting their material for publication: ARTICLES/ CASE STUDIES should not exceed 2500 words. For book reviews and event reports, the word limit is 800. AN ABSTRACT of the article/case study not exceeding 200 words should be submitted along with the article/case study. ALL ARTICLES/ CASE STUDIES should provide proper references. Authors should give in writing stating that the work is new and has not been published in any form so far.

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August 2009

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EDITORIAL Volume 4 | Issue 8 | August 2009

P RESI DENT

Dr. M P Narayanan E D ITOR-IN-CHIEF

Dr. Ravi Gupta P RO D U CT MA NA G ER

Dipanjan Banerjee mobile: +91-9968251626 email: dipanjan@ehealthonline.org P RINCIP AL CORRESPONDENT

Divya Chawla email: divya@ehealthonline.org S R. CO RRESPONDENT

Harsha Chawla email: harsha@ehealthonline.org S ALE S & MA RKETI NG

Arpan Dasgupta Executive Officer - Business Development mobile: +91-9911960753, +91-9818644022 email: arpan@ehealthonline.org Bharat Kumar Jaiswal Sr. Executive - Business Development mobile: +91-9971047550 email: bharat@ehealthonline.org

‘Budget’ Healthcare! The current drought in the global economy has not had much of an impact on the growth of the healthcare, biotechnology and pharmaceutical industry. The healthcare industry’s impressive contribution to India’s GDP was 5.2 percent in 2002 and is estimated to increase to 6.2 – 7.5 percent by 2012. The upward trend in this industry is hence, likely to continue in future as well, making it one of the key sectors that can fuel economic growth in the country. The industry expects the government to take key healthcare initiatives to bridge the yawning divide between the offered health services and their demand. However, the government, in the Union Budget ‘09-‘10, did not take any extraordinary steps to fulfil the demands of this industry. Rather, it followed a safer approach, considering the global meltdown, by marginally raising government spend on health services. Increased allocations for crucial programmes such as National Rural Health Mission and Rashtriya Swasthya Bima Yojana and an overall increased spend of Rs. 4,000 crore have been offered on a platter to the healthcare industry. Find out more on this in the ‘Cover Story’ of this issue. Robotic surgery, a relatively naïve field, has recently generated much excitement among surgeons all over the world. India is also in this league with premier hospitals like AIIMS and Escorts implementing the technology in their surgical procedures. While the innovative technology has a lot to offer in the future of healthcare, the high cost associated with it is a roadblock for its widespread installation. The future, still has hope, with the infiltration of products incorporating improved technologies and lower costs. Catch up with the latest developments in this domain under ‘Tech Trends’ of this issue.

S R GRAP HI C DESIG NER

Bishwajeet Kumar Singh GRAP H I C DESIG NER

Om Prakash Thakur WEB

Zia Salahuddin S U BS CRIP TIONS & CIRCULA TION

Manoj Kumar (+91- 9891752931) manoj@ehealthonline.org ED ITO RIAL CORRESPONDENCE

eHEALTH G-4 Sector 39, NOIDA 201301, India tel: +91-120-2502180-85 fax: +91-120-2500060

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is published by Elets Technomedia PVt. Ltd in technical collaboration with Centre for Science, Development and Media Studies (CSDMS). Owner, Publisher, Printer - Ravi Gupta. Printed at Print Explorer 553, Udyog Vihar, Phase-V, Gurgaon, Haryana, INDIA and published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP Editor: Dr. Ravi Gupta

August 2009

COVER STORY

Healthcare Budget: Expectations versus Allocations The Indian health care industry has witnessed consistent augmentation in the past few years in terms of size of the industry as well as research and development activities. Unfortunately, the economic slowdown retarded this upward trend and the rejuvenation of this industry largely depended on the reforms provided in this year’s budget. The Government, with Union Budget 2009-10, has been able to tap upon some of the most important segments in the health care industry.

he health care sector in India is a key sector poised for substantial growth in the coming years. The Indian health care industry currently stands at USD 35 billion and has a future potential to reach over USD 75 billion by 2012 and an estimated USD 150 billion by 2017. With the increase in the spending power of the Indian middle class, the demand for quality health care is also seeing a surge. Further increase in the lifestylerelated and other diseases, and the growing elderly population are other factors fueling demand for health care services. As a result, in spite of a steady growth in the supply of health care services, there remains an imbalance in the demand and supply that creates friction in the growth of this industry. Considering the huge demand for health care services in India, the sector expected tremendous support from the government in the Union Budget 2009-10. With various met and unmet expectations, the announcement of budget 2009-10 brought an increase in the allocation for the health care industry by nearly Rs. 4,000 crore amounting to a total of Rs. 21,113.33 crore. A significant allocation has been an increase of Rs. 2,057 crore over the proposed Rs. 12,070 crore in the interim budget for National Rural Health

August 2009

Mission (NRHM), a flagship program of the UPA with a goal of health care for all, considering the importance of this program. The program’s main focus is on 18 states that comparatively have a weaker public health infrastructure. These states include: Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu and Kashmir, Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Orissa, Rajasthan, Sikkim, Tripura, Uttarakhand and Uttar

Pradesh. The Rashtriya Swasthya Bima Yojana (RSBY), a scheme that aims at providing poor families with a freedom of choosing a desired health care service from a list of public as well as private hospitals, also received due recognition owing to its considerable importance in the rural sector. It has been allotted an increase of 40 per cent amounting to Rs. 350 crore. With the help of the provided budgetary

Budget 2009-10 Highlights • Increased allocation for National Rural Health Mission (NRHM) • Increased allocation for Rashtriya Swasthya Bima Yojana (RSBY) • Increase in deduction in respect of maintenance of a dependent, who is a person with severe disability • Decrease in customs duty and exemption from excise duty and countervailing duty on nine specified life saving drugs • Reduction in customs duty on specified heart devices • Exemption from rise in excise duty for certain medical equipments, drugs and pharmaceutical products • Allocation for National Program for Prevention and Control of Deafness (NPPCD) • Allocation for a program for starting medical and non-medical nursing and non-nursing courses under various institutions • Allocation for the department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) • Allocation for development of AIIMS-like institutions as well as upgrading 13 existing medical colleges • Extended tax holiday for export profits • Extension of weighted deduction on expenditure incurred on in-house R&D

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COVER STORY allocation, the government aims to bring all BPL families under this scheme. Initiation of health insurance programs at the urban level as well as rural level is an important step towards promotion of delivery of affordable and quality health care. Out of the total health care spend in India, a meager 10 percent comes from insurance while the rest 90 per cent comes from the pocket of the common man. A budgetary allocation of Rs.1447.92 crore has been proposed towards development of All India Institute of Medical Sciences (AIIMS)-like institutions in the country as well as upgrading 13 existing medical colleges. With this move, the government plans to strengthen the tertiary sector. The plan outlay for setting up and upgrading medical colleges in India projects that the project will be completed this year while the institutions will become functional in 2010-11. The project aims at diminishing the regional

imbalances in the availability of health care services in India with the development of the AIIMS prototypes in Patna (Bihar), Raipur (Chhatisgarh), Bhopal (Madhya Pradesh), Bhubaneshwar (Orissa), Jodhpur (Rajasthan), and Rishikesh (Uttarakhand). A program for starting medical and non-medical nursing and non-nursing courses under various institutions with a reservation of 27 per cent for the other backward classes (OBC) will also be kickstarted with a budgetary

allocation of Rs. 100 crore. Although the budget does not contain any particular proposals for the benefit of the pharma sector, yet the decrease in the customs duty of certain drugs and pharmaceutical products from 10 to 5 per cent has been appreciated and welcomed by the industry. These nine life saving drugs particularly include biologicals used for the treatment of cancer, HIV, hepatitis B and arthritis. In addition, this reduction will also apply to the bulk drugs used for the manufacture of these drugs. These drugs will also be totally exempted from excise duty and countervailing duty. Abolition of the fringe benefit tax (FBT) is another beneficial move for the pharmaceutical and biotech companies, as earlier they were spending about 5 per cent of their marketing expenses, amounting to 15 percent of their total turnover on FBT. Going further, with an aim to provide relief to oriented drug firms, the Finance Minister extended the tax holiday for export profits by a year to fiscal 2010-11. The scope of the current provision of weighted deduction of 150 per cent on expenditure incurred on inhouse R&D to all manufacturing businesses (except for a small negative list) has been extended, and this is expected to promote local R&D initiatives. In order to broaden the accessibility of various medical equipments, devices and consumables, the health care industry expected a complete removal or reduction of excise duty and VAT being charged on these. The Finance Minister was generous enough to exempt certain medical equipments from the increase in the excise duty from 4 to 8 per

Health Budget Update Health care has the potential of creating a much healthier population and is definitely one of the key industries with significant scope of growth in the country. Every Abhishek P Singh new bed creates Principal Consultant employment for 5 Healthcare, Technopak personnel directly and about 25 personnel indirectly. There is a huge requirement for health care workforce in the country, as the existing number is pretty much insufficient. This will not only help the domestic sector, but also outside the country by increasing the size of rich Indian diaspora around the world, thus, helping the country by additional remittances.

This year’s budget is just an extension of same policies with marginally higher spend. This year’s budget has not taken any new stance which can stimulate all such opportunities. It is just an extension of same policies with marginally higher spend. We need policy stimulus to enhance spend in medical education, health care infrastructure and indigenous production of medical equipments by providing the right financing mechanisms and environment for investment. Infrastructure status is what the industry has been seeking since long. The GoI has taken some concrete steps with Rashtriya Swasthya Bima Yojana (RSBY) scheme and is taking it through different states one by one. Other directional steps that the GoI needs to look at in terms of medical insurance should include the enhancement of retail medical insurance plans and distribution. The GoI also needs to address the health care insurance companies’ call for enforcing minimum standard guidelines on medical establishment across the country and thus promoting quality health care provision. This of course must be done in collaboration with the health care industry leaders in the private sector. August 2009

COVER STORY

Budget Focusing on Health Infrastructure schemes like NRHM, JNNURM, and RSBY. This will improve the quality of primary health care services for the rural population, which is a major step towards improving health care services in India.

How do you think the abolition of fringe benefit tax (FBT) would impact the health care industry?

Supratim Majumdar Industry Analyst – Pharmaceutical and Biotechnology Healthcare, South Asia and Middle East, Frost and Sullivan

Do you identify health care as one of the key industries in India with significant scope of growth? Will this year’s budgetary allocations have a positive effect on the growth of the health care industry?

There is another big segment just above BPL, or more or less same as BPL, which has been always left out in such schemes. With the cost of health care going up, the government should look at increasing the BPL limit as well.

There has been a pressing demand from the health care industry to be granted infrastructure status. What are your views on this?

Yes, we see health care as one of the key industries with significant growth prospects in India. This year’s budget is focused on improving health care infrastructure and its accessibility.

This year, there hasn’t been a specific initiative for promoting medical insurance in India at the urban level even though the sector has tremendous potential for growth. What initiatives are needed from the government to enhance growth through this sector?

There has been a significant increase in outlay for health care sector

A budget of Rs. 350 crore has been allocated to cover all BPL families

The government will take a few more years to grant infrastructure status to the health care industry. In my view, all positive and negative aspects of this should be analysed thoroughly before granting this status.

A positive move has been the exemption from rise in excise duty from 4 per cent to 8 percent for certain medical equipments, drugs and pharmaceutical products.

Systems of Medicine and Homeopathy (ISMH), the department was launched in March 1995 and renamed as AYUSH in December 2003. The main aim of the programme is to improve AYUSH educational standards, quality control and standardisation of drugs, availability of medicinal plant material, research and development, and awareness generation about the efficacy of the systems domestically and internationally.

was allocated Rs.734 crore. Earlier known as the Department of Indian

An allocation of Rs.10 crore has also been proposed for the National Programme for Prevention and

cent. On the other hand, the decrease in the custom duty on heart devices such as artificial heart and PDA/ASD occlusion from 7.5 to 5 per cent was highly appreciated. Another positive move has been the exemption from rise in excise duty from 4 per cent to 8 per cent for drugs and pharmaceutical products falling under chapter 3. In its bid to develop, promote and make the Indian systems of medicines more scientific, the Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) under the health ministry

Yes, the abolition of FBT will cause some changes. This will result in increased savings for the pharma sector and will also have an impact on hospitals and other organisations. Pharma companies spend about 5 per cent of the marketing expenses on FBT, which constitutes 15 per cent of their turnover. Abolition of FBT is expected to benefit the pharma companies but it will be, to some extent, neutralised by the increase of Minimum Alternate Tax (MAT) from 10 to 15 per cent.

under Rashtriya Swasthya Bima Yojana (RSBY). The budgetary allocation has been increased by 40 per cent over previous year’s allocation. Biometric cards issued under this scheme empower poor families, providing them freedom of choice for using any health care facility from an extensive list of both government and private hospitals. When health insurance coverage in India is depriving a large population from availing quality health care facilities because of affordability, such schemes with increased investment are expected to make health care facilities available to the bottom of the pyramid.

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Technology Innovations in Healthcare...

Control of Deafness (NPPCD). The pilot phase of this project is being launched in 25 districts over the next two years. NPPCD was launched with an aim to prevent avoidable hearing loss and ensure early identification, diagnosis and treatment of ear problems responsible for hearing loss and deafness. The programme was started considering that hearing loss is one of the most common sensory deficits in humans. India, itself, has a huge population suffering from ear problems as WHO estimates the prevalence of significant auditory impairment in approximately 6.3 per cent in the Indian population. Children, between ages 0 to 14, constitute a large percentage of this population. The NPPCD’s main objective is to prevent and control the major causes of hearing impairment and deafness, and reduce the total disease burden by 25 percent by the end of the eleventh five year plan. Disappointment has been expressed by the health care industry, particularly the pharmaceutical sector, on the decision of the Finance Minister to increase the Minimum Alternate Tax (MAT) from 10 to 15 per cent on book profits. The general perception is that this move may have a direct negative effect on the research activities in this sector. In contraindication, the Finance Minister feels that this will enhance the equity in the taxation process of the corporate tax payers. However, in order to incentivise the corporate

A massive USD 80 billion investment is required to bring up the quality of health care in India as the current 1:1000 bed:population ratio stands nowhere as compared to the 7:1000 bed:population ratio in developed countries.

sector to undertake R&D activities, the extension of the weighted deduction of 150 per cent on expenditure incurred on in-house R&D may bring in some relief for companies undertaking these activities. A long-standing demand of the health care industry has been to be granted the infrastructure status. This will facilitate hospitals to get funds for expansion. The fiscal benefits achieved thereafter can be used for promoting active participation of the private sector, which can play a

pivotal role in bringing health care of international standards to India. As the infrastructure status usually comes with a tax holiday of five years, it can provide considerable benefits to the private hospitals which will then be able to generate cheaper long-term capital. In addition, the tax holiday that will come with the infrastructure status will be extremely beneficial for this industry. The commerce as well as health ministries have been in the favour of this move. Disappointing enough for the health care industry is that the infrastructure status has not been granted in this year’s budget also. The development of the healthcare sector in recent years has been spurred by the entry of several private players. This has provided the much needed impetus for the growth and development of Indian healthcare infrastructure, supplemented by the continual support provided by the government. Several new sectors within the health care industry have now emerged as important growth drivers and have enhanced the capability of this sector to grow at a much faster pace. Businessmen, equipment makers and service providers have abundant opportunities for investing in curative and preventive services. Further, investments in medical infrastructure and medical tourism are pouring in from all sides. Yet, a massive USD 80 billion investment is required to bring up the quality of health care in India, as the current bed to population ratio (1:1000) stands nowhere as compared to bed to population ratio (7:1000) in developed countries. A WHO survey has indicated that out of a list of 175 countries, India ranks 171st in terms of total GDP spend on health care, while the same survey suggests that in terms of private sector spending on health care, India ranked 17th. Expectations from the budget every year are hence very high, and although the government has been able to tap on a few of them with this year’s budget, yet there are other areas that still require government’s attention.

August 2009

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TECH TRENDS

The Operating Theatre of the Future Medical robotics and computer-assisted surgery systems, support the surgeons in performing tedious surgeries with complete precision. This is one of the newer technologies that has completely taken the surgical profession by a storm.

ntegration of information technology has brought about a revolution in almost all human activities and the inception of robotics has the potential to completely alter the way surgeries are being performed. The work of a surgeon is supported by computers working in tandem supported by microprocessor-based technology, bringing in safety and precision in performing various surgeries. The need to perform delicate surgeries with complete perfection has been the major force behind the growth of the global market of medical robotics and computer-assisted surgery (MRCAS) systems. As per a technical report, the global market of MRCAS devices and equipments is estimated to be less than USD 1.30 billion in 2008 and rise to more than USD 1.30 billion in 2009. The major contributor in this market is the US, which accounts for almost 52 percent share. However, with a slow CAGR of nearly 18 percent (between 2009 and 2014), this share is expected to decrease to 46 percent, thereby making space for other countries to fit in. While the overall annual market is estimated to be more than USD 500 million, the growth rate is tremendous, even more than the growth rate of the surgical devices and equipments market. Research and development of robots and robot enhancements are

August 2009

taking place throughout the world. Systems with enhanced capabilities are being developed to offer surgeons with cutting-edge technology. One of the first systems developed ever for surgery was the Puma 560, which eventually led to the development of Probot, a robot specifically designed for transurethral resection of the prostate. Robodoc was another system being developed during those times for hip replacement surgeries, which eventually turned out to be the first robot approved by the FDA for surgery. This marked the beginning of an era, which has ever since been experiencing development of several systems and technologies being marketed by various companies. Going further, Aesop (voice controlled camera holder) prototype robot was the first surgical robot marketed by the US FDA in 1994. In 1997, Intuitive Surgicals Inc. launched the da Vinci robot that has proven to be a breakthrough technology in this domain. This robot is a master-slave manipulator with three arms, one for the camera and two for operating the instruments. In the meanwhile, Zeus, another master-

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slave manipulator system for general, cardiothoracic and gynaecological surgeries was also developed. These and several newer instruments are now being used the world over for performing robotic surgeries.

Widespread Applicability Technological advances and the incorporation of robotics into the operation theatre has been mainly via

TECH TRENDS the use of microscopy, navigation, instrumentation, optics and imaging. As more and more institutions acquire robotic surgery as a tool to perform various surgical procedures, the number and types of surgeries being performed by robots is increasing rapidly. Robotic procedures are now spanning a vast spectrum of surgical procedures and are headed towards an era where robotics will be included in everyday surgical procedures. There are a plethora of specialities where robotic surgeries are already being implemented. Some of these include: Neurology: Neurosurgery has traditionally been at the forefront of advancing technologies adapting to new technologies, among which are surgical robotics. The implementation of robotic interventions is relatively new in brain and spine surgery and there have been several robotic approaches to address the challenges in interventions on the brain. The implementation of robots in the intracranial procedures has been made possible through developments focussed on gaining access to deep pathology or structures in the brain with the help of image-based navigation systems and development of precise target-acquisition capabilities. Orthopaedics: Orthopaedic surgery is an ideal application for medical robots. Robot-assisted techniques apply improved accuracy and precision to orthopaedic surgical procedures including bone surface preparations and greater spatial accuracy. Various orthopaedic procedures that are currently under investigation for the application of robotassisted techniques include total hip and knee replacement, tunnel placement for reconstruction of knee ligaments, and trauma and spinal procedures. Urology: Following a slow development, the use of robotics in urology was initially focussed on image-guided systems. Urology has incorporated robotic assistance in a growing number of applications such as transurethral resection of the prostate, percutaneous renal access, laproscopy and brachytherapy. As a matter of fact, majority of robotic applications now are in the field of urology. Cardiology: Minimally invasive cardiac surgeries have transformed medicine completely and generated maximum excitement among surgeons. It is one of the latest attempts of converting open heart surgical procedures to minimallyinvasive procedures, causing least trauma to the patient. Robotic surgeries are now being performed in varied cardiac procedures including repair and replacement of the mitral valve, bypass of coronary arteries, closing atrial septal defects, implanting left ventricular pacing leads and resecting intracardiac tumours. Robot-assisted cardiac procedures are however, still in the development stage and require much research and development before they can be fully incorporated into all cardiac surgeries.

Advantage over Traditional Procedures Robotic surgeries practically eliminate the need of multiple surgeons and assistants in an operation theatre; a single surgeon can perform the entire surgery by controlling the

August 2009

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Robotic Intervention in Cardiac Surgeries Percutaneous coronary intervention (PCI) is a major method of revascularization for coronary artery disease, with over 2 million coronary interventions performed annually. The majority of interventions (more than 90 percent) are coronary dilatations, which are performed using stents. The Dr Ganesh Kumar catheterization laboratory Chief Interventional Cardiologist personnel so far have been Dr LH Hiranandani Hospital operating in an unfriendly environment subject to continuous x-ray radiation. This has been unchanged since the beginning of the field of interventional cardiology more than 25 years ago. “Interventionalists’ disc disease” is a well confirmed entity with cardiologists reporting more neck and back pain, more subsequent time lost from work, and a higher incidence of cervical disc herniations, as well as multiple level disc disease owing to the tiresome standing procedure of angioplasty and the heavy weight of the antiradiation gear that takes a toll on the operator. Robotic System for PCI and its Advantages over Conventional Systems Dr LH Hiranandani Hospital, in May 2007, installed the first robotic arm for angioplasty. The Physician Workstation incorporates a touch-screen control console and a joystick. With this, Dr LH Hiranandani Hospital became Asia’s first and one of the world’s few centres of excellence to be conducting research on this exciting international breakthrough. This robotic remote control PCI system not only helps patients avail precise stent placement by removing human error, but also helps physicians to operate in an x-ray free and relaxed environment with lesser chances of spinal risk, thereby increasing the ability of the operator to deal with long procedural hours. In contrast to the present angioplasty procedure that requires two cardiologists, the robotic remote control procedure can be conducted without need of assistants making the process more efficient and reproducible and reducing chances of operator-based error. The robotic arm allows remote manipulation of percutaneous coronary interventions (PCI). It allows the physician to control the wire and device movements from a remote location. In this system motors and motion sensors are used to manipulate angioplasty wires, stents and balloons via a joystick and a computer touch screen leading to enhanced precision of balloon and stentpositioning (which may be an extremely important feature in DES therapy). Semi-automatic procedures can also be robotically controlled by the system by obtaining continuous Continued on page 18

robotic arms through the computer console of the surgical robot. In future, this will also serve as a scope for the emergence of telesurgeries, where a surgeon sitting miles away would be able to perform a surgery via a computer console that is connected to the surgical robot placed at the site of the surgery. Further, robotic surgeries considerably reduce the trauma caused to the patient and the recovery time as surgical procedures can be performed simply by making two or three small incisions in the body compared to the long incisions being made in conventional surgeries. Also, traditional surgeries that lasted for several hours caused immense amount of fatigue to the doctors. On the other hand, during robotic surgeries, the surgeon is comfortably seated at the computer console and performs simple tasks to control the robotic arms. This not only reduces the stress on the operating surgeon, but also enhances the efficacy of the surgery being performed, thereby improving the outcome of the entire procedure. Robotic surgical procedures have also been able to overcome many of the obstacles of the laproscopic surgical procedures. The major advantages include improved dexterity, improved hand-eye co-ordination and ergonomic position and enhanced visualisation. The conventional laproscopic cameras offer 2D vision, whereas the 3D view with depth perception is a remarkable improvement. Also, technically difficult surgeries can now be performed with ease with the help of these systems.

Drawbacks The robotic systems are very expensive and have equally high maintenance costs. Further the upgradation of these systems may also invite huge expenditures by the hospitals and healthcare institutions. This is a major roadblock in the applicability of this technology in a cost-sensitive market like India. India currently has poor health statistics as compared to the developed countries; in such a scenario, adoption of such a costly technology may not be practical. Widespread multidisciplinary usage is hence absolutely necessary for the justification of the high costs of these systems. The size of these systems is another major disadvantage. The surgical robots have relatively large footprints and hence are difficult to accomodate in a standard operation theatre. Innovation in terms of reducing the size of these systems is hence required to make comfortable room for them in the operation theatres. zA lack of potentially compatible instruments and equipments is another disadvantage. There is an increasing trend towards incorporation of cutting-edge technology, advanced medical equipments and treating and testing modalities in institutions. Installation of medical robotics and computer-assisted surgery devices is one of the top priorities of institutions wanting to join the league of the most advanced centres in the country. Although, the technology is still in its infancy, yet it has generated much excitement among surgeons all over the world. While future advancements in this field are already being researched, several technical upgradations are required before the full potential of this technology can be realised.

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Continued from page 16

image based feedback data. On-line communication with the patient is obviously of value in generating trust and confidence of the lightly sedated patient and the medical team. The robotic remote-control system allows for doctorpatient interactions with voice and image technology. If for any reason the system malfunctions it can be switched to manual mode in a few seconds. The current remote navigation system (RNS) is the first clinically oriented system for remote manipulation of PCI and allows full navigation of coronary wires and devices in parallel allowing operation in a standardised catheterization laboratory using standard wires and devices that are robotically manipulated and allow for transatlantic communication. This RNS is composed of a bedside unit and a remote manipulation unit. The bedside unit has individual wire and device manipulators capable of precise manoeuvring and positioning of the wires and devices. Interventional physicians are among the most highly trained operators in the field of noninvasive surgery; robotic intervention utilizes the physician’s existing techniques while incorporating an additional level of control through the use of robotic technology. This combination introduces the exactitude of robotic precision to interventional procedures and is expected to produce better clinical outcomes in the drug eluting stent era. Further, a high level of x-ray exposure to medical professionals is a fundamental concern, which has grown with a marked rise in case load in the past decade. Remote controlled technology significantly reduces x-ray exposure to operators. The use of lead protective garments, and the related health problems known as ‘interventionalist’s disc disease’ is another major problem for operators and staff. Severe physical ailments are associated with prolonged use of heavy lead attire causing preventable pain and disability. Remote controlled technology provides a safe and comfortable working environment while assuring procedural accuracy. Future: This robotic remote control PCI system will help patients avail services of their preferred doctors over large distances by having a robotic unit installed at smaller district hospitals or at remote interior places of the country and the expertise (the operator) sitting at long distance (say 500 kms away) and perform the case.

Manufacturers/Distributors of MRCAS Systems • • • • • • • • • • • • • • •

Berchtold GmbH Brainlab Ltd. B Braun Medical India Pvt. Ltd. Conmed Corp. Delhi Hospital Supply (Prosurgics) DSS Imagetech (Immersion Medical) GE Healthcare J Mitra and Bros. (Intuitive Surgical) Karl Storz Endoscopy India Pvt. Ltd. Philips (India Medtronic Pvt. Ltd.) Siemens Healthcare Smith & Nephew Healthcare Pvt. Ltd. Steris India Pvt. Ltd. Stryker India Pvt. Ltd. Viking Systems (Surgdent Medicare)

get noticed...

’

IT Directory’ - November 2009 Issue’

eHEALTH magazine is coming out with a ‘first-of-itskind’ directory of IT vendors and suppliers for hospitals, healthcare providers and doctors. The directory is aimed to create a comprehensive compilation of companies offering hardware, software, networking and communication solutions, as well as those offering specialised medical/health IT solutions including EMR, EHR, HIS, HMIS, RIS, PACS and ERP.

For advertising opportunities in this issue, please contact: Arpan Dasgupta, arpan@ehealthonline.org, 9818644022; Bharat Kumar Jaiswal, bharat@ehealthonline.org, 9396423085

SPOTLIGHT

Enhanced IT Implementation in Healthcare Medsynaptic is an emerging medical informatics company in India with a diversified product range for the medical imaging industry. The company has successfully installed its products across various countries worldwide. Further, the company is dedicated to developing solutions with cutting-edge technology to enhance the overall workflow of healthcare facilities and at the same time improve patient outcomes.

Dr Ashish Dhawad Chief Executive Officer, Medsynaptic Pvt. Ltd.

In an interview with eHealth, Dr Ashish Dhawad, Chief Executive Officer, Medsynaptic Pvt. Ltd., provides an insight into the growth of Medsynaptic in the medical informatics market and the future of Health IT in India. Excerpts from the interview.

Tell us in brief about your early career and your journey with Medsynaptic. What have been some of the milestones so far?

(OEMs), large hospitals and individual clients installing our solutions and the world-class service that we offer.

It has been a very interesting journey so far! After completing my graduation in medicine, I did my post graduation in bioinformatics and medical informatics and then teamed up with another doctor to start Medsynaptic almost 10 years ago. Initial years were a struggle and we had to change the prevailing mindset of the radiology community from film-based to computer-based diagnosis. Once we had overcome these challenges and demonstrated the advantages of using our solutions as compared to traditional methods, we grew from strength to strength. Over these years, Medsynaptic has become the leading player in medical image management, picture archiving and communication system (PACS) and teleradiology market with several original equipment manufacturers

Some of the milestones that we have achieved so far are having the largest installation base in India, developing the first Indian web based PACS, successfully achieving a patent for eXray film digitiser (and another patent pending), developing several OEM tie-ups and being the biggest player in the teleradiology space. I foresee Medsynaptic crossing several more in the coming future as we have a highly committed and hard working team.

20 August 2009

What is the current portfolio of products and solutions that you offer? What is your flagship product in terms of number of installations and in terms of revenue? Our focus is imaging and we have a full range of products, which help doctors and hospitals to manage data, reduce

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costs and improve their workflow. Our suite of products include: • Medsynapse – Web based enterprise PACS • MiniPACS – Centralised image archiving and distribution system • ScanDoc – Multimodality DICOM workstation for CR/DR/CT/MR • ScanDoc A2D – Non DICOM to DICOM conversion software for CT/MR • SonoDoc – Ultrasound image management system • SonoDoc DICOM – Non DICOM to DICOM conversion software for ultrasound • ScopyDoc – Endoscopy image management system • ScopyDoc DICOM – Non DICOM to DICOM conversion software for endoscopy • SonoDoc 3D – Freehand 3D software for ultrasound • ScanDoc 3D – 3D reconstruction software for CT/MR

SPOTLIGHT • • •

eXray – Teleradiology ready x-ray film digitiser CardioDoc – Cathlab workstation xImager – C-arm memory

At present our flagship product is ScanDoc multimodality workstation, which is sold with a large number of equipment manufactured by the OEMs, and teleradiology software, where we are the market leader. Our web-based PACS has been received very well by clients and I see PACS becoming the largest revenue generator in the years to come.

In the years to come, hospitals in India will definitely increase their IT spend and invest in deploying technologies, which will improve the patient outcomes and also improve workflows.

Do you partner with hardware providers and system integrators to deliver turnkey solutions for clients? Do you have technology/solution partnership with any global health IT vendor? Yes, we have partnerships with companies like Microsoft, Intel and HP for technology and GTM activities. We also work very closely with leading medical equipment companies like Carestream (earlier Kodak), Philips Medical, Siemens, Agfa, etc. to offer our solutions in the marketplace. Wipro has also chosen us as a PACS partner for some projects. We are in discussion with several global vendors for international tie-ups, which hopefully will materialise soon.

Which are some of your notable clients from among Indian and overseas hospitals and healthcare providers? Going ahead what will be your strategy for increasing footprints and increasing market share? We have a very large client base spread across India and several other countries. Many of our products are installed in hospitals like Apollo Hospitals, Manipal Hospital, MIOT Hospital, Ruby Hall Clinic, several defence and railway hospitals, KEM Hospital, Max Hospital etc. Internationally, we have several installations in leading hospitals in Indonesia, USA, Dubai etc. Going ahead, we are strengthening our direct sales network within India and also plan to start direct sales in several international locations. At the same time we are also planning to increase our presence in USA, Europe and Middle east through tie-ups with

channel partners and OEMs. We plan to announce an interesting tie-up during the Radiological Society of North America (RSNA) 2009 in Chicago for the US market.

What new products/solutions are in your pipeline and planned to be launched in the future? We are coming out with a new version of our PACS within a month which has some really interesting features for handling 64/128 slice scanners, which generate thousands of images and improved tools for radiologists. Recently we have also launched the new version of our teleradiology product with many additional features and faster download of images even at low bandwidth. xImager was launched recently and this is an advanced hardware memory for C-arm, which is one generation ahead of the existing ones available in the market today. Couple of new unique products for improving the department workflows within a hospital are in the pipeline and will be available in the market soon.

IT still doesn’t feature as a priority area for most Indian hospitals. How do you foresee the trend change in this regard? What are the drivers for the growth of this market? Although this is true, I believe the mindset is changing and changing very rapidly. In the years to come, hospitals in India will definitely increase their IT spend and invest in deploying technologies, which will improve the patient outcomes and also improve workflows. Many hospitals are already doing this and others are on the verge of doing it. We have been able to practically demonstrate to a number of hospitals how investing in PACS will give them a ROI sometimes within one year and this has enabled them to take positive decisions. Increased competition, health tourism, pressure to improve efficiency and reduce costs, increased government spend on modernisation of healthcare infrastructure and push from insurance companies are some of the drivers, which will help this market to grow. August 2009

IN CONVERSATION

LifeCell to bring NxG Stem Cells Technology to India Incepted in 2004, LifeCell International is India’s largest stem cell solutions provider involved in research, therapy, banking and clinical applications. LifeCell International started operating in India when very little was known about the importance of stem cell banking. Therefore, since day one its main aim has been to educate people about it. Today, it has more than 12,000 clients who have stored their baby’s umbilical cord blood stem cells with them. Currently, LifeCell offers two primary services, one being umbilical cord blood stem cell banking and the other being stem cell therapy solutions for needy clients. In an interview with eHEALTH, LifeCell’s Executive Director Mayur Abhaya tells about the latest developments at LifeCell.

Q. What is the present and future potential of stem cell technology for clinical and non-clinical applications? A. Stem cell therapy is already

Q. How LifeCell is positioned to offer clinical, R&D and consumer services in this domain? A. LifeCell has an operational

being used by hemato-oncologists for treatment of blood-related disorders. With new frontiers emerging in stem cell therapy with the advent of mesenchymal stem cells, their potential use is being investigated in tissue regeneration too for ailments such as diabetes, arthritis, Crohn’s disease, heart stroke, cardiac arrythymia, COPD, spinal cord injury, multiple sclerosis, critical limb ischemia, etc. Apart from the clinical applications, the stem cells are being used to better understand mechanisms of action of various diseases, and also to explore liver and cardiac toxicity of new investigational drugs.

stem cell therapy center at Sri Ramachandra Medical College, and is working with global leaders in this space to bring the best offerings to India. A case in point is our clinical trial with Harvest Therapeutics on Critical Limb Ischemia. A few more clinical trials are being planned in other disease settings. Also, LifeCell in collaboration with Cryo-Cell plans to launch the menstrual blood stem cell banking service very shortly in India. The Harvest stem cell therapy procedure uses a point-of-care device to isolate autologous stem cells from the bone marrow within the operating room, so the same

August 2009

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could be used by physicians in hospital settings. LifeCell has exclusively partnered with Harvest to promote this in India. Further, LifeCell has also assembled a reputable R&D team with decades of experience in the field of cutting edge stem cell research. The development of a process to isolate, process and cryopreserve mesenchymal stem cells from the umbilical cord tissue was a complete in-house work. Also, we are trying to improve the expansion efficiency of these stem cells and to evaluate their efficacy in clinical setting. With these credentials, LifeCell is a preferred partner for leading players, and also the preferred service provider for clients wanting to preserve their vital stem cells or seek therapy.

IN CONVERSATION Q. LifeCell is known to be the first and largest stem cell banking service provider in India. What is the current market size for stem cell banking in India? What is your present customer base in the country? A. The estimated market size for stem cell banking in India would be approx Rs 100 crores. Our current customer base is 20,000.

Q. What is your current R&D capacity, infrastructure facility and team strength in India? A. Our R&D team has three doctorates, five research assistants, and three junior scholars and other support staff. The facility is about

2500 sq ft with clean rooms to process stem cells, and lab area for downstream analysis and storage.

Q. LifeCell announced the introduction of Bone Marrow Aspirate Concentrate (BMAC) technology in India in association with Harvest Technologies of USA. LifeCell, Chennai What are the benefits of this new technology? A. The most remarkable feature is Q. How do you plan to increase R&D and the ability to isolate autologous stem service capacity in future? And, what is cells by 15 minutes of aspiration. the percentage of revenue and market This way time is considerably saved, share that you foresee in the short and as one doesnâ&#x20AC;&#x2122;t need to take it to a lab long terms? and wait for 4-6 hours while it gets A. Future plans for R&D would be processed. This saves the patient from an additional procedure, and from a clinical perspective there is a much higher yield of stem cells from a smaller volume of the bone marrow. It has made it simple and easy for physicians to include stem cell therapy in their practice without large investments and skilled manpower.

investments in clinical trials to evaluate the efficacy of mesenchymal stem cells from cord tissue and menstrual blood. Also, we would be expanding our footprint in 25 additional cities in India. We expect revenue to grow 50 per cent year on year, and see ourselves maintaining market leadership.

CATCH UP WITH latest news, articles, interviews and case studies at

www.ehealthonline.org August 2009

PERSPECTIVE

‘Enterprise Apex LIS has improved efficiency and turn around time’ Piramal Diagnostic Services Pvt Ltd is India’s largest chain of diagnostic centres from pharmaceuticals major Piramal Healthcare, providing a comprehensive range of tests under one roof. It is spread across the country with 104 diagnostic centres in 48 cities and over 300 collection centres, and performs over 4 million pathology and radiology tests every year. Girish Mehta President and CEO, Piramal Diagnostics Services

During the past two years, Piramal Diagnostic Services implemented 21st Century Health Management Solutions’ Enterprise Apex Laboratory Information System (E-LIS) across 45 labs to reduce the turn around time for test reports, especially in cases where the reports are needed urgently, which has made data transfer easy and increased accuracy by eliminating human errors. eHEALTH caught up with Girish Mehta, President and CEO, Piramal Diagnostics Services and VasuKumar Nair, Principal Consultant and Director of 21st CHMS, to know more on the implementation of E-LIS.

VasuKumar Nair Director, 21st Century Health Management Solutions

How has Apex LIS helped Piramal Diagnostics? GM: Piramal Diagnostic Services is India’s largest Pathology and Radiology Centre chain from pharmaceuticals major Piramal Healthcare. When you have a chain of more than 100 centres, efficiency, accuracy and quick response time to clients become vital. Since we provide advanced diagnostic facilities under one roof, turn around time ( TAT ) is a very important aspect of our delivery. Earlier in cases where tests reports were required urgently, the manual process of sending the test results to centres was causing delays.

August 2009

Tracing the samples sent for tests was also an issue. However, Enterprise Laboratory Information System (E-LIS) has transformed the manual and errorprone system to an automated one, thereby, improving the efficiency and resulting in significantly faster TAT .

Can you tell us how E-LIS improves efficiency? VK: E-LIS changes the operations in labs by reducing human interface. Bar coding to track samples and direct interfacing with hi-tech medical equipment is the key. Bi-directional interfaces transfer data from sample in vacutainer to the medical equipment

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and the test result is transferred directly from the medical equipment to the LIS application. Therefore, it eliminates human errors and increases accuracy, reliability and speed. It also reduces manpower cost and rework. The policy setting and monitoring system at our head office controls even the remotest centre, thereby, implementing standard protocol across all centres. The doctors authenticate the reports online with their digital signatures.

How can E-LIS change the way laboratories work? VK: Enterprise LabNET solutions can be a game changer. It can do to labs

PERSPECTIVE

and diagnostics business what core banking did to banking sector in India. ICT driven processes follow minimum mandatory quality norms and ensure that the non-compromising policy norms are built in the system.

How was the E-LIS system customised for Piramal? GM: We wanted robust yet flexible software. So, it all started with brainstorming – our doctors, administrators, marketing experts, and finance experts sat down with 21 CHMS. Our needs for a software that would be compatible with all medical diagnostic equipments, right from radiology to pathology, were laid down. We found the consultants at 21CHMS were very knowledgeable about issues impacting pathology labs business. 21CHMS consultants follow a systematic methodology of mapping their solutions with our requirements which brings out the best possible solution. Their knowledge of latest medical equipments and readily available interfaces hastened the automation process. We also mapped our front office effectively to handle cash payments and ensure efficient and accurate billing.

What are the strengths of ICT solutions provider company? VK: Knowledge of IT has to be backed by in-depth domain knowledge. 21 CHMS is not just an IT implementation company. We come with strong domain knowledge and therefore follow a consulting approach. Our expertise in healthcare allows us to advice our

August 2009

clients on how to meet their needs with minimal customising, at the same time offering valueadd consulting towards improving services. ICT is used strategically to implement policies and best practices across the chain and not simply for computational or automation purposes.

Does Piramal Diagnostics plan to modify this system or top it with anything else? GM: As a future plan, Piramal Diagnostic intends to integrate a patient service module in the LIS solution. It will enable the patients to get their reports online by logging into a website and also get reminders and relevant info by SMS.

How does it feel to be nominated for “Best IT Implementation of the year 2009” by PCQuest magazine ? GM: I must compliment all the team members at PDS as well as 21CHMS ELIS who worked really hard to make this successful. It is a vindication of the strategy and supporting processes which have made us India’s largest chain of Diagnostic Centres in less than a period of five years. VK: For 21CHMS, it is a matter of great pride to be recognised by the industry. It is our mission to provide innovative and affordable ICT solutions built on in-depth domain knowledge which can transform healthcare industry not only in India but worldwide. We are grateful to Piramal Diagnostics and Girish Mehta for resposing their faith in our commitment and ideas. We are implementing similar innovative Enterprise Apex HMIS Solutions for large Hospital Chains, such as, Narayana Hrudayalaya which will take this concept to the next level.

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About 21st Century Health Management Solutions 21st Century Health offers consulting services, state-of the-art HealthNET solutions as well as implementation methodologies based on people, processes and technologies. In a span of 6 years, 21st Century Health has provided consulting services and HealthNET solutions to many known hospitals, diagnostic centers, laboratories chains, medical colleges and management institutes, and leading endoscopy/ laparoscopy surgeons and cardiologists.

About Piramal Diagnostics Services Piramal Diagnostics, India’s largest chain of clinical diagnostic centres, is a venture of Piramal Healthcare. Piramal Diagnostics is spread across the country with 104 diagnostic centres in 48 cities and over 300 collection centres, and performs over 4 million pathology and radiology tests every year with the widest test menu. It offer a comprehensive range of tests in pathology covering Biochemistry, Immunology, Hematology, Histopathology and Immunohistochemistry, Microbiology, Molecular Biology, Cytogenetics and Flow Cytometry. Some of its key laboratories and Centres of Excellence are accredited by the National Accreditation Board for Laboratories (NABL). It uses the NABL process norms in all the laboratories and the radiology centres use the ISO norms. Recently, Piramal Healthcare announced its net profit, which in the first quarter this fiscal has risen 45.5 per cent to Rs.74 crore, compared to the Rs.51 crore notched up in the corresponding period last year. Its total income has increased 16.4 per cent to Rs.569.76 crore from Rs.489 crore earned in the year-ago period.

INTEGRATED EMR Helps you eliminate paper charts Faster document processing Easy storage and retrieval of data Instant access to patient records Support for Charts and Schematics

EASY TO USE User friendly interface Simple mouse-click access Quick learning curve

CUSTOMIZABLE Designed for individual requirements Integration with existing applications Workflow based technology Selective modules

SECURE Access control passwords Encrypted data for confidentiality HIPAA compliant Audit on all transactions HL7 transactions

ADVANCED FEATURES Publish Charts/EMR Follow-ups Referral Management Voice Recognition Workflow Management Correspondence Manager SMS and Email Alerts Centralized/Distributed Implementation

APPLICATION

‘Enabling Integrated Healthcare’ Adoption of patient centric web-based integrated solutions have become indispensable for all healthcare facilities.

patient care coordination, enhancing provider productivity and facilitating knowledge management activities. HealthObject improves the efficiency and productivity of physicians and support staff and is targeted towards clinics, multi-specialty clinics, diagnostic centres, nursing homes, and medium and large hospitals.

HealthObject comprises of three main components:

Seetharam Malur Director IdeaObject Software Pvt.Ltd.

mproving the quality of patient care and the productivity of physicians and their staff, enhancing organizational efficiency, and providing a better patient experience are becoming the de-facto requirements in the healthcare industry. This means that collaboration between various stakeholders like clinics, hospitals, doctors, patients, and labs is extremely important for better healthcare. Hence, the drive towards electronic records and seamless availability of patient information becomes all the more important.

HealthObject, a flagship product of IdeaObject, is widely recognised as a healthcare enabler improving

August 2009

HealthObject™ Core: provides comprehensive administrative and clinical functionality used by doctors, administrators and other care providers. It supports management of uniform processes and practices in a multi location and multi-specialty care setting. Patient Portal: an online web portal through which the patients can login in a secure manner and view their medical records such as prescriptions, lab results, discharge summary, etc. The patient can search for doctors and schedule appointments online. DisplayObject: a digital information signage that can be set up in the reception / waiting area / lobby through which the clinic / hospital can display slide shows comprising of facilities offered, awards received, disease awareness, healthcare education, appointments, doctors’ availability and much more. The display panel can pull-in real-time information such as next appointment, doctors’ holidays and display them. Hospitals can also use these displays to

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promote health care related products and services of third party providers on a revenue model.

Would your practice benefit from HealthObject? Some of the strategic considerations that practices can take into account before deciding on a modern healthcare enabler technology like HealthObject are: • Does your practice occasionally face errors due to illegible paper records? • Are you trying to be in touch with patients to ensure that they keep up with their treatment schedules? • Do you spend a lot of time in locating patient records or have you faced the problem of lost patient records? • Do your care givers spend a high percentage of their time documenting interactions with patients manually? • Do you maintain a fair strength of full-time employees just to maintain paper-based medical records? • Do your physicians spend a humungous amount of time doing administrative tasks? Do you face problems in retaining • technology resources that helped you in building your own healthcare systems? Or you don’t have the necessary technology know-how to build and manage your own healthcare system in the first place?

APPLICATION •

•

Do your patients spend a lot of time in getting to see the physicians’ due to unintelligent appointment scheduling? Do your physicians spend a considerable amount of time in going through the patients’ case history using paper-based documents available? Do you want to make your facility a place where patients can learn a lot about healthcare through display screens?

If your answer to any of the above considerations is ‘yes’, then HealthObject can certainly help your practice.

The Technology behind HealthObject HealthObject is a secure, reliable and high performing application built using Microsoft . NET 3.5 framework. It is built on open standards based web services (service oriented architecture) and is easy to integrate with existing bestof-breed solutions. The user interface is windows presentation framework (WPF) based and it provides a rich user experience.

Key Differentiators Solutions like HealthObject were considered possible only for large hospitals and medical groups; but the

Multi-nodal implementation of HealthObject makes it a healthcare enabler of choice for medical chains. It is a secure, reliable and high performing application built using Microsoft.NET 3.5 framework. on-demand model of HealthObject makes it viable for smaller practices. HealthObject, due to its intuitiveness, has a very high user adoption rate. Many small and medium healthcare practices typically have problems related to the adoption of a healthcare enabler and hence the benefits of using one were not realized by them. Multi-nodal implementation of HealthObject makes it a healthcare enabler of choice for medical chains. Some of the differentiators are: User Adoption: Intuitive, easy-touse interface with WPF, drives higher user adoption and in turn higher productivity. On-Demand: Available as an ondemand solution (also, known as SaaS) and works on a pay-as-yougo model. Configuration: Highly configurable workflow at an organizational

level and high-level of personalization at an individual level. Security: High level of security with authorization and authentication at each activity level and complete audit log of transactions. Multi-nodal: Multi organizational and multi location model; available both as an on-demand and on-premise solution. Reports: Management of dashboards for patient analytics and practice performance metrics.

Benefits of using HealthObject HealthObject offers providers the ability to better serve patients and improve the productivity of the healthcare practice. To summarize: • • • •

• • •

Better patient care through greater access to information Increased flexibility as to where and how physicians work Fewer errors by eliminating paper-based systems Reduced costs through streamlining manual processes and eliminating paper files Ability to see more patients with a smaller support staff Ability to locate information quickly Reduced patient wait times; easier scheduling of appointments

Down the Road HealthObject aims to offer this solution on handheld platforms, for physicians to access it easily from anywhere and anytime. Higher adoption of healthcare systems will mean availability of a number of solutions, which have to become interoperable. This would mean adoption of standards and HealthObject would comply with those standards and will set the tone for the industry in terms of interoperability. Essentially, HealthObject will become the nerve centre of consumer centric healthcare systems, where the customer will have control over where he can get the best services at a cheaper cost and higher quality. August 2009

EXPERT CORNER

A Puzzling Bladder Condition In the absence of reliable diagnostic tests, it’s not uncommon to misdiagnose Interstitial Cystitis with a variety of other conditions related to the bladder.

Dr. Nagendra Mishra Consultant Urologist Jivraj Mehta Hospital, Ahmedabad

Interstitial Cystitis (IC)/Painful Bladder Syndrome (PBS) is a chronic disorder of urinary bladder characterised by variable degree of pelvic pain, frequency and urgency. The awareness about IC is lacking, therefore, it is still considered to be a disease of the western world. IC is a clinical entity which is not well-defined, is poorly understood, and inadequately treated, and can be extraordinarily bothersome. The exact prevalence of IC in India is not known. But, I believe it is as common in India as in USA and other countries (300- 600/100000). By conservative estimates there can be 3 million patients and it is more often found in women than in men. Though several theories have been put forward, but the cause of IC/PBS is still unknown. It is believed that the primary defect lies in the urothelium, or bladder lining (where the surface glycosaminoglycan (GAG) layer is damaged) which allows absorption of substances such as potassium and urea on the bladder wall. This eventually leads to tissue damage and pain as well as symptoms of frequency and urgency. Activation of mast cells with histamine release and neurogenic inflammation are also considered important factors in

August 2009

the etiopathology of IC. These changes cause upregulation of the sensory nerves of the bladder resulting in a state of “neurologic wind -up” which presents as hyperalgesia. The symptoms of IC/PBS are often misdiagnosed as a “common” bladder infection (cystitis) or a UTI (Urinary Tract Infection). However, IC has not been found to be caused by a bacterial infection and, therefore, treatment by antibiotics is ineffective. To diagnose IC/PBS, these symptoms must be present for more than 4- 6 weeks. Once a diagnosis of IC/PBS is made, generally the doctor discusses treatment options. There is currently no cure for IC/PBS, but there are treatments that can improve your symptoms dramatically and make you comfortable. But, most of the treatments take time to show results. Please note that IC/PBS is not a harmful disease. Treatment is difficult, but not impossible.

Suggested Treatments Medication: Pentosan Polysulfate Sodium, this is the first and only FDA-

Common Symptoms • Pain, pressure or discomfort,

• • • • • •

which worsens with bladder filling and improves with urination Symptoms may trigger with a certain food or drink In chronic conditions, frequency of passing urine can be every 5-10 minutes Burning sensation in the urethra while urinating Waking up many times at night to urinate Difficulty in passing urine, hesitancy and dribbling Desire to pass urine even after urination

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approved oral treatment for IC. It is a capsule taken by mouth, usually 3 times a day. And while the exact mechanism of action is unknown, it is thought to add to the normally protective bladder lining. However, this drug is presently not available in India, but soon there will be a revolutionary change with the drug Pentosan Polysulfate Sodium (Elmiron) being manufactured and launched by Swati Spentose. Lifestyle Changes: Some patients find that avoiding caffeine, alcohol, tomato products, citrus, chocolate, soda, and supplements containing vitamin C and potassium help them. Your doctor may suggest an “elimination diet.” While on this diet, a patient begins with a bland diet, and then slowly adds various foods and beverages one at a time to see which ones cause symptoms to appear or worsen. Stress is also believed to have a profound impact and often is associated with symptom flare-ups. Relaxation exercises, stress management, yoga, or massage may help reduce stress and its negative impact on your health. Therapeutic Hydrodistension: Though controversial, I have found it useful. Hydrodistension gives initial relief in most of the patients. Here the urologist distends your bladder with water or saline under anaesthesia. Intravesical Therapy: A cocktail of drugs in liquid form is administered in bladder via a catheter. Intravesical Botox injection: In patients who do not show signs of improvements with the above mentioned therapies, Botox is injected in the bladder through endoscope. Neuromodulation: Pacemaker is implanted in the lower back or perineum to control the symptoms. Surgery: This may be the last resort if all other modalities of treatment fail. It is specially for the patients who have a small capacity bladder.

DEVELOPMENT DIMENSION

Connecting Leaders and Information Technology for Health Transformation CHIK Services Pty Ltd is a non-for-profit company established to provide global communication services bridging the health and information and communication technology (ICT) sector.

hile the global financial downturn creates much uncertainty in the economies of our nations, there is contrasting certainty in the growing recognition of a vibrant health sector’s potential to contribute to economic stability and growth.

Sally Glass & John Glass Founders, CHIK Services Pty Ltd. Australia

CHIK connects local and global leaders with information technology to support healthcare transformation. CHIK’s key drivers are sustainable, affordable healthcare delivery; the application of appropriate technology; and regional development.

Although the body of evidence linking a strong health sector and a strong economy has been growing steadily over recent years, recent economic turmoil has served to increase the visibility. This is most notable in the USA where President Obama’s health agenda has catapulted health transformation enabled by e-health to the top of the national priority list and in doing so has raised e-health’s profile in the consciousness of leaders in many countries around the world. Healthcare transformation will play a significant role in economic growth and it is only a matter of time before other countries also invest in this vital sector of the economy as they look to stabilise their economies. E-health technologies, systems and processes are critical to the required transformation of healthcare. Based in Australia, CHIK Services (CHIK) is at the forefront of these issues - uniquely positioned in the e-health space, CHIK connects leaders and information technology for healthcare transformation.

CHIK’s genesis – a personal journey CHIK Services (www.chik.com.au) is a phoenix that arose from the ashes of the Collaborative Health Informatics Centre (CHIC) that closed its doors in 2002 after government funding ceased. My belief – that information technology is an essential underpinning for the delivery of safe, accessible, quality healthcare – was a key driver in my becoming an e-health advocate in the early 1990s. For me this was a natural progression from hands-on nursing roles in high-tech environments such as intensive care. So when CHIC closed down (leaving me downhearted and out of a job) it was natural for my husband John and me to buy the assets and engineer a seamless transition into what is now CHIK Services. CHIK’s focus on making connections and delivering pragmatic services that are appreciated by the market has led to our unique position as a trusted, independent, privately-funded organisation working to advance ehealth issues and make connections between all the players in the health sector (in Australia and further afield). In 2009, seven years since its establishment, CHIK is recognised for services that provide innovative and effective ways of increasing dialogue and action on the role of information and communications technology (ICT) in transforming healthcare delivery. August 2009

DEVELOPMENT DIMENSION

The Australian Health Sector The Australian health sector consists of interweaving relationships between payers, providers and the delivery of healthcare services. It is governed by the national Australian Government and eight state and territory governments. Both levels of government fund and provide healthcare; and in some jurisdictions local governments also play a role. The non-government sector is made up of individuals, private hospitals, non-government service providers, private health insurers and other non-government funding sources. Together, these groups fund and provide healthcare to over 21 million people, spread over 7.6 million square kilometres. The degree of complexity and the number of stakeholders involved in the Australian health sector has been mapped by CHIK in Diagram 1. Together, these stakeholders deliver healthcare within home, community and hospital-based settings, predominantly in urban and rural

locations and less frequently across vast distances. Responsibility and funding of public hospital and community based services are separated and as a result, information sharing between stakeholders tends to be fragmented. This means that there is not a single entity within the Australian healthcare system that has responsibility for developing and implementing a ‘whole of system’ approach to allow the sharing of information between these settings through electronic health records and other e-health initiatives.

Making E-Health Connections In a disparate and complex system, making connections between the different levels of government, health providers and the private sector is vital and it is a role that has evolved for CHIK over its seven years of operation. CHIK facilitates communications between government agencies, public and private healthcare organisations and providers in acute, primary, specialist, community and aged care

settings, health ICT industry suppliers and associations, many SMEs, plus academics and researchers. Its strength comes from its independence, its knowledge and its extensive relationships and broad network of contacts that span the public and private sector within Australia and abroad. Soon after its establishment, CHIK convened an Advisory Panel to consider strategic and philosophical ‘big picture’ issues relevant to the delivery of health services and to identify practical methods by which the health ICT industry can assist in achieving key healthcare delivery goals. Members attend in their own right, not as representatives of their respective organisations, and play no part in commercial or managerial aspects of CHIK Services. We have been fortunate to attract many high profile Australian, New Zealand and International advisers to our annual Advisory Panel meetings. Examples of the Advisory Panel’s outputs are the Global Health Knowledge Base Cycle (2005) (See Diagram 2) and the “Pebble in the Pond” discussion paper (2008). CHIK Services uses a number of methods to connect healthcare providers, policy makers and funders with health ICT product and service providers. One of these is a fortnightly e-newsletter service that acts as a key communication tool, providing a synopsis of the latest health ICT industry news, trends, events and business opportunities (tenders and grant programs). Over 12,000 readers companies, institutions and individuals - within Australia and overseas receive the newsletter. CHIK facilitates regular meetings of Chief Information Officers from private hospitals throughout Australia, providing them with opportunities to interact and meet with public hospital peers, with national organisations such as the National E-Health Transition Authority (NEHTA) and Medicare Australia, and to interact with visiting VIPs.

Diagram - 1

August 2009

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DEVELOPMENT DIMENSION

Organising Committee, recruiting supporting organisations plus exhibitors and sponsors. Over the years, CHIK has hosted delegations to many international e-health conferences. These include the annual HIMSS meetings in the US (where CHIK is an invited Co-Sponsor); the Healthcare Computing Conference in the UK; and the inaugural World of Health IT in Geneva.

CHIK’s Health-e-Directory

Diagram - 2 Another of CHIK’s facets is as a provider of specialist health ICT research. The professional team has extensive knowledge of the health ICT sector and provides research and information services tailored to meet the specific requirements of health/ICT professionals, health and government organisations, and ICT companies. CHIK’s commissioned research specifically advises on: Current health ICT issues, trends • and new technologies; Health ICT market trends and • opportunities in Australia or overseas; and ICT products/services • identification or evaluation. Research initiated by CHIK is supported by research syndicates made up of organisations that seek exclusive access to the results for a defined period prior to broader release. The latest syndicated research to be published by CHIK is Australian eHealth Market: Acute Care 2004-2010 that was released to syndicate members in March 2009 (and will be more broadly available from 1 August 2009).

Our Interconnected World CHIK’s association with the USA-based Healthcare Information Management

August 2009

and Systems Society (HIMSS) resulted in joint efforts to help establish a series of HIMSS AsiaPac conferences in the Asia Pacific region. The first event, HIMSS AsiaPac07 in Singapore, attracted more than 1100 attendees, the second in Hong Kong in 2008 attracted over 1500 attendees and third in Kuala Lumpur earlier this year brought over 1800 people together to share their experiences.

In 2006 CHIK established Australia’s first Healthe-Directory www.healthe-directory.com.au - which provides a comprehensive listing of products and service solutions for e-health As the local contact point CHIK brought its relationships with key organisations and individuals and its extensive understanding of the Asia Pacific region to bear. CHIK was responsible for building relationships across the region including drawing together the Advisory Board and

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With continued growth of the Australian health ICT sector, CHIK identified the need for a consistent, reliable and comprehensive source of information on health ICT solutions. In 2006 CHIK established Australia’s first Health-e-Directory www.healthe-directory.com.au - which provides a comprehensive listing of products and service solutions for e-health. The Health-e-Directory service, a combined online and in print directory, is recognised as an independent, trusted source of information about health ICT product and service providers that support the Australian and New Zealand markets. Interest in listing is also increasing from companies across the Asia Pacific region. The Directory is freely available online and annual print editions are distributed free of charge to influencers and purchasers of health ICT products and services in all health settings. It demonstrates the breadth and depth of Australia’s e-health product and service capability to potential customers, business partners and investors within Australia and overseas. Listing in the Directory is available freely to all, with packages ranging from free basic listings to detailed paid listings and advertising. Endorsed by government, industry and professional associations and extensively promoted within Australia, New Zealand and further afield, the 2009 print edition was launched by Australian & New Zealand High Commissioners at the Australian High Commissioner’s residence in Kuala Lumpur in February.

CHIK expects the Health-e-Directory service to grow in diversity, demand and geographical reach as our region continues to experience increased interest and collaboration in e-health enabled healthcare.

Casting a ‘Pebble in the Pond’ of Current Thinking In a discerning and timely move, towards the end of November 2008, CHIK released A Pebble in the Pond: A Vision for E-Health Enabled Healthcare Transformation. Via this discussion paper CHIK calls to extend the healthcare reform debate beyond the health arena, establishing it as a national priority worthy of a concerted, whole-of-government approach. “A Pebble in the Pond” presents a vision for e-health enabled healthcare transformation and identifies key elements that make up that vision, as well as elements that need to be in place to enable the vision to be realised. In laying out its vision, the paper highlights the need for basic mechanisms for broader collaboration and consultation across the sector. It presents a consensus view arising out of discussions at the latest meeting of CHIK’s Advisory Panel held in September 2008. The meeting involved over 20 thought leaders from Australia, New Zealand, Singapore, Hong Kong, United Kingdom and the United States. CHIK has positioned the paper to clearly articulate the need to: • recognise that the viability of our health system affects every aspect of Australia’s future (both social and economic). • move the healthcare reform debate beyond the health arena, establishing it as a national priority worthy of a concerted, whole-ofgovernment approach. • recognise the critical role that e-health plays in achieving successful health reform. • bring stakeholders with seemingly divergent views and interests together to remind ourselves

CHIK believes that Australia’s healthcare community and the community at large want to get behind effective national leadership to move forward with a common purpose, as well as a sense of urgency. that what we are striving for is essentially the same. “A Pebble in the Pond” was disseminated widely and we continue to receive positive feedback from a range of stakeholders including healthcare professionals and senior executives from government, healthcare providers and the e-health industry. The discussion paper is available at www. chik.com.au

Health-e-Business: Economic & Social Imperatives of E-Health As CHIK is in the business of making connections, its participation and presence at industry forums is critical. From the company’s beginnings to the present day, CHIK provides opportunities for people to connect - whether at CHIK conferences or conferences managed in association with CHIK, via delegations to international conferences, industry briefing sessions or in facilitated forums and workshops. CHIK’s seminal event is the annual Health-e-Nation Conference and Exhibition www.health-e-nation.com. au. Health-e-Nation brings together key international and Australian executives, clinicians and decision makers to explore the role of information and communication technology as enablers of health service reform. In 2009, Health-e-Nation will engage health, e-health and business leaders around the theme “Health-e-Business: Economic & Social Imperatives of E-Health”. It will be held in Canberra, Australia’s national capital and seat of

the federal government on 19th August with associated events for industry leaders on the 18th an 20th August. For the second year the Health-e-Nation conference will be run in conjunction with HIC’09 – providing a full program of events from 18 – 20 August 2009 and a 3 day exhibition spanning both conferences. This is a time of great change, both economic and operational. As a result of these pressures, CHIK believes important decisions will be made in the next 12 to 18 months on the direction and scope of major e-health implementations. Health-eNation will provide an opportunity for stakeholders in e-health and healthcare to learn more about what the future holds for the sector. We will be bringing together health and e-health leaders from Australia, New Zealand, India, UK, US, and Canada for stimulating debate and to chart the path forward.

Looking Forward I am extremely proud of all that CHIK has accomplished in our seven year history. Based on feedback received from many knowledgeable stakeholders, I believe CHIK is unique in its structure and the services we provide, and is a model that may have a place in other parts of the world. CHIK believes that Australia’s healthcare community and the community at large want to get behind effective national leadership to move forward with a common purpose, as well as a sense of urgency. This theme is echoed across the globe as nations publicly recognise that now is the time for health and e-health to take their rightful place as not only social priorities but as key national economic priorities. I look forward to CHIK continuing to be a key player in Australia’s ehealth sector and to identifying new opportunities for CHIK to connect people and information technology around healthcare transformation agendas. Further information on CHIK can be found at www.chik.com.au August 2009

EVENT REPORT

Seeking Credibility for ‘A Credence Good’ Conference on “Accreditation of Hospitals”organised by CII in New Delhi on July 4, 2009

onfederation of Indian Industry (CII) in collaboration with QCI/NABH organised one day seminar on “Accreditation of Hospitals” to sensitise all the stakeholders about the need and benefits of accreditation, which is still in its nascent stages in India. The seminar was chaired by Dr. Girdhar J Gyani, secretary general, QCI and the speakers at the seminar were from the regulatory bodies, private and government accredited hospitals and healthcare industry among others. The delegates participating in the seminar were from across the industry verticals, government and private hospitals, medical colleges, architecture colleges, healthcare consultants, insurance providers, banks, IT and NGOs among others. The seminar consisted of four sessions: Background for the preparation of CII report; Accreditation of hospitals in India; Need and status of accreditation and accreditation bodies in India; and Accreditation: Different perspectives and process for obtaining accreditation. The seminar saw a consensus emerging between the speakers and the delegates, that once accreditation becomes widespread, the need to differentiate and establish a favourable price equation will emerge as a prime imperative for hospitals. The stress was on the benefits of accreditation which would improve patient care and boost consumer confidence. The panelist suggested that mandatory accreditation of hospitals was on the anvil as healthcare providers faced greater competition. A fivepoint agenda outlined by the CII for this includes the need for creating awareness among healthcare providers about the benefits; greater role of the government in accreditation of public

August 2009

Panellists in a session on “Accreditation of Hospitals” organised by CII.

. . . once accreditation becomes widespread, the need to differentiate and establish a favourable price equation will emerge as a prime imperative for hospitals. hospitals; pre-packaged accreditation programmes to facilitate cost-effective implementation; and the role of industry and the necessity of grading. Acknowledging that the concept is still confined to metros, Prof. Ranjit Roy Chaudhury, Chairman, CII Healthcare Sub-Committee on Standardization

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and Quality, said it was necessary to look into the steps that would carry the process further in semi-urban and rural areas. Saying that accreditation and quality are two sides of the same coin, Dr Gyani appreciated the recent move by the government that diagnostic laboratories are to be accredited by NABL for empanelment with CGHS. Dr Anupam Sibal, Group Medical Director, Apollo Hospitals, described accreditation as a risk reduction strategy. Dr Ajit K Nagpal, Chairman, CII Healthcare Sub-committee on PPP and Chairman, Batra Hospital, asserted that medicine was ‘a credence good,’ thereby accreditation would help in measuring a product that was based on credibility in the marketplace. He said the lead role taken by the CII would go a long way in setting high standards for health care. The seminar also highlighted the processes required for accreditation. The discussions enabled delegates from the healthcare industry to draw up a checklist to further quality standards in their institutions.

NEWS REVIEW

Bill Gates: Go high end on R&D On a visit to New Delhi, Bill Gates, co-founder of Microsoft Corp, urged India to move away from low-cost labor toward high-end research and development to keep its giant IT sector competitive. He called on the Indian government to speed up its commitment to R&D and to boost low number of home-grown PhD students. “At first some of that (IT boom) was built on low-cost labor. And, of course, as time goes on, you don’t want to have that as the only differentiator and it’s not a sustainable thing, because others can come along with that as well,” Gates said. (Source: Reuters)

Carestream Health India appoints new MD

Health portal with social networking

Carestream Health, India, the leading provider of medical and dental imaging systems has announced the appointment of Prabir Chatterjee as Managing Director, Carestream Health India. Mr. Chatterjee will be responsible for Carestream Health’s business and operations in India, Bangladesh, Bhutan, Nepal and Sri Lanka. Mr Chatterjee moves to his new assignment in India from the company’s regional headquarters in Geneva, Switzerland, where he held the position of Finance Director. He joined the company in 1991 when it was the Health Division of Eastman Kodak Company, and has held since senior positions in finance, operations, project management and information technology. Carestream Health Inc., the leading provider of medical imaging systems and healthcare IT solutions, was formed in 2007 when Onex Corporation purchased Eastman Kodak Company’s Health Group.

The first-of-its-kind Indian portal for health and wellness was recently unveiled. The portal, bolohealth.com, will enable users to network with health enthusiasts and access health-related information online. “bolohealth.com attempts to break the clutter by becoming your online health buddy – it makes you ask, voice your opinion and thoughts, and participate through ‘My bolohealth,” says Dr. Simanta Sharma, Founder and Managing Director, HealthOn Infosoft Pvt. Ltd. “In its content portfolio bolohealth.com is rich and comprehensive with its many microsites, such as, on pregnancy and women’s health, skin, hair and beauty, diet, nutrition and fitness, sex and relationships, children’s health and parenting and many more – all of these addressing the diverse needs of modern day users,” informed Sharmistha Dey, Co-founder and Chief Editor of the portal.

August 2009

NEWS REVIEW

Google Health to safeguard “end-of-life” wishes Google has invited people to store “end-of-life” wishes at its free online health records management service. Google Health made available “advance directive” forms on which people can specify what they want doctors to do or not do in the event they are too ill or injured to express their wishes. Forms created with collaboration from an organisation specialising in elder care are available free for download online and can be customised to the laws in US states, according to Roni Zeiger and Julie Wilner of the Google Health team. “An advance directive allows you to determine your end-of-life wishes so that your family and doctor can honor them if you get sick and are unable to communicate,” Wilner and Zeiger said in a message at Google’s official blog. “The decision to sign an advance directive is an important and personal one, and Google Health now makes it a little bit easier.” Google Health recently added a feature that lets people upload scanned medical records to profiles for storage or selective sharing. “We would like to reduce the unnecessary use of paper in patient care,” Zeiger and Wilner wrote. “We hope someday we’ll move beyond paper, but until then Google Health can help you store your paper medical records electronically, including an advance directive, in one safe place,” they wrote. (Source: AFP)

CEE for MBBS aspirants

Dabur eyes acquisitions in healthcare

Medical Council of India (MCI) passed new recommendations to Central Government about the single examination centre for all aspirant doctors and a ‘Common National Entrance Examination’ to cover admissions to all medical institutions across India. The sub-committee formed by MCI for this relevant matter says, “This (multiple entrance exams) also involves hardship of various kinds including travelling to far-off places, overlapping dates, insufficient time gap between different entrance exams being held at different places, the money spent on travelling and for fee etc. for participating in the entrance examinations and various other incidental expenses.’’ The institutes which will follow this rule includes all related institutes, deemed universities (Central Govt.), PSU, local self governments, trusts, charitable societies and others. However, MCI made it clear in the proposal that single entrance examination will not necessarily results in single counselling process. MCI added there would be an arrangement for different states’ eligible students to get separated from the total list of candidates, which will be then utilised by the state authorities to admit students based on their admission criteria.

Fast moving consumer goods (FMCG) company Dabur is planning to acquire more companies in the healthcare segment in India and could spend up to Rs 500 crore for the buyouts. The move follows the recent acquisition of Fem Care Pharma for over Rs 250 crore. The company is also open to brand buyouts of up to Rs 200 crore. “We are looking for acquisitions of companies in the range of Rs 200-500 crore and brand acquisition of Rs 10200 crore. There is no financial cap, but it should be a good fit and have scalability,” said Sunil Duggal, chief executive officer, Dabur. As with the past acquisition of Balsara — which added brands like Promise, Meswak, Odonil and Odopic to its oral care and home care portfolio — or the recent acquisition of Fem, which now gives it a presence in the Rs 2,500 crore mainstream skincare products market, Dabur is keen to diversify its traditional healthcare portfolio from ayurveda to include mainstream brands.(Source:Business Standard)

Australia warns of 6,000 swine flu deaths Australia’s health minister Nicola Roxon warned there could be 6,000 swine flu deaths here this year under a “worst case scenario” without vaccines and anti-viral drugs. However, Roxon said the death toll from the disease was likely to be much lower, with the government planning a mass vaccination program in October capable of immunising the entire population. “We could expect around 6,000 deaths across the country,” she told ABC radio. “That’s really the worst-case scenario that is being projected at the moment.” (Source: AFP)

August 2009

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NEWS REVIEW

US to work with India on healthcare services: Clinton America will work to meet health challenges facing India among other countries and will have a comprehensive dialogue to improve maternal and child healthcare services, US Secretary of State Hillary Clinton said on her visit to Mumbai on July 18, 2009. “US has announced a large commitment to global healthcare policy. Our government is already spending a lot of money on HIV/AIDS but we wanted to add maternal and child health to that commitment as it is important for India,” Clinton said. “Commitment was also in eradication of infectious diseases like Tuberculosis (TB) and Polio which are also problems in India,” she said after visiting a Self Employed Womens Association (SEWA)’s trade outlet in Mumbai. “We are trying to work with our counterparts in India on these and will have a comprehensive dialogue in solving some of these healthcare challenges,” she said. (Source: PTI)

Pvt equity, venture capital cos turning to healthcare: Report

YES Bank closes project finance for Medanta Medicity

Private equity and venture capital firms are keen on increasing their investments in Indian healthcare and life science companies, a report released by research firm Venture Intelligence says. Over the last five years, they have invested over $2 billion in this industry. They are now turning their attention to hospital chains, diagnostic services, medical devices and wellness products, according to the firm which surveyed 60 PE and VC firms. “The survey titled ‘Private equity pulse on healthcare and life sciences’ shows that the investors are especially keen to tap into sectors such as diagnostic services, medical devices or equipment, hospital chains and wellness products and services,” VI said in release. According to the report, 87 per cent of the fund managers polled said healthcare and life science firms should get at least 10 per cent of the new investments being raised for India. (Source: Business Line)

YES Bank has announced the Financial Closure of an Rs5 bn Project Finance for Medanta - the Medicity Super specialty Tertiary Care Hospital, promoted by the noted cardiac surgeon, Dr. Naresh Trehan. YES Bank was appointed as the Sole Underwriter and Mandated Lead Arranger for Rs5 bn of debt. After a syndication spearheaded by the syndication team at YES Bank, 4 leading PSU Banks in addition to YES BANK have participated - Allahabad Bank, Dena Bank, Punjab & Sind Bank and State Bank of Hyderabad. The syndication process was completed within 60 days of its launch. The project envisages construction of a 1250 bed facility in Gurgaon at a total cost of Rs9.32 bn to be funded at a debt - equity ratio of 1:10. The hospital is at an advanced stage of completion, expected to commence operations from October 1, 2009.

Malicious Medicine ‘Malicious Medicine: My Experience with Fraud and Falsehood in Infertility Clinics’ is a recently released book authored by Anitha Jayadevan. It tells a story about the writer who got married at twenty-three and was anxious and impatient when a year passed by and she had not conceived. Jayadevan recounts the story of the next eight harrowing years of her life, when visits to infertility clinics, blood tests and scanning in the name of assisted reproductive technology (ART) became part of her everyday existence. The treatment was painful, invasive and expensive, and the medical practitioners more often than not were callous, inefficient and unfeeling. The result was a twin pregnancy after seven long years. But the joy was short-lived as she lost both the foetuses and in the bargain nearly her life. Then, as the final act of betrayal, she discovered that all she had been was a surrogate mother. The book is not just about the physical ordeal and the psychological trauma Anitha went through. It asks larger questions about the sanctity of life and the importance of ethics that separate the medical profession from an assembly line production.

Only Rs 37 a month for an Indian citizen’s healthcare India spends a mere Rs 37 per head every month to provide healthcare facilities for its one billion plus citizens, a reply tabled in the Lok Sabha has revealed. “The per capita expenditure for the years 2006-07 to 2008-09 is in the range of Rs 300 to Rs 450,” Health Minister Ghulam Nabi Azad said in a written reply. At the top end of the scale, this works out to Rs 37 a day. Azad said the Commission of Microeconomics and Health set up by the World Health Organisation (WHO) had estimated that the minimum expenditure for essential health interventions for one person should be at least $34 (Rs.1,600) per year. Though India’s health budget for fiscal 2009-10 has increased by Rs 3,107 crore from Rs 19,534 crore to Rs 22,641 crore, the allocation constitutes a little over one percent of the GDP. Public health experts believe that government must provide around three per cent of the GDP for health related expenditure. August 2009

NEWS REVIEW

MAQUET’s Solution for Digital OR-Integration MAQUET’s newly developed AV CONFERENCE PREMIUM MODULAR enables the modular and individual adaptation of central functions to specific customer demands. The hospital will be able to deploy different components as required. Any subsequent changes in customer demands can be accommodated at any time with a retrospective system expansion. Three modules make up the core of AV CONFERENCE PREMIUM MODULAR. The basic module is the medical video communication system for distributing images and videos. Here, you can switch between video, image and data sources (endoscope, OR field camera, PACS, C-arms, etc.). The MAQUET Group is the global market leader for Medical Systems, focusing on the Operating Room (OR) and Intensive Care

Search doctors on www.JustHealth.in Internet based marketing specialist iMarketing Advantage launched www.JustHealth.in, a comprehensive health information website. Individuals logging into the website will have free access to comprehensive information about doctors, hospitals and other health-related resources and issues in their respective cities. The objective of the health portal is to support its users to make an informed choice by enabling them to view details of the doctor/s before visiting them. The health portal lists more than one lakh doctors across India, apart from hospitals and other health service providers. It allows search for doctors by name, specialisation or location and access to a detailed profile of doctors. It also provides maps and directions for people to reach doctors and hospitals conveniently. “Apart from the healthcare directory service, the portal also has insightful tips on health, news for easy reference and features that include latest information about health products in the field of medicines, insurance, wellness and other related issues,” said Nitin Dhawan, CEO, iMarketing Advantage.

India healthcare industry to hit $14.2 bln by 2012 - KPMG The Indian healthcare industry is estimated to touch $14.2 billion by 2012, propelled by rising income levels, changing demographics and shift in illness patterns in the country, consultancy firm KPMG said in a report. Rising incomes and a growing incidence of life style-related ailments such as diabetes will see the value of the domestic healthcare industry quadrupling by 2017, the report says. Currently, the domestic healthcare sector is undergoing considerable reforms driven by the rapid economic growth, the report said, adding emerging sectors such as diagnostic chains and medical device manufacturing were attracting investments. In the study, KPMG estimated private and public spending in Indian health infrastructure would touch $14.2 billion in 2013, at an annual growth rate of 5.8 percent from 2009. The western state of Maharashtra would be the highest spender in the country, investing $7.3 billion between 2009 and 2013, the report added. (Source: Reuters)

12th Workshop on ‘Biomedical Informatics and Communication’ (Supported by DBT & ICMR) November 20 - 21, 2009 Twelfth workshop on ‘Biomedical Informatics & Communication’ is being organised at Bioinformatics Centre, JB Tropical Disease Research Centre, Mahatma Gandhi Institute of Medical Sciences, Sevagram, during November 20 to 21, 2009 to expose medical/science teachers, scientists and PG/PhD students to basics and advances in Biomedical Informatics and Communication. Lectures on Biomedical Informatics, Telemedicine, Telepathology, Genomics, Proteomics, Evidence-based Medicine, Hospital Information System, Healthcare Management, Biomedical Communication, and Biomedical Information Retrieval will be delivered by eminent resource people. Demonstrations and hands-on sessions will be arranged with desktop work on gene and protein sequence analysis and other techniques related to Biomedical Informatics and Communication. Contact Person: Dr. Satish Kumar, Professor, Biochemistry & Dy Coordinator, BIC e-mail: mgims.btisnet@nic.in, info@jbtdrc.org, Telefax: 07152-284038 For further information and Registration Form, visit at www.bicjbtdrc-mgims.in; www.jbtdrc.org

August 2009

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Usage of public health services by the bottom 20% of population (classified by income), is only marginally higher than that the top. Only 24% of rural areas in India have direct access to healthcare facilities. Total Healthcare spending of Asia-Pacific countries in â&#x20AC;&#x2DC;08 is estimated to be US$ 889 billion Last year, HSBC Asian Ventures Fund 2 invested US$ 10.47 million in Trivitron Medical Systems

‘Hospital CIO Conclave’ @ 25 - 27 August 2009 Hyderabad International Convention Centre, India

Catch some of India’s top-notch hospital CIOs in conversation on “Best Practices” & “Next Practices” of ICTs in healthcare

For sponsorship/exhibition opportunities, please contact: Arpan Dasgupta, arpan@ehealthonline.org, 9818644022; Bharat Kumar Jaiswal, bharat@ehealthonline.org, 9396423085

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Hospital CEOs, CIOs, CTOs, GMs, VPs; IT/Systems Managers; Medical Directors, Superintendents & Administrators; Government Health Officials; Technology Vendors & Solution Providers; Investors & Entrepreneurs; Researchers & Academicians Special Sessions/Panel Discussions: •

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www.eindia.net.in/2009/ehealth/ For Sponsorship/Exhibition Opportunities: Arpan Dasgupta, M:+91 9911960753, E: arpan@ehealthonline.org Bharat Kumar Jaiswal, M: +91 9971047550, E: bharat@ehealthonline.org