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The Monthly Magazine on Healthcare ICTs, Medical Technologies & Applications Vo l u m e 5 | Issue 2 | F EBRUARY 2010 | INR 75 / USD 10 | ISSN 0973-8959

Technology Enabled Proactive Healthcare - India’s only Hope against the Chronic Disease Epidemic Rajeish Moondraa, CEO, Truworth PAGE 20

Services in Modern Health Care Industry - A Columbia Asia Experience Divya Chawla, Principal Correspondent, eHEALTH PAGE 26

The New Dimension in Ultrasound Scanning Divya Chawla, Principal Correspondent, eHEALTH PAGE 31

Virtual Touch Gnanakumar Vivekanandan, Senior Manager - Ultrasound, Siements Healthcare PAGE 34

BioSense Program - Leveraging Informatics to Prevent Public Health Crisis Dr. Sanjeev Sood, Wing Commander, Indian Air Force PAGE 38

www.e h e al t h on line.or g

HEALTH CIO OUTLOOK SURVEY 2010


CONTENTS w w w . e h e a l t h o n l i n e . o r g | volume 5 | issue 02 | February 2010

ISSN 0973-8959

8 8 20

“HEALTH CIO OUTLOOK 2010”

“Technology Enabled Proactive Healthcare India’s only Hope against the Chronic Disease Epidemic” Rajeish Moondraa, CEO, Truworth Group of Companies

26

26

Services in Modern Health Care Industry - A Columbia Asia Experience Divya Chawla, Principal Correspondent, eHEALTH

31

The New Dimension in Ultrasound Scanning Divya Chawla, Principal Correspondent, eHEALTH

31

34

Virtual Touch...

38

BioSense Program - Leveraging Informatics to Prevent Public Health Crisis

Gnanakumar Vivekanandan, Senior Manager - Ultrasound, Siemens Healthcare

Dr. Sanjeev Sood, Wing Commander, Indian Air Force

40

4

43

News Review

February 2010

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February 2010 Introduction to IT & Health Information System Basics of Computer Applications- Level 1 for Nurses & Paramedics

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Database & Knowledge Management Design & Implementation

26-27 Feb

March 2010 Integrated Hospital Information System

13-14 March

June 2010

May 2010 Basics of Computer Applications- Level 2 for Doctors

Electronic Health Records & Related Standards in collaboration with O-Tech, USA 20th April PACS in collaboration with O-Tech, USA 21st April DICOM and HL 7 introduction in collaboration with O-Tech, USA 22nd April HL7 version 2.6 in collaboration with O-Tech, USA 22nd April PACS Troubleshooting in collaboration with O-Tech, USA 23rd April HL7 version 2.6 in collaboration with O-Tech, USA 22nd April HL7 version 3.0 in collaboration with O-Tech, USA 23rd April Certificate exams for HL7 version 2.6 and version 3.0 conducted by HL 7 India 24th April Cost effective Electronic Medical Record (EMR) 25-26 April

22-25 May

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6

February 2010

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14- 16 June


EDITORIAL Volume 5 | Issue 2 | February 2010

CIO strategies ..revealed! Technology deeply influences each and every sphere of human existence in the present era. Infact it is gradually being ingrained into the issues that concern human existence on this planet. Health among all is the most significant and crucial element for the survival of human race. With the rapid penetration of Information and Communication Technology (ICT) in hospitals and healthcare infrastructure across the globe, it is indeed needed that evaluation of health infrastructure from this perspective is not missed out by any chance in the Indian context. This is possible through technology. With this objective in mind we have done the ‘Health CIO Outlook Survey 2010’ to bring to the fore a comprehensive coverage of the extent of ICT usage in healthcare industry in India. The aim is to highlight various aspects of ICT integration in hospitals to draw the attention of technology providers and the users in the domain. The parametres employed in the study pertains to IT strategy, technology roadmap, purchasing trends, evaluation priorities and a host of related aspects that concern the modern healthcare industry. The trend across hospitals showed that IT implementation is needed to bring long-term benefits to the business. The survey also delineated that most hospitals prefer vendors who can provide end-to-end technology solutions to the hospitals covering every aspect of their functioning. As regards software, most hospitals have gone for customized as well as COTS software which are interoperable with IT solutions deployed in other affiliated/ partner hospitals. ICD, IHE, SNOMED, HL7 and DICOM are some of the preferred standardisation protocols across hospitals. The survey result has some broad underlying indicators for both the users and providers of technology and gives them a direction for right approach. This issue also highlights some of the emerging technological developments in healthcare diagnosis and treatment. New dimensions in ultrasound scanning are evident which has enabled the decade old imaging technology to go beyond the confines of radiology and being increasingly used by non-radiologists for diagnostic purposes in a variety of clinical settings. Advanced ultrasound is possible through development of sophisticated software and novel analytical methods to interpret data. Many other technological revelations in health industry are taking place. A few of them have been captured in this issue. For instance, ‘Virtual Touch’ – a new ultrasound based technology from Siemens for screening, diagnosis and therapeutic clinical applications using measurement of relative tissue elasticity in response to acoustic radiation pressures. Also, find out more about the ‘Biosense Programme’ for providing real-time information on disease detection, monitoring and health situational awareness. Happy Reading!

Dr. Ravi Gupta Ravi.Gupta@ehealthonline.org

President: Dr. M P Narayanan | Editor-in-Chief: Dr. Ravi Gupta, Product Manager: Dipanjan Banerjee (Mobile: +91-9968251626) Email: dipanjan@elets.in Editorial Team: Dr. Prachi Shirur, Dr. Rajeshree Dutta Kumar, Shipra Sharma, Divya Chawla, Sheena Joseph, Yukti Pahwa, Sangeeta Ghosh De, Subir Dey, Dinoj Kumar Upadhyay, Pratap Vikram Singh, Gayatri Maheshwary, Saba Firdaus Sales & Marketing Team: Debabrata Ray, Anaam Sharma, Arpan Dasgupta (Mobile: +91-9818644022), Fahimul Haque, Bharat Kumar Jaiswal, Ankur Agarwal, Priya Saxena, Vishal Kumar, Gaurav (sales@elets.in) Subscription & Circulation: Lipika Dutta (Mobile: +91-9871481708), Manoj Kumar, Gunjan Singh (subscription@elets.in) Graphic Design Team: Bishwajeet Kumar Singh, Om Prakash Thakur, Shyam Kishore Web Development Team: Zia Salahuddin, Amit Pal, Sandhya Giri, Anil Kumar IT Team: Mukesh Sharma, Devendra Singh | Events: Vicky Kalra Editorial Correspondence: eHEALTH, G-4 Sector 39, NOIDA 201301, India, tel: +91-120-2502180-85, fax: +91-120-2500060 email: info@ehealthonline.org does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. Themagazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. is published by Elets Technomedia PVt. Ltd in technical collaboration with Centre for Science, Development and Media Studies (CSDMS) Owner, Publisher, Printer - Ravi Gupta, Printed at Vinayak Print Media, D - 320, Sector - 10, Noida, UPs, INDIA and published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP, Editor: Dr. Ravi Gupta

February 2010

7


COVER STORY

HEALTHCARE CIO OUTLOOK There has recently been a surge in the implementation of information and communication technologies in hospitals and healthcare facilities across the globe. In an effort to track this trend, eHEALTH brings you a comprehensive coverage of the extent of ICT usage in healthcare in its Health CIO Outlook 2010 report. The aim of preparing this report was to capture the mindshare of CIOs and senior IT executives of India’s leading healthcare organisations. The CIOs shared their perspectives on issues pertaining to IT strategy, technology roadmap, purchasing trends, evaluation priorities and a host of related aspects that concern the modern healthcare industry. The Health CIO Outlook 2010 Report comprises of the results of the responses received from CIOs of some of the leading hospitals in the country and provides an overview of the recent patterns in IT implementation in hospitals and healthcare facilities. 8

February 2010

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COVER STORY

“A plethora of software options are available these days that add to the confusion of hospitals that have to choose the best solution that fulfils all their requirements. Given an option, almost 70 percent of hospitals would prefer a solution that is customized as well as a COTS software. �

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February 2010

All hospitals r e p o r t e d that through implementation of an IT solution in the hospital, they look for enhancement of overall quality and customer satisfaction. Seventy five percent of the hospitals follow the IT implementation a p p r o a c h to achieve standardization of their internal processes, while almost 60 percent reported that their ultimate objective is to achieve long term strategic value. Also, while choosing a vendor, more than 50 percent of the hospitals choose end-toend deliverers, while none of the hospitals give cheaper solutions more preference. While choosing a software, the hospitals prefer a solution that is a mix of commercially available off-theshelf software as well as a solution that is customized as per their needs. Interoperability with IT solutions in affiliated/ partner hospitals is also a criterion. Although no standardization guidelines for health IT have been set, yet hospitals across

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the country are looking for solutions that are compliant with all.most common health IT standards laid internationally.

Macro Objectives Implementation

of

IT

On being asked to respond on their macro objectives for IT implementation, almost 60 percent of the hospitals look at achieving long-term strategic value, in contrast to the remaining 40 percent that are only aiming for short term departmental process improvement. This implies that a greater number of hospitals in the country are currently aiming at deploying IT solutions for

achieving long-term benefits for their business.

Benefits of IT Implementation In terms of the basic objective, 75 percent of hospitals deploy health IT solutions for standardization rather than flexibility. Most of them, hence believe that by achieving standardization, they will be able to extract most out of their health IT solution.

Basis for Choosing an IT Vendor A number of vendors in India are offering varied health IT solutions to fulfil different needs within a healthcare facility. The products and solutions offered by them range from basic EHR/EMR solutions to more


COVER STORY

comprehensive and customized solutions that computerise the entire functioning of a hospital ranging from administration, laboratories to

satisfy all their IT requirements, while almost 43 percent of hospitals have also expressed their interest in best quality providers.

S o f t w a r e Selection

patient records and files. It is evident from our survey that 60 percent

A plethora of software options are available these days that add to the confusion of hospitals that have to choose the best solution that fulfils all their requirements. Given an option, almost 70 percent of hospitals would prefer a solution that customized as well as a COTS software. The remaining 30 percent would either opt only for a COTS software or a customized solution.

Preferred Level of Interoperability of the Software

of the hospitals are looking for an end-to-end deliverer who is able to

While choosing an IT solution, a lot of importance is given to the interoperability of the solution whether with the existing IT solution, with the IT solution in affiliated/partner hospitals, or with an IT solution of all other hospitals. Most of the hospitals,

replied that they would prefer a system that is able to interoperate with the IT solution deployed in other affiliated/ partner hospitals. The rest, however, would either opt for a interoperability with an existing IT solution of with IT solutions in other hospitals.

Requirement Software

for

Standard-based

There are a variety of standardization protocols available for Information Technology solutions. These include—ICD, IHE, SNOMED, HL7 and DICOM. Seventy five percent of the users said they would prefer a software compliant to all or most common health IT standards, while some said they would be satisfied with only an ICD or HL7 compliant system.

Participating Hospitals • • • • • • •

Sir Ganga Ram Hospital, New Delhi Calcutta Medical Research Institute, Kolkata Apollo Hospitals International Ltd., Ahmedabad Asian Institute of Medical Sciences, Faridabad QRG Central Hospital and Research Centre, Faridabad Max Healthcare RG Stone Urology and Laparascopy Hospital, New Delhi

February 2010

11


COVER STORY

Expert Speak “Computerisation of Sir Ganga Ram hospital is aimed towards improving patient care by making the right information available to the right care providers at the right time, even though this may necessitate utilization of increased number of human resources and altered workflows. It is also aimed at improving hospital functioning through better management information of hospital functioning so that bottlenecks can be identified and utilization of resources optimized.”

Dr. Karanvir Singh Head – HIS Implementation, Sir Ganga Ram Hospital, New Delhi

Vishnu Gupta CIO, Calcutta Medical Research Institute, Kolkata

“IT roadmap in healthcare information technology has evolved from being just a facilitator to an important driver of care and business. Health information technology is increasingly seen as a critical tool to help contain healthcare costs and improve administrative efficiency, while enhancing patient safety and quality. Hospitals can establish their IT roadmap through giving importance on specific areas like consumers (patients and doctors), pharmacy, behavioural health, long term care plan, and public health, etc. In a large multi-layered hospital which devotes considerable emphasis on patient care. The short term objectives of the on-line computerised system are to reduce costs and improve the accuracy and timeliness of patient care, accounting and administration, record keeping, and management reporting. The long term goal is to build and maintain a patient database for analysis of data to facilitate clinical and non-clinical decision making process. Since eHealth is a 21st century’s approach to healthcare deliverables, it’s the possibility of healthcare deliverables with minimal touch or minimal physical communication in a fast and effective way. Desired deliverables from eHealth in an organization are as following: Increased efficiency and decrease costs by consolidation on various IT systems and bring them all on a more uniform platform. •

Enhanced quality of care by providing best of IT support at points of care and sale. • Setting standards with information exchange and communication within organization. • Leaping out of the conventional boundaries of healthcare and set phase wise focus on aligning and implementing newer systems dedicated toward the approach of minimal touch. • Making e-health interventions more evidence based. • Empowerment of consumers and patients by making knowledge bases of medicine and personal electronic records accessible in electronic form. • Equality in health care at all levels. The focus of IT is to now widen the scope of healthcare deliverables from Curative to Proactive wellness approach and to channelize the resources available with the healthcare delivery system towards the effective new approach wellness care.”

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February 2010

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What does India in 21 Century need to achieve Hon. Dr. A.P.J. Kalam's vision of Healthcare for all by 2020?

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COVER STORY

Saneesh MV Manager - Systems, Apollo Hospitals International Ltd., Ahmedabad

The information strategy is challenging. Our ability to work effectively is largely dependent on our information systems. We intend to sustain end-toend collaborative information systems where all stake holders could create and access information. Providing patient care is a complex endeavour that is highly dependent on information. To provide, coordinate and integrate services, healthcare organizations rely on information about the science of care, individual patients, care provided, results of care, and their own performance. Like human resource, material and financial resources, information is also a resource that must be managed effectively by the organization’s leaders. Every organization seeks to obtain, manage, and use information to improve patient outcomes and individual and overall organization performance. Over time, organizations become more effective in: • Identifying information needs • Designing an information management system • Defining and capturing data and information • Analyzing data and transforming it into information • Transmitting and reporting data and information • Integrating and using information Although computerization and other technologies improve efficiency, the principles of good information management apply to all methods, whether paper based or electronic. These standards are designed to be equally compatible with non-computerized systems and future technologies. The information process in a healthcare delivery comprise of various components like, data captured from the patients, visitors, doctors observation, treatment and procedures done, result of various investigations, images, clips, audio etc. All these heterogeneous components culminate to a ‘Digital File’ (Patient Record) for a person or patient. Computerization is essential for any organization to effectively store and retrieve these digital files. In order to complement and support growth of the organization, MI division must have a definite structure and framework. The specific guide lines for functional components of the information system are made to avoid or minimize ambiguity. Our strategic IT vision is to support growth challenges of the organization and to align with group IT initiatives.”

“Our vision is to try to provide a solution which will make the hospital 95% paperless and 10% manual dependent. Our strategy is to ensure the delivery of our vision to the organization.”

Shuvankar Pramanick Head - IT, Asian Institute of Medical Sciences, Faridabad

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February 2010

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COVER STORY

Sudhakar Manav VP QRG Central Hospital and Research Centre, Faridabad

“I envisage IT to be an integral healthcare solution to the communities by interlinking all healthcare providers and the related government and non government agencies. It should encompass business intelligence for decision making based on the various quality and performance indicators, data analysis based strategy formulation, quality standardization to provide customer and employee satisfaction, compliant to all healthcare laws, bye laws and standards. The software should provide security and safety to the EMR/EHR. It should be user friendly and suggestive for process improvements. I wish that IT should be instrumental in hastening the service delivery and data recovery. The healthcare personnel and the patients should receive mobile alerts on their cell phones about the diagnosis and management of ailments. In general IT should be the breakthrough in providing healthcare anywhere by innovating and integrating all the related systems.”

“Our vision is to enable our internal customers to provide highest standards of medical service to patients. Towards this end, we have embarked on an ambitious project to provide an electronic health record system for standardization of care delivery and reducing medical errors. Again, to be able to support such a critical and mammoth system, the infrastructure and support required is of a high order of magnitude. Therefore, we have taken a strategic decision to outsource IT service and delivery to our partners DELL Perot Systems as a long term relationship. We wish to provide a seamless infrastructure across all our facilities, so as to ensure that there is a continuity of care for the patient, no matter which Max facility he/she visits. Therefore our systems and network are designed to provide a real time view of any Max patient record on demand.”

Neena Pahuja CIO, Max Healthcare

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Technology Enabled Proactive Healthcare

India’s only Hope against the Chronic Disease Epidemic Truworth brings state-of-the-art technology to India that is easy to implement and use. The company offers products and services for the entire list of stakeholders in the healthcare vertical. In an interview with eHEALTH, Rajeish Moondraa, Director and Chief Operating Officer, Truworth Group of Companies, talks about the importance of preventive as well as proactive healthcare in the Indian setting.

What is the importance of preventive healthcare?

Rajeish Moondraa CEO Truworth Group of Companies

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February 2010

India is on the brink of a disaster of chronic diseases like diabetes, cardio-vascular ailments, respiratory diseases and obesity. In the latest report of International Diabetes Federation, India has 50.4 million diabetic patients that amounts to approximately 7% of the adult population. By 2010, 3 out of 5 heart patients in the world will be Indians. More than 50% of deaths due to stroke and 25% deaths due to heart diseases occur because of hypertension. Considering mainly the effects of premature mortality, WHO estimates that (between 2005 and 2014) diabetes, heart disease and stroke combined will cost patients USD 336.6 billion in India. It will be a huge tragedy if these diseases are not controlled in a timely manner. The biggest problem with these diseases is that these diseases are silent killers – they do not show symptoms until they reach a stage where life-long medication or surgery is the only solution left, and once you are affected by them, you are at risk for

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the rest of your life. The only saviour for India now is preventive healthcare. In fact, I would take it one step further and call it proactive healthcare where people are motivated to be proactively health conscious and take necessary steps to delay, if not avoid, the onset of these life-threatening diseases. To handle the growing epidemic of chronic diseases in the country, mere education and awareness will not help – a proactive program is needed.

If the magnitude of the problem is so huge, why is preventive healthcare still being neglected in India? Preventive healthcare, as of now, is voluntary in India and requires a visit to a lab or hospital. Very few people in the age group of 25-40 go for a preventive health check because it is not affordable in terms of actual costs and time for the middle class, which is the largest market segment and forms the biggest chunk of India’s productive workforce. Preventive healthcare for the majority ends at the lab values. The


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current process eats up about half working day from one’s schedule, which is a big deterrent for both individuals and their employers. Psychologically also, it is difficult for an individual to undergo screening in the care delivery setting. Lack of awareness of the severity and non-symptomatic silent killer characteristics of these diseases is another major reason why people are so negligent about the whole phenomenon. Labs are using health check-ups as money-making tool by bundling essential and non-essential tests thereby jacking up the cost. Believe it or not, even grown-ups are scared of syringes. Nobody wants to go to the hospital by choice.

What are the initiatives taken by your company in this area? Keeping in mind all of the above hindering factors, Truworth has created a service for people to avail preventive healthcare and technology enabled proactive healthcare at their doorsteps, with minimal effort required from their side, at a fraction of the time and cost that it takes them now to get a preventive health check done. Truworth also runs corporate wellness programs and disease management programs.

What is the current portfolio of products & services that you offer? What is your flagship offering in terms of expected impact on the market? Our flagship offering is called Make Me Healthy, which is our lifestyle health risk assessment service. It facilitates health checks at people’s doorsteps brining in ultimate convenience in terms of time, cost and availability. We also have disease management programs for different chronic diseases. No Extra Sugar (www. noextrasugar.com) for diabetes, No Extra Cholesterol (www. noextracholesterol.com) for high cholesterol and heart ailments and No Extra body-fat (www. noextrabodyfat.com) for obesity management. Apart from this, Truworth is also

into healthcare HIMS & EMR.

informatics

like

Tell us more about how Make Me Healthy works? Make Me Healthy (MMH) is where preventive healthcare starts. Unless you know where you stand, you cannot decide how you will reach where you want to. Therefore Make Me Healthy, is the first key to opening the doors of good health by providing a lifestyle health risk assessment (LHRA). Make Me Healthy is a homehealth check-up program which harnesses technology to give the best customer experience. Those who want to undergo the LHRA simply make a call or send an SMS to the MMH call-centre. MMH technician reaches the home/office (or any other place of preference) of the individual and conducts the LHRA in just 15 minutes. LHRA comprises of collection of personal health history, family health history, symptomatic assessment, social lifestyle habits and biometric screening. Biometric screening comprises of ECG, spirometry, pulse oximetry, total cholesterol, triglycerides, random blood sugar, blood pressure and body composition. All these tests are performed using US-FDA approved bluetooth enabled point-of-care diagnostic equipment. These equipment transfer test results instantaneously to a laptop or

smart-phone, which sends it to the central monitoring station (CMS) along with the entire information collected. At the CMS, there is a team of doctors that analyses all information and test results and creates a comprehensive risk profile. This risk profile, along with the doctor’s report, nutritionist’s guidelines, fitness expert’s tips and a health guide are sent to the individual by email within 4-6 hours. If they want it in print, it is delivered using next-day courier service at no extra cost.

What is your target market for Make Me Healthy? How do you plan to reach out to this market? All of the above services are available to retail customers as well as companies for health management of their employees. We believe that everyone has a right to good health. Therefore, the target market is any individual, group or organisation looking to use technology enabled proactive care. We have successfully launched the service and are now looking to take it pan-India. Our plan is to appoint franchise partners, who will take care of the front end sales and assessment service-delivery while we take care of the backend operations such as selection of equipment, technology integration, set-up and training, managing team of doctors and

February 2010

21


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experts, scientific algorithm design and improvement and report creation and delivery. We are also looking to work closely with hospitals, who would want to provide these services under their own brand. We can take care of the complete preventive healthcare department for hospitals including marketing, sales, setup, health risk assessment and further counselling for primary and secondary treatment at the hospital.

Apart from the end customer, who else can benefit from this service? Since healthcare is a very complex industry with several stake-holders, we see a lot of other agencies benefiting from this service. We have already discussed about how hospitals can benefit by improving their brand and business. The second biggest beneficiary will be the pharmaceutical companies as they could reach out to the right set of people who need their treatment methodologies by partnering with Make Me Healthy. We also see life and health insurance companies as potential partners because they benefit from knowing the risk profile of their potential customers before issuing the policy of their existing customers on a periodic basis so they could motivate them towards proper treatment to avoid any untoward incident of illness or death.

How do you see Make Me Healthy benefiting corporates and their

L to R: Mr. Gaurav Mundra (COO, Make Me Healthy), Mr. Rajeish Moondraa (CEO, Make Me Healthy), Mr. Ashwini Kumar Sharma (MD, RajComp), Dr. Sanjay Tyagi (Director, STPI Rajasthan)

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February 2010

employees? The USD 336.6 billion burden of chronic diseases primarily consists of the opportunity cost of time lost by employee’s illness. Imagine your most important resource taking a sick leave three days before the all important project’s deadline! These diseases come with several co-morbidities like degeneration of organs (kidney, lungs, eyes, nervous system etc.), slow healing of wounds, increased risk and slow recovery from other diseases and ailments. In severe cases, often amputation is the only solution left. In this era of cut-throat competition where quality of human capital is the defining factor between success and failure, no organisation can afford to lose good employees. If the employees’ health is taken care of by the organisation, there is a very high chance that the retention period and productivity of the employee will increase. Studies suggest that employers who take care of their employees’ health needs see lower rate of attrition as compared to peers not doing the same.

Which are some of the recent milestones for Make Me Healthy? The response to MMH has been very encouraging since its launch. To mention some of the recent milestones, MMH has been awarded an exclusive contract by the Disease Management Association of India (DMAI) to conduct Health Risk Assessment of India (HRAI). Make Me Healthy also bagged both jury’s choice and online voting award for the “eHealth Initiative of the Year

2009” at the eRajasthan summit, held on 18th December 2009 in Jaipur. Make Me Healthy and The Times of India’s wellness banner Times Wellness, jointly published a Health Guide to be distributed to people focusing on the risk of chronic diseases. Make Me Healthy’s HRAI efforts were featured in the Disease Management Association of America: The Care Continuum’s newsletter.

Where do you see yourself and Make Me Healthy two-years down the line? Our sincere effort is to make sure that people from all strata of the society get access to preventive healthcare in the coming years. We see Make Me Healthy becoming a pan-India phenomenon in the long term and the next two years will be crucial for the same. In the next two years Make Me Healthy creating its presence in at least 20 major cities in India using franchise partners for Lifestyle Health Risk Assessment.

When can we see the Disease Management services in action? Disease Management services will be started in its first location within Q1-2010. After the completion of first successful training, the learning thereof will be incorporated in the program and the same will be replicated at all our franchise locations. Therefore the expected time frame to see a wide-spread Disease Management program will be around end of 2010.

Make Me Healthy bagged both the ‘Jury’s Award’ and the ‘Public Choice Award’ at the prestigious eRajasthan 2009 in the category - ‘Private Sector Healthcare Initiative’ of the Year. Make Me Healthy has proven that it is a commercially successful venture that has a huge social impact too.

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POWER HOSPITAL

Services in Modern Health Care Industry A Columbia Asia Experience Columbia Asia Group, a recognised name in international healthcare, has come up with state-of-the-art healthcare service units in Bangalore, Gurgaon and Kolkata. Already a trusted name in Asia, the group has brought to India the culture of hospitals with modern facilities focusing on complete customer satisfaction.

H

ealthcare delivery in India is changing due to the growing awareness among the middle-income groups. Standards of living are continuing to rise. With this comes an increase in demand for quality healthcare services. Columbia Asia hospitals’ medical services are designed to address the changing healthcare needs of millions of Asians. With well-established hospitals in Malaysia, Vietnam, Indonesia and now India, Columbia Asia is today a recognized name in international healthcare engaged in the delivery of modern healthcare services to the growing middle-income groups of India.

Refined Front Office Services Available in all Columbia Asia’s hospitals, the Customer Care department focuses on all aspects of customer/patient relations. The main goal of this department is to continuously improve customers’ satisfaction by providing efficient and friendly services. Its main duties include managing the reception desk for inquires, movement of patients within the hospital, appointment scheduling,

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February 2010

registration, admission, bed management, in patient services, customer feedback, problem solving, and lobby and entrance management.

Refined Services

Catering

Café Columbia, a brand extension of Columbia Asia and available in all of Columbia Asia’s hospitals, aims to provide a pleasurable culinary and dining experience to our patients, visitors and staff. Headed by a manager and chef, the café was developed to better manage in-house food services, in accordance with the advice and guidance of our dietitians. The in-patient dining experience will involve stylishly uniformed staff – in charge of taking orders and serving meals right up to the bedside, balanced

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and well presented meals served in portable hot boxes and a wide selection of menu tailored to suite patients’ dietary requirement. Our in-patients’ meal sequence consists of eight meals a day – starting with Sunrise (hot


POWER HOSPITAL

beverage), followed by Breakfast and Midmorning (cool beverage). Lunch is served with side salad and dessert, followed by Tea (hot beverage) and Sunset (snack) – soup service. Dinner will then be served and towards the end of the day, patients will be given Nightcap (hot non caffeinated beverage). The main meals come in four choices - Local Favorites, Heart Healthy (vegetarian), International and Rice Bowl (noodle and soft rice-based items). The Café’s general dining area covers a buffet counter focusing on breakfast, lunch and dinner items, with an all day convenient snack menu. All food items prepared are heart-friendly for better dietary management, without compromising on taste. The Café Columbia is created to compliment the hospital’s vision in healthcare management, strictly guided by brand standards.

Refined Customer Relations True to its motto “Customer First”, Columbia Asia’s hospitals place high importance on customer relations, via excellent customer services and high level of efficiency and accountability, to compliment its customer care and brand standards. Its goal is to be a partner to its customers by providing a touch of Columbia friendly hospitality in all of its hospitals in the region.

Refined Ward Management Ward Management in Columbia Asia is collectively managed by the Customer Care, Nursing and Support Services Departments. Its well trained Customer Care personnel are in charge of room allocation and movement of patients, upon registration to admission to the room, while the daily upkeep of the wards is done by Support Services staff and the nurses. Columbia Asia Hospital wards are stylishly designed, blending colours and furnishings that project 21 century healthcare

“Till date, the hospitals records the lowest rate of infection, benchmarked on the international figures published by Centre for Disease Control (CDC). This reduces chances of infection in the hospital and in turn, contribute towards patients’ speedy recovery” brand identity. The area is maintained by a team of dedicated housekeeping attendants, trained to ensure high hygiene standards – monitored by the Nursing and Support Services departments.

Refined Hygiene Management The main function of Hygiene Management, one of the important areas in Columbia Asia Hospitals, is to contain infection

within the facility. Till date, the hospitals records the lowest rate of infection, benchmarked on the international figures published by Centre for Disease Control (CDC). This reduces chances of infection in the hospital and in turn, contribute towards patients’ speedy recovery. Hygiene management in Columbia Asia hospital follows stringent international protocols and best practices, which include excellent resources and infrastructure for hand hygiene practices, hospital waste management, sharp disposable system, availability of adequate personal protection equipment, isolation practices, barrier nursing, use of medical disposable and excellent disinfection and sterilization practice. The staff is well trained on all these protocols and has planned scheduled training modules. Internal and external audits used to maintain our hygiene management standards. On top of this, feedback from patients and guests also serve as a push factor to continuously improve our effort in infection control.

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ADVERTORIAL

SonoSite – Customer Testimonials “SonoSite systems are small but are power packed. They can be carried easily and can perform everything that a big cart-based system can perform. We are very happy with the versatility and image quality of the system for the vast majority of our portable workload, and since then, use of point-ofcare ultrasound has dramatically expanded in the hospital. Point-of-care ultrasound complements the traditional radiology services. Besides, routine scanning performed throughout the hospital by resident staff, we also use point-of-care ultrasound for specific applications and situations. We are using this machine primarily for intra-operative procedure especially for liver and kidney transplant.” Dr. Mukund Joshi Chief Consultant - Sonography Department, Jaslok Hospital, Mumbai

“We have been using SonoSite systems regularly in our NICU, CCU, ICU. I feel, we have been very well rewarded when it comes to versatility and diagnostic ultrasound. I would like to make a special mention to its use in NICUs which has made our job much simpler since the system can be carried to babies bedside directly which has made our work more interesting. I feel SonoSite systems are excellent state-of-art equipments for versatile applications.”

Dr. Arun Kinnare HOD, Ultrasound Department, KEM Hospital & Jahagir Apollo Hospital, Pune

Prof. Niranjan Khandelwal Prof. & Head, Department of Radiodiagnosis, Post Graduate Institute of Medical Education & Research, Chandigarh

Dr. Lakshman Thadani Private Practitioner, Mumbai

Dr. Hemant Pakhale Private Practitioner, Mumbai

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“It’s a high value for money system which gives high-end diagnostic image quality. The system can perform all radiological examinations including vascular imaging- arterial and venous line placement, guided for biopsies, small part examinations like scrotal, thyroid, MSK. Since the system is truly portable and rugged, it can be used in intensive units, bedside examinations of critically ill patients where quick diagnosis with high image quality is required. Also system can be used for operations due to the availability of Intra-operative probes.” “I would like to call SonoSite’s system as the Little Genie with Sumo Potential. The system has exceptional high-end image quality in ultra portable units comparable to big-cart based systems and has a range of transducers for different procedures. It is a high value for money with 5 years of warranty. The system can provide instant answers when time is of the essence, such as in emergency and critical care medicine and various other clinical diagnostic purposes.” “SonoSite’s M-Tourbo hand-carried ultrasound system is a powerful frontline medical tool. The systems are extremely useful in emergency trauma, ICU, CCUs, intra operative of all head to toe surgeries, pain clinics, nerve blocks, obstetrics, labour rooms/OTs and vascular applications. The system is sturdy, portable, user friendly, and has a quick boot-up.”

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TECH TRENDS

The New Dimension in Ultrasound Scanning Ultrasound technology has aided in the improvement of clinical outcomes by providing immediate and actionable clinical information at the point-of-care. The technology helps in reducing overall costs by replacing more expensive diagnostic exams. Divya Chawla examines the latest technological trends and application areas in this field. The emergence of ultrasound modality as a medical imaging technique more than three decades ago marked the advent of an increasingly diversified market segment in the diagnostic market. Ever since, the diagnostic capabilities of ultrasound have grown beyond imagination, spanning a plethora of medical specialities such as obstetrics and gynaecology, orthopaedics, and cardiology, among others. In fact, in recent years ultrasound technology has proliferated beyond the confines of radiology and are being increasingly used by non-radiologists for diagnostic purposes in a variety of clinical settings. The speed, safety

and cost-effectiveness of ultrasound are some of the key features that give this technology an edge over the other imaging modalities, in addition to its ever increasing information density. Its uniqueness lies in its ability to use sound waves instead of ionizing radiations to image various structures in the human body. Around the world, ultrasound’s cost-effective imaging technology is eliminating the need for more expensive imaging modalities for carrying out diagnostic procedures.

The Fourth Dimension in Ultrasound Advancements in technology leading to enhanced computing power of

ultrasound equipment for complex signal processing tasks in recent past has now made it possible to obtain ultrasound images in three and four dimension. This technology marks the next-generation integrated solution for medical imaging allowing clinicians to provide faster treatment and improve therapeutic success rates. Leading ultrasound vendors have introduced ultrasound systems with 3D/4D capabilities that have revolutionized the imaging of unborn babies. One of the 4D ultrasound systems that have recently hit the market is GE’s Voluson 730 4D ultrasound scanners. Philips, a leader in medical technology,

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TECH TRENDS

also offers systems that offer great performance and unmatched 4D ultrasound imaging. Technological advancements have actually made it possible to view ultrasound images in the fourth dimension. There is no doubt that the technology holds much promise and augments the growth potential of the entire ultrasound market.

Miniaturization—The Latest Trend Windows PC-based architecture and device miniaturization are making it possible to pack increasing amounts of processing power into smaller and smaller medical devices. The ultrasound device segment has also adopted this trend with the introduction of laptop-size, handcarried ultrasound systems. The increasing focus on ergonomics has augmented the miniaturisation of ultrasound systems. Further, the rapid advancement in software and semiconductor technologies coupled with no need for bulky lead shielding, miniaturization of ultrasound equipment provides lesser challenges and difficulties. Currently, one of the fastest growing segments in the ultrasound equipment market, hand-carried Dr. Bharat Aggarwal Strategic Business Development, Diversification and IT Diwan Chand Satyapal Aggarwal Imaging Research Centre

Please tell us about the ultrasound machines that are currently installed at Diwan Chand Satyapal Aggarwal Imaging Research Centre? Currently we have three colour Doppler machines, two from Siemens and one from Philips. All these are high-end colour Doppler multi-purpose machines with all applications.

Have you installed any systems that offer 4D imaging? We are looking at doing some amount of 4D ultrasound scanning. The technology has value add features in some areas of specialization,

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ultrasounds are growing at an explosive pace and are becoming increasingly popular among clinicians throughout the world. The need of the hour is premium quality imaging at the point-of-care and integration of advanced technologies is making these systems more widely acceptable by clinicians. The major attraction for end-users include improved technology, offers diagnostic-quality images, longer battery life and better tissue penetration. The more obvious benefit of hand-carried ultrasound systems—their role in time saving—is another factor that continues to drive its growth. In addition to the already established players in this segment, such as SonoSite, a number of other players, both big and small, have also included hand-carried portable ultrasound systems in their product portfolio. Physicians report that newer ultrasound systems offer excellent performance and great portability, which eliminates the need for investing in a separate ultrasound system for each location. As a result, radiology departments, across the world, are replacing their traditional cart-based systems with latest hand-

thus offering enhanced imaging. We are upgrading to newer machines with 4D technology and automated acquisition techniques, which have recently been introduced by Siemens and GE.

What is the scope of hand-held ultrasound systems? Hand-held ultrasound is going to be an important tool for gastroenterologists as instead of palpating the liver they can easily use the hand-held machine to view the liver. It can also be used by the gynaecologist to have a look at the uterus. A drawback, however, is that it has poor resolution and a back-up high resolution traditional ultrasound system will always be required by any facility that is using hand-held systems. The hand-held system can

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carried ultrasound equipment that are capable of docking to accessory carts to become pseudo-cart-based systems.

Ultrasound and Liver Elastography The latest liver elastography technology, introduced in India by Siemens Ltd., holds huge potential in terms of detecting liver diseases at an early stage. State-of-the-art ultrasound scanners can examine tissue elasticity in real-time offering the clinicians with the intricate details required to study various liver diseases including liver tumours, such as those causing cirrhosis. In addition to differentiating between malignant and benign tumours, the technology can also be used to detect breast cancers. Though falling in the high-end category, the technology is expected to reduce the overall procedural and treatment costs. As the technology proliferates, the costs are required to fall further making the technique more economical and cost-effective. In fact, in future, the technology is expected to be a major factor that will drive sales of ultrasound equipment installed with software that are compatible with this technology.

act like an extended diagnostic tool, which is readily available with the clinician.

Which are technologies sector?

the other latest in the ultrasound

A lot of IT vendors are developing technologies to see ultrasound images on PDAs. However, these images cannot be used for diagnostic purposes because of offering smallersized images and lower resolutions. Hence, PDAs can be used for viewing and advising purposes but not for diagnosis. Another technology that we are keenly looking at is ultrasound elastography—both liver and breast. Another important area is ultrasound contrast media, even though it is expensive.


TECH TRENDS

The Road Ahead Development of sophisticated software and novel analytical methods to interpret data has completely transformed ultrasound technology in recent years. An ageing population with increased incidences of aneurysms and osteoporosis, cardiovascular diseases, and the like are some of the key factors driving growth in this segment. Three major areas identified for higher

growth include—hand-carried ultrasound systems, proliferation of ultrasound technology in a gamut of medical specialities other than obstetrics and gynaecology, and adoption of ultrasound by new user groups including surgeons, anaesthesiologists, and emergency physicians. Vendors, across the globe, are pioneering new and innovative technologies for varied applications such as cardiac

imaging and 4D neonatal imaging, leading to emergence of unlimited medical applications of ultrasound. Trends in this sector are changing every season with development of portable ultrasound machines and real-time image viewing. With so much happening, it would be unfair to underestimate the growth in this sector—the future definitely has scope for an explosive growth in the ultrasound market.

Ultrasound Products in the Indian Market vendor

Product Details

Blue Star (Hitachi Medical Systems)

Hitachi Medical Systems offers modern ultrasound scanners with ergonomic features for various clinical applications. Hitachi has also added real-time tissue elastography technology in its ultrasound product range.

Chayagraphics (Wipro GE Medical Systems)

A Bangalore-based company, Chayagraphics is an authorised channel partner for Wipro GE Medical Systems. Its range of products in the ultrasound segment range from basic black and white systems to 4D colour Dopplers.

Esaote India

Esaote India offers the MyLab range and Aquila Pro colour Doppler ultrasound scanners for a range of clinical specialities including cardiology, radiology, vascular, obstetrics and gynaecology and for various other dedicated applications.

GE Healthcare

GE Healthcare has introduced breakthrough technologies in the ultrasound segment with its Logiq, Vivid and Voluson product families. In addition, it offers powerful IT applications to support these technologies.

L&T Medical

L&T Medical offers Scintila colour Doppler system for multi-speciality applications and black and white ultrasound scanners.

Medion Healthcare (SonoScape)

Medion brings to India a range of high-end ultrasound systems from SonoScape. These include an entire range of black and white and coloured systems offering extended applications in a variety of clinical procedures.

Mindray

Mindray offers the DC range of coloured ultrasound scanners and the DP range of black and white systems. It has also forayed into laptop-sized ultrasound systems with the launch of its M5 ultrasound scanner.

Philips Medical Systems

Philips’ ultrasound systems span the entire arena—cardiology, emergency medicine, general imaging, regional anaesthesia, vascular, women’s healthcare, and more. It also offers a range of transducers for all applications and ultrasound systems.

Sanrad (Zonare)

Sanrad represents Zonare in the ultrasound systems market space in India. With this Sanrad brings to India the advanced z.one sonography technology offered by Zonare.

Shimadzu

Shimadzu, in India, offers both black and white scanners and colour Dopplers under its SDU range. The Sarano ultrasound system offered by the company encompasses advanced technologies for professional-level clinical diagnosis.

Siemens Medical

Siemens offers the complete range of ultrasound systems. In addition, It is first in India to provide a comprehensive suite of Tissue Strain applications that provides a new dimension of diagnostic information of the mechanical stiffness of tissue.

SonoSIte

SonoSite one of the leaders in hand-carried ultrasound systems, offers a broad range of products in this category. Its latest product the NanoMaxx is extremely portable and tough, suited for high resolution imaging and procedural guidance.

Toshiba (Erbis)

Toshiba, has been at the forefront of ultrasound imaging by introducing new applications and setting world-class standards that have extended ultrasound capabilities. The company offers and array of products in this segment.

Trivitron (Aloka, Japan)

Trivitron offers black and white ultrasound systems and colour Dopplers from Aloka, Japan. It also offers the Terason range of laptop ultrasound systems in India.

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SPOTLIGHT

Virtual Touch... Tissue Strain Analytics could represent the most important development in ultrasound technology since the advent of Doppler imaging.

Gnanakumar Vivekanandan Senior Manager, Ultrasound Siemens Healthcare

Tissue strain analytic applications that enable qualitative visual or quantitative value measurements of the mechanical stiffness (elasticity) properties of tissue are the new dimension of diagnostic information. These applications are not available using conventional sonographic imaging and represent the most important development in ultrasound technology for noninvasive study of liver characterization since the advent of Doppler imaging. Tissue stiffness information is complementary and independent from the acoustic impedance information provided by B-mode (grayscale) imaging as well as vascular

flow information provided by doppler imaging (Figure 1). Thus, tissue strain analytics provide information that is complementary to other ultrasound derived information in approaching diagnostic challenges. Siemens is first in India to provide a comprehensive suite of tissue strain applications that provides a new dimension of diagnostic information through either qualitative assessment or quantitative measurement of the mechanical stiffness of tissue. Further, Accoustic Radiation Force Impulse (ARFI) imaging is a new tissue strain imaging technology that utilizes sound waves to interrogate the mechanical stiffness properties

(Figure 1)

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SPOTLIGHT

of tissue. Virtual Touch tissue imaging and Virtual Touch tissue quantification are the first and only commercially available software applications implementing the tissue strain imaging technology. Unlike conventional B-mode sonography, which provides anatomical detail based on differences in acoustic impedance, Virtual Touch imaging describes relative physical tissue stiffness properties. In this sense, Virtual Touch imaging is more similar to a physical palpation exam of tissue than conventional sonographic evaluation. In complement, Virtual Touch tissue quantification provides accurate numerical measurements related to tissue stiffness at userdefined anatomical locations. For example, a given lesion or structure can be qualitatively visualised for its overall stiffness relative to surrounding tissue as well as the relative stiffness of its internal structure. Subsequently, numerical measurements of the lesion can be made. Overall, Virtual Touch software is an advanced form of sonographic imaging and provides complementary information to a conventional ultrasound scan, while benefiting from anatomical localization.

Virtual Touch Tissue Imaging A Virtual Touch software image is a qualitative grayscale map of

(Figure 2)

relative tissue stiffness (elastogram) for a user defined ROI (Figure 2). This information is computed by examining the relative displacements of tissue elements due to an acoustic push pulse. For a given elastogram image, bright regions depict tissue that is more elastic (less stiff) than dark regions. While a Virtual Touch software image may be displayed side-by-side with a corresponding conventional ultrasound B-mode

“Virtual Touch tissue imaging and Virtual Touch tissue quantification are the first and only commercially available software applications implementing the tissue strain imaging technology. ”

the ROI, a baseline conventional ultrasound signal description of the tissue is obtained. Next, a push pulse is applied along this line. Conventional tracking beams are applied along the same line to obtain the displaced tissue signal. The baseline and post-push signals are compared using a crosscorrelation algorithm. This allows computation of differences in tissue position, at each point along the axial line, between the relaxed and compressed states. The computed differences are related to the maximum displacement experienced at a given spatial tissue location due to the elastic properties of the tissue at that location. The more elastic a given tissue element, the more displacement it experiences. The above process is repeated for each axial line within the ROI as with a conventional B-mode scan. Finally, all computed displacements across the entire ROI are converted to an elastogram image depicting relative tissue stiffness (Figure 3).

Virtual Touch Tissue Quantification image, apparent tissue boundaries may differ between the images as they rely on different tissue contrast mechanisms. The Virtual Touch tissue imaging application forms an image by combining independently acquired multiple axial lines of tissue displacement information. Starting with the left most axial line within

In addition to qualitative imaging, ARFI technology may be utilized to measure a numerical value of shear wave speed3 as implemented by Virtual Touch tissue quantification (Figure 4). In general, the more stiff a region of tissue, the greater a shear wave’s speed as it travels through this region. Thus, the measured

(Figure 3)

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SPOTLIGHT

(Figure 4)

(Figure 5)

shear wave speed is an intrinsic and reproducible property of tissue. Shear waves are generated and travel perpendicular to an accoustic push pulse induced displacement of tissue much like ripples resulting from a stone dropped into a pond. Thus, in contrast to conventional axially oriented ultrasound waves, shear waves do not directly interact with the transducer. In addition, unlike conventional ultrasound waves, shear waves are attenuated approximately 10,000 times more rapidly, and thus require greater sensitivity to measure. However, as the shear wavefront travels through tissue, the generated displacements are detectable using ultrasound tracking beams. By observing the shear wavefront at several locations, and correlating these measurements with the elapsed time, the shear wave speed is quantified. For Virtual Touch tissue quantification, an anatomical location for measurement is first identified using a ROI placed on a conventional ultrasound image. An acoustic push pulse is applied just lateral to this location, inducing a shear wave that travels through the ROI. Tracking beams, sensitive to greater than 1/100 the wavelength of sound, are applied adjacent to the push pulse path. These beams are continuously transmitted until the

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passing shear wavefront is detected. The time between generation of the shear wave and detection of the peak is utilized to compute the shear wave velocity. Multiple measurements are made for a given spatial location before a value is reported in order to ensure measurement quality (Figure 5).

The Indian Scenario It is estimated that liver diseases are among the top ten killer diseases in India, causing lakhs of deaths every year. Besides, there are those who suffer from chronic liver problems,

“It is estimated that liver diseases are among the top ten killer diseases in India, causing lakhs of deaths every year.� needing recurrent hospitalization and prolonged medical attention, which leaves them physically, mentally, emotionally and financially devastated. On the other hand, there are millions of cases of hepatic diseases, which go unreported or are reported when the matters have gone out of hand. Utter poverty coupled with lack of education and awareness prevents people from

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seeking medical advice until it is too late. In addition, high cost of treatment pose as major obstacle in convincing people about taking treatment. Studies have indicated that some liver related diseases like Hepatitis B and Hepatitis C virus could burgeon into an epidemic much larger in scale than the dreaded HIV. However, these diseases being silent killers with long gestation periods do not attract the attention of the Government or the other influential bodies. The needs of patients with liver- related disease have been grossly underestimated and largely ignored.

Conclusions Virtual Touch tissue imaging and quantification are the first and only commercially available implementations of acoustic radiation force impulse imaging. Through this modality, previously difficult or impossible elastographic examinations are made accurate and practical. Most importantly, Virtual Touch software technology enables a new dimension of tissue information to be applied for screening, diagnostic and therapeutic clinical applications and Virtual Touch applications may offer a way to reduce unnecessary biopsies and other invasive procedures otherwise needed to give an accurate diagnosis through easy evaluation of pathology.


DEVELOPMENT DIMENSION

BioSense Program

Leveraging Informatics to Prevent Public Health Crisis The article provides an overviev of the BioSense Program, which is an excellent example of application of informatics to strengthen public health system to effectively monitor and respond better to a public health crisis situation like one being currently faced by India by collating and integrating all data at various levels of the government. Effective surveillance shall enable keeping track of all cases, avoid panic, encourage knowledge sharing and mount coordinated response to public health crisis.

Dr. Sanjeev Sood Wing Commander Indian Air Force

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Preparing for a Public Health Crisis

Overview

Media news channels, newspapers and internet websites are full of many dire predictions about largescale loss of life from biological or chemical attacks or a swine flu pandemic. Computer models estimate that between 2 and 100 million people could die in the event of flu pandemic, depending on the virulence of the virus. Fears of a major public health crisis are greater now than ever before, and governments throughout the world are trying to improve their capabilities for identifying biochemical attacks or pandemic outbreaks more rapidly. On May 3, 2006, the United States government issued an Implementation plan for its National Strategy for Pandemic Influenza to improve coordination among federal, state, and local authorities and the private sector for pandemics and other public health emergencies. The implementation plan calls for improving mechanisms for real-time clinical surveillance in acute care settings such as hospital emergency rooms, intensive care units, and laboratories to provide local, state and federal public health officials with awareness of the pandemics.

One such initiative is the Bio Sense Real-Time Clinical Connections Program developed by the U.S Federal Centers for Disease control and prevention (CDC). The BioSense program, initiated in 2004, is an innovative bio-surveillance program designed to increase the nation’s emergency preparedness through the development of a national network for real time disease detection, monitoring, and health situational awareness. Bio Sense sits atop a hospital’s existing information systems, continually gathering and analyzing their data in real time. Custom software developed by CDC monitors the facility’s network traffic and captures relevant patient records, diagnoses, prescription information and other demographic data about the cases. BioSense requires Data Sources to transmit data using the Public Health Information Network Messaging System (PHINMS). PHINMS is written in JAVA and is certified to run on platforms that support the Sun Java Run-time Environment (JRE). The Sender (Client) is capable of sending messages as a batch or real time streaming data, receiving

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DEVELOPMENT DIMENSION

acknowledgements to those messages. The software converts these data to the HL7 data messaging format, which is the standard for the health-care industry, encrypts the data, and transmits them every 15 minutes over the web to the CDC where they are maintained in a large data repository. The system summarizes and presents analytical results by source, day, and syndrome for each ZIP code, state, and metropolitan area using maps, graphs, and tables. Registered state and local public health agencies as well as hospitals and health care providers are allowed to access data that pertain to their jurisdiction. They access BioSense via a webbased application over a secure data network. Information from BioSense could show early signs of a pandemic or biologic attack and alert local hospitals, health workers, and federal and state agencies to take preventive measures.

The core principles Communication and Collaboration: To strengthen public health informatics capacity and capability, promote community participation, encourage knowledge sharing, and enhance stakeholder value. Transparency: To improve system operations, ensure operational excellence and leverage existing state, regional, and community level capabilities and solutions. Innovation: To advance the research and practice of bio-surveillance and informatics. The traditional process for public health surveillance is manual and tedious. Hospitals, physicians, and laboratories would mail or fax paper reports to public health agencies, who would then call health care providers for more detailed information. This slow chain of person-to-person communication is not well-suited to respond to a major public health emergency. The system helps CDC epidemiologists quickly detect early signs of a flu pandemic or bioterrorist attack and provide public health

and government decision makers with the information needed to manage preparedness and response. Simultaneous access of the data by all levels of public health decreases the time needed to classify health events as serious public health problems; decreases the time to identify causes, risk factors, and appropriate interventions; and decreases the time needed to implement countermeasures and health guidance. BioSense first became operational in 2004, when it began gathering daily data from U.S Defense Department and Veterans Affairs (VA) Hospitals and Laboratory Corporation of American (LabCorp) orders for medical tests. (Labcorp operates a large nationwide network of testing locations and service centers and is one of the largest clinical lab service providers in the United States). Approximately 700 Defense Department and 1,110 VA facilities report data to Biosense. In late 2005, CDC started to expand the BioSense network to civilian hospitals in major metropolitan areas and anticipates sharing its analysis of local and regional influenza-like illness trends with health care and other public agencies in affected areas. To help civilian hospitals to BioSense, the CDC enlisted the Consella Group health care information technology consultants. Consella explains the benefits of participating in a project that will serve their specific interests as well as those of the public at large and will put their data in standardized format. Currently BioSense supports more than 800 registered users; connects with 770+ hospitals; receives an average of 175,000 near real-time messages per hour; receives data from 1300+ Department of Defense (DoD) and Veterans Affairs (VA) hospitals and healthcare facilities; and, receives laboratory data from LabCorp and RelayHealth

Challenges in Interoperability However,

many

hospitals

have

not been anxious to jump on the bandwagon because the transition would be burdensome and timeconsuming. To transmit data to BioSense, each hospital must standardize its patient and other medical data. Most hospitals use their own coding systems for symptoms, diseases, and medications. CDS’s contractors would have to work with the hospital to translate its data codes into the standards used by CDC’s software. According to Barry Rhodes, CDC’s associate director for technology and informatics, “To standardize the data and do all the data validation steps is a huge technological challenge”.

Roadblocks to universal acceptance Some in the medical community question whether the BioSense network is worth the effort. However, BioSense contractors, points out that a hospital’s medical staff might not know right away that there’s a serious problem when patients start showing up with symptoms. CDC scientists using the system will be in a better position to spot a major pandemic or biological or chemical attack over a wider geographic area. Having a bigger picture of what’s happening will help CDC help hospitals, police, and emergency units mobilize a better response. Although participation in Bio Sense is voluntary physicians and health officials might resent the system because it enables the federal government to encroach on what has traditionally been the domain of local health care providers and organizations. They note that they and not the CDC have the responsibility for responding to and managing a pandemic. Additionally, hospitals are reluctant to sign up because of concerns about maintaining privacy and security of patient information. BioSense would let the CDC “listen in” on their treatment of patients on a real-time basis. The CDC does not use any data that would identify individual patients.

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NEWS REVIEW

Biodesign programme to be launched in Singapore Stanford University Biodesign Program and Singapore’s Agency for Science, Technology & Research, and the Singapore Economic Development Board (EDB) have come together to develop a new training programme called Biodesign to train the next generation of Asian leaders who can develop innovative medical devices to address Asia’s growing healthcare needs. The Singapore program will provide a fellowship for four Asian fellows to go to Stanford for six months of training in the Biodesign process. First hand experience will be given to the fellows in determining clinical needs in hospitals and clinics. They will subsequently develop solutions to address these clinical needs through new medical device technologies and bring concepts to the prototype or proof-of-concept stage. These fellows will come from different disciplines (engineering, medicine, business) that represent key segments of Stanford’s Biodesign process to invent, develop, and commercialize innovative medical devices. Medical technology constitutes a key part of Singapore’s biomedical sciences sector, which comprises about 4 percent of the nation’s gross domestic product. About 600 researchers in 30 global Medtech companies are helping to put Singapore at the forefront of advances in Medtech innovation, as they seek to develop new products to address health- care needs in Asia and beyond.

Siemens signs agreement to license Microsoft HealthVault

Apollo Hospital’s plan for huge investment in two years

Microsoft Corp. and Siemens AG (through its Siemens IT Solutions and Services division) have announced the signing of a licensing agreement to introduce Microsoft HealthVault in Germany to enable its citizens to store, manage and share health data with physicians, hospitals and pharmacies. HealthVault, a personal health application platform that enables individuals to store their health information including immunizations, disease history and prescriptions in an online account and make them available to healthcare providers and family members that they select. Siemens will be the exclusive operator of HealthVault in Germany and will market the platform to developers, application providers and device manufacturers to join the service and provide citizens with tools that will help foster dynamic, trusted and personalized healthcare. Users can store information from multiple sources, including medical monitoring devices, to measure things like blood pressure, pulse and weight; diagnostic findings from general practitioners and medical specialists; imaging procedures; and training plans developed by physiotherapists and rehabilitation facilities. In addition to manually entering the information, data from certified devices can be transferred through a personal computer into HealthVault accounts using HealthVault connection Centre.

Apollo Hospitals will invest around Rs 1,800 crore in the next two years for increasing the number of hospitals under its operation to 70 with a capacity of 13,500 beds. Currently the company owns 46 hospitals under its operation with a capacity of around 8,000 beds. The plan is to increase the bed strength to about 13,500 across 70 operational hospitals in India and overseas markets according to Apollo Hospitals Group Chairman Prathap C Reddy. It also announced opening its 47th facility in Bhubaneswar. By mid-February 2010, Apollo Hospitals will open its 47th Hospital in the Temple City of Bhubaneswar (Orissa) with 300 beds, modern diagnostic equipments and super-speciality services. The hospital will be connected to international centres through a dedicated telemedicine network. Apollo has recently received USD 50-million from the World Bank arm International Finance Corporation (IFC) for expansion of its secondary care hospitals under the brand ‘Reach’. The company also announced the appointment of R Basil as the Executive President of Apollo Hospitals group who brings with him over 30 years of rich professional experience across leading organisations in India, including Manipal Hospitals, Wipro GE Medical Systems and Crompton Greaves.

Users are able to access their data virtually anytime, from anywhere, and decide for themselves who is granted access to the information. Siemens will host all stored health data in security-enhanced data centres in Germany. To help protect consumer privacy, user data is transmitted through an encrypted connection over the internet. As their own health managers, users keep control of the information stored in HealthVault and can decide the people who are permitted access. This is going to be a reliable and competent partnership that can jointly bring innovative solutions to the German healthcare system.

US hospital deploys iPhone to assist nurses Huntington Hospital in the US has deployed a new technology to relieve nurses from non-clinical duties to allow them to concentrate on providing quality patient care. The Voalte iPhone Application provides voice services, alerts and text messages for streamlined and simplified communication between staff members. The technology allows nurses to focus on patient care with fewer interruptions, optimising workflow and improving patient satisfaction and safety, the company said. Huntington’s director of informatics Ron Rutherford said that nurses in the hospital had been carrying hospital-provided pagers, wireless phones and separate pagers designed to alert them of critical patient alarms.

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NEWS REVIEW

South Asia’s first medical technology park to make quality healthcare affordable in India Trivitron has set up the first technology park indigenous manufacture of world-class medical devices at Irungattukottai, near Chennai. Technology products at the park will offer international quality yet cost effective solutions to healthcare providers. This is going to be another feather in the cap of Tamil Nadu’s healthcare system as the state is the leader in healthcare delivery in the country and is the choicest destination for international medical tourism. Trivitron Medical Technologies Park is an initiative of Trivitron Healthcare Private Ltd, one of the leading medical technology companies in India. The park aims to bring cutting edge medical technology to medical professionals across the country at affordable costs. A range of products including Ultrasound systems, Colour Dopplers, X – ray machines, C-arms , in-vitro diagnostic reagents and instruments, cardiology diagnostic instruments, critical care instruments, modular operating theatres, operating theatre lights and tables and implantable medical devices will be manufactured at the park. The first of the various facilities to be set up at the park was inaugurated by Dr. Prathap. C. Reddy, Chairman, Apollo group of Hospitals, the Aloka Trivitron Medical Technologies facility is a joint venture between Aloka, a Japan based company credited with pioneering the diagnostic ultrasound technology globally and Trivitron. With the setting up of this park the need of making quality healthcare available in the country will certainly be met. Indigenous manufacture of world class medical devices in collaboration with the best medical technology companies and research institutes in the world will spawn a new era in the spread of life saving medical technology across the country. New facilities will be set up in the park very soon by Trivitron for which the company has already entered into joint ventures with other leading international medical devices manufacturers.

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1000 crore mental health plan to address manpower shortage Manpower shortage will be met by appointing 1756 mental health worker under the initiative of ‘manpower development scheme’ of National Mental Health Programme ( NMHP). The Union Minister of Health and Family Welfare, Shri Ghulam Nabi Azad has said that 1756 mental health worker will be produced with the initiatives under ‘manpower development scheme’ of National Mental Health Programme (NMHP). Releasing the National Guidelines on Psycho Social Support and Mental Health Services in Disasters brought out by National Disaster Management Authority (NDMA), the Union Minister of Health and Family Welfare, Shri Ghulam Nabi Azad has emphasized that NMHP was re-strategized for community based approach with an allocation of Rs.1000 Crore making mental health services available at the primary care level and integrating it into general health care. In line with felt needs of the community, new components of life skill training & counselling in schools and colleges, services for homeless mentally ill, out of school adolescents, slum dwellers and other vulnerable groups have been planned. Under Centre of Excellence in Mental Health Programme, 11 existing mental health hospitals/institutes are being upgraded and strengthened to produce qualified manpower. Manpower Development scheme intends to provide Manpower in Mental Health training centers. Under this scheme Govt. will support starting PG courses or increasing the intake capacity for PG training in Mental Health, for establishing / improving department in specialities of Mental Health in Govt. Medical Colleges / Govt. General Hospitals.

Ampyra gets approval for multiple sclerosis The Food and Drug Administration(FDA), United States has approved the drug, Ampyra (generic name dalfampridine, formerly known as fampridine), which is the first Multiple Sclerosis therapy that is taken orally and the first of its kind to receive FDA approval. It is designed to help people with any type of MS improve their walking speed. Phase III clinical trials of Ampyra showed that 35 and 43 percent of patients experienced, on average, a consistent improvement in their walking speed, increasing it by about 25 percent. According to the National Multiple Sclerosis Society, even a modest improvement in walking ability could mean that thousands of people could benefit from the drug. The drug can be used by most people with multiple sclerosis according to Dr. John Richert, executive Vice President of Research and Clinical Programmes at the National Multiple Sclerosis Society. Further study and clinical practice may help to determine the extent to which the drug may impact other functions, and may also provide hints as to which patients are most likely to respond positively to the therapy. This drug would not help nerves that have been destroyed but people should try to see if it works for them. Ampyra will not work for everyone and its most likely that people will have different responses so they should consult their doctors before starting a therapy on Ampyra.

3-D view of arteries possible through technology A new technology has been tested for the first time on people which can give a 3-D image of the patient’s arteries and better treat heart diseases. The technology is in the early stages of testing according to a feasibility study published in Circulation: Cardiovascular Interventions, an American Heart Association journal. According to the cardiologists this is a very exciting technology that holds great promise. The study allows doctors to assess more accurately and rapidly the length, branching pattern and angles of heart arteries, as well as any blockages. Cardiologists currently use two-dimensional X-ray images shot from different angles to visualize arteries inside the body. They also inject contrast dye into a thin tube -- a catheter -- inserted into a patient’s leg artery and threaded up to the heart to produce shadow images during a cardiac catheterization procedure. Although it uses existing X-ray systems, the new software reduces the need for several of the images, thus reducing patients’ exposure to radiation and contrast dye while also decreasing the time doctors need to analyze the images. The comparison of 2D and 3-D computer images of the coronary artery systems will be tested in multiple centres around the world. It will be formally tested to see the impact on clinical care. Cardiovascular disease is the number one killer in the United States. According to the World Health Organisation, it is responsible for 17 million deaths worldwide.

Hospital monitors heart rates over the phone Southend Hospital in the UK has started checking patients’ heart rates over the phone. Patients with pacemakers can send information over the phone line to medics who can interpret the information. All the information is recorded on a monitor and doctors can follow up patients more closely without them coming into the hospital. Southend Hospital implants about 350 pacemakers every year.

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Delhi to get country’s one of the first 3-D dental imaging facilities Carestream Health India, the worldwide leader in digital radiology systems for medical and dental uses, announced a milestone in India with its most advanced 3D Dental Imaging machine – the Kodak 9500 3D’s installation at Diwanchand Imaging Center in Delhi. The Kodak 9500 is a flexible and easy to use 3D dental imaging system that enables dental professionals to obtain localized, high-resolution three-dimensional (3D) images, as well as panoramic examinations, at a very affordable price point – making the power and utility of 3D technology available to general practitioners and specialists alike. The Kodak 9500 3D’s installation at Diwanchand Imaging will be the first such machine to be installed in India and amongst the few worldwide.. Three-dimensional imaging in colour is now a diagnostic standard for the most complex of procedures performed by endodontists, implantologists, and other specialists. Digital 3-D imaging provides highly detailed pictures that show actual representations of the patient’s anatomy that can be viewed from any direction. Using this modality, anatomical depth and relationships between individual features can be precisely identified and measured for more accurate diagnoses and treatment. However, 3D imaging has typically been complex and expensive. Moreover, high doses of radiation were often associated with 3D imaging technology.. The Kodak 9500 3D system from Carestream Health on the other hand uses very low radiation dosage as compared to medical CT and on the other hand, it is a Large Field system allowing capture sizes that allows a field of view of the entire skull or jaw of the patient. The detailed information across a large area of view can result in less invasive surgery for tooth extractions and optimized plans for orthodontic treatment.

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Ignite acquires new gene-sequencing equipment The Ignite Institute for Individualized Health, a new medical research startup has acquired a new gene sequencing machine. The nonprofit research institute will now focus on how to personalize medical care and drug development based on a patient’s genetic makeup. It has entered into a new collaboration with Life Technologies Corp., a Carlsbad, Calif., diagnostics tools company. It has a large presence in Frederick. Life Technologies has agreed to sell 100 of its next-generation gene sequencing machines to the Ignite Institute for an undisclosed sum to be paid through the next three years. The machines will start arriving to Ignite by March 31, and they will continue to be shipped to Ignite’s temporary home at the Center of Innovative Technology headquarters in Herndon throughout the year.These machines represent Life Technologies latest advances in gene sequence analysis, allowing Ignite scientists to more precisely zoom in on the presence and cause of an individual patient’s disease based on that person’s DNA. The new product can generate up to 100 gigabases of mappable DNA sequence data at a cost of $6,000 per genome. That’s a significant discount from the roughly $3 billion it took to sequence the 6-some billion letters of the first human genome in 2000. The instrument is very revolutionary in mapping the entire human genome at just unprecedented levels of accuracy. With 100 of these sequencers, Ignite said it will house the largest concentration and highest capacity of genetic sequencing capability in North America.

Remote areas to benefit from technology Cell phone technology is being used to deliver health care to remote parts of the country. Post Graduate Institute of Medical Education and Research (PGIMER), the Chandigarh based institute, is working in collaboration with Bhabha Atomic Research Centre (BARC), on a pioneering national health care project called m-health. This Project will enable the doctors to provide medical advice to patients who are living in remote areas. It is also considered to be a promising initiative in the field of geriatric care, involving medical care for aged patients. In this project, the health worker will first take the electrocardiogram (ECG) of a patient on a battery-operated, hand-held machine. The hand-held ECG has been developed by BARC, in which by using the bluetooth technology, the health worker transfers the data to his own mobile phone. The data is then transferred to the mobile phone of a specialist who may be based elsewhere. The specialist reads the ECG of the patient and gives advice on his condition to the health worker. So, the health worker can provide correct primary care to the patient. As part of the pilot project, the ECGs of patients taken through the m-health equipment are being compared with the ECGs of the same patients taken at the hospital premise on its in-house machines. This is being done to check the efficacy of the data taken through the m-health equipment.

US unveils standards to boost e-Health records US health officials have released standards for electronic medical records to spur the development of the technology, with hopes of cutting health costs and reducing medical errors. The Centers for Medicare & Medicaid Services issued a set of standards focusing on the usefulness of electronic records to healthcare providers in managing health records. Requirements include that at least 80% of all patients who request an electronic copy of their health records receive it within 48 hours. The Health and Human Services Department issued another set of standards to enhance the interoperability, functionality, utility and security of health information technology. The standards, which are subject to a period of public comment, may affect many service providers. A final rule on standards will be issued this year.

Novartis will provide over USD 2.5 million for victims of Haiti earthquake Through its local organizations in countries throughout the region, Novartis is providing the equivalent of over USD 2.5 million in immediate emergency aid for victims of the recent earthquake in Haiti. The support includes both direct financial aid to relief agencies working in Haiti as well as donations of essential medicines, including antibiotic and pain relieving drugs. Novartis employees worldwide are encouraged to make cash contributions to internationally and nationally recognized relief organizations in support of the victims of the earthquake. These donations will then be matched by the company. Finally, Novartis will work with local authorities and aid organizations to identify where assistance can be provided on a longer-term basis to ensure that there is sustainable support for people impacted by this tragic natural disaster.

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1st International Conference on Transforming Healthcare with Information Technology The First Conference on “Transforming Healthcare with IT- 2010� is going to be held from March 8-10 at the Intercontinental Eros, New Delhi. The conference is going to be a comprehensive discussion on the adoption of Healthcare IT and industry best practices for enhanced operational efficiencies and patient care. The Conference is organized by Apollo Group along with its consortium partners CISCO, IBM and TCS. The conference brings together Policy Makers, Healthcare leaders and Technologists from across the globe, on the same platform combining the synergies of Healthcare IT and Mobile technology to bring about a more connected healthcare ecosystem. It will also address the innovations, infrastructure and information in the healthcare landscape that will proliferate, promote and propagate benefits of IT to healthcare administrators, providers and beneficiaries at the grass root level. Healthcare providers and policy makers across the globe are grappling with a deep and diverse set of healthcare challenges that cut across the spectrum. According to Ms Sangita Reddy, Executive Director Apollo Hospital Group and Advisor, this conference will address the literal healthcare jigsaw and examine how technology can be applied in different ways to facilitate communication in a highly collaborative and mobile environment like healthcare. The conference is a 3-day event, aimed at Key Healthcare decision makers, Hospitals Administrators, Doctors, IT teams. The conference will comprise of keynotes, plenary sessions, workshops focusing on Delivery in Healthcare System, Prevention & Wellness / Consumer Centricity, Emerging Markets & Emerging Technologies, Connecting the Ecosystem, Infrastructure in Healthcare System and the impact of IT and Telecom convergence-driven transformational solutions. The Conference will also showcase demos of technologydriven transformational approaches and solutions. Working groups at the three day meet will deliberate on various key issues including Uniform standards, need for National EMR etc. Noted speakers at the conference include industry luminaries like Mr. Sam Pitroda, Nobel Laureate Archbishop Desmond Tutu, Mr. Som Mittal, Prof. Ricky Richardson, Dr Prathap C reddy, Mr. Anjan Bose, Baron Nigel Crisp, Mr. Baljit Singh Bedi, Mr. David K. Aylward and Mr. Marc Probst amongst over 50 national and international speakers. Another highlight of this conference is the Healthcare awards that are the first independently audited awards by KPMG. Award categories include HIS Xcellence Awards, EMR Xcellence Awards, Healthcare ICT product innovation, Healthcare ICT Champion of the Year, Best Website (Association) and Solution with Greatest Market Potential.

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EVENTS DAIRY

4 – 5 March 2010 Cost-Effective Healthcare Conference

15 – 18 June 2010 CommunicAsia 2010

The Westin Kuala Lumpur, Malaysia

http://www.communicasia.com/

Singapore Expo, Singapore

The Westin Kuala Lumpur, Malaysia

4 – 6 August 2010 eHEALTH India 2010

4 – 6 May 2010 Qmedic Doha Exhibition Centre, Doha, Qatar

Hyderabad International Convention Centre, Hyderabad

http://www.conexqatar.com/qatarmedic/

http://www.eindia.net.in/2010/

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Health Outlook CIO Survey 2010 : February 2010 Issue