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VOLUME 4 | I S S U E 2 | F E B RUARY 2 0 0 9

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ISSN 0973-8959

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A Monthly Magazine on Healthcare ICTs, Technologies & Applications Vo l u m e 4 | I s s u e 7 | J U LY 2 0 0 9 | I N R 7 5 / U S D 1 0

COVER STORY Best of South PAGE 8

LEADER SPEAK Fostering Reforms in Indian Healthcare Dr Devi Shetty, Chairman Narayana Hrudayalaya PAGE 18

LEADER SPEAK Holistic Eye Care Dr SS Badrinath Chairman Emeritus Sankara Nethralaya PAGE 22

EXPERT CORNER Online and Mobile Healthcare Nandini Ishwarakrishnan, Research Associate, Healthcare Technical Insights Frost & Sullivan PAGE 32

Up South

SPOT LIGHT Aarogyasri Health Care Trust Pratap Vikram Singh, Correspondent, CSDMS PAGE 34

Coverage of some of the top-flight hospitals of South India, which are setting benchmarks in Indian healthcare industry. LEADER SPEAK Dr Devi Shetty Narayana Hrudayalaya, Bangalore

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U K Ananthapadmanabhan KMCH, Coimbatore

Dr K Mohandas SCTIMST, Thiruvananthapuram

Dr K Hari Prasad Apollo Hospitals, Hyderabad

Dr Prem Nair AIMS, Kochi


w w w . e h e a l t h o n l i n e . o r g | volume 4 | issue 7 | July 2009

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COVER STORY

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‘Practising medicine as it should be practised’ Rajendra Kumar, Chief of Business Development, Care Group of Hospitals

Best of South An insight into 12 hospitals based in the four southern states of India.

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Narayana Hrudayalaya, Bangalore & Wockhardt Hospitals, Bangalore

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Manipal Hospital, Bangalore & KIMS, Thiruvananthapuram

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AIMS, Kochi & SCTIMST, Thiruvananthapuram

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Care Hospitals, Hyderabad & Apollo Hospitals, Jubilee Hills, Hyderabad

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L V Prasad Eye Institute, Hyderabad & CMC, Vellore

17 Sankara Nethralaya, Chennai & KMCH, Coimbatore

Dr K Hari Prasad, CEO, Apollo Hospitals

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Innovating Technologies for Low-cost Healthcare Dr K Mohandas, Director, Sree Chitra Tirunal Institute for Medical Sciences & Technology

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EXPERT CORNER

Online and Mobile Healthcare Nandini Ishwarakrishnan, Research Associate- Healthcare, Technical Insights, Frost & Sullivan

Fostering Reforms in Indian Healthcare Dr Devi Shetty, Chairman, Narayana Hrudayalaya

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Setting New Trends in R&D Dr Prem Nair, Medical Director, Amrita Institute of Medical Sciences

LEADER SPEAK

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Apollo City: One-stop Healthcare

Towards Patient-centered Care U K Ananthapadmanabhan, President, Kovai Medical Center and Hospital

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SPOT LIGHT

‘Aarogyasri’ - revolutionising public health through conviction and innovative ICT application Pratap Vikram Singh, Correspondent, CSDMS

REGULAR SECTIONS 22

Holistic Eye Care Dr S S Badrinath, Chairman Emeritus, Sankara Nethralaya

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

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

BOOK REVIEWS should include details of the book like the title, name of the author(s), publisher, year of publication, price and number of pages and also have the cover photograph of the book in JPEG/TIFF (resolution 300 dpi). Book reviews of books on e-Health related themes, published from year 2002 onwards, are preferable. In the case of website, provide the URL. THE MANUSCRIPTS should be typed in a standard printable font (Times New Roman 12 font size, titles in bold) and submitted either through mail or post. RELEVANT FIGURES of adequate quality (300 dpi) should be submitted in JPEG/ TIFF format. A BRIEF BIO-DATA and passport size photograph(s) of the author(s) must be enclosed. All contributions are subject to approval by the publisher.

Please send in your papers/articles/comments to: The Editor, eHealth, G-4, Sector 39, NOIDA (UP) 201 301, India. tel: +91 120 2502180-85, fax: +91 120 2500060, email: info@ehealthonline.org, www.ehealthonline.org

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EDITORIAL Volume 4 | Issue 7 | July 2009

Up to the South ! PRESIDENT

Dr. M P Narayanan EDITOR-IN-CHIEF

Dr. Ravi Gupta PRODUCT MANAGER

Dipanjan Banerjee mobile: +91-9968251626 email: dipanjan@ehealthonline.org SR. CORRESPONDENT

Harsha Chawla email: harsha@ehealthonline.org SALES & MARKETING

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

Bishwajeet Kumar Singh GRAPHIC D ESIGNER

Om Prakash Thakur WEB

Zia Salahuddin SUBSCRIPTIONS & CIRCULATION

Manoj Kumar (+91- 9891752931) manoj@ehealthonline.org 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. The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided.

That South India is a favourite to foreigners, lair of the geeks’ and erudite academicians is too old a story. But, before I delve into the other facet of Dakshin Bharat I would like to take my readers quickly through some of the findings of a recent report on the imbalances in the health status across Indian states. The report ‘Governance of the Health Sector in India: Has the state abdicated its role?’ released by the Independent Commission on Development and Health in India and published by the Voluntary Health Association of India says that Kerala, Maharashtra, Himachal Pradesh and Tamil Nadu that account for 18.8 per cent of the country’s population have health indicators similar to those in middle-income countries, such as, Venezuela, Argentina and Saudi Arabia. Whereas BIMARU-plus states (Bihar, Jharkhand, Madhya Pradesh, Rajasthan, Uttar Pradesh, Orissa and Assam) that comprise nearly 42 per cent of the population have indicators which are close to those in sub-Saharan African countries. It didn’t come as a surprise during the research work that the four southern states hold a unique position in the landscape of Indian healthcare by having better IT-enabled hospitals than in any other part of the country. Some of them were truly paperless hospitals, with Kerala and Tamil Nadu leading the race. Not just that, most of them are leaders in different spaces like R&D, Health IT, CSR, medical tourism, highly-specialised surgical procedures, etc. In this edition of eHealth, we offer a glimpse of some of the rising southern stars of Indian healthcare. It was a daunting task to cherry-pick 12 hospitals among the four Southern states of India. Therefore, we narrowed the parameters and, finally, included those who were spearheading the Health IT and patient-centered initiatives in their respective states. However, apart from being in the forefront of adopting latest technologies, the chosen hospitals provide quality healthcare services too. And, again not surprisingly– the four southern states have 63% of the nation’s medical colleges and 67% of the total seats–some of them are the famed medical colleges of India. And, because of the presence of the best clinical acumen, owing to the notable medical colleges, these states also have many firsts to their credit, such as, establishing the first corporate hospital in India, performing the first heart transplant surgery and the first paediatric heart and lung transplant surgery. Most of you must be aware about our upcoming annual conference and exhibition – ‘eHEALTH India 2009’, scheduled between 25-27 August at the majestic Hyderabad International Convention Centre. Following the resounding success of our last two events (in ‘07 & ‘08), we are once again gearing up to present you with yet another power-packed three days of conferencing and technology showcase – dotted with highly insightful sessions and panel discussions with some of the leading Indian eHealth experts, practitioners and institutions. See you there.

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

Dr. Ravi Gupta Ravi.Gupta@ehealthonline.org

July 2009

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COVER STORY

Best of South Coverage of some of the top-flight hospitals of South India, which are setting benchmarks in Indian healthcare Industry

It is the four southern states of Tamil Nadu, Karnataka, Andhra Pradesh and Kerala where outstanding innovations in healthcare are taking place. South India stakes claim to some of the best Indian healthcare achievements: home to the world’s biggest chain of eye hospital, millions of medical tourists flock to get a low-cost treatment, innovative surgical procedures like first ‘awake surgery’ and provision of free care for poorest patients, to name a few. Some of the disciplines for which South India is renowned worldwide are: Cardiology and Cardio-thoracic surgery, Pediatric Neurosurgery, In-Vitro Fertilization, Dental Care and Cosmetic Surgery, Orthopedic Treatment and Renal and Bone Marrow Transplants, Ophthalmology and LASIK surgery, Neurology, Shoulder, Hip and Knee Replacement surgery and Hematology. This issue, we give you an insight into the 12 hospitals based in Kerala, Tamil Nadu, Karnataka and Andhra Pradesh, which are among the top hospitals in South India in terms of adoption of technologies, cheaper treatments, R&D initiatives, sustainable business models, patient friendliness, IT usage and automation. 8

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COVER STORY: SOUTH INDIA SPECIAL

Narayana Hrudayalaya, Bangalore E

stablished in 2001, Narayana Hrudayalaya is a 1000-bed multispecialty hospital located in the outskirts of Bangalore. The hospital receives about 800 patients everyday. The hospital is known for providing affordable health care facilities to the needy. Narayana Health city was conceptualised six years ago by creating a conglomeration of hospitals in one campus with a 1000 bed heart hospital called Narayana Hrudayalaya, 500 bed orthopedic hospital called Sparsh Hospital, 300 bed eye hospital with the infrastructure to perform 500 cataract surgeries everyday and 1400 bed cancer hospital a joint venture of Narayana Hrudayalaya with Kiran Mazumdar of Biocon. Projects in the making are a 500-bed Neuro hospital, 500-bed kidney hospital and a women and children hospital. Narayana Hrudayalaya group

has two heart hospitals in Bangalore and Kolkata which perform about 10 per cent of the heart surgeries done in the country. In Bangalore, the hospital has an infrastructure to perform 30 major heart surgeries in a day and in Kolkata 10 major heart surgeries in a day. Narayana Hrudayalaya conducts 49 training programmes and is short-listed by the University Grant Commission for the status of the Deemed University. In 2003, Narayana Hrudayalaya in association with the state government launched a micro health insurance programme called Yeshaswini, which covers the healthcare of nearly 3

million farmers and is considered as India’s largest Micro Health Insurance Programme for a monthly premium of 10 rupees. Narayana Hrudayalaya in association with India’s Space Research Organization runs one of World’s largest Tele-Cardiology programmes using ISRO satellite and have treated close to 30,000 heart patients.

Wockhardt Hospitals, Bangalore F

ounded in 2006, Wockhardt Hospitals, Bangalore, is a 400 bedded multi-speciality hospital with state of the art facility equipped with latest technology and clinical talent dedicated to the whole range of Cardiac, Orthopedic, Neurosciences, Minimal Access Surgery and Women and Child Services. Wockhardt Hospitals operates a chain of super-specialty hospitals in Mumbai, Bangalore, Hyderabad, Kolkata, Rajkot, Surat and Bhavnagar. Wockhardt Hospitals, Bangalore, has become the first super-speciality hospital in South Asia to achieve accreditation from Joint Commission International (JCI), USA. With this, Wockhardt Hospitals joins an exclusive group of 71 hospitals worldwide, which have passed JCI’s stringent clinical quality standards. The hospital is the first in South Asia to be recognised by the American Blue Cross and Blue Shield association in its worldwide

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network of participating hospitals. It is recognised by 17 leading insurance providers across the globe, including CIGNA. Wockhardt Hospitals has an exclusive association in India with Harvard Medical International, the global arm of Harvard Medical International, and is a treatment destination for patients from US, UK and other European Countries besides South Asia, South East Asia, Middle East and Africa. The hospital has centers of excellence in Cardiac Care, Bone and

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Joint, Minimal Access Surgery, and Brain and Spine. A centre of excellence in Interventional Cardiology and Cardiac Surgeries is a preferred destination for adult and pediatric cardiology and cardiac surgeries. The hospital provides treatment on the entire gamut of cardiac diseases from newborn to adolescent. The hospital has set benchmark in heart surgery by successfully performing the first Awake Minimally Invasive Heart Valve Repair Surgery in the country. The Wockhardt’s Bone and Joint Care has evolved as the centre of excellence for joint replacement surgeries and is equipped to treat all types of musculo-skeletal problems ranging from surgeries to minimally invasive arthroscopic surgeries. The hospital also specilalises in surgery for joint replacements, sports medicine, spine surgery and physical therapy for rehabilitation.


COVER STORY: SOUTH INDIA SPECIAL

Manipal Hospital, Bangalore M

anipal Hospital, Bangalore, is the flagship hospital of Manipal Health Systems (MHS). It is a 600 bedded hospital and plans to add another 300 beds soon. Today, the hospital has over 22 specialties and over 60 sub and super-specialities. Some of the centers of excellence are: MILDD (Manipal Institute of Liver and Digestive Disorders), MHI (Manipal Heart Institute), MINU (Manipal Institute of Nephrology and Urology), MIND (Manipal Institute of Neurological Disorders), Manipal Comprehensive Cancer Center and MARS (Manipal Andrology and Reproductive Services). MILDD has been one of the few institutes in India who have successfully conducted living liver related donor transplants. MHS has 18 units operating all over India. To name a few--Vizag, Vijayawada, Manipal, Mangalore, Bangalore (4 units), Tumkur, Salem, Kasargod, Udupi and Goa.

The Manipal International Patient Care Cell caters to the needs and requirements of the international patients, right from looking into their medical query and providing them full support in acquiring a medical visa. The patients are assisted throughout their stay at the hospital. The hospital has a telemedicine facility which enables people from rural areas to consult with doctors from Manipal Hospital via an online system. This project was initiated in Andhra Pradesh. Manipal Hospital is one of the few centers in India where Mesenchymal Stem cells clinical trial and experimental therapy is done. Also, Manipal Hospital is one of the few

integrated development centers (IDC) in the world for GE. New GE coils and sequences are tested and validated at the hospital before release. Hospital’s casualty is fully equipped to deal with all types of emergencies and has the full support of the intensive care units (ICU) in their respective areas of expertise.

KIMS, Thiruvananthapuram E

stablished in January 2002, Kerala Institute of Medical Sciences (KIMS) is a 450-bed multi-specialty tertiary care hospital. Over the years KIMS has emerged as one of the leading centres of pioneering medical work, research and academics in South India with a global outreach. KIMS has over 40 specialities backed by comprehensive, best-in-class technology and welltrained para-medical staff. Some of the advanced facilities available at the hospital are: Cardiology and Cardiovascular surgery, Orthopaedics and Joint Replacements, Neurology and Neuro surgery, Cosmetic Surgery, Cochlear Implant, Dental Procedures, Keyhole surgery, Cataract Surgery, Sleep Lab facility and Phonosurgery. Accredited by the National Board of Hospitals and Healthcare Providers (NABH) and the Australian Council on Healthcare Standards International (ACHSI), KIMS is the only hospital

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in India with both national and international accreditations. The hospital has dedicated intensive care units and nine state-of theart operation theatres and provide round the clock emergency, laboratory, diagnostic and pharmacy services KIMS International Patient Relations Department offers international patients worldclass treatment, personalised attention and a comfortable stay. Air-conditioned deluxe rooms and suites with telephone, television and internet are available to the patients. Our plush designer rooms on the executive floor offer luxury to our discerning patients. KIMS with its sister concern “The Great India Tour Company” offers extremely cost effective packages for a variety of ailments and a choice of tourist destinations for recuperation.

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KIMS Ayurveda compliments the healing environment by ensuring the goodness of Ayurveda. KIMS was awarded the stable rating by CRISIL for best financial reporting in the year 2008 and AV Gandhi Memorial Award 2007 and 2008 for excellence in Cardiology.


COVER STORY: SOUTH INDIA SPECIAL

Amrita Institute of Medical Sciences, Kochi A

mrita Institute of Medical Sciences and Research Centre (AIMS) is a 1250-bed hospital spread over 94 acres of land. The hospital supports a daily patient volume of about 1400 outpatients and with a 95 per cent inpatient occupancy. Annual patient turnover touches a figure of over 4,60,000 outpatients and nearly 40,000 inpatients. AIMS infrastructure offers extensive facilities comprising 25 modern operating theatres, 210 equipped intensive-care beds, a fully computerised and networked Hospital Information System (HIS), a fully digital radiology department, a 24/7 telemedicine service and a NABL accredited clinical laboratory. AIMS has computerised nearly every aspect of patient care including all patient information, lab testing and radiological imaging and has more

than 1300 computers. The Amrita Vishwa Vidyapeetham University has four main campuses at Amritapuri, Bangalore, Coimbatore and Kochi. The medical college campus is attached to AIMS in Kochi. Educational programmes are offered in Medicine, Dentistry, Nursing, Pharmaceutical Sciences and Paramedicine both at graduate and post-graduate levels.

AIMS has been awarded research protocols from funding agencies such as the Department of Biotechnology (GOI), the Department of Science and Technology (GOI), the Indian Council of Medical Research, and the State Department of Science, Technology and Environment. AIMS is involved in multi-centred international clinical studies. Doctoral-level research facilities are available in certain areas of basic medical sciences and epidemiology. The present areas of advanced clinical research at AIMS include: Molecular Biology, Molecular Medicine, Nano Medicine, Biodegradable Stent, Heart Muscle Disease, Tumour Immunology, Vulnerable Plaque Recognition and Management, Studies on Tropical Pancreatitis & Hepatitis B.

SCTIMST, Thiruvananthapuram S

ree Chitra Tirunal Institute for Medical Sciences & Technology has a 239-bedded hospital for tertiary care of cardiovascular and neurological diseases, a biomedical technology wing with facilities for developing medical devices from a conceptual stage to commercialisation, and a center of excellence for training and research in public health. It is an Institute of National Importance established by an Act of the Indian Parliament. All the departments in the hospital have up-to-date facilities for diagnosis and treatment including doppler echocardiography, cardiac catheterisation with digital subtraction angiography, CT scan, MRI facility, interventional radiologic procedures, balloon and laser angioplasty, surgery for intracranial vascular lesions, and open heart surgery for congenital and acquired diseases of the heart. The hospital has recently started

an epilepsy care programme which provides precise diagnosis, optimal drug therapy and appropriate counselling to patients with epilepsy. All the services are offered free of charge to the poor patients and at subsidised rates to low and middle income groups. The Biomedical Technology Wing of Sree Chitra has played a pioneering role in the establishment of a medical device industry base in India by successfully developing and transferring technologies for diverse

medical products, such, as disposable blood bag system, mechanical heart valve prosthesis, blood oxygenators, ophthalmic sponge, concentric needle electrode and hydroxyapatitebased biocermaic porous granules. The institute holds a number of international patents for devices and processes. The institute has the status of a university and offers post-doctoral, doctoral and postgraduate courses in medical specialties, public health, nursing, basic sciences and health care technology. It is a member of the Association of Indian Universities and the Association of Commonwealth Universities. The Achutha Menon Centre for Health Science Studies (AMCHSS) is a health sciences wing of the Sree Chitra. The AMCHSS offers an international Master of Public Health (MPH) programme, short courses and Ph.D. programme. July 2009

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COVER STORY: SOUTH INDIA SPECIAL

Care Hospitals, Hyderabad I

n 2000 the Care Group of Hospitals, owned by Quality Care India Limited (QCIL), acquired a five-star hotel premises at Banjara Hills, Hyderabad and converted it into 200-bed multi-specialty hospital. Today, the hospital stands tall with 430 beds, including 120 critical care beds, with annual inflow of 1, 80,000 patients for consultations, and 16,000 patients for admission. Care Hospital, Banjara Hills, is the flagship hospital of Care Group and comprises contemporary accommodation facilities ranging from general wards to super deluxe rooms. With more than 150 specialist physicians, the hospital provides specialty medical services in cardiology, cardio-thoracic surgery, pediatric cardiology, pediatric cardio-thoracic surgery, neurology, neuro surgery, nephrology, urology, internal medicine, gastroenterology, pulmonology, ENT, orthopedics, organ transplants etc round the clock.

The hospital is equipped with stateof-the-art equipments and has 10 operating rooms catering around 1700 cardiothoracic surgeries and 5000 noncardiac surgeries annually. Over 4000 cardiac interventions are carried out in the advanced cathlabs every year. The hospital also acquired the first

dual source, 128 slice CT scanner (for high precision cardiac imaging), the first of its kind in South India. Care Hospital, Banjara Hills, also has the reputation of being the first hospital to launch online telemedicine services which links various district hospitals.

Apollo Hospitals, Hyderabad A

pollo Hospitals, Jubilee Hills, Hyderabad is a 550-bed tertiary care centre. Spread over a campus area of 35 acres, the hospital has a built-up area of 190,000 square feet with over 50 medical and surgical disciplines. Its services are supported by sophisticated technology and experienced medical professionals. The hospital was the first in India to install a PET Scanner in 2005. The average staff to patient ratio for the hospital is 3:1 with a 1:1 ratio prevailing in priority areas like the Intensive Care Unit and the Cardiac Care Unit. The hospital receives close to 100,000 patients a year coming from Tanzania, the USA, the UAE, Kenya, Oman and neighbouring Asian countries. Apollo Health City, Hyderabad, is the first health city in Asia and is a perfect example of an integrated healthcare system offering solutions across the healthcare space. It has a

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a multi-specialty hospital with over 50 specialties and super-specialties, 10 centers of excellence, education, research, information technology. Apollo Health City, Hyderabad, covers the entire spectrum to illness to wellness and is thus a health city and not a medical city. Institutes for Heart Diseases, Cancer, Joint Diseases, Emergency, Renal Diseases, Neurosciences, Eye and Cosmetic Surgery are all centers of excellence and are positioned to offer the best

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care in the safest manner to every patient. Apart from patient care, each of these centers of excellence spend a significant amount of time in training and research essentially aimed at preventing disease and improving outcomes when the disease does occur. Also, the Center for Innovation at Apollo Health City, Hyderabad, continuously works on identifying newer applications that would benefit both the sick and the healthy.


COVER STORY: SOUTH INDIA SPECIAL

LV Prasad Eye Institute, Hyderabad S

tarted in 1987, L V Prasad Eye Institute (LVPEI), Hyderabad, is a comprehensive eye health facility with 73 beds. The LVPEI has two tertiary centres in Bhubaneswar and Visakhapatnam, and 72 secondary and primary care centres that cover the remotest rural areas in the state of Andhra Pradesh, India. The Andhra Pradesh centers alone have provided eye care to 1.5 million outpatients and over 50 per cent of these have received treatment free of cost. And, more than two thirds of 150,000 surgeries performed at the hospital have been without charging the patients. LVPEI also plays a key role in monitoring the quality of cataract surgery in 80 Rotary hospitals in the country. The LVPEI is a non-profit organisation governed by the Hyderabad Eye Institute (HEI) and the Hyderabad Eye Research Foundation (HERF). The mission of the institute is to provide affordable and competent

eye care to all sections of society. Therefore, the institute focus on economically disadvantaged groups, including both the rural and the urban backward classes and extend their services to them through satellite clinics and rural affiliates. LVPEI’s innovative and comprehensive approach to community eye health, known as the LVPEI Eye Health Pyramid, has been adopted as a model by the Government of India and by other developing countries. LVPEI is also a World Health Organization Collaborating Center for Prevention of Blindness. In the past 22 years LVPEI has provided outpatient services to 4

million people and surgical care to over 400,000 patients – 50 percent of them free, regardless of complexity. The institute has trained over 10,000 eye care personnel from India and abroad.

Christian Medical College Hospital, Vellore E

stablished in 1918, Christian Medical College Hospital or CMC, a 1800-bed hospital located in the city of Vellore, Tamil Nadu, receives about 4500 patients everyday. Founded by Ida S. Scudder, CMC Hospital occupies a prominent place among the medical institutions in India. It’s a leading referral tertiary care hospital attending to the needs of the underprivileged. The hospital performs the maximum number of bone marrow transplantations in the country. As a pioneer in live liver transplantation, it has conducted 20 such transplantations so far. Also, it runs 50 telemedicine centres throughout the country. CMC has been given a five star rating by the National Assessment and Accreditation Council, an autonomous

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institution of the University Grants Commission, in recognition of its quality of medical education and health care. CMC has been categorized as a super-speciality teaching hospital of the highest quality and assigned the H1 grading by the Investment Information

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and Credit Rating Agency (ICRA) Ltd. The H1 grading implies that the institution has resources and processes consistent with those required to deliver the highest quality of care. At present, there are postgraduate diploma courses in 11 specialities and postgraduate degree courses in 35 specialities. This institution has been a pioneer in India in the development of higher specialities like cardiology, Thoracic Surgery, Neurology, Neurosurgery, Urology, Nephrology, Endocrinology, Gastroenterology and Haematology.


COVER STORY: SOUTH INDIA SPECIAL

Sankara Nethralaya, Chennai I

ncepted in 1978, Sankara Nethralaya, Chennai, receives 1500 patients and performs about 120 surgeries a day. Sankara Nethralaya, run by Medical and Vision Research Foundation, has achieved distinction in providing state of art care in Vitreo Retinal diseases, Glaucoma, Keratoplasty, etc. The institution has introduced many innovative ophthalmic procedures for the first time in India. Likewise upgradation of instruments and equipments has kept the institution technologically in the forefront. Sankara Nethralaya has five campuses in Chennai. The hospital has 85 full time ophthalmologists working under one roof. Of the 120 surgeries performed at the hospital in a day, 35 per cent are done free of cost. Of the free surgeries 20 per cent are for complicated conditions like Glaucoma, Corneal transplants, Paediatric and Vitreo-retinal surgeries. Each day over 40 patients are seen

in the Contact lens clinic. Each day, over 250 special procedures like OCT, Yag Laser, Visual Fields etc are done at the hospital. Sankara Nethralaya has implemented rural teleophthalmology project which has also helped in increasing the awareness about eye care and eye diseases amongst the rural uneducated population. Sankara Nethralaya is the first eye Hospital in Asia to get ISO 9001-2000 certification. The Hospital has obtained the re-certification from Bureau Veritas— a certification in the fields of Quality, Health, Safety, Environment, and Social Responsibility (QHSE-SR). The Hospital has recently received NABL certification for its laboratory services. Vision Research Foundation, a sister organisation working in tandem with the Medical Research

Foundation, started functioning from the main campus from 1983. The Vision Research Foundation does research in both clinical and basic sciences applicable to Ophthalmology and vision sciences. It is an institution of national importance according to the Dept. of Science and Technology, Government of India.

Kovai Medical Center, Coimbatore K

ovai Medical Center and Hospital (KMCH) is a 500-bed multidisciplinary, super-specialty hospital located in Coimbatore. The hospital has more than 50 medical disciplines and over 1000 patients are treated every day at the hospital. KMCH is equipped with 11 operation theatres, and super-speciality procedures like open heart surgeries and other cardiac surgeries, kidney transplants, knee replacements, hip replacements and complex brain surgeries are done regularly at the hospital. KMCH is recognised for organ transplant programmes by the Government of Tamil Nadu. Several Kidney transplants and corneal transplants from live donors and cadavers have been done. KMCH also provides treatment of Stroke Management and Uterine Fibroids with the latest technique in Interventional procedures. The state-

of-the–art fertility center at KMCH is well-equipped to do the Assisted Conception Program like IVF, ICSI. There are four satellite centers attached to KMCH: City Center, Erode Center, Erode Speciality Hospital, and Perundurai Center. KMCH has a rural health center at Veeriampalayam to serve the rural community and the underprivileged. KMCH in collaboration with the

Rotary clubs of Coimbatore and Erode have 5 Trauma Care Centers, which operates round the clock and are equipped with wire-less, telephone and mobile phone facilities. In order to ensure immediate transportation of the patient from the accident spot, KMCH has an emergency control room facility, which operates round the clock to co-ordinate all Trauma Care Centers established by KMCH. July 2009

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COVER STORY: LEADER SPEAK

Fostering Reforms in Indian Healthcare Established in 2001, Narayana Hrudayalaya, Bangalore, is a 1000-bed hospital spread over 25 acres. It’s known around the world for subsidised healthcare services for the needy, unique micro health insurance scheme and renowned cardiac surgeon cum social entrepreneur of the country Dr Devi Prasad Shetty. The hospital receives about 800 patients a day and performs the largest number of heart surgeries on children in the world. In an interview with eHEALTH, the incorrigibly optimistic Dr Devi Shetty, Chairman, Narayana Hrudayalaya Pvt. Ltd (NHPL) group of hospitals, talks about the great strengths of the Indian healthcare system and the policy changes it requires to emerge as the largest healthcare provider in the world. Excerpts:

Could you detail upon the remarkable achievements of Narayana Hrudayalaya in recent years? Narayana Hrudayalaya is the world’s largest heart hospital performing over 50 heart surgeries a day. We are the only hospital in Asia doing artificial heart transplants. And, a month ago we performed a heart surgery, known as Norwood procedure, on a three-dayold baby.

What has been your most recent professional milestone? Nowadays, I am concentrating on a surgical procedure in which the entire Aorta can be replaced from the body. I strongly believe that Aorta is disposable and can be replaced with a pipe if damaged. At NH, we have replaced several patients’ Aorta.

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meet the requirements of a developing country like ours where majority of the people cannot afford healthcare services. We require 3000 to 5000bed hospitals for volume-based cost reduction in health care facilities. In a 5000-bed facility, the blood bank and other medical facilities are shared among a huge number of patients than in a 200-bed hospital. For example, on an average a 200- bed hospital does about 200 MRI scans in a day and charges at least 5 to 10 thousand rupees per scan. Whereas if you do around 500 MRI scans in a 5000-bed hospital, each MRI woul cost a few hundred rupees.

Why do you believe that health cities can alone meet up the health requirements of our country?

Your hospital conducts the largest number of cardiac surgeries in the world and you are the only hospital providing the cheapest cardiac care for the needy - 65, 000 for an open heart surgery - without compromising on the quality. How have you made it possible?

Hospitals with 200 or 300 beds cannot

By having a team of passionate doctors

July 2009

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who believe in the cause of treating patients with great compassion. You will find medical professionals who after reaching a level of excellence acquire a degree of eccentricity, and it’s not the money or fame they work for. It’s something else. At Narayana Hrudayalaya, we try to give them that. And, that’s the reason our attrition rate is zero at the senior level.

Could you explain how Indian health care system be reformed if the government becomes a health insurance provider than a health care provider? The reason why Indian Government doesn’t run IT companies is that it is a complicated business. It is a knowledge-based industry where a company has to be extremely flexible, as it depends on the abilities of highlyskilled manpower. And, if you lack the flexibility and uniformity in your work you can never build centres of excellence. Think about the healthcare


COVER STORY: LEADER SPEAK industry which is hundred times more complicated than other businesses. For instance, in our hospital a technician with a B.Sc. degree, who runs a heart lung machine, draws an annual salary of 3 lakhs. How would you justify his remuneration unless you value his skills? So, the government instead of becoming a healthcare provider should become a health insurance provider. We have already shown to the world through Yeshasvini that you can run a health insurance scheme on a premium of 5 rupees a month. Today, five million farmers are covered under Yeshasvini. And, the Government of Karnataka in coming days plan to cover 60 per cent of the state population under the scheme.

How can the Indian health care industry be transformed into a biggest employer? Indian healthcare industry can emerge as the largest employer not just in the country but also in the world like the British Health care system, Indian Railways and the Chinese Army, provided we enforce the required regulatory reforms. Consider this: for a 2 crore turnover the Indian IT industry employs about 5 to 7 engineers coming from middle class and upper class strata of society. Whereas for a 1 crore turnover, the Indian healthcare industry employs about 200 people comprising of nurses and class 4 employees. Healthcare is the only industry which is poised to take up the responsibility of accommodating a large workforce of highly-skilled and semi-skilled people.

Besides the health insurance coverage, what reformations can make health care accessible to the poor masses? Government should encourage and support industries to build a large number of hospitals all across the country. Unlike other industries, health care industry is very sensitive to volumes. Say, for example, the cost of manufacturing an antibiotic tablet is less than a rupee, but a patient buys it at 300 rupees. So, what makes its price so high? It’s not the cost of the chemical which the antibiotic contains, but the R&D cost that goes into finding that particular chemical by the scientists.

Narayana Hrudayalaya, Bangalore

I believe that India will become the first country in the world to dissociate healthcare from affluence. In our lifetime we will see millions of people, still living in slums with no running water or sanitation, but when they are unwell, they will have access to high-tech healthcare like an American or European citizen. And, the reason the R&D cost per tablet is so high is because, at present, there are a few takers. But, once a few million start buying it the price will come down significantly. Therefore, the only way to bring down the cost of health care is to have more beds, more OTs and more surgical procedures.

Where do you see the Indian healthcare industry in a few years from now? I believe that India will become the first country in the world to dissociate healthcare from affluence. In our lifetime we will see millions of people, still living in slums with no running water or sanitation, but when they are unwell, they will have access to high-tech healthcare like an American or European citizen. You will see slum dwellers living with artificial hearts which a few Americans may afford. This can only happen in India because we produce the largest number of doctors, nurses and medical technicians in the world. We have everything required to dramatically change the way health care is delivered. The only missing link is money. Once that is replaced by health insurance sponsored by the Government there will be a big transformation.

What challenges does the hospital face in achieving its goal of 30,000 bed strength in various centres across the country? There is no great challenge except the finances.

What are the plans ahead? We have hospitals in Jaipur, Kolkata, Jamshedpur, Hyderabad, Ahmedabad and we are planning to come up in tier2 cities. July 2009

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Towards Patient-centered Care Established in 1990, Kovai Medical Center and Hospital is a 350-bed super-facility corporate hospital located in Coimbatore on a sprawling 20 acre site. It has over 50 medical disciplines with 100 full-time medical consultants,11 operation theatres with the most modern medical equipment, such as, 64 slice CT, cathlab, state-of-the-art laboratory equipment and EBUS equipment. KMCH has been a forerunner in adopting technology in diagnosis, treatment and and in every facet of hospital’s operation to optimise cost and improve delivery of care to patients. In an interview with eHEALTH, U. K. Ananthapadmanabhan, President, KMCH, talks about recent health initiatives taken by the hospital and how technology has revolutionised healthcare in the country and around the world. Excerpts:

What are Kovai Medical Center and Hospital’s significant achievements in recent years? Dr Nalla G Palaniswami, Chairman, KMCH, established the hospital in 1990 with 250 beds and 17,000 shareholders. We became the second corporate hospital in the country and the first such hospital in a second-tier city like Coimbatore. We added 100 beds in the year 2000 along with other satellite centers in the Coimbatore district. We are in the middle of a huge expansion involving an addition of 250 beds, 10 more operation theatres, cancer therapy units with Linac and PET scan equipment, with cost outlay of more than 200 crores. The work is expected to complete by 2010, which will make Kovai Medical Center and Hospital one of the largest hospitals in the corporate sector in Southeast Asia.

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Currently, we treat over 1000 inpatients and outpatients a day and it is expected to double in the next two years. We are getting a large number of patients from north-eastern states like Meghalaya ,Assam ,Tripura and Manipur and their number is increasing by about 20 to 30 per cent every year. The patronage from the local districts has been overwhelming due to which patient load has tremendously increased during the last 5 to 6 years. We have now emerged as one of the leading centers in Intervention Radiology in the world and a teaching centre in this discipline. We have expert consultants who perform Single Incision Laproscopic Surgeries (SILS) and Endoscopic Spine Surgery and Spine Correction Surgery involving 20 to 22 hours of meticulous surgical work, which very few hospitals in the country are doing.

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What has been your most recent professional milestone? I distinctly remember 20 years ago we did most of our transactions like billing, registration, taking in diet order or sterilisation of linen manually, but over the years I have been able to automate every transaction in the hospital. And, I have been mentoring many of my junior colleagues in adopting the latest technologies in their hospitals. I feel very proud when doctors, administrators and patients tell me that our hospital is one of the finest hospitals in terms of care, treatment, technology and cost-effectiveness. To me it is a constant learning process by visiting hospitals, conferences and writing examinations and teaching.

What have been the important initiatives on the Health IT front in the past two years?


COVER STORY: LEADER SPEAK Our hospital is truly a paperless hospital where all the laboratory equipment like auto analyzers, blood gas analyser, blood cell counters are networked. Central sterilisation equipments are also completely automated. Pharmacy, laboratory, dietary requests etc are done through computer network without involving any paperwork. We have empowered the patients by providing touch screen facilities at various locations within the hospital premises. The touch screen information facility provides various details like general enquiry, facilities of KMCH, tariff etc. An in-patient can also view billing information and medical details with his unique identification number. We are now working on providing a facility to order meals through the mobile phone. We have also focused our attention on energy management which involves energy monitoring, energy conservation and use of alternate sources of energy. We have installed 14,000 litre solar water heating system which has resulted in huge saving in energy costs and has also provided 24hour hot water supply to the patients. We have connected all our high energy loads to a Local Area Network (LAN) through which we monitor various electrical parameters like voltage, current , power factor, energy consumption. By this we have saved Rs 10 lakhs in a year on energy. The cost of this solution has been a fraction of the savings made last year. In appreciation of this work, we were awarded ‘The Most Eco-friendly Hospital Building of the Year’ by the RACC Association and the British scholars of India.

Any new initiatives taken by the hospital in academics? Ever since the hospital started, teaching, training and research have been part of our clinical practice. KMCH has post-graduate DNB programmes in various disciplines like radiology, cardiology, anesthesiology, cardio thoracic surgery, ENT, germedicine and surgery, orthopedics, paediatrics and obstetrics and gynaecology. Hospital under its research and education trust has graduate and post-graduate programmes in all paramedical disciplines like physiotherapy, occupational therapy,

Indian Government should realise that it is not possible for them to develop infrastructure and talent pool to cater to the needs of 1.3 billion people of the country and, therefore, allow more privatepublic partnership in building up Indian health care delivery system. nursing, pharmacy. Apart from these programmes we also have skill development programmes at the level of the technicians like respiratory therapy programme, operation theatre technician programme, dialysis technician programme and so on. To promote professional hospital management we also have postgraduate programmes in hospital administration affiliated to the state university at Coimbatore.

What challenges does the hospital face in achieving its goals? The biggest challenge that the hospital face is the non-availability of skilled manpower at all levels. Today, majority of the skilled manpower prefers to work in metropolitan cities because of which availability of manpower is in shortage in tier 2 and 3 cities. The other challenge that the hospital face is the high cost of medical equipment, and the rate of obsolescence in the medical equipment which puts tremendous pressure on the overall cost of medical treatment.

According to you, what are the reforms needed in the Indian healthcare industry? Firstly, there is a need to bring a change in the mindset of people. People should see healthcare as a service that needs to be paid for. And, the government should realise that it is not possible for them to develop infrastructure and talent pool to cater to the needs of 1.3 billion people of the country and, therefore, allow more private-public partnership in building up Indian health care delivery system. Health care must be treated as a priority sector and certain facilities like lower electricity tariff, land at subsidised rates should be provided. Tax sops, custom duty exemptions must be liberally provided to individuals and institutions coming forward to establish accredited hospitals. Lastly, efforts must be taken to promote indigenous manufacturing of medical equipments which make medical care very expensive to the common man. Government should universalise health insurance for BPL families and also promote medical insurance in the private sector by allowing foreign companies to come in, and raise the insurance premium limit for income tax exemption for individuals to Rs 50,000.

Are there any schemes/programs started by the hospital to provide affordable healthcare facilities to the poor? We provide concession to children from poor families, senior citizens and Army personnel at the hospital. We have performed over thousand free open heart surgeries on the poor children, in and around Coimbatore district. We have established 6 rural healthcare centers in villages like Thekkalur, Annur, Veeriampalayam, where we provide medical treatment at a very nominal cost for the benefit of the poor. We have also established Trauma care centers which operate 24/7 . We transport patients not only to our hospital but also to other hospitals. The patients, who are transported to government hospitals after first aid treatment, are not charged for the service. July 2009

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Holistic Eye Care Sankara Nethralaya, Chennai, run by Medical and Vision Research Foundation, is a superspecialty institution for ophthalmic care receiving patients from all over the country. Each day, about 1500 patients are seen in the out-patient department of the hospital. And, about 120 surgeries are performed in the hospital, out of which 35 per cent are done free of charge. In an interview with eHEALTH, Dr S S Badrinath, Chairman-Emeritus, Sankara Nethralaya, talks about the recent developments at the hospital. A Padma Shri and Padma Bhushan awardee, Dr Badrinath founded the Medical and Vision Research Foundation in 1978 with an objective of practicing quality eye care in ophthalmology. Excerpts:

What makes Sankara Nethralaya stand apart from other eye hospitals? Sankara Nethralaya is a non-profit organisation run by a board of trustees who do not have any financial interest in the institution. Whatever surplus is made is spend on the upgradation of the facilities as well as on the expansion activities. Nearly 40 per cent of the surgeries at Sankara Nethralaya are done free of charge. The surgeries are not only cataract surgeries, but also complex surgeries such as those for vitreoretinal disorders, orbit and oculoplasty, cornea, glaucoma, uvea etc. And, if some patients who need multiple surgeries express their inability to continue with the treatment, the hospital offers them subsidised treatment depending on their socioeconomic status. Our community ophthalmology center Jaslok Community Opthalmic

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Centre has infrastructure to perform nearly 40 cataract surgeries a day. We have tie-ups with several NGOs like Tulsi Trust, Lions Club, Sri Sathyasai Baba Trust etc., which get patients screened at nearby suburbs and villages, and are brought to the centre for free of charge treatment. This programme has been running successfully for many years.

What are the new initiatives undertaken by the hospital on the Health IT front? The Electronic Medical Record (EMR) was developed in collaboration with TCS and is currently being implemented at the out-patient department. For the in-patient department we are still in the process of implementation. Currently, the data of the patients visiting OPD for the first time is being entered on the EMR system. It has already benefited the hospital in many ways. For example, it has reduced the paperwork and

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given an instant access to the patient records from any geographic location. As data entry is parameterised, the data is easily retrieved and analysed, thus helping in the research work. However, considering the large number of consultants and several geographic locations, the process is bound to take time before it is fully functional. Also, the Hospital Information System has helped us in streamlining the patient flow and extracting information such as patient waiting period etc. The institute has been running a website ekalavya.org for many years which hosts a number of CME programmes and case discussions for ophthalmologists, optometrists etc.

What are the recent advances in ophthalmic research at Sankara Nethralaya? Sankara Nethralaya is researching into


COVER STORY: LEADER SPEAK tumours, such as, Retinoblastoma and Melanoma. Collaborative research in these areas is going on within the country as well as with several other countries. Epidemiological studies in Diabetic Retinopathy and Glaucoma and a major study on phenotype– genotype conversion of ocular traits in collaboration with the National Eye Institute, USA, is underway. Prof. H N Madhavan, Director of Research, Vision Research Foundation, has recently patented one of the techniques of Polymerase Chain reaction (PCR). He was also instrumental in developing a Macro DNA chip for the rapid diagnosis of certain infections of the eye both within the eye (endophthalmitis) and externally. He is currently involved in developing a similar chip for blood infections and brain infections in collaboration with CSIR. Vision Research Foundation is a sister organisation of Medical Research Foundation. So, all the research done at Sankara Nethralaya is effectively done at the foundation.

Nearly 40 per cent of the surgeries at Sankara Nethralaya are done free of charge. The surgeries are not only cataract surgeries, but also complex surgeries such as those for vitreoretinal disorders, orbit and oculoplasty, cornea, glaucoma, uvea etc.

Can you tell us about the patientcentric services started by the hospital in recent years? Sankara Nethralaya has a quality control programme, which monitors the needs of the patients and aims to improve the process. We have recently implemented changes in the appointment scheduling system in order to reduce the patient waiting time and it has been successful to a great degree. We have also introduced outpatient facilities in the evening hours especially for the office goers. Our LASIK service for correction of refractive errors is now available on a few Sundays in a month. We have also started a specialty headache clinic for which will look after the serious conditions causing headache by surgery or other appropriate means.

What are the challenges faced by the hospital in achieving its goals? Shortage of manpower and lack of money are the main challenges faced by the hospital. Nowadays, trained and experienced manpower is in short supply in the country especially in highly-specialised areas. And, as the hospital is a charitable organisation providing free treatment, the money generated from the treatment of paying section fall short to finance all activities of the hospital.

What are the expansion plans of the hospital? Sankara Nethralaya has established a new facility in Mukundapur, Kolkata. The newly-built hospital has 11 consultants and offer all kinds of modern healthcare facilities. We also have plans are to start a hospital in Bangalore in the near future. And, we have signed an MOU with the Mauritius government and would possibly start a hospital in Mauritius.

What, according to you, is a ‘must-do’ reform needed in the Indian healthcare system?

Sankara Nethralaya, Chennai

Health insurance is definitely the way to go forward, so that every citizen of the country has access to medical care. The state government’s initiative to insure the families below poverty line would be a welcome move. July 2009

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“Practising medicine as it should be practised� The Care Group of Hospitals owned by Quality Care India Limited (QCIL) acquired a five-star hotel premises at Banjara Hills, Hyderabad, in 2000 and converted it into 200 bed multi specialty hospital. Today, the hospital stands tall with 430 beds, including 120 critical care beds, with annual inflow of 1, 80,000 patients for consultations, and 16,000 patients for admission. Care Hospital, The Institute of Medical Sciences, Banjara Hills, comprises contemporary accommodation facilities ranging from general wards to super deluxe rooms. In an interview with eHEALTH, Rajendra Kumar, Chief of Business Development, Care Group of Hospitals, talks about the recent developments at the hospital. Excerpts:

What are the highlighting features of Care Hospital, Hyderabad? Today, Care Hospital, Hyderabad, has a host of specialists and superspecialists with minimum 500 years of cumulative experience. The team of specialists and super-specialists has conquered several milestones in the field of medical sciences like the first team to conduct angioplasty in India in 1985, to develop the coronary stent (Kalam-Raju Stent) in India, to launch telemedicine services in the state of AP, to perform cardiac MRI in the country and to perform robotic cardiac surgery in South India. Care Hospital, Hyderabad, is one of the few centers in India equipped with complete cardiac imaging services. These cardiac imaging services include cardiac MRI, cardiac CT, nuclear cardiology and 2D and 3D echocardiography.

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Care specialists are exclusively invited to attend international conferences and seminars to represent India. Medtronic, a medical device manufacturing company, has crowned Care Hospital, Hyderabad, as a Centre of Excellence in implanting devices, such as, pacemakers and others. Care Hospital has installed the first dual source CT in South India with an exclusive team of certified cardiac imaging specialists. Care Hospital has achieved several milestones in the past 12 years like 5,00,000 OP consultation per year, 35,000 IP/admissions per year, 4000 cardiac surgeries per year, 10,000 cardiac catheterisations per year, 1500 cardiac interventions per year and 9000 non-cardiac surgeries per year. The hospital is known as the mecca of echocardiography in India.

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Could you brief us about the new initiatives being undertaken by the hospital in the areas of patient care, adoption of new technologies, Health IT and enhancing the quality of medical facilities? Care Hospital, Hyderabad, has undertaken various initiatives at all levels for the benefit of patients as well as to improve the quality of medical facilities offered. The hospital carries out a complete identification of the patient prior to any procedure or medication administration. Monitoring of infection control practices as well as patient care bundles have been implemented to prevent the spread of various infections. To minimise the scope of any error, the hospital promotes reporting of incidents and medication errors, and takes preventive measures and corrective actions. The hospital has implemented a time motion study to


COVER STORY: LEADER SPEAK understand, analyse and take adequate measures to reduce the discharge time of patients. In terms of adoption of new technologies, the hospital is exploring the implementation of electronic medical records of patients. Also, some projects are in the pilot stage which include “feedback forms analysis module” and “module to assign tasks and follow up on the action taken regarding particular tasks.” For better direction flow in the hospital, Care is displaying signage boards at various areas. It is also implementing valet parking for easy entry into the hospital.

In which domains does the hospital plan to expand? The hospital is currently planning the expansion of PDC (Pharmacy, Diagnostic & Consultations) clinics across the city of Hyderabad, home health care and telemedicine connections.

Are there any programs or schemes, at present or in the pipeline, to provide

Care Hospital, Hyderabad

affordable health care facilities to the common man? In the past, we have performed free of charge heart surgeries on poor children through donations and hospital charity. We have taken care to keep our tariff affordable for the poor people. Also, we run a Smile Training Programme to offer cleft lip and pallet surgeries free of charge to poor people.

Where do you see Care Hospital in the emerging Indian health care industry in Asia?

We want Care Hospital to emerge as the best health care institute known for “practicing medicine as it should be practiced,” and the best medical knowledge sharing center.

What, according to you, is a ‘must-do’ reform needed in the Indian health care system? The way Andra Pradesh Government is providing health insurance to patients living below the poverty line through Arogyasree scheme, the other state governments should also provide similar facilities to the poor.

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Apollo City: One-stop Healthcare Apollo Health City, Hyderabad, is a 350 bedded multi-specialty hospital with over 50 specialties and super-specialties besides 10 centers of excellence, education, research, information technology. The average staff to patient ratio for the hospital is 3:1 with a 1:1 ratio prevailing in priority areas like the Intensive Care Unit and the Cardiac Care Unit. eHEALTH caught up with Dr. K. Hari Prasad, CEO, Apollo Hospitals, Jubilee Hills, Hyderabad, to know about the hospital’s achievements and initiatives in recent times. Excerpts:

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What are the hospital’s remarkable achievements in the past one year?

What are the highlighting features of Apollo Hospital, Hyderabad?

What has been your most recent professional milestone?

Apollo Hospital, Hyderabad, is the first hospital in the world to be accredited by the Disease or Condition Specific Care Certification (DCSC) for acute stroke by JCI. With the support of world-renowned consultants backed by outstanding clinical staff and sophisticated equipments, we have been able to reduce the average length of stay at the hospital from 11 days to 4.5 days for acute stroke patients. The hospital has also received JCI reaccreditation and NABL certification for the laboratories. On the technology front, we have recently acquired world’s most powerful and versatile platforms for NonInvasive, Image-Guided Radiosurgery Novalis Tx Radiosurgery. In the past few years, we have expanded ourselves by establishing a world-class International Healthcare Center with Knee Institute, Bariatric Surgery Institute and Institute for Aesthetics and Cosmetic Surgery. We have also started the first Reach Hospital in Karimnagar under our plan of launching150 hospitals in the next five years. Apart from this, we have also launched two Sugar Clinics (for diabetics) in Hyderabad and have started working towards making our hospital a Six Sigma hospital.

Apollo has been providing high-quality healthcare at affordable costs to its patients, because we focus on treating ambulatory patients efficiently so that they get back to their work or home the very next day. Apollo Health City offers medical BPO services for off-shore customers, online education for medical professionals and telemedicine services. Apollo is a pioneer in the field of telemedicine in India and is credited with being the first to set up a Rural Telemedicine Centre in the village of Aragonda, Andhra Pradesh. We are now the single largest telemedicine solution provider in India. Apart from these, the Center for Medical Innovation at Apollo Health City, Hyderabad, continuously works on identifying newer applications that would benefit both the sick and the healthy. Also, the hospital has the nation’s first pre-hospital emergency network consisting of 12 fully-equipped ambulances manned by trained personnel. Apollo Cancer Institute provides world-class comprehensive cancer care with dedicated professionals and stateof-the-art equipment and facilities with a Tumor Board and now PET CT.

I have recently started the Bariatric Surgery Institute and Knee Clinic and Reference Laboratory with central labs.

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What are the new initiatives being undertaken by the hospital on the Health IT front? Apollo Hospitals is working on tailormade software for the group with TCS which is world class in terms of its operations, networking and functioning. We are aiming at making the hospital a complete paperless hospital within next 8-9 months.

In which domains does the hospital plan to expand? The hospital is focusing on expanding its IT infrastructure and systems, improving patient care and services and preventive health check-ups.

What, according to you, are the reforms needed in the Indian health care system? We need to increase the GDP for healthcare, spread public awareness and design a method of comparing outcomes of various hospitals, so that patients have the right to choose their partner for care.


COVER STORY: LEADER SPEAK

Setting New Trends in R & D Started in 1998, Amrita Institute of Medical Science, Kochi, has a massive healthcare infrastructure with over 26,00,000 sq. ft of built-up area spread over 94 acres. The hospital has 25 modern operating theatres, 210 equipped intensive-care beds, a fully computerised and networked Hospital Information System (HIS), a fully digital radiology department, a 24/7 telemedicine service and a NABL accredited clinical laboratory. In an interview with eHEALTH, AIMS’s Medical Director, Dr Prem Nair, talks about his hospital’s significant achievements, recent Health IT initiatives and future plans. Excerpts:

What has been your most recent professional milestone? The liver transplant programme which started two years ago is the most important achievement for us professionally, medically and administratively. Unlike other transplants, liver transplant requires co-ordinated efforts from a large team of physicians, social workers, support personnel, laboratory personnel, and other professionals from various medical disciplines. It also requires a large infrastructural and critical care support. With legions of patients coming in for a transplant at AIMS, we consider it as our very proud achievement.

Could you detail upon AIMS’s remarkable achievements in the past one year? Over the years we have expanded our inpatient and outpatient services. We have gone up from 5,50,000 to 6,50,000 lakhs outpatients. Our inpatient activity has also increased from 40,000 to 42,000 last year. Overall, we have registered a growth of 12 per cent annually. In the last 2 years, AIMS has been receiving a

large number of international patients from all over the world. Their numbers have increased so much that we have had to develop a special facility to accommodate these patients and their relatives. We consider it an important achievement because of the trust these patients bestow on us. We have also expanded our medical services through the outreach programme to the Andaman and Nicobar Islands and the Lakshadweep Islands. We are also looking at starting the outreach programmes within Kerala. Additionally, we have also set up many primary health centres in rural Kerala. On the technology front, we always have had the latest biomedical equipments. We have also maintained a very high quality of imaging. And, we have developed centers of excellence which are multi-disciplinary in nature. For instance, we have set up the Department of Head and Neck where a multi-disciplinary team of specialists in the fields of head and neck surgery, plastic surgery, maxillofacial surgery, neurosurgery and otorhinolaryngology look at the management of complex

ailments which require multidisciplinary approach. Also, we have a NABL recognised fully-automated laboratory with a very high level of quality control. The laboratory is operational 24x7 and conducts all kinds of routine biochemical, hematologic, pathologic and micro-biologic investigations. In addition, we also have an advanced diagnostic laboratory that does all the molecular diagnostics.

Could you brief us about the new initiatives being undertaken by the hospital in the areas of academics and research? We have added numerous Post Graduate programmes in medicine, pharmacy, nursing, dentistry; Masters programme in basic sciences; and Doctoral programme in basic sciences as well as in clinical areas. AIMS has received accreditation from the most reputed certification bodies, such as, National Accreditation Board for Hospitals and Healthcare Providers (NABH) and National Assessment and Accreditation Council (NAAC) for the educational programmes. We have July 2009

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COVER STORY: LEADER SPEAK also received an A grade from the UGC, which is the highest in its field. We have been certified by NABL and ISO also. Over the past several years, we have initiated some innovative educational programmes like Physician Assistant where we provide an M.Sc. degree in Allied Health Sciences. Other disciplines are Perfusion Technology, Diabetes Sciences, Diabetes Education, Medical Laboratory Technology, Neuro-Electro- Physiology, Respiratory Therapy, Cardio Vascular Technology. The recent most important development at AIMS is starting a major research initiative. AIMS has been awarded research protocols from funding agencies such as the Department of Biotechnology (GOI), the Department of Science and Technology (GOI), the Indian Council of Medical Research, National Institute of Health, USA, and the State Department of Science, Technology and Environment and numerous industry grants to start a very major research initiative. So, the major push is on research. It’s a very uncommon feature of a hospital in India. I say this because there are very few hospitals in India that have initiated major research and educational programmes.

How has the hospital’s IT preparedness improved patient care, streamlined the hospital operations and increased the productivity of its facilities? We are probably the only hospital in India to start an integrated Hospital Information System (HIS) from the very first day of operation. We have both administrative and clinical information systems as well as PACS from the very beginning. Subsequently, our indigenously developed HIS system has evolved substantially over a period of time. Our HIS system provides a network system linking every area of hospital function from finance to purchasing, admission to discharge and from radiology imaging to histopathological imaging. We also maintain electronic medical records. Therefore, ours is a paperless system. The HIS has a strong influence on the hospital’s functions since it’s implementation. To give you an example, all internal and external communication in AIMS is done through emails, which saves paper. A

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One of the areas of concern that we are addressing very vigorously is in the field of research where we are looking at the lowest cost of a particular service, so that we are able to provide fairly remarkable amount of healthcare services including surgeries at a very low cost. major advantage of implementing HIS has been the improvement in patient care. For instance, patient care data is available instantly at the point of care because the system allows centralised access to all organisational and patient data through a single web interface to any authorised user. We have also been adding substantially large number of reporting modules. They are of use to the administration as we get real time information on administrative measurables department-wise, institute-wise, patient number and procedure number. It enables us to do real time costing department-wise and doctor-wise, and look at some of the wastages that can be prevented or reduced. We also conduct audits based on follow-up materials that can be very quickly picked up from the HIS.

What are the recent innovative developments at Amrita Technologies?

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Amrita Technologies is developing an eHealth grid which would link multiple institutions at the tertiary level in the form of a horizontal link, and vertical link down from the tertiary to the primary health centres to sub centres. We are looking at some models and pilot projects where we can provide a grid concept to make available patientcare information across regions and populations. We are very excited about this project as it’s going to have a major impact on health care.

Are there, at present, any programmes or schemes to provide affordable health care facilities to the common man? The hospital has 500 beds reserved for the poor in the general ward where they get free medical treatment. We are working with the government on a public-private partnership mode to provide cost-effective health care to people with a very basic health insurance programme. AIMS runs charitable programmes funded by funds that the ashram receives. The hospital’s founder Sri Mata Amritananadamayi runs a large number of humanitarian activities funded by donations from millions of devotees. A large chunk of the donations received, goes not just into healthcare, but also in other projects, such as, building houses for the poor, providing pensions for widows or elderly women, schools for the poor, old age homes etc. One of the areas of concern that we are addressing very vigorously is in the field of research where we are looking at the lowest cost of a particular service, so that we are able to provide fairly remarkable amount of healthcare services including surgeries at a very low cost in a controlled environment. Also, we are the only institution who is at the forefront of Palliative care. We are looking at setting up a society where members of the community make a very minimal contribution and support each other in the geriatric age group or chronically-ill age group. The community members are trained to go to the homes, check on basic medical parameters, collect blood samples and send it to the health centres. This can dramatically reduce the cost of healthcare and improve the quality of life of the patient and their family.


COVER STORY: LEADER SPEAK

Innovating Technologies for Low-cost Healthcare Known for its indigenous development of heart valve, blood bag, dental implants and many consumables needed for medi-care, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Thiruvananthapuram, signifies the convergence of medical sciences and technology. It has a 239-bed hospital for tertiary care of cardiovascular and neurological diseases, a biomedical technology wing for developing medical devices from the conceptual stage to commercialisation, and a center of excellence for training and research in public health. In an interview with eHEALTH, Dr K Mohandas, Director, SCTIMST, who has been nurturing the institute for the past 15 years, tells us about the institute’s strengths and the current scenario of research in medical informatics in India. Excerpts:

What are the new initiatives taken by Sree Chitra in the areas of patient care, academics and adoption of new technologies? In 1998 , the hospital started a Center for Comprehensive Epilepsy Care for the first time in India which has become a pioneering centre today. It’s a unique centre as it provides the whole spectrum of treatment modalities for epilepsy. The centre has so far performed more than 1000 surgeries successfully. And, in 2000 Sree Chitra opened a Center for Comprehensive Care for movement disorders, again for the first time in this country . These two centres have been some of the most important achievements of Sree Chitra in the one past decade. We have introduced neuroendoscopic procedures and interventional radiology procedures in the hospital. We also have a new cath lab for interventional radiology. On the technology front, we have installed PACS in the hospital.

The institute offers DM and MCh in Cardiology, Cardiovascular Thoracic Surgery, Neurology and Neurosurgery . Recently, we introduced DM in Neuro and Interventional Radiology and in Cardiovascular Thoracic Anaesthesia. And, we were the first to start a master’s program in Public Health (MPH). Also, we were the first to introduce M. Tech. in Clinical Engineering and Ph.D. in Biomedical Devices and Technology. It’s a joint degree programme with the Indian Institute of Technology Madras (IITM), Chennai and Christian Medical College (CMC), Vellore, is a partner institution in this venture. The course was started looking at the changing needs of Indian healthcare industry. With the increased use of high-tech equipments in Indian hospitals there is an urgent need of clinical engineers. Like in the West, where a registered clinical engineer is allowed to operate medical equipments, we need a cadre of clinical engineers who can look after equipment

management, safety evaluation and preventive maintenance. Currently, we are at the mercy of manufacturers as once the warranty period expires we have to shell out huge sums of money on maintenance.

What, according to you, are the urgently required changes in the Indian medical device industry? In the late 70s, healthcare was becoming increasingly dependent on technology with most medical equipments being imported. And, no initiatives were being taken to promote indigenous development of technology and the industry was either unwilling or incapable of investing in research. So, it was decided that the government should take the initiative. By then, Sree Chitra had established its credibility as a tertiary care center for cardiology and neurology. So, we were given the task of establishing a medical device industry base in India by developing technologies for a number of devices July 2009

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COVER STORY: LEADER SPEAK and implants. Our primary concern is that our technologies should reach the patients and for this we require the industry to manufacture and market our technologies. Today, Sree Chitra has more than a dozen tie-ups with industries who have licensed our technologies. The industries who had taken up our technologies in the past are now investing in research, because they know that our technologies are commercially viable. For instance, the latest model of Sree Chitra heart valve is fully sponsored by TTK healthcare. However, to promote indigenous manufacturing of medical devices we need to have more and more industry collaborations. Today, majority of the research work in India is funded by the Ministry of Science and Technology and other government funding agencies, but I hope very soon most of the research will be sponsored by the industry. Also, we need an independent medical device regulatory authority which is not under the control of the Drug Controller of India (DCA). A good regulatory mechanism in place will assess the quality of medical devices manufactured in India as well as of imported devices. Also, it will help the industry in gaining credibility in the international market.

Can you share with us the new innovations and product developments in the pipeline? Sree Chitra nearly has 130 patents out of which more than 40 per cent have been converted to technology. And, it is supposed to be a good record. The latest product in the line is oral insulin. The technology has already been transferred to a Mumbai-based company, USV Ltd, for further development. They will start conducting the clinical trials very soon. And, I do hope that they will be able to complete all formalities and market the product, beating several other groups all over the world.

Technology plays an important role in the fields of cardiology and neurology which makes medical treatment very expensive. Are there any ways to provide subsidised medical treatment in cardiology and neurology? Firstly, I think we need to put more

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Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram

The industries who had taken up our technologies in the past are now investing in research, because they know that our technologies are commercially viable. emphasis on health education. We need to re-focus on every aspect of prevention. Preventive medicine should be part of every discipline of medicine, be it cardiology, neurology or oncology. And, I think we should do away with the department of community medicine and make it part of the academic curriculum of every specialty of medicine at the MBBS level and beyond .

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Secondly, Indian doctors are extremely good at adopting new technologies, but tend to ignore the cost at which they are acquired. Consequently, patients bear the brunt when a new technology is acquired by the hospital. It’s important to look into the health economics to control the ever increasing cost of healthcare.

Could you tell us about the steps being taken to improve the quality of R&D in the institute? We follow a very strict process of selecting scientists and engineers which is purely merit based. We have various committees such as the technology development committee which oversees R&D efforts. The biomedical technology wing has implemented a quality system to meet the requirements of international standard ISO/IEC 17025. The evaluation and testing of devices and implants are in strict accordance with ISO standards by tests accredited by Le Comite Francais d’Accreditation (COFRAC) of France. It ensures that not just the product, but the process also follows ISO standards. Even the canteen follows the set standards. And, any activity that goes in the laboratory goes through the quality check.


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EXPERT CORNER

Online and Mobile Healthcare the rise in technology savvy patients. Another main reason is the shortage of healthcare infrastructure in the rural areas which has raised an enormous amount of concern in the recent past. Considering all these factors, it has become pertinent for the healthcare industry to consider incorporating ICT in order to have a better tomorrow and survive the challenges of today.

Mobile Health is Synonymous with e-Health Nandini Ishwarakrishnan, Research Associate- Healthcare, Technical Insights,Frost & Sullivan

The world has been witnessing several changes in the field of science over the past few decades with rapid advances and fast paced innovations happening in all areas ranging from electronics to information and communication technologies to healthcare. Two major technological developments that have transformed science since the mid 1990’s are the internet and mobile communication. While the internet has been considered to be a rapid and valuable source of information to a majority of the world’s population, advancements in mobile communication have made the world smaller with the advent of wireless technologies. The convergence of wireless communication, wireless sensor networks and other computer based technologies could impact healthcare options to a larger extent amongst other industries and reshape the scenario as a whole.

The changing face of Healthcare The healthcare industry by itself has seen a transition from the traditional paper based records to electronic records. Yet another revolution in this field has been the incorporation of wireless technology. The increasing cost to plug in wired devices has paved way for the usage of wireless technologies in several hospitals. There has also been a need to get fast information due to the number of healthcare regulations in place, ever escalating healthcare costs and

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E-health or electronic health can be defined as the use of ICT for enhancing health and seeking information while mobile health (M-health) can de defined as the use of mobile technology for health related purposes. E-health can mean creating electronic versions of patient records across a national system while M-health can serve as access points to provide remote information to healthcare providers. In developing countries, these technologies find a wide array of applications that include remote data collection and monitoring, disease and epidemic tracking and diagnostic and treatment support amongst others.

Key Technology Trends in Online and Mobile Healthcare Some of the key trends in online and mobile healthcare include the following.

Databases With the increasing aging population and healthcare requirements in rural areas, technological advancements have led to the development of databases that provide ready to use healthcare information. These databases provide information on pivotal clinical studies, development in disease management to the physicians while few others provide A-Z information regarding diseases, health and drugs to patients. Examples of these include WebMD and Epocrates Rx.

Infrastructure Based Solutions Telemetry: This refers to the use of a wireless technology that is used to

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monitor patients with the use of radio waves. However, the usage of this technology has some guidelines in order to prevent the interference of other radio waves with telemetry signals as this can be hazardous to the life of the patient. A recent development in the area of wireless patient monitoring has been the introduction of the GE CARESCAPE Telemetry Platform that is capable of simultaneously leveraging and coordinating cell phone, Wi-Fi and other wireless technologies on a single platform. Bluetooth: These are user-friendly networks for communicating through cellular phones, PC’s and personal digital assistants and falls under the wireless personal area network (WPAN). This technology is low-priced, consumes lesser power and is all set to replace the currently existing forms of wired connectivity. WiFi: Wireless fidelity (WiFi) is yet another revolutionary technology that has been in use to boost efficiency and enhance care in hospitals. These wireless networks provide secure infrastructure and flexible access than wired solutions. RFID: Radio Frequency Identification (RFID) is an enabling technology that uses radio frequency waves to monitor tagged objects and personnel. The principal components of the system include the RFID tags and the reader apart from the software that is being used. RFID has been used both in pharmaceutical industries and hospitals. RFID covers a wide array of applications in healthcare ranging from tracking medical devices such as pacemakers and defibrillators to monitoring patient safety and quality assurance applications.

Software Applications and Devices Software applications are an integral part of the hospital environment that can assist the healthcare providers with their point of care applications. Palm OS: This typically represents an operating system that has a touch screen graphical user interface. The wide range of applications in the


EXPERT CORNER system along with ease of use and lower memory requirements has been considerably gaining importance across the healthcare industry over the past few years. Pocket PCs: Microsoft first developed an operating system for hand-held devices which was very similar to the well known Windows version. This was known as Windows CE. However, these require larger storage capacities when compared to Palm OS and hence are less preferred as opposed to the easy to use Palm systems in healthcare. Laptops: These are similar to the desktop PCs in terms of functions and appearance. However, these are easily transportable in a hospital environment and if connected with a WLAN, can enhance functionalities in both administrative and patient care environments. Tablet PCs: This is a relatively newer development and carries the same function as a laptop but is equipped with a touch screen and a pen based capability. This enables the user to directly write prescriptions instead of the more tedious process of printing the entire document and later writing on it. Microsoft again has been a major provider of tablet PCs.

Key Technology Adoption Trends Some of the key trends which have gone in favor of adopting mobile and online healthcare technologies are outlined below.

Mounting Healthcare Costs A rising concern across public healthcare systems and healthcare insurers is the rising costs of delivering care to patients. With the ever escalating treatment and therapy costs, it is indeed favorable for the industry and hospitals to adapt to mobile and online means of patient care.

Increased R&D Spending Pharmaceutical Industries

in

A considerable amount of investment in pharmaceutical industries goes into drug discovery and development. Although several drugs are being developed, only a few get into the market while others still remain at the research and development phase. Implementing wireless applications

into these stages of clinical R&Dcould significantly reduce time up to 30 percent whilst also saving costs.

Increased usage of EMR/HER Realizing the benefits of wireless technologies, several healthcare providers are resorting to using Electronic medical records (EMR) and Electronic Health records (EHR). The e-prescription and Electronic Medical Record (EMR) markets are estimated to reach $166.7 million in 2013. (Source: Frost and Sullivan)

Reduced Administrative Burden Wireless and online technologies considerably reduce burden on nurses and therapists. Technologies such as PDAs (Personal Digital Assistant), smart phones and Ultra-Mobile PC (UMPC) can also aid in patient-centric healthcare by providing details of patients including clinical histories, lab reports, ongoing and past treatments and so on.

Opportunities for Online and Mobile Healthcare in Asia Pacific Asia Pacific has been characterized as a region that has significantly low quality healthcare when compared to the Western World. There are opportunities galore in the aforementioned areas due to the deprivation of quality health to those in the underprivileged areas. • The introduction of web cameras and internet in rural areas along with other mobile technologies can aid in extending health services in these areas. • Another area would be to improve healthcare surveillance in rural areas. With the advent of mobile technology in the rural areas, efforts can be taken to provide realtime monitoring of health related issues. SMS alerts can be used to target people in areas where clinics and healthcare workers are limited. • Data collection is yet another area that is of vital importance in healthcare. Data collection programs can be offered through smart phones, mobile phones and PDAs than manual entry which can contribute to bridging the gap that exists in the current scenario.

• Implementation of remote monitoring applications can improve the outcome of various chronic diseases whilst also opening newer avenues of treating patients in an outpatient setting. • Usage of mobile phones can also be helpful in improving communication amongst the healthcare providers to enhance patient care. This can also be used to monitor the incidence and outbreak of infectious diseases. • The use of mobile phones as a point-of-care device can enable patients to receive diagnosis and treatment assistance at their homes and villages itself thereby averting expensive hospital visits.

Few Prominent Developments by Companies in the e-Health Space • In 2007, Intel launched a lightweight tablet PC known as mobile clinical assistant to document patient information on a minute to minute basis. • Mobile electronic prescription service by Ascribe enables a pharmacist to receive a doctor’s prescription written from the patient’s bedside. • Kaiser Permanente provides healthcare services to consumers in order to enhance patient care. The services provided are region based and include emergency care, immunization programs and screening diagnostics to name a few. • Aeroscout Solutions provides WiFi based RFID for healthcare, logistics and other applications. Several hospitals worldwide have incorporated Aeroscout’s RFID solutions as a part of their patient monitoring activities. Although the implementation of online and mobile health technologies seem appealing and impressive, their proliferation into several fields of healthcare could take time due to issues like security breaches and difference in opinion amongst healthcare professionals. Nevertheless, this technology in future could contribute to improved patient care, increased healthcare efficiency and most importantly reduce healthcare costs overall. July 2009

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SPOTLIGHT

‘Aarogyasri’ - revolutionising public health through conviction and innovative ICT application

R

ajiv Aarogyasri, a government initiated health insurance scheme (working on a publicprivate partnership model) running in the southern Indian state of Andhra Pradesh, is one of the successful government endeavours ever for sustainable provision of health cover for people living below poverty line. Currently, Aarogyasri has no precedence anywhere in the country, and not even outside. Its success and related confidence of the state authorities can be gauged by the fact that the scheme started with INR 50 crore budget in 2007, which was further increased to INR 450 crore in 2008-09 and now for the current fiscal year it has been sanctioned more than INR 1000 crore (possibly INR 1350 crore). Covering majority of the state population and most importantly including the lowest strata of human society, the scheme has proved to be inclusive in real terms.

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project has been a huge success and the enthusiasm of the government can be observed by its consistently growing financial allocations. A web based solution has been designed which provides real time information about every individual patient - right from the moment somebody comes to a primary healthcare centre to his/her admission into a city hospital and till the time he/she is discharged after the medical treatment. In addition, every single medical report of a patient is available online... so in case of a follow up, hard copy of medical records are just supplementary and not the primary requirements. Besides, with a 24x7 operational call centre, manned by 100 doctors and 1500 paramedics, telephonic medical counseling is provided through toll free numbers 104 and 108, and is also used for calling ambulance for emergency situations.

Though in India, it will be inappropriate to say that there has been any dearth of populist schemes, programmes, layouts or funds, but it would be quite appropriate to comment that the actual number of beneficiaries have been regrettably less. The popular inference of the former Indian Prime Minister, Late Rajiv Gandhi, and a similar statement made by his son Rahul Gandhi highlights the fact that out of every rupee allocated by the government, only 15 to 20 paise percolates to its intended beneficiaries. However, in case of Aarogyasri, it is not exactly the same!

Work Process It’s a unique scheme, connecting PHCs, hospitals, a health insurance company and the state government, and providing cashless treatment to almost 90% of the state population. Under this scheme, the empanelled hospitals (367 till date) are required to organize a health camp in rural and interior areas once in a week, for offering medical services to BPL families free of cost. Patients with minor health problems are seen and discharged immediately after providing required medicines and vaccinations, while those with severe ailments are given first-hand treatment and thereafter referred to a city hospital for complete cure - covering upto INR 2 Lakhs of medical expenses.

Use of ICTs for monitoring the

When a patient comes to a hospital he has an option of taking assistance of

July 2009

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Aarogya Mithras in getting to the right doctor and for allotment of a bed. An Arogya Mithra is a volunteer appointed by Star Health Insurance company who assists Aarogyasri beneficiaries. Mithras will firstly verify if a person is eligible for Aarogyasri scheme or not. After inspection, he counsels the patient and takes him to the appropriate doctor. Depending on the case, the patient may be admitted or discharged after initial treatment and in case of complexities, Mithra or his/her team leader speaks to the medical superintendent and get the matter resolved. Also, he looks that every Aarogyasri patient and his/her attendant are getting proper quality meals while their stay in the hospital. There are currently 3394 Aarogya Mithras across the state, out of which 1554 are positioned at networked hospitals and rest1840 Mithras are deputed ate PHCs/CHCs/ local hospitals. According to the data made available by Aarogyasri officials, the scheme covers 2.03 crore families of the state of Andhra Pradesh, screening nearly 8000 people every day and processing 14-15,000 cases every 24 hours. There are more than 350 networked hospitals where Aarogyasri beneficiary can visit whenever required. Preauthorisation approvals are given within 12 hours for normal cases and almost immediately for emergency cases (through telephonic conversation). On an average, almost INR 3.5 crore worth of insurance applications are processed each day.

ICT in Aarogyasri Ahamed Babu, Chief Executive Officer of Aarogyasri, said, “Such a thing


SPOTLIGHT is almost impossible without a web based solution. Use of IT provides visibility, robustness, speediness and transparency in operations. Each case is traced right from the health camps and PHCs, duly integrating it with the call centre.” The software used in Aaroyasri has been designed by TCS. While Aarogyasri Trust provided the domain knowledge, TCS provided the technical design and developed the solution accordingly. Interestingly, Ahamed Babu has himself developed most part of its website - www.aarogyasri.org. The consistently updated website provides information about every element and factors involved in Aarogyasri ecology. The site has a section which delivers real time information about the number of medical camps, people screened, case registered, in patients, out patients, preauthorisations, surgeries/therapies and insurance amount claimed thereof. “We started with fax machines for doing pre-authorisation procedures. Initially, we were getting only 20-30 enquires in a day (in April 2007). It was then when we realised that we are not reaching every one. Thus, we planned to get an IT solution and worked through it; and now everything in the scheme is online and on real time” Babu said. The beauty of the project is in the simplicity of its processes, leveraged by the IT application. According to Babu, “We have taken all of the complexities and technicalities on our side [in the back end] and provided a simple nonsophisticated front end gateway to the end user”. The capacity building part of the project is equally fascinating, and it can be gauged by a simple fact that 5000 people were provided ICT training to work on Aarogyasri systems in a matter of just two days.

Recognition and Replication Because of the non-complex nature of the project implementation and operation, the scheme has attracted many countries from the East as well as from West. Babu cited the eagerness

among the Western countries for adoption of the scheme and stated, “I went to make a presentation to WHO in Geneva, having representatives from 44 countries including UK, US, Germany etc… none of them said that this is happening in their country and everybody wanted to adopt this.” “The most important thing that attracted their attention was the reasonable cost of the ICT solution. I spent only $0.02 per beneficiary for having this solution. Whereas, countries like Germany and Holland spent up to $5000 per beneficiary, and that too without any appreciable outcome. Even in US, the government spends $300-400 million on IT but the outcome is not satisfactory. I suppose I have become an enemy for many IT companies,” he added. 19 state governments in India and three countries (South Africa, UK and USA) have already studied our model. China, Egypt and Germany have shown interest in copying this scheme. Two states, namely Karnataka and Tamil Nadu, have announced their schemes - Suwarna Arogya Surakhsha Yojana and Chief Ministers’ Health Insurance Programme respectively. However, they have not implemented as yet. The main challenge coming on their way is the database, whose availability has been one of the success factors in Aarogyasri.

Challenges and Success factors Like any other project, Aarogyasri had its own challenges and strengths. Change management (at the lower level) and acceptance (and approval at top level) have been some of the major issues. “Though change management is a challenge, you have to break down the hollow surrounding around IT, and the mindset that IT is not do-able and done only by highly trained people,” Babu said raising a very valid point.

A. Babu, CEO, Aarogyasri, Health Care Trust, Govt. of Andhra Pradesh

“We have taken all of the complexities and technicalities on our side [in the back end] and provided a simple non-sophisticated front end gateway to the end user”

Political will coupled with technology literate people working on the project has made it a success. Also, it’s important to note that Aarogyasri is one of the few government offices in the state, which works 24x7. Right from the CEO to a health worker (Aarogya July 2009

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Screenshot of www.aarogyasri.org

SPOTLIGHT

Mithra) involved in this scheme, a consistency in the commitment level can be easily noticed. Thus, one can say that commitment of the team has been a great driver for Aarogyasri. According to people working with Aarogyasri Trust, the higher-level officials work for more than 14 hours a day. The CEO himself comes to office in the morning and returns not before 10 in the night. The team leaders of Aarogy Mithras have to oversee some 6 to 8 hospitals and in some cases they have to stay for long even after their duty hours. But interestingly, many of them don’t feel any trouble in doing so. No doubt, with this kind of conviction from top to bottom, the target of covering all possible beneficiaries set for 2009, was achieved in the beginning of 2008 itself. For each case operated and discharged, the system generates a letter in the name of CM, which goes to the beneficiary, requesting to write about his/her experience in getting service through this scheme. According to Babu, response ratio for the feedback system is nearly 65% and these letters are the tools to conduct a sort of social auditing, by judging the performance of various stakeholders involved in providing the services. “As a result of such a system, every hospital is

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treating their patients very carefully. We do take action on the basis of these letters and in the past, some 50-60 hospitals have been carved out because of repeated negative feedback about them.�

Neglected Aspects While the scheme has set precedence in the history of providing the very basic amenity needed in human life, that is, the health care to the people under poverty line, there are some issues related with the ecology of the scheme which demands equal attention. With the initiation of a health insurance scheme like Aarogyasri, its quite natural that the number of patients coming to hospitals, both government and private, will increase manifold. Proportionately, the state government was supposed to expand and increase the existing resources in terms of number hospital beds, doctors, specialists etc. Another important aspect that has emerged over these years is the increased financial burden on government hospitals - since only a specified amount is refunded to it, rest of the follow up and other related treatment is done without any reimbursement. Another important facet essential to notice here is the soaring of number of surgeries in private hospitals as

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compared to the government hospitals. Bigger government health centers which have procured sophisticated and expensive instruments and manage a good pool of doctors are finding it difficult to realise the true potential of their capabilities for providing critical surgeries in a relatively cheaper rates as compared to private hospitals, which are fortunately enjoying a good share of the total money spent on surgeries through this scheme. For instance, in October 2008 the cardiology wing of the Gandhi Hospital (a government hospital) was inaugurated with a capacity to perform 1,000 surgeries in a year. Nevertheless, between January and May 2009, the department has done only 85 surgeries. Taking stock of the current prevailing situation, in a recent review meeting, the Chief Minister of the state has contemplated streamlining the medicine procurement and its supplies in government hospitals and rationalising number of beds and other facilities. We can hope that in near time, the state government of AP, will come up with measures to fulfill the demand side requirements of the scheme and will continue to maintain the existing level of standards and regular enhancement of service delivery in Aarogyasri. Pratap Vikram Singh, Correspondent


NEWS REVIEW

WHO puts world on swine flu alert With 74 countries reporting 27,737 cases of infection, including 141 deaths, the World Health Organization (WHO) has declared influenza A (H1N1), also known as swine flu, a pandemic. The global health body has moved swine flu to the final phase-6 stage on its six-point pandemic scale. India has 15 confirmed influenza A (H1N1) cases, with infections confirmed in seven people in Hyderabad, five in Delhi, two in Coimbatore and one in Goa. Of these, two are localized infections, where passengers from the US infected family members in India. Admitting that the severity may vary from country to country, the WHO clarified that a single assessment may not be relevant

Canadian Organization Awards Carestream Health’s RIS Radiology Information System by Carestream Health received an award for ‘Exceptional New Product or Service’ from the Innovation and Technology Association of Prince Edward Island (ITAP) in Canada. It was a form of recognition of the innovative technologies and development methodologies of the company’s RIS platform, as well as its worldwide sales and support. Local information technology companies that contribute to the economy and the IT industry through technology adoption and product development are recognized by ITAP’s annual awards. RIS features include time-saving features including structured reporting, standard answers, and the ability to copy content from prior reports. The RIS platform supports voice-driven commands that allow users to create a report without using a keyboard or mouse. This platform also facilitates communication with colleagues through built-in critical results notification, and supports peer review and emergency department discrepancy workflows.

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NEWS REVIEW

Ministry of Health in India planning to issue e-Health cards to new borns Dinesh Trivedi, Union Minister of State for Health and Family Welfare, Government of India has mentioned that ministry is considering issuing of e-Health cards to all new borns in the country. The ministry wants to lay emphasis on introducing right to health for all. It was described that every new born baby would be given an e-Health card which would include all the details related to the child such as the birth time, weight, blood group, how many vaccines have been administered, etc.; in short it would be a complete health profile of the child.

iSOFT Launches Its New Diagnostic Imaging PACS Solution iSOFT recently introduced its new iSOFT PACS (Picture Archiving and Communications Solution), enhancing its global portfolio of IT products designed to create a seamless Electronic Health Record. The iSOFT PACS will integrate with existing solutions, including iSOFT’s Radiology Information System (RIS) and Hospital Information System (HIS). The PACS is also embedded as part of LORENZO, iSOFT’s next-generation health IT solution to electronically connect patient records across the full spectrum of healthcare provision. iSOFT offers clinicians in both public and private radiology and cardiology departments one of the most technically and functionally advanced PACS solutions available that addresses Medical Image Repository needs. Offered as a standalone product or as part of an existing system, iSOFT PACS was designed as a cost-effective, easily deployable and upgradeable solution with multi-site scalability. In partnership with software developer CDP Medical Developments Ltd., iSOFT now has a diagnostic imaging solution with the functionality, architecture and flexibility to successfully compete on both functional and commercial terms. Together with the company’s RIS, which is installed in more than 270 sites, iSOFT will be able to leverage its expertise and complementary imaging systems across its global footprint.

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Allocation for India’s National Rural Health Mission increased by INR 20,570 million in the interim budget for ‘09-’10. Medical tourism industry in India is estimated to be US$ 450 million. The Indian X-ray market is estimated to reach US$ 45 million by 2011.

10.6 million plastic surgeries were performed in India in ‘06. Currently, consumer spending on healthcare in India stands at 7%.


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25 - 27 August 2009 Hyderabad International Convention Centre, India

knowledge for change

Department of Information Technology Ministry of Communications & IT Government of India


5th

India's Largest ICT Event

INDIA

2009 25-27 August 2009 Hyderabad International Convention Centre Hyderabad, India

...the definitive event on healthcare ICTs, technologies and applications Focus Areas

Hospital Automation & Management Systems; Clinical Information Systems; HMIS & ERP; EMR & Medical Informatics; EMR & Medical Informatics; Medical Imaging; RIS & PACS; Communication & Network Solutions; Tele-medicine & Remote Healthcare Target Audience

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

‘Hospital CIO Conclave’ - an exclusive panel discussion involving CIOs of top-notch hospitals and healthcare institutions of India

'VC & PE Investors' Summit' - a high powered session of venture capitalists and private equity players investing in healthcare and health technology companies

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


Up South: July 2009 Issue