Ehealth july 2016 web edition

eHealth Magazine

volume 11 / issue 07 / JULY 2016

` 75 / US $10 / ISSN 0973-8959

On the Road of Continuous Transformation E EATUR

LF SPECIA

SPECIAL INTERVIEWS

try e Indus althcar t with e H l il W Jackpo y?

Hit the topper in Fra S w o h S New

Dr Peter Edelstein

Sunil Khurana

Rajesh Maurya

Niranjan Kumar

Vivek Kanade

Anurita Chopra

Chief Medical Officer Elsevier

CEO & MD BPL Medical Technologies

Regional Director SAARC Fortinet

CIO Sir Ganga Ram Hospital

Executive Director Siemens Healthcare Private Limited

Area Marketing Lead Oral Health, ISC GSK Consumer Healthcare

Asia’s first Monthly Magazine on the enterprise of healthcare Volume 11

Issue 07

July 2016

EDITOR-IN-CHIEF: Dr Ravi Gupta EDITORIAL TEAM - DELHI/NCR Senior Assistant Editor: Nirmal Anshu Ranjan Assistant Editor: Souvik Goswami, Gautam Debroy, Kusum Kumari Senior Correspondent: Arpit Gupta, Manish Arora BANGALORE BUREAU T Radha Krishna - Associate Editor MUMBAI BUREAU Kartik Sharma - Assistant Editor Poulami Chakraborty - Correspondent JAIPUR BUREAU Kartik Sharma - Assistant Editor CHANDIGARH BUREAU Priya Yadav - Assistant Editor HYDERABAD Sudheer Goutham B - Senior Correspondent SALES & MARKETING TEAM: eHealth Product Head: Fahim Haq Mobile: +91-8860651632 Senior Executive: Priyanka Singh Mobile: +91-8860651631 SUBSCRIPTION & CIRCULATION TEAM Manager Subscriptions: +91-8860635832 subscription@elets.in DESIGN TEAM Creative Head: Pramod Gupta, Anjan Dey Deputy Art Director: Om Prakash Thakur, Gopal Thakur, Shyam Kishore EveNt Team Manager: Gagandeep Kapani ADMINISTRATION Head Administration: Archana Jaiswal EDITORIAL & MARKETING CORRESPONDENCE

eHealth – Elets Technomedia Pvt Ltd: Stellar IT Park, Office No: 7A/7B 5th Floor, Annexe Building, C-25, Sector-62, Noida, Uttar Pradesh - 201301 Phone: +91-120-4812600, Fax: +91-120-4812660, Email: info@elets.in

Your pitch to Healthcare leaders goes here...

Visit ehealth.eletsonline.com

eHealth is published by Elets Technomedia Pvt Ltd in technical collaboration with the Centre for Science, Development and Media Studies (CSDMS).

Owner, Publisher, Printer - Dr Ravi Gupta, Printed at Vinayak Print Media, D - 249, Sector-63, Noida 201 307. Uttar Pradesh and published from 710, Vasto Mahagun Manor, F-30 Sector-50, Noida, Uttar Pradesh

Editor in Chief: Dr Ravi Gupta

All rights reserved, No part of this publication may be reproduced or transmitted in any form or by any means, electronic and mechanical, including photocopy, or any information storage or retrieval system, without publisher’s permission.

ehealth.eletsonline.com egov.eletsonline.com digitallearning.eletsonline.com events.eletsonline.com bfsi.eletsonline.com smartcity.eletsonline.com Write in your reactions to news, interviews, features and articles. You can either comment on the individual webpage of a story, or drop us a mail at: editorial@elets.in

4

July / 2016 ehealth.eletsonline.com

Schiller’s Offerings in Imaging & Neurosurgery

ROSA BRAIN & ROSA SPINE TM

TM

Robotic Surgical Assistant

CereTom® 8 Slice Portable Head & Neck CT Scanner

Radius XP (CCD & Flat Panel)

BodyTom®

Mobile Lab for Neurosurgery Mobile Lab for Interventional Cardiology

32 Slice Portable Whole Body CT Scanner

For enquiries contact : sales@schillerindia.com | Website : www.schillerindia.com | Toll-Free No. : 1-800-2098998 Swiss H.Q.: Schiller AG, Altgasse 68, P. O. Box 1052, CH - 6341 Baar, Switzerland, Indian Corporate Office: Schiller Healthcare India Pvt Ltd., Advance House, Makwana Rd, Off. Andheri Kurla Road, Marol Naka Metro Station, Andheri (East), Mumbai - 400 059.

Tel.: + 91- 9833123910, +91-22 61523333/29209141 | Fax: +91-22-29209142 E-mail: sudipbagchi@schillerindia.com, sales@schillerindia.com, support@schillerindia.com Factory : No. 17, Balaji Nagar, Puducherry - 605010 CIN : U33110MH1997PTC111307

july / 2016 All registered trademarks acknowledged ehealth.eletsonline.com

5

Contents

JULY 2016 | VOLUME - 11 | ISSUE - 07

10 Patient Monitoring – Cover Story

On the Road of

Continuous Transformation The healthcare industry underlines the need for complete care & not mere simplification of technology

27 Big Data Management – Special Feature

Face to Face with

Real Challenges of Big Data Will healthcare industry hit the jackpot with the new show stopper in fray?

58 Telangana Government Initiatives – Aarogyasri Healthcare Trust

Building Hope by Saving Lives via Healthcare Schemes & Easyto-Use App Dr M Chandrashekar CEO, Aarogyasri Healthcare Trust

6

JUly / 2016 ehealth.eletsonline.com

TECHNOLOGY AT THE HEART OF YOUR LABORATORY The most versatile range of clinical chemistry analysers in their class, the RX series combines robust hardware and intuitive software with the RX series dedicated test menu putting innovation, ease-of-use, and superior technology at the heart of your laboratory.

Tel: +91 80 2802 5000

A global market leader in the in vitro diagnostics industry for over 30 years

therxseries@randox.com therxseries.com

Patient Monitoring

Corporate

14 Niranjan Kumar CIO, Sir Ganga Ram Hospital 18 Arvind Savargaonkar

48

Director, Critical Care Solutions, CURA

22 Hisao Masuda

Sunil Khurana CEO & MD, BPL Medical Technologies

Managing Director, Omron Health Care Services, India

24 Rupak Barua

Group CEO, AMRI Group of Hospitals

Big Data Management

54

52

28 Rajesh Maurya Regional Director, SAARC, Fortinet 34 Suresh Venkatachari

Chairman, 8K Miles Software Services

38 Vivek Kanade

Executive Director, Siemens Healthcare Private Limited

40 Dr Suhas

Chief Operating Officer, Bonanza Healthcare

42 Tony Mira

Anurita Chopra Area Marketing Lead - Oral Health, ISC, GSK Consumer Healthcare

Dr Sanjiv Agarwal Founder and Managing Director Diabetacare

Founder & Group CEO, Ajuba Solutions

46

61

Clinical Decision Support Tools – Elsevier Standardising Healthcare Practices via Clinical Decision Support Tools Across 130 Crore Population

TechEmerge Health Innovation Summit – Aims at Accelerating Adoption of Technology via Matchmaking

It will take some time with the committed government and physician leadership to get the right infrastructure and ensure cultural & philosophical shift in the way medicine is practiced Dr Peter Edelstein Chief Medical Officer, Elsevier

Nikunj Jinsi Global Head, Venture Capital Investments at IFC - International Finance Corporation

Ruzgar Barisik Senior Investment Officer IFC/World Bank

Start-up

65 8

JUly / 2016 ehealth.eletsonline.com

nSmiles.club: Offers Early Detection Tools to Reduce Mental Diseases by 30%

editorial

Are We Betting On Wrong Horses?

In the July issue, eHEALTH Magazine strives to play the role of a ‘deep thinker’ to comprehend “Whether the healthcare industry is betting on the wrong horses?”

Undoubtedly, the Indian healthcare industry has come quite far from the traditional debates & methodologies. The world has leaped unimaginably, especially in the ‘Patient Monitoring’ & ‘Big Data’ segments, which are the core themes of this issue. However, the bone of contention is whether the leap has been transformed into ‘demonstrable benefits’ or not.

As such, the healthcare stakeholders are both ecstatic & nervous about changes in both patient monitoring & big data. On one hand, a spate of portable patient monitoring devices forays into the market with immense fervour & fade away in no time. And, on the other hand, stakeholders now feel more than ever the chill wind of security risks due to a large volume of data generated on a continuous basis. In this time-crunched world, there is an urgent need to segregate good from bad to adopt solutions capable of offering clinical efficiency, productivity & business growth.

As always, eHEALTH Magazine in this issue wants to clear the air by understanding such less-understood obscure matters. Once again we bring a number of thought leaders to share & guide stakeholders still learning the rules of healthcare business. We have a distinct feeling that this issue will become a reference point for all. It’s time to stop betting on the wrong horses by reading eHEALTH Magazine!

As far as we can judge, such confounding problems cannot be addressed without right intervention & brainstorming. As a concerned stakeholder, we are all bright-eyed to extend invitation to the healthcare stakeholders to join us at ‘Elets Smart Healthcare Conclave 2016’ scheduled on 12th August to challenge the ongoing trends to comprehend contradictory trends still to catch attention. The conclave also promises to wow the stakeholders with the rare opportunity of networking & knowledge sharing. We bet not a single summit offers the never-seen-before combination of government functionaries, corporates & start-ups on one platform. Come & Join Us in this Never-Ending Journey to Explore New Business Relationships & Strategies!

Dr Ravi Gupta ravi.gupta@elets.in

July / 2016 ehealth.eletsonline.com

9

Patient Monitoring

Cover Story

Patient Monitoring: On the Road of

Continuous Transformation The healthcare industry underlines the need for complete care & not mere simplification of technology

U

ndoubtedly, ‘Real-Time Monitoring’ of the physical condition of the patients is the latest buzzword doing rounds in the Indian healthcare system. In order to ensure delivery of ‘continuous care’, both wireless and with lesser human intervention, many innovators and service providers are now betting heavily upon the entire idea of portable home-based patient monitoring devices, even for critical care. In the Indian healthcare system, including an ever-growing ageing population, such an approach beyond a reasonable doubt has been unanimously welcomed by all as the right discourse to be followed.

However, stakeholders continue to wonder whether such a calculated risk is based on the objective of delivering larger benefits

10

July / 2016 ehealth.eletsonline.com

through cost-effective solutions or can be simply considered as a money-minting strategy for short-term gains. eHEALTH Magazine, as the voice of Indian healthcare system, wanted to investigate whether the deluge of portable home-based patient monitoring devices in the market is merely the result of random thoughts lacking conviction or a goal-oriented innovation to ensure ‘Complete Care’ by monitoring vitals, such as blood pressure, body temperature, heartbeat, etc. With fair players in the fray, patient monitoring devices can definitely enhance the better decision-making capacity. As every game has rules, similarly there is a need to define guidelines and rules for the players in this race to address the needs of patients. The healthcare industry

feels that service providers should not splutter away their ideas after registering a windfall.

In order to understand the challenges and benefits of such innovations in the patient monitoring segment, we raised the following questions: • What is the future of patient monitoring with numerous scalable and portable homebased monitoring devices in the market? Do you think it will enable in meeting the challenges of patient monitoring in terms of clinical efficiency and decision-making?

• How can patient monitoring can be made more effective and real time to ensure lesser medical errors and delays? Please provide details.

Here are the excerpts:

Patient Monitoring

Cover Story

Dinesh Seemakurty

Abhishek Shah

• There are many portable home-based monitoring devices in the market, but very few of them are successfully thinking about the complete patient experience. It’s not sufficient anymore to just have a device that can collect vital signs, which has been solved years ago. The future of patient monitoring is the detailed design of the full workflow. Device designers have to consider everything from how the doctors prescribe this technology to how the care plan will be followed by the end patient. Even more difficult is to ensure the right data gets to the right person at the right time. Clinical efficiency and decision-making will come from solving these problems, not simply scattering more measurement devices in the hospital and home.

• Patient monitoring needs to be simplified and better analysed to become more effective. Most sophisticated doctors know that adding today’s monitoring solutions generally means more nursing staff, more information overload and more headaches.

Innovative companies need to focus on how more monitoring will reduce the clinical load on doctors and nurses. An effective patient monitoring system will allow doctors to half the time monitoring twice the number of patients. There is no point adding monitoring if no caregiver knows when and how to use the surplus of information.

• The future looks bright with connected patient monitoring devices and smartphone pairing. Costs are significantly lower than what they used to be. Personally, I do think that better, cheaper devices will help tremendously in addressing the challenge of access and accuracy. In a lot of cases, they will help in giving data where no data existed previously. However, I don’t think it’s enough, especially in the out-of-pocket markets. Clinical efficiency requires better data, better analytics, and timely and accurate decision-making to enable better patient outcomes.

To ensure better decision-making, all information needs to be structured in a comprehensible manner.

• Patient data today is sporadic & patchy. For it to be efficient and real time, it must be made continuous where possible and more frequent where not. Better patient experience demands artificial intelligence that learns and adapts to users’ habits and behaviour, and triggers actionable messaging like notifications on smartphone apps to achieve the highest probability of patient response. These apps should be comprehensive and engaging. The main driver towards efficient and real-time data is changing the role of the patient. The patient must become an active member in this process.

In order to reduce errors, the complete data has to reach the clinician at the right time, with a decision support system and analytics to equip the clinician to take better decisions.

Co-Founder, Stasis Labs

Co-Founder & CEO Wellthy Therapeutics

Dr Anand Gupta

Consultant & In-Charge, Transplant Critical Care, Saroj Super Speciality Hospital, Delhi • The integration of communication technologies into patient care has provided clinicians with a gamechanging solution to deliver better care, improve patient safety and enhance clinical outcomes. Portable and scalable patient monitoring equipment plays a major role in meeting the increasing demands of an ageing population, as well as in reducing hospitalisation cost and duration. These portable home-based monitoring devices are readily integrating information management and clinical decision support systems. In the coming future, with the advancement in patient monitoring equipment and integration of wireless and mobile technologies, such as the ability to store a significant amount of information on a mobile device, radio-enabled watches and a grid of body sensors, will facilitate better patient care. This will allow accessibility of critical medical information, such as blood group, allergies, and past and existing medical conditions, to be used in delivering urgent and suitable medical care. Hand-held devices will sense one or more vital signs and transmit alert messages to hospitals, ambulances and healthcare providers for getting urgent care services. In the long-term, affordability, portability and reusability of wireless technologies for patient monitoring and preventive care will also reduce the overall cost of healthcare services. However, due to several limitations, including unpredictable and spotty coverage of users by wireless networks, the quality and reliability of patient monitoring equipment would be a major concern.

• In my opinion, the most effective way to ensure lesser medical errors or delays can be achieved with continuous upgradation of knowledge of nurses/caregivers about the patient psychological condition, technological updation and learning the efficient manner of data interpretation to enhance clinical decision-making. Providing nurses or caregivers with information about the patient’s physiologic status in a manner that is easy and fast to interpret will be helpful in reducing the time needed to detect any abnormality.

12

July / 2016 ehealth.eletsonline.com

Patient Monitoring

Sir Ganga Ram Hospital

Sir Ganga Ram Hospital: Continues to be Pioneer via Establishing Smarter Technologies

Virtual solution is not really solving the healthcare needs as it is not a comprehensive solution and is only targeting one or the other diseases, shares Niranjan Kumar, CIO, Sir Ganga Ram Hospital exclusively with Kusum Kumari of Elets News Network (ENN) Despite being a charitable organisation, Sir Ganga Ram Hospital has stood test of the time because of goodwill. What are your expansion plans?

We do have expansion plans. In fact, the construction of the new building has already started. Another 200 beds will be added to our current capacity. A multi-storey car parking facility is also coming up. With these developments we would be able to extend our service to more needy patients. Our hospital has always been blessed to have visionaries driving the organisation with a futuristic approach. Our leaders Shri Ashok Chandra Ji, Chairman, Sir Ganga Ram Trust Society and Dr DS Rana, Chairman, Board of Management have been continuously guiding the institution with the greatest noble aim to grow the abundant goodwill that we have earned.

With such a huge inpatient facility, more than 600 beds, what measures are undertaken by Sir Ganga Ram Hospital to ensure correct patient monitoring in both critical and non-critical areas?

Overall, Sir Ganga Ram Hospital has definitely been one of the pioneer hospitals in adopting IT. Somewhere in 2002, we started a lot of IT implementations. In 2005-2007, we emerged as one of the India’s leading health technology interface systems.

The adoption of technology has been so far really good. All patient-related areas

14

July / 2016 ehealth.eletsonline.com

Sir Ganga Ram Hospital

are most of the time automated, whether it is capturing of the information, equipment interfacing, presenting order in my dashboard for the right care, etc. Currently, each and every critical patient bedside monitor is connected to a system and data is captured. It’s available for the emergency doctors, consultants and nurses taking care of the patients to get information at fingertips.

One more initiative that we are actually trying to achieve is to get all the information available outside the facility to ensure access to such information to the consultant or surgeon treating the patient. In order to achieve this, we even shortlisted a few products for our pilot project. However, the challenges we are actually facing in adopting such technology is the way they are interpreted by equipment vendors, hospital information system (HIS) and different stakeholders. A lot of time is wasted in interfacing and other issues.

Though service providers often promise of offering a complete solution, they come up with limitations and challenges once talks start.

We have already started a very innovative and state-of-the-art smart OPD. When we go live, maybe in a year’s time, I can challenge that we will be one of the very few hospitals in India that will be capturing each and every bit of patient information in a structured format, which will be available to patients, hospitals (not only Sir Ganga Ram Hospital), and doctors on mobile and cloud. We have already finished the pilot project and it’s now up and running.

All we are going to do is extending bedside monitoring information into the patients and doctors’ mobile. However, the level and intensity of the patient

Patient Monitoring

Smart OPD – Key Takeaways • Will change the entire hospital approach • Will allow continuum of care • Will enable real quality care • Will avoid repeat prescriptions & repeat visits • Will also include additional patient information

Home-based monitoring device will reduce hospital stay, but cannot replace hospitals

data transferred need to be determined as too much of data becomes overload to the consultant. Only when there is a problem, information will be escalated in a hierarchical manner. If all goes well, in next 2 to 3 months we should be able to integrate the bedside monitoring into this platform.

The technology innovation project like smart OPD, which is being driven by the clear understanding and directions of Dr DS Rana and Dr Ajay Swaroop, is something from which other hospitals will learn.

The second challenge is the volume of patients, which is a challenge for both nurses and doctors. In developed countries, there are predefined

Patient Monitoring - Key Challenges • Increased volume of patients • Medical errors due to lack of automated systems & manual recording of readings • Excess workload

slots during which the doctors need to communicate with the patients.

However, the Indian scenario is totally different due to lack of training and increased number of patients. In India, we need a system to save quality time to spend more time on patients. As such, most of the parameters can be captured automatically. There are small tools or monitors ready to put on patients that will capture 14 parameters. The centralised monitoring system alerts only when there is a problem. As statistics suggest, in one in seven cases previous readings were copied. This is one problem we often face. The monitoring system will also control medical negligence or medical errors witnessed due to wrong reading due to excess workload. As the pilot project will be started in August, we are planning to start this system in lesscritical areas, not in critical care units (CCUs) and intensive care units (ICUs), as patients are already monitored there. Such a monitoring system will

July / 2016 ehealth.eletsonline.com

15

Patient Monitoring

Sir Ganga Ram Hospital

also enable conversion of semi-critical areas into critical areas, which is one of the clinical advantages. Our motivated clinical administrators, such as Dr Ruby Sahney and her team, are working round the clock to ensure that the proposed technology is being put in place for the meaningful purposes.

Despite having portable and scalable patient monitoring devices in the healthcare sector, particularly in lifestyle disease section, we have not seen any decrease in the number of chronic disease cases. What is your overall opinion?

The concept of virtual healthcare is really coming up as the next buzzword, which is different from telehealth. In telehealth, one still

targeting one or the other diseases.

Unless a patient does not feel confident that he or she will be taken care of, such devices will not survive for long.

Virtual solutions should follow holistic approach and that’s the reason why home care is not really picking up as much it is supposed to be.

As a hospital often faces scarcity of beds, home care can reduce the hospital stay. Despite such obvious benefits, home care cannot replace hospital care, especially during emergencies. Many of the things are not discussed, structured and integrated. Therefore, we need a governing body to address these challenges. Tools are merely enablers and cannot be solution providers.

The assurance that a patient gets in a hospital setting will not be provided in a home-based setting. It will take

Sir Ganga Ram Hospital’s state-of-the-art smart OPD will enable capturing of every bit of patient information in a structured format

keeps the facility in the hospital and only extends communication through telecommunication technology to reach out to the patients. On the other hand, virtual healthcare aims to replace hospitals. Recently, I am aware of few innovative initiatives in places like Hyderabad, where they are coming up with a virtual hospital facility where all the services are offered through internet of things (IoT). If this kind of solution comes up, we can see decrease in patient flow.

Stand-alone telehealth equipment and solutions are not really solving the healthcare needs as they are not a comprehensive solution and is only

16

July / 2016 ehealth.eletsonline.com

another 2 to 3 years, unless big virtual healthcare solution providers that are trying to invest go completely live. The companies, such as Call Health, are really coming up. If they succeed, virtual healthcare will emerge as a big segment.

How will your project ‘Smart OPD’ redefine hospital approach?

Please provide details.

If our ‘Smart OPD’ project succeeds, the entire hospital approach towards the patient will go through a series of changes. As we already have an established connectivity with patients, they can share more information to allow ‘continuum of care’ through our

mobile app. This will allow holistic and longitudinal view of the patient’s condition based on the inputs and entire information shared between the patient and doctor. Consultations can continue even after the patient has gone back home. We are bringing in clinical secretaries to allow doctors to continue their consultation approach (feel and touch approach) and capture information. In next 1 year, we will have at least 300,000 patients’ structured records in our system. This will enable real ‘quality care’ and real satisfaction and avoid repeat prescriptions and repeat visits. The Smart OPD will also include additional patient information.

In the light of growing cyber threat in healthcare sector, particularly due to the availability of a large volume of data, what measures you think need to be undertaken?

Currently, the only tool we are giving access to patients or consultants or outside the hospital is the mobile app where the information is secured on the premium cloud platforms. As an organisation, we started focusing on cyber security quite early, as it is more than firewall. The realisation of importance of IT has really added up.

We plan to introduce some kind of cyber locks to enable encryption of any data going outside the hospital and avoid intrusion of malware. My only worry is that cyber security should not become a hyped up threat to restrain sharing of information. Security solutions are already available; however, cost incurred due to adoption of such a technology and inconveniences to the end users continue to remain the key challenges. We need to decide how much we are ready to compromise and invest.

Around 60 per cent problem is due to indiscipline amongst the users. Most of the time, we witness cyber security breach due to the users’ mistakes. Until and unless this area is not addressed, no amount of investment can address the immediate needs of the cyber security.

Press Release

ICMED – Significant Milestone for Both Consumers & Manufacturers

T

he Indian Certification of Medical Devices Scheme (ICMED), India’s first quality assurance system for medical devices & a joint initiative of the Association of Indian Medical Device Industry (AIMED), Quality Council of India (QCI) and National Accreditation Board for Certification Bodies (NABCB), was launched on March 15 in the presence of luminaries from government, healthcare industry, etc.

Additionally, Hindustan Syringes & Medical Devices Ltd (HMD), makers of Dispo Van, is the first Indian manufacturer to get ICMED.

ICMED - Key Takeaways • Will establish news standards for device/patient safety for consumers • Will provide much-needed product credentials to manufacturers • Will eliminate trading of substandard products of doubtful origins • Will fill the big regulatory void witnessed earlier due to lack of India-specific quality assurance system that led to loss of competitiveness to foreign companies

Key Objectives • To bring down the substantial time and cost-run to obtain globally accepted quality certification for Indian companies • To eliminate the malpractices of substandard or fraudulent certification or quality audits, thereby ensuring substantial savings, enhanced credibility and increased competitiveness.

Options for Certification • ICMED 9000 Certification (an ISO 9001 plus additional requirements) for low-risk medical devices • ICMED 13485 (An ISO 13485 Plus additional requirements) for medium and higher risk devices.

A third level, which would additionally prescribe medical device specifications developed by the National Health Systems Resource Centre (NHSRC) of the Ministry of Health & Family Welfare is still under development and would be launched later this year.

Key Parameters to be Followed • Need to approach any one of the certification bodies approved by the QCI under the scheme for obtaining certification.

• The certification bodies shall be under the oversight of NABCB, which as the national accreditation body, would accredit these certifying bodies according to the applicable international standards.

• Open to both indigenous and foreign manufacturers though Indian manufacturers would be expected to queue up initially.

• Since it’s a voluntary certification scheme, its initial success would ride on procurement agencies demanding for this as a qualifying criterion.

Dispo Van

July / 2016 ehealth.eletsonline.com

17

Patient Monitoring

CURA

CURA: Adding High-Quality Technologies to Empower Healthcare Space The interconnected patient monitors & information management systems are aggregating patient information that is presented to the clinicians in the unified way. This is enabling clinicians to take more informed and evidence-based decisions for patient management, shares Arvind Savargaonkar, Director, Critical Care Solutions, CURA with Elets News Network (ENN) It’s quite interesting to note CURA’s emphasis on the concept of ‘affordable luxury’. Please explain in detail the key objectives behind the coining of this concept.

Indian healthcare has been growing at a much faster pace in comparison to developed countries and most of the developing markets. This is due to rising income levels, swelling private sector investments, growing older age population and government incentive in healthcare space. Despite all, there is a huge gap between demand and supply of healthcare services in India, especially in tier-II and tier-IV population. Our aim is to address this space

and try to bridge the gap as far as possible. CURA is into empowering diagnostics, imaging and critical care space. Both of them are of primary importance for healthcare services.

How has CURA scaled up its services & products postacquisition of medical device manufacturing companies known for excellence, such as DE Healthcare & Concept Integrations?

CURA has been into imaging diagnostics space. In order to expand its basket of solutions and services, it acquired DE Healthcare, which has a strong deoxyribonucleic acid (DNA) in ultrasound and Color Doppler for over a decade and a half. Post acquisition, the ultrasound business has doubled installation base & tripled its revenue.

Similarly, post acquisition of Concept Integrations, we have started manufacturing products in the Chennai facility, upgraded products to be CE accredited, and added technologies, such as Masimo and Suntech, to compete in high-end monitoring markets.

Since our next issue is about patient monitoring, please walk us through

18

July / 2016 ehealth.eletsonline.com

Patient Monitoring

CURA

CURA’s critical care devices.

With healthcare now becoming more patient-centric, what key developments and innovations have been witnessed in the patient monitoring segment?

The patient monitoring segment is keeping pace with the advancements witnessed in the technology space.

Interconnectivity and exchange of information are becoming progressively commonplace in the intensive care set-ups. The interconnected patient monitors and information management systems are aggregating patient information that is presented to the clinicians in the unified way. This is enabling clinicians to take more informed and evidence-based decisions for patient management. The newer monitoring parameters are also becoming available to the clinicians.

The sedation levels and anaesthesia depth can be monitored using various electroencephalogram (EEG) indices.

Non-invasive monitoring of cardiac output, as well as estimation of arterial oxygen or carbon dioxide, is becoming possible. These parameters equip the clinicians with highly significant information to treat the patients.

The new generation systems have also incorporated improved and clinically-aware data processing techniques that ensure improvement in efficiency and better utilisation of clinician’s time. The new systems have greatly improved alert and alarm function that reduce the occurrence and frequency of false alarms. This

considerably improves the reliability of alarm functions and reduces the distractions to clinicians in intensive care set-up, thereby allowing clinicians to focus on real health conditions of the patient and manage them better.

In what ways, CURA’s patient monitoring devices stand apart from its competitors in enabling appropriate medical decision-making & therapeutic interventions?

CURA has consistently maintained its focus on meeting the highest quality standards to provide reliable and dependable products to its customers.

This is further backed up by CURA’s commitment to provide effective service support throughout the lifetime of the products.

CURA’s patient monitoring devices are developed to provide reliable patient information in the simplified and friendly way that helps in easy identification of patient’s health status.

It is well known that the way information is displayed affects speed and accuracy of perception and decision-making. The patient monitoring devices are also equipped with multi-input features, including touch screen user interface.

The simple user interface coupled with a touch screen feature provides great user experience. CURA is incorporating analytics capabilities in its patient monitoring systems that can aggregate and analyse multidimensional data.

These capabilities are aimed at early detection of clinical deterioration of

CURA’s Patient Monitoring Devices – Key Features • Provide reliable patient information in a simplified way to identify a patient’s health status • Equipped with multi-input features, including touch screen user interface • Simple user interface coupled with a touch screen feature provides great user experience • Incorporating analytics capabilities to aggregate & analyse multidimensional data

20

July / 2016 ehealth.eletsonline.com

CURA – Key Objectives • Address the existing huge gap between demand & supply of healthcare services • Empower diagnostics, imaging and critical care space • Reducing incidence of avoidable emergencies & deaths through early detection • Capturing completely new insights through analytics on multidimensional information • Meeting the highest quality standards patient health status, thereby enabling early interventions and reducing the incidence of avoidable emergencies and deaths. Apart from this, analytics on multidimensional information provides completely new insights to the clinicians for diagnosis and intervention.

What steps are undertaken

by CURA to ensure quality standards to meet the customer expectations?

CURA complies with the international ISO 9000 and ISO 13485 quality certifications and has been demonstrating a high level of maturity in the implementation of its quality management systems. CURA products are also CE certified. CURA has consistently employed most modern quality management methodologies and CURA’s internally developed COMPASS compliance management system has won acclaims at multiple quality forums including Quality Council Forum of India.

Patient Monitoring

Omron Healthcare

Omron Healthcare: Targets both Aging Population & Caregivers to Grow Business Aggressively We recognise the potential that India offers as a market and are focusing on growing the business aggressively, shares Hisao Masuda, Managing Director, Omron Health Care Services, India with Elets News Network (ENN) It’s interesting to note that Omron Healthcare focuses on home-based healthcare monitoring. How interesting and big is India in terms of homebased monitoring equipment and which are the key segments where you see the maximum adoption?

Home health monitoring market is growing at a fast pace. According to Sandler Research, it is expected to grow at a compound annual growth rate (CAGR) of 8.85 per cent during the period 2016-2020. This clearly shows the potential this market holds along with the scope of growth.

With the kind of lifestyle changes that the urban Indian is going through, health has somehow taken a backseat due to which there has been a considerable rise in lifestyle diseases, such as hypertension, asthma, obesity, etc. In majority of the cases, people are unaware of the fact that with regular monitoring, such diseases can be avoided and the higher risk of acute problems can be mitigated.

Hence, preventive care can go a long way in controlling health problems within the comfort of one’s home.

Preventive care plays a key role in the overall healthcare of individuals and India continues to be one of the key markets of Omron healthcare. Over the last few years, we have focused on building our product awareness in the region. In 2015, we achieved a 36 per cent growth in blood pressure monitor

22

July / 2016 ehealth.eletsonline.com

(BPM) sales; this proves to show that there is a need from the consumer’s end that has to be addressed. We have constantly focused on reaching out to the aging population of the country (40 years and above) and along

with that we are now focusing on ‘caregivers’, which essentially means young working individuals who are responsible for taking care of their elders/parents in the family.

In the next phase of development,

Omron Healthcare

we would like to focus on creating awareness about preventive care in the country and dive deep into tier-II and tier-III cities to further strengthen our position as the leading preventive healthcare company in India. Currently, we are the leading player in Indian market for BPMs and nebulisers, with respect to both volume and market share. We recognise the potential that India offers as a market and are focusing on growing the business aggressively. Our target for the next 3 years is market penetration and increase share of market.

How far has Omron Healthcare succeeded in integrating its home-based monitoring equipment with the regular medical facilities to enable ease of access and strengthen preventive cure?

We are closely working with the key opinion leaders in each market (KOL program). KOL program, an educational process which enables to continuously renew the clinical knowledge and practical skills for medical professionals, and Omron aim at improving the quality of medical care and safety of patients.

As these key opinion leaders understand the importance of preventive care, they recommend the home monitoring equipment to every patient (such as BPMs, nebulisers, weighing scale and blood glucose meters (BGM)).

Are all of your devices adaptable in home-based environments or some of the professional products are meant specifically for medium and smaller size medical facilities?

Key Objectives • Market penetration • Increase share of market

Patient Monitoring

Key Takeaways • Achieved a 36% growth in BPM sales • The leading player in Indian market for BPMs and nebulisers, both volume and market share • Works closely with the key opinion leaders in each market • Focuses on creating awareness about preventive care in the country • Targets tier-II and tier-III cities to strengthen position as the leading preventive healthcare company in India We offer a wide array of preventive healthcare devices for both personal home care and hospitals (mid and small sized) as mentioned below: Home care products: • BPMs: There are two types, including upper-arm type and wrist type • Nebuliser • BGMs • Thermometer: there are three types including forehead type, ear type and pencil type • Body fat monitor • Weighing scale • Step counter • Cushion massager • Pulse massager • Pulse oximeter Hospital use products: • BPMs • Nebuliser • Electrocardiograph • Non-invasive vascular screening device Currently, we manufacture our products in Japan, China and Vietnam, and will look at manufacturing in India, once we reach enough volume to justify the investment in a manufacturing facility.

What are the key challenges and benefits in operating an emerging market like India?

Do you see a progressive behavioural change when it comes to adoption of homebased machines & wearables?

Some of the major challenges include transportation, tax issues and infrastructural issues. However, home healthcare is one of the fastest growing markets and India is second only to China in both scale and future expectations. In India, there is limited awareness about diseases, such as hypertension, asthma, etc.

At the same time, a large part of the population is unaware of devices that can help in reducing high risks involved with these diseases. In order to bring more awareness about the diseases and the device, we initiated the following activities: • Digital promotional activities to engage the youth: Here, we have gone ahead and educated the consumers about preventive healthcare devices and diseases that it can monitor.

• On ground activities: We have conducted road shows in various parts of the country, including tier-I and tier-II cites by holding free BP and body mass index (BMI) checkups for the consumers.

• Additionally, we have also used electronic channels, such as radio and TV, to promote our devices in tier-II cities in the country.

We will continue to play a major role in the preventive healthcare segment with our deep focus towards engaging with consumers and educating them about various diseases and preventive tools that can help them in living a healthy lifestyle.

July / 2016 ehealth.eletsonline.com

23

Patient Monitoring

AMRI Hospitals

AMRI Hospitals: Implementing Latest Technology to Offer Best Care The AMRI chain of super specialty hospitals has brought in advanced health technology in Eastern India with four centres across West Bengal and another 400-bed unit in Bhubaneswar, Odisha. Rupak Barua, Group CEO, AMRI Group of Hospitals, spoke to Namita Panda of Elets News Network (ENN) about the implementation of technology in healthcare offered at this premier brand of hospitals How is AMRI Hospitals employing patient monitoring technology?

We all know the fact that technology is helping immensely in finding medical solutions and hence a lot of attention is being paid to technology of late. Additionally, mobile apps, sensors and software developed by Accenture have emerged as essential tools for collecting critical vitals of patients, which are available for

doctors even through SMS service.

Even AMRI Hospitals uses such technology and our patients get reports of their pathological tests through our website after their blood samples have been collected. In the mobile technology segment, the facility of downloading online reports is a beginning.

It is predicted that the use of remote patient monitoring

technology in conjunction with electronic health record (EHR) could save healthcare industry US$700 billion in 15 to 20 years.

What is your opinion?

In India, the rate of adoption of remote patient monitoring technology is even now in a nascent stage. However, it for certain that in the healthcare industry, electronic medical record (EMR) can change the entire delivery system in future. Additionally, medical care can become more efficient and error free without the intervention of human resource.

However, as healthcare providers, it is also important for us to identify which mobile technology is useful and what we need. At AMRI Hospitals, we already have the facility of online prescriptions and we implement the latest technology wherever possible.

What measures have been undertaken by AMRI Hospitals towards wireless patient monitoring? Please provide details.

To accelerate move towards wireless patient monitoring, we have introduced a robot in the intensive care unit (ICU) located in our Bhubaneswar centre. The doctors through this robot can remain in touch with patients even without

24

July / 2016 ehealth.eletsonline.com

Patient Monitoring

AMRI Hospitals

laparoscopic procedures, such as nephrectomy, pyeloplasty, etc., are also being routinely performed in the department. Advanced facilities are also available for the treatment of various renal problems in the paediatric age group.

being present themselves. As patients have access to it through remote control, it can fetch medicines and other necessities on command. In our critical care units, we offer high-end facilities and we are in a discussion stage with General Electric (GE) to begin an e-ICU or a remote control ICU. This will be implemented on a hub and spoke concept basis, which will be especially beneficial in rural health development.

AMRI Hospitals, Bhubaneswar recently collaborated with Asian Cancer Institute (ACI) of Mumbai. What are the facilities offered here?

At AMRI Hospitals, Bhubaneswar, the diabetes treatment unit is known for being extremely advanced in terms of technology. Please provide details.

Kidney diseases affect millions of people worldwide; 10 per cent of the population worldwide is impacted by some form of kidney disease. The latest numbers show that chronic kidney diseases is predicted to increase by 17 per cent over the next decade and is recognised by the World Health Organization (WHO) and other organisations as a global public health issue. Therefore, it is crucial to encourage and facilitate education and awareness about chronic kidney diseases. AMRI Hospitals in Bhubaneswar has an advanced department of renal sciences. The nephrology department is well equipped with a state-of-theart haemodialysis unit with facilities of dialysis for hepatitis patients.

It also has the facilities of kidney biopsy, plasmapheresis, continuous ambulatory peritoneal dialysis (CAPD)

AMRI Hospitals has introduced a robot to accelerate the adoption of wireless patient monitoring

and permcath insertion. It provides advanced facilities to patients with all kind of kidney-related disorders, both acute and chronic.

The urology department has exclusive facilities, such as highend lithotripsy (extracorporeal shock wave lithotripsy (ESWL)) for urinary stone diseases, and 100W holmium laser for the treatment of kidney stones. There are facilities also for prostate problems, urethral obstruction and bladder tumours.

Apart from routine urological operations, advanced

AMRI Hospitals, Bhubaneswar - Key Takeaways • Has introduced a robot in the ICU • Offers high-end facilities in critical care units • In a discussion stage with GE to begin an e-ICU or a remote control ICU • Has an advanced department of renal sciences • Offers world-class cancer treatment

26

July / 2016 ehealth.eletsonline.com

We offer world-class cancer treatment to the people of Odisha and East India. The cancer population in India is around 45 lakh, of which around 10 lakh of new cancer patients are getting added every year. While men in India are getting afflicted mostly with cancer of head and neck, lungs and prostate gland, women are getting largely diagnosed with breast cancer along with ovarian and cervical cancer. The causes of cancer and the new areas of treatments are still being studied and addressed globally. Through this collaborative endeavour, ACI will try to reach out its services beyond Mumbai and offer world-class treatment in cancer to the entire country. In the first phase, we have set up a 50-bed cancer treatment facility in Bhubaneswar.

What is your view about medical device manufacturing in India, especially when it comes to patient monitoring?

Medical devices are the most important source of clinical care today.

So far we used to import major patient monitoring devices. Now, important devices, such as electrocardiography (ECG) machine and pulse oximeter, are manufactured indigenously and have also helped in rural areas. Additionally, multinational corporations (MNCs) have their own research and development (R&D) facilities in India now, like GE and Philips have established their R&D set-ups in Bengaluru.

Special Feature

Big Data Management

W

Face to Face with Real Challenges of Big Data Will healthcare industry hit the jackpot with the new show stopper in fray?

hen appropriately and adequately utilised, big data analytics will drive growth and ensure cost reduction and better customer experience.

However, we are yet to learn the rules of taming a large volume of data generated on a daily basis in the healthcare industry. With so many data security providers, end users may be lulled into a false sense of security; however, the truth is challenges due to big data are increasing with each day. During our discussions with the healthcare stakeholders, we realised the real challenges and risks confronting the healthcare industry and the real reasons behind such risks. eHEALTH Magazine as the voice of the healthcare industry was particularly interested in understanding the real reasons behind the increased number of cyber attacks in the healthcare industry. There was a need to comprehend this shift of cyber security issues from the financial sector to the healthcare industry and whether we were barking up the wrong tree in this entire process. Post intensive discussions, we reached to the conclusion that in order to create a security blanket to avoid security breaches and data threats, we need to create a highly responsive system with simple tools to address such risks as much as possible. A clear incident responsive plan that can identify threats quickly will mitigate threats in a very responsible manner. Though 100 per cent security is not possible, the above structural changes will build a system that can be implemented across the industry.

More than structural and operational changes within an organisation, spreading the right awareness about IT discipline and protocols to be followed while accessing systems will also play a crucial in addressing cyber security related issues.

July / 2016 ehealth.eletsonline.com

27

Big Data Management

Fortinet

Fortinet: Aims at Prevention via Single Collaborative Security Solution Integration To successfully compete in the new digital economy, healthcare organisations need to implement a tightly coordinated security strategy that can see & govern data across an entire borderless network without compromising agility or performance, shares Rajesh Maurya, Regional Director, SAARC, Fortinet exclusively with Elets News Network (ENN) We have lately seen an unimaginable 340 per cent increase in the number of targeted cyber attacks in healthcare sector. Keeping this in mind, please enumerate the measures undertaken

by Fortinet to go beyond the Health Insurance Portability and Accountability Act (HIPAA) to ensure data protection?

Currently, healthcare networks are undergoing dramatic change.

Organisations are simultaneously wrestling with issues, such as bring your own device (BYOD), the Internet of things (IoT), virtualisation, software-defined networking (SDN), cloud, the proliferation of applications, big data, and the expectations of the next generation of employees to blend their work and their personal lives on a single device of their choice, with instant access to any data, at any time, from any location.

This has exponentially increased the attack surface that organisations need to be concerned with. For example: • IoT and cloud solutions mean organisations need to worry about an attack surface that many times may not be visible to IT. • Many IoT devices are headless, run simple communications protocols, and are unable to run a client

28

July / 2016 ehealth.eletsonline.com

or even be patched. They rely exclusively on the access network for security.

• Critical and proprietary business and patient data is being moved into the cloud and managed by third parties. Known as Shadow IT, this trend is expanding, with many organisations simply unaware of where data is currently located or what security measures are in place to protect it.

• The transformation to a digital business model has extended the network beyond the perimeter, which means that today’s networks and their related security are becoming borderless.

• BYOD devices are highly mobile, blend personal and work profiles, and represent real risk as critical data is accessed from public locations, or when devices are lost or stolen.

The response to increasingly complicated networked environments needs to be simplicity. Securing these evolving environments requires three things: • C o l l a b o r a t i v e intelligence: Local and global threat intelligence needs to be shared between security

devices, and a coordinated response between devices needs to be orchestrated centrally.

• Segmentation: Networks need to be intelligently segmented into functional security zones.

End-to-end segmentation, from

Fortinet

IoT to the cloud, and across physical and virtual environments, provides deep visibility into traffic that moves laterally across the distributed network, limits the spread of malware, and allows for the identification and quarantining of infected devices.

• Universal policy: A centralised security policy engine that determines trust levels between network segments, collects real-time threat information, establishes a unified security policy and distributes appropriate orchestrated policy enforcement This is the reason why Fortinet has introduced its new security fabric architecture. It is designed to integrate security technologies for the endpoint, access layer, network, applications, data centre, content and cloud into a single collaborative security solution that can be orchestrated through a single management interface.

In case of any IT disaster or electronic media errors, what technical measures have been put in place to ensure patient information is recovered accurately? How do you plan to leverage advanced

cybersecurity technologies to provide a new level of defensegrade cybersecurity?

A clear detection and remediation process is an essential part of a good network security system, because no matter how much money companies spend on security, no organisation is 100 per cent secure from breaches.

Every organisation needs a clear incident response plan to ensure you have processes, procedures and skilled resources to quickly identify and mitigate threats as soon as they hit your network.

Once an intrusion has been validated, users, devices and content should be quarantined, with automated and manual systems in place to ensure the safety of network resources and organisational data.

Previously unknown threats should be forwarded and analysed in depth, resulting in updates being fed back to the different services in the network providing every layer with the right mix of up-to-date protection.

Prevention is better than cure and our Cyber Threat Assessment Program (CTAP) is designed to provide organisations with a detailed look into the type and amount of cyber threats posing risks to their

Understanding FortiGuard Labs • Fortinet’s dedicated security research team • Leading the industry in innovation powering all Fortinet top-rated security platforms • Composed of security threat researchers, engineers & forensic specialists • Tasked with outsmarting the cybercriminals & delivering cutting-edge protection tools to our customers • Offers real-time intelligence on the threat landscape • Delivers comprehensive security updates across the full range of Fortinet’s solutions • Collaborates with the world’s leading threat monitoring organisations

Big Data Management

Key Takeaways • A clear detection & remediation process is essential • Simplicity is the apt response to increasingly complicated networked environments • No organisation is 100% secure from breaches • Ensure a clear incident response plan to quickly identify & mitigate threats networks, yet are going undetected by their existing security solutions. This new offering is part of a broader effort

by Fortinet and its FortiGuard Labs threat research team to integrate risk and advisory capabilities with its end-to-end security platform to provide customers greater insight into dynamically changing cyber risks that threaten their businesses.

According to the statistics available, healthcare organisations have chronically underinvested in IT security measures to protect its data and electronic health records (EHRs).

In the light of the above, do you see an increased investment in data protection in the Indian healthcare institutions?

Even within the healthcare industry, few people realise just how vulnerable many of our systems are to cyberattacks. We talk about protected health information (PHI) and HIPAA compliance, as well as worry about penalties, but few organisations see themselves as targets for the sophisticated attacks that have wreaked havoc for the likes of Anthem.

The reality, though, is that the

July / 2016 ehealth.eletsonline.com

29

Big Data Management

Fortinet

black market for patient data is up to twenty times more valuable than that for credit card data often stolen in retail breaches. Healthcare data is detailed, rich and full of information that cybercriminals can use for identity theft and fraud. More importantly, it takes far longer for patients to know their information has been compromised – it can take up to a year or more for someone to realise that their patient data has been compromised.

According to Frost & Sullivan, the expected spending in India on network security in 2016 by education vertical is US$ 20 million and manufacturing is US$ 38 million. The healthcare vertical lags far behind in terms of investment in network security, leaving it far more vulnerable than its peers in other industries.

The time to address healthcare security is not when medical record breaches like the Anthem start making headlines. The time is now.

The healthcare industry as a whole needs to be proactive and begin deploying systems with security baked in, protected at both the network and application levels. The stakes are simply too high to wait.

India’s digital capabilities to protect crucial infrastructure and data lag significantly behind the regional and global players due to lack of investment & expertise.

What measures are being undertaken by Fortinet to address this problem?

For 15 years, Fortinet’s dedicated

Fortinet - Key Objective • Fortinet’s mission is to deliver the most innovative, highest performing network security platform to secure & simplify enterprise IT infrastructure security research team, FortiGuard Labs, is leading the industry in innovation powering all Fortinet top-rated security platforms. This accomplished group is composed of security threat researchers, engineers and forensic specialists tasked with outsmarting the cybercriminals and delivering cutting-edge protection tools to our customers.

FortiGuard Labs offers real-time intelligence on the threat landscape, delivering comprehensive security updates across the full range of Fortinet’s solutions. The team collaborates with the world’s leading threat monitoring organisations, other network and security vendors (leading the first multi-vendor cyberalliance), and law enforcement, both advising on new threats discovered by patented technology and examining new network trends.

Based on this synergetic approach, the FortiGuard Labs team specialises in developing new adaptive defense tools to help protect against multivector targeted attacks.

In India, we have a Technical Assistance Centre (TAC) situated

Fortinet - Role in Indian Market • Has a TAC situated in Bengaluru (Bangalore) • Provides Level 1, Level 2 & Level 3 phone support to Indian a&nd SAARC customers • TAC will oversee professional services and technical account management, ensuring expert & timely deployment of local projects

30

July / 2016 ehealth.eletsonline.com

in Bengaluru (Bangalore). Besides providing Level 1, Level 2 and Level 3 phone support to Indian and the South Asian Association for Regional Cooperation (SAARC) customers, Fortinet’s team at the TAC will oversee professional services and technical account management, ensuring expert and timely deployment of local projects.

The company has also invested in highly skilled engineering resources to help customers solve difficult technical issues and deploy complex architectural designs and implementations. These resident engineers will have direct access to Fortinet’s developers and support resources for on-site or off-site implementations, and will ensure a timely, precise and complete service experience for customers.

Our professional & support services are designed to ensure critical replacements and technical assistance are readily available to customers at any point of time to ensure business continuity. Our support service complements our world-class technology solutions with enterprise-grade support to match our customers’ needs and expectations.

In terms of data protection, healthcare stakeholders are witnessing more challenges now than ever, as we now not only have vulnerable digital connected medical devices but also home-based digital health devices with no in-built security measures. How is Fortinet planning to confront this challenge in a largely unregulated country like India?

Today, everything from heart monitors to IV pumps can be networked, automatically interfacing with EHR systems and providing real-time alerts to healthcare providers. From the perspective of patient care and operational efficiency, this is a good thing. From a security perspective,

Big Data Management

Fortinet

it’s a potential nightmare.

Most of these devices, as well as magnetic resonance imaging (MRI) machines, computed tomography (CT) scanners and countless other diagnostic machines were never designed with security in mind. Many diagnostic systems use off-the-shelf operating systems, such as Microsoft Windows, while other devices use purpose-built software designed to collect data - not keep it safe.

Device proliferation isn’t just occurring in hospitals. An increasing numbers of home health devices, mobile apps, wearables, and more are collecting and transmitting personal health information. Not only do these devices and apps potentially expose patient data (or at least fail to adequately protect it), but they also often interface directly with EHR and clinical data systems. When everything from a home glucose monitor to an iPhone app can become part of the attack surface, it should become clear just how badly exposed healthcare institutions are.

Fabric Security is Critical to Sustain Business Innovation in the Healthcare Industry Today’s digital-driven healthcare organisations connect more users, devices, applications and data than ever before to drive business value.

Billions of new Internet Protocol (IP) enabled, non-user IoT devices are transmitting vast amounts of

32

July / 2016 ehealth.eletsonline.com

Risks of Home-Based Digital Health Devices • Networked & automatically interfaced with HER systems • Never designed with security in mind • Either use off-the-shelf operating systems or purpose-built software designed to collect data • Collecting & transmitting personal health information data traversing wired and wireless access points, through both public and private networks, and across traditional and cloud infrastructures.

To successfully compete in this new digital economy, healthcare organisations need to implement a tightly coordinated security strategy that can see and govern this data across an entire borderless network without compromising agility or performance.

Fortinet’s Security Fabric Delivers Security Without Compromise To address the challenges brought on by the digital economy and subsequent evolving enterprise IT infrastructure, Fortinet’s

Security Fabric brings traditionally autonomous systems together into a single architecture, designed with five critical and interdependent attributes – scalability, awareness, security, actionable and open.

In comparison to the major powers, such as the United States (US) & China, India confronts the problem of digital disconnection and density. What are your recommendations to address this problem?

An effective defense is often founded on building a cohesive and extensible protection framework.

This framework is critical as it incorporates current security capabilities, emerging technologies and having a learning mechanism that creates actionable security intelligence from newly detected threats. Other measures include assessing the network environment and devising a response plan. It is important to secure potential bottlenecks, monitor the network, and ensure they look beyond large attacks and plan countermeasures.

A strong partnership with a security provider is also essential.

The partner can provide up-to-date information and threat intelligence to the IT staff, as well as define an escalation path when an incident is detected. The government agencies should also proactively partner cyber security organisations and solution providers to share threat information, so that collectively, the industry can have a more comprehensive view of the global cyber threat landscape and respond better to attacks.

Lastly, while a comprehensive assessment and plan can be developed, it is crucial to educate government employees on cyber threats. Employees with access to sensitive information have to be specially trained to know how to deal with that data.

Big Data Management

8K Miles Software Services

8K Miles Software Services: Enabling Move to Cloud by Offering Platforms of Choice According to a recent cloud compliance report, on-premises users have an average of 61 attacks per year while SaaS/cloud customers only experience an average of 27 attacks annually, shares Suresh Venkatachari, Chairman, 8K Miles Software Services with Elets News Network (ENN) Please walk us through the solutions offered by 8K Miles Software Services that enable institutions to undertake appropriate management and governance-related decisions?

8K Miles has been focusing on building integrated solutions on the cloud and managed services based on the foundation of security, compliance, privacy and identity access governance capabilities. This includes EzIAM, an identity and access management on the cloud, Access Governance as a Service, and Security Intelligence and Analytics as a Service offering. CloudEzRx, a cloud acceleration platform and framework composed of interdependent infrastructure, security, automation, compliance, governance and service management functionality (ITSM) to deploy a fully qualified and validated infrastructure platform design and implementation service. The validated framework defines a company-wide solution to provide cloud services for users via a self-service dashboard. Thus, CloudEzRx enables life sciences companies creating a cloud environment meeting stringent security, privacy and regulatory challenges and strategies, including GxP, Health Insurance Portability and Accountability Act of 1996Health Information Technology for Economic and Clinical Health (HIPAA-HITECH), etc. Integrated advanced DevOps automation ensures that continuous compliance is met at every step of cloud adoption, implementation and managed services. An all-in-one integrated dashboard provides a powerful interface to manage, control and audit the entire IT portfolio.

The healthcare sector has emerged as

34

July / 2016 ehealth.eletsonline.com

8K Miles Software Services

one of the most vulnerable sectors due to massive volumes of patient data generated through different sources? How is 8K Miles Software Services assisting medical facilities in better & secure management of data?

Technological advancements are transforming the entire healthcare industry. The proliferation of new technology in healthcare is exploding.

The following list highlights some opportunities and concerns for these rapidly evolving technological advancements: • Wearable Tracking Devices • Patient-Centered Care • Increased Data Demands • Attaining Meaningful Use and Switching to ICD-10 • Data Security and Compliance Healthcare providers are now looking to provide efficient care delivery, patient engagement and safety, improved interoperability and at the same time with reduced security and compliance risks at a lower cost.

The challenges include improving financial performance, increasing cost effectiveness, improving population health status and boosting quality of care. There is an increasing need to address these challenges through innovation and efficient operational models. Cloud solutions provide the opportunity, agility and increased efficiencies, but at the same time, it may create disruptions for any organisation.

8K Miles’ healthcare solutions

Big Data Management

Key Takeaways • Building integrated solutions on the cloud and managed services based on the foundation of capabilities, such as security, compliance, etc.

• Enable healthcare providers & their partners to support the sharing of clinical & administrative data between healthcare organisations, and provide auditing and reporting capabilities • Allow doctors, nurses, pharmacists & other healthcare providers to securely share a patient’s vital medical information electronically • Help smaller hospitals & physician offices in joining the major hospital networks in a much easier & faster way and services enable healthcare providers and their partners to support the sharing of clinical and administrative data between healthcare organisations, and provide auditing and reporting capabilities.

These solutions can help foster improvements in the areas of better patient care delivery, patient privacy protection, and efficiency and patient safety. Specifically, these solutions should allow doctors, nurses, pharmacists and other healthcare providers to securely share a patient’s vital medical information electronically – reducing the need for patients to store, transport and share information, such as medical history, lab results, images or prescriptions with other health professionals.

8K Miles has been already providing electronic health records (EHRs) and support services to

hospitals across North America.

8K Miles’ CloudEzCare platform, an automated and validated HIPAA compliant cloud environment, can be built and operated in a secure and cost-optimised manner. Through CloudEzCare platform, 8K Miles also can help smaller hospitals and physician offices in joining the major hospital networks in a much easier and faster way and at a very low cost for members, as well as assure industry-wide regulatory compliance, privacy, identity and security requirements.

Being a one of the key cloud solution provider, please enumerate the main challenges of big data management in the Indian market.

Key Challenges: Integrating Data into Big Data System: The scale and different types of data to be absorbed into a big data environment can be overwhelming for an unprepared data practitioner, making data accessibility and integration a challenging task. It might seem obvious that the intent of a big data programme involves processing or analysing massive amounts of data. Yet they may not be aware of the complexity of facilitating

July / 2016 ehealth.eletsonline.com

35

Big Data Management

8K Miles Software Services

the access, transmission and delivery of data from the numerous sources and then loading those various data sets into the big data platform.

Availability of Skilled Resources: There is great opportunity around big data applications; however, we don’t have a large community of experts available to help in implementation.

With the phenomenal rise in the cyber attacks in the healthcare industry, how far are the cloudbased applications or software as a service (SaaS) secure in comparison to other tools?

How do you intend to make it more secure with the growth of data now becoming totally unimaginable?

Perception is that on-premises solutions are more secure than on the cloud. While both on-premises enterprise infrastructure and cloud-based infrastructure have equal chances of getting attacked, recent reports show that cloud is actually more secure than on-

36

July / 2016 ehealth.eletsonline.com

Key Offerings • EzIAM • CloudEzRx • CloudEzCARE premise. According to a recent cloud compliance report, on-premises users have an average of 61 attacks per year while SaaS/cloud customers only experience an average of 27 attacks annually.

Here are the benefits 8K Miles’ cloud security framework can offer to healthcare customers. These benefits include secured virtual private cloud infrastructure, secured virtual private network (VPN) tunnel connection between enterprise to cloud environment, perimeter controls, biometrics, multiple pipes for bandwidth, secure proxies, data encryption at rest and in transit, identity access governance, security intelligence, logging and analytics, HIPAA compliance monitoring, GxP

validated and qualified applications and data for life sciences industries.

There seems to be a lot of misconceptions around what kind of security precautions need to be undertaken when using cloud-based storages, services, etc. Please provide the details on how 8K Miles Software Services is working upon addressing such misconceptions.

Enterprises have traditionally been slow to adopt cloud-based applications and almost totally resistant to any suggestion of business-critical applications and data to be to be hosted on a public cloud. First misconception is that the applications and data are not safe on the cloud. Second misconception is that the applications don’t have proper access control or policies built around them. Third misconception is about bad governance on the cloud.

Based on our experience and market research data, healthcare providers and payers will have to increasingly adopt the cloud in order to meet the regulatory requirements around infrastructure with rising costs and handling of healthcare data that involves social aspects. The best way to ensure that the healthcare providers have control over their data is to extend the internal controls and governance onto cloud. 8K Miles is becoming one of the very few fully audited and certified managed service providers for public cloud.

8K Miles’ CloudEz platform for pharma has been recognised as the platform of choice or Trusted Cloud for Industries by multiple public cloud providers. This platform brings ITSM automation, HIPAA and GxP compliance validation, access control security and governance capabilities for accelerating the move by healthcare providers, payers and life sciences/pharma companies to cloud.

Know the Social credentialS of eHealtH

Big Data Management

Siemens Healthineers

Siemens Healthineers: Intends to Aggregate & Integrate Data to Turn into Significant Information Big data pools thousands of patient experiences, indicating what treatments work best for customers, shares Vivek Kanade, Executive Director, Siemens Healthcare Private Limited with Elets News Network (ENN) How is the enormous volume of data collected during clinical practice & research going to impact the entire healthcare system in the coming days?

Please enumerate the key repercussions on the population.

To bring it to the point, collecting data will enable much better informed, more objective decisions with results that have repeatable quality. However, data by itself will not do the trick. It needs to be transformed into useful information.

When healthcare providers harnessing the large quantities of data already collected combine data with new patient-generated information, it will accelerate adaptability of big data to the major challenges facing the industry, which are mainly to reduce costs, while at the same time maximising outcomes for each patient.

Providers that implement best practices can immediately streamline a number of their processes, including coding, billing and supply management practices. Most importantly, big data will let healthcare providers, both large and small, access and analyse their patient outcomes to pinpoint where money is best spent and where it can be saved.

Big data also allows healthcare providers to meaningfully evaluate their practices and compare them within and across organisations. Big data pools thousands of patient experiences,

38

July / 2016 ehealth.eletsonline.com

indicating what treatments work best for customers.

Long a buzzword in the field, big data will make personalised medicine a reality. Precision medicine is promising a diagnostic and therapeutic approach towards a patient that is much more tailored to an individual’s requirements.

Increasing the number of recognised different groups of diseases and patients on the other hand decreases the number of comparable patients within these groups. The availability of larger data sets offers a chance to find statistically significant information needed to practice precision medicine.

When unlimited data remains ungoverned and unprotected, there exists the risk of big data becoming a liability rather than an asset. What measures are being undertaken by Siemens Healthineers to tap the real potential of ‘Big Data’?

Our big data activities follow privacy by design approach to avoid an ungoverned growth of data pools.

Data protection is a core requirement in all product definition and engineering efforts in this direction.

Let’s take our software teamplay as an example.

With teamplay, Siemens Healthineers offers a

cloud-based network for physicians, medical professionals and decisionmakers in healthcare. It allows simple evaluation of capacity utilisation for imaging equipment, various workflows, and individual tests and examinations.

For solutions like teamplay, we

Siemens Healthineers

follow a managed service approach by partnering with industry leading partners, such as Microsoft, to apply state-of-the-art IT security and data protection technology at a level that would be hard to reach in a nonmanaged service setting.

Because it handles personal and potentially sensitive information, teamplay puts a strong focus on transparent data use: • Compliant with applicable law: Software teamplay helps healthcare providers to work in compliance with local regulations and applicable laws on both data privacy protection and data security.

• Enabling organisation’s privacy policy: Three pre-defined data privacy profiles allow for a robust transparency and control over the patient data that is processed by teamplay.

• Compliant beyond borders: Software teamplay meets the United States (US) standards of Health Insurance Portability and Accountability Act of 1996 (HIPAA), as well as the requirements of the European Data Protection Directive.

• Protected by a strong security partner: Employing the Microsoft Azure cloud comes with cuttingedge security to avoid breaches and malicious attacks. Encryption and segregation most prominently help to safeguard all data.

• Retaining full control: Protected health information will not be uploaded into the cloud without consent, including patient consent to third party data access as required

Big Data Management

Big Data - Key Takeaways • Will let healthcare providers analyse their patient outcomes • Will allows healthcare providers to meaningfully evaluate their practices and compare them within and across organizations • Will make personalised medicine a reality • Will provide statistically significant information needed to practice precision medicine by the applicable law.

• Transparent use: An agreement ensures joint responsibility of all involved parties and lists obligations of security and confidentiality elements for patient information.

What are the key objectives of Siemens Healthineers when it comes to ‘Big Data Management’? How do you intend to expand in this sector which seems to have no end?

Our aim is to bring medical devices, healthcare professionals and patients together. Building on our deep understanding of the diagnostic imaging, in-vitro diagnostic and advanced therapy areas, it is our objective to gain compliant access to data. We intend to aggregate and integrate the data to turn it into information and be able to derive insights that in turn help our customers to answer their existing and upcoming challenges, based on data insight.

Based on teamplay, we will build a rich ecosystem of a network and applications. We provide the

Siemens Healthineers – Key Features • Holds a substantial pool of algorithms that can automatically detect anatomy & can help enrich unstructured image data with structured data • Provides the infrastructure to exchange data & collaborate among different information systems to support coordinated, more efficient & patientcentered care

infrastructure to exchange data and collaborate among different information systems to support coordinated, more efficient and patient-centered care.

We provide a cloud-based platform & network for intelligent data services, supporting decisions for providers and process optimisation. This will help our customers to: • Gain valuable insights • Streamline processes by analysing big data • Plug into true value-based care by discovering and correcting inefficiencies

According to the International Data Cooporation (IDC), the overall size of the digital universe will be tenfold what it was 5 years earlier. Keeping this statement in mind, what research & development (R&D) is being done by Siemens Healthineers to ensure smarter data management approaches and tools?

A large part of the growing data pool is unstructured; take diagnostic imaging as an example where a lot of data is pixel data that encodes information about physiology and potential diseases in a patient. Siemens Healthineers holds a substantial pool of algorithms that can automatically detect anatomy and can help enrich unstructured image data with structured data about the images aiding the development of systems to smartly access and process the data further.

July / 2016 ehealth.eletsonline.com

39

Big Data Management

Bonanza Healthcare

Bonanza Healthcare: Open to Newer Technologies to Aid Decision-Making Process For a seamless adoption and implementation of data management tools in tier-II and tier-III cities, the availability of good data speed is of primary importance, shares Dr Suhas, Chief Operating Officer, Bonanza Healthcare with Elets News Network (ENN) How is Bonanza Healthcare ensuring ‘complete healthcare’ through its twin products ‘Bonanza Medical Tourism’ and ‘Bonanza Health Card’? Please provide details.

The ethos of Bonanza Healthcare is creating an ecosystem that can help people take informed health decisions.

Bonanza Healthcare started its journey in the healthcare sector through its Medical Tourism Product by connecting people from across the globe to quality treatments at accredited healthcare facilities at an affordable cost. There was a great deal of learning in the process over the years - understanding the lacuna, the non-transparent practices and policies followed by the Indian healthcare facilities, and the rising cost of medical treatments, led us to design and develop this unique product called “Bonanza Health Card”, which connects customers with the best diagnostic and wellness centres in India. It gives the biggest discounts on carefully curated wellness, rejuvenation and preventative health packages.

The Bonanza Health Card is designed to make sure that everyone can be in good health at all times.

We believe that prevention is better than cure and that prevention should not be expensive. Members can get

40

July / 2016 ehealth.eletsonline.com

Bonanza Healthcare

discounts on any of our packages or treatments any number of times during their membership. As we book the appointments and also send reminders, the customers need to merely show up. Use your free online account to store your medical reports, doctor’s notes and treatment history, so that you always have them at your fingertips.

With such a huge customer base, what measures are being undertaken by Bonanza Healthcare to ensure management of patient data and records? How far have you succeeded in educating patients on ‘patient management’ skills?

Bonanza Healthcare has implemented all security aspects to preserve the confidentiality of its members’ data and records. All data stored in its servers which are uploaded by its members are completely encrypted and which can be accessed only by the member. There are access restriction features for reports and other data sharing which is at the sole discretion of the members and which cannot be accessed by any other third party without the consent of the member.

All data passes through secured protocols to prevent any breach.

Patient management skills are a continuous and ongoing process and we at Bonanza Healthcare take it very seriously through development of the knowledge, values and skills germane to the standard safety procedures, fundamental examination procedures, etc. into

Bonanza Healthcare Key Objectives • Prevention is better than cure • Prevention should not be expensive

the patient-client management model and applied through clinical simulations that incorporate clinical reasoning, patient/family education and evidence-based practice principles to provide a foundation for best practice.

What all technologies are used

by Bonanza Healthcare to tame the growing threat of ‘big data’ in the healthcare sector? Are you planning to adopt any new technologies to ensure not just storage of data but also data privacy?

Big data will be a big boon to the healthcare sector and is going to aid the entire health ecosystem in the coming days. At Bonanza Healthcare, we are very open to the implementation of newer technologies and process to enhance and aid the decision-making process to help customers in taking informed

Key Takeaways • Offers discounts • Books appointments • Send reminders • Access restriction features enabled in reports • All data go through secured protocols

Big Data Management

health decisions.

Protection of our customers’ data is of paramount importance to us and we are and we will be implementing all advanced technologies for data storage and data privacy.

Please throw light on how far service providers like Bonanza Healthcare have succeeded in increasing the rate of adoption of patient data management tools in tier-II and tier-III cities of India?

We still face a lot of challenges primarily from mobile network and data connectivity issues.

For a seamless adoption and implementation of data management tools in tier-II and tier-III cities, the availability of good data speed is of primary importance. There is pretty decent acceptance of these tools in tier-II and tier-III cities and people are very open to look at it as an important substitute from their conventional practice.

As one of the stakeholders in Indian healthcare ecosystem, what will be you key recommendations for policymakers and service providers in terms of ‘big data management’?

Big data management is becoming an important ingredient in almost all aspects of heath ecosystems, be it clinical trials, studying of genes of different ethnicity, and implementation of mass healthcare programmes and various other health ancillaries. We feel that policymakers should look at creating a central depository of all health records and other aspects of healthcare through a common unified identity, such as a Permanent Account Number (PAN), Mobile and Aadhar number, which can be accessed by healthcare providers to provide correct, timely and accurate treatments to patients in India.

July / 2016 ehealth.eletsonline.com

41

Big Data Management

Ajuba Solutions

Transition to ICD-10 to Ensure Greater Specificity, Fewer Rejected Claims & Improved Benchmarking The essence of assigning medical codes to patient data is to create an approach to the solutions that aren’t just arithmetic, but are in some sense logarithmic and logical, shares Tony Mira, Founder & Group CEO, Ajuba Solutions with Elets News Network (ENN)

W

hat healthcare i n f o r m a t i o n management (HIM) service providers hope is the notion that the patient data generated helps in effective healthcare delivery, whether or not it actually contributes to better outcomes is dependent on the service-

level dynamics that are bounded by regulation. One such transition that has recently been implemented is the ICD-10 compliance. ICD-10 is the 10th updated edition of the International Classification of Diseases (ICD) codes and will replace the current ICD-9 system of the United States (US).

The revised system, which falls

ICD-10 - Key Takeaways • Insurers use the codes to determine reimbursement • Researchers & health statisticians use codes to evaluate medical processes & outcomes under the guidance of the World Health Organization (WHO) and is used to classify diseases and causes of death, has adaptations for the US usage that include inpatient hospital procedure codes. On October 1, providers covered by the Health Insurance Portability Accountability Act (HIPAA) had to transition to a 10th version of the International Statistical Classification of Diseases. Insurers use the codes to determine reimbursement.

Researchers and health statisticians use them to evaluate medical processes and outcomes.

Facts about Transition The transition from the old ICD9 to ICD-10 was long overdue in the US. To be approximate, it took the country nearly 30 years to adapt the system for both public and private healthcare payers and providers. While in the European countries, where healthcare is

42

July / 2016 ehealth.eletsonline.com

Ajuba Solutions

Big Data Management

centrally coordinated, the ICD-10 was implemented way early. The UK had implemented it in 1995, France in 1997 and Germany in 2000.

Coding Matters The essence of assigning medical codes to patient data is to create an approach to the solutions that aren’t just arithmetic, but are in some sense logarithmic and logical. The ICD10 coding system for instance has two parts.

• ICD-10-CM (Clinical Modification) codes that healthcare providers assign to every medical diagnosis and description of symptoms for patients • ICD-10-PCS (Procedure Coding System) codes that designate procedures. These are only used in the US for inpatient hospital settings ICD-10, has 68,000 diagnostic codes, five times more than the previous version while the ICD-10-Procedural codes (ICD-10-PCS), which are assigned to every hospital procedure, have increased 29 times over the list in the ICD-9 The ICD-10 provides for significantly greater specificity, not only about an individual’s health condition, but often about the circumstances that led to an injury or illness. According to an American Medical Association (AMA) fact sheet on ICD-10, the more precise codes also have the potential benefit for fewer rejected claims, improved benchmarking data, improved quality

Facts • Transition from ICD-9 to ICD-10 in the US took 30 years • Healthcare in centrally coordinated in Europe; ICD-10 was implemented way early

and care management, and improved public health reporting.

With increase in specialisation and precision-based treatment, the US had a long overdue for transforming from ICD-9 to ICD-10 process. Medical coding has evolved over the years with its focus majorly on devising various codes with a high level of precision.

Now, the Indian IT services industry alone which has been projected to become a 1.9 billion dollar industry, has a lot of pressure and demands to be met. Healthcare IT sector is now emphasising more on Big Data Analytics and Cloud Storage models in order to ensure better performance and efficiency.

Challenges Ahead Most of the medical errors in the medical system are not due to bad doctors, but due to systematic errors while diagnosing and doing clinical analysis. Errors in ICD-9 are 30 years old and very rigid. However, this new iteration of the ICD has enabled better clinical documentation and patient data management.

Now around more than 130 countries have adopted this code and this was mainly used for systematic allocation of patient data stored in a data base where electronic medical records (EMRs) had to be accessed for clinical diagnosis, reimbursement of claims and resource utilisation, altogether which makes this storage process voluminous and sensitive .

The ICD-10 process being very technically complicated needs more expert-based tutoring and training to all the next-generation medical professionals, as many complicated

codes and the codes yet to be assigned or decoded will have to be properly briefed and explained to them.

Documentation part of the process has always many challenges while performing coding. Now when a patient has a medical ailment in any part of the body, the process indicates the exact body part, as well as reviews both the code and the documentation.

Careful and methodical analysis, if suppose is not done while performing this clinical diagnosis process, then it gives a highly complicated output with errors.

Corruption in the medical system is very rampant and that remains to be the greatest barrier which is not transparent and a tough nut to crack in countries across the world.

This malaise leads to erroneous treatments and diagnosis coupled with serious and grave medical consequences, such as permanent disability or death, etc. Despite the presence of Medical Negligence Law, as well as the Federal Law in the US, or regulatory institutions, such as Medical Council of India (MCI) and US Food and Drug Administration (USFDA), the medical world has succumbed to some terrible and regrettable lapses in the past.

A gamut of issues has to be looked into. Presently with more than 68,000 codes in the new process, the transition time generally takes very long, as it is not possible to transfer the technology or the new coding methodology within few months.

Medical experts and business leaders argue the fact that this ICD-1O may lead to a massive revenue loss.

Since there are no any immediate experts in denial managements,

July / 2016 ehealth.eletsonline.com

43

Big Data Management

Ajuba Solutions

medical coders and billers using this model may encounter various errors due to improper mapping, as well as no any well laid out precise codes. Let us take, for example, if a hip joint is needed for a patient or if a patient visits a hospital to get an X-ray due to cough or cold, then in these cases the coding does not have precise code, as for what is the material for the hip joint or what may be the different health complications for the X-ray. Now the hip joint may either be ceramic or some other material, as well as the X-ray may indicate pneumonia or lung infection. Such precise codes are yet to be worked out for better clarity and simplicity.

Physicians may pronounce the correct verdict on their clinical diagnosis, but the medical professionals may not record it correctly if codes are unavailable or inappropriate at that particular point of time. Even in the claim processing cycle, the clearing houses may deny the payments or reimbursement thus affecting the workflow of the organization, as well as leading to an overall performance deficit of the medical professionals.

Issues like these may have to

44

July / 2016 ehealth.eletsonline.com

Key Challenges • Needs more expertbased tutoring & training • Lack of careful & methodical analysis will give a highly complicated output with errors • Corruption in medical system can lead to erroneous treatments & diagnosis • Needs periodical upgradation and a well-planned professional approach for smooth transition from ICD-9 to ICD-10 be fixed immediately in order to avoid any further complications or huge exodus of proper or effective recording of patient data.

Getting into the Transition Mode: Proper Coordination of Care

Now when the transition has already set in, we cannot reverse the changes and step back. Instead take proactive steps in order to manage the transition period by regularly updating all the HIM professionals.

Now very critical and sensitive data needs to be protected through various models, such as Business Analytics and Population Health Management System, as the threat of data security and malware attacks have also recently lead to a serious loss of patient data in the recent times.

A good code is tested for code frequency, code productivity, volume of a coder, claims denial rate, quality of clinical documentation, types of denials, various other factors related to claims denial and complaints, etc.

Healthcare professionals, juniors and students in their graduation days must be well updated through periodic guiding, training and coaching, as regular updates and proper teaching methodologies will keep them hooked and dynamic in this competitive and highly critical industry.

Proper coordination of patient data is needed as this sensitive data, as well as the highly critical information, leads to proper clinical diagnosis and highly skilled professional treatment.

Therefore, regular quality checks and proper updating methodologies along with a proactive approach of ensuring the best possible results for the company’s finances are needed, as issues like denial in claims or improper mapping of codes will surely result in the deluge of quality patient care and treatment.

Every transition may come up with its own complexities; this one too needs periodical upgradation and a well-planned professional approach with proper coordination and support among the medical health professionals. If these things are followed, I hope we may face a smooth period of transition as supposed to wrongly perceived period of gloom and hopelessness.

WASH

SUMMIT

HOST PARTNER

Department of Water and Sanitation Government Of Punjab

PUNJAB

CONFERENCE | AWARDS | EXPO 6 August, 2016 | Hotel Mount View | Chandigarh

WE SUPPORT CLEAN WATER

AND SANITATION SWACHH PUNJAB

FOR SWACHH BHARAT

Chief Guest Shri Parkash Singh Badal Honb’le Chief Minister, Punjab

KEY THEMES Swachh Punjab for Swachh Bharat: Road Ahead Making Communities Water Secure Hygienic Sanitation for All Strengthening WASH through Women Participation Industry Participation for making Swachh Bharat a Success PSUs for WASH and many more

Guest of Honour

PARTICIPATION FROM Ministry of Urban Development, Government of India Ministry of Drinking Water & Sanitation, Government of India Department of Water and Sanitation, Government of Punjab Various State Sanitation Departments from Across India Urban Local Bodies of Punjab & India PSUs International Agencies and many more

wash.eletsonline.com | #elets_WASH

Shri Surjit Singh Rakhra

Honb’le Minister of Rural Development, Punjab

Clinical Decision Support Tools

Elsevier

Elsevier: Standardising Healthcare Practices via Clinical Decision Support Tools Across 130 Crore Population

It will take some time with the committed government and physician leadership to get the right infrastructure and ensure cultural & philosophical shift in the way medicine is practiced, shares Dr Peter Edelstein, Chief Medical Officer, Elsevier exclusively with Kusum Kumari & Shivani Srivastava of Elets News Network (ENN) During this visit to India, what are your key objectives in terms of empowering clinical leaders with knowledge-based systems?

Please provide details.

During this trip to India, we want to guide hospitals to learn how to reduce variability through clinical decision support (CDS) solutions. There is a need to know how to uniformly reduce variability not just within the premier institutions, such as All India Institutes of Medical Sciences (AIIMS), but also in the region and in the entire country.

CDS solutions empower providers and patients with current and evidencebased guidelines to ensure in the end better patient care. Elsevier supports people to reduce variability through CDS tools. One of the biggest challenges Elsevier witnesses is the misconception that the physicians often have that CDS tools cannot work without electronic medical records (EMRs). EMRs were designed as an efficient system to deliver

46

July / 2016 ehealth.eletsonline.com

solutions to medical personnel ranging from nurses, paramedics to doctors.

However, even systems that do not have EMRs can also use CDS tools. India as a country is currently at that stage where it needs to develop business strategies to ensure consistent and sustainable care. In order to achieve sustainable care, the medical institutions need to commit to the concept of CDS tools and finances behind it to maximise the benefits for patients and the institution itself. In order to have a current evidence-based guideline, CDS tools need to be rapidly delivered to all kind of patient care and all medical personnel. As India like many countries is witnessing the emergence of new groups of healthcare providers, such as home healthcare experts, pharmacists, etc., Elsevier will play a very crucial role in such a scenario.

In the light of current debate around the quality of healthcare

in India, how far has Elsevier succeeded in integrating its clinical solutions across both public and private institutions?

Please provide details.

We actually have these couple of divisions. In the United States (US), I focus mostly on adult practitioners and patients. However, I partner with a team focusing exclusively on students and education because those silos or breaks are artificial. Our company says that listen here’s the reality that you may need to learn some different skills when you are training as medical students in terms of population health, cost reduction, etc, but the concepts are now consistent. It does not make sense to not to be teaching our students about what population health is and what CDS is. In fact, in the US, Elsevier’s nurse educators’ customers heard some talks they gave and asked Elsevier to author a book for educators about what nursing students need to know about

Elsevier

healthcare to enable students succeed in their career. It’s no different in a country like India. One of the biggest mistakes people make is that they think we are merely talking digital solutions.

I believe that knowledge gained from any source should be welcomed. If we don’t start with students, they would not succeed in integrating their learning with their practice.

With dramatic changes in healthcare, now medical services are all about improving the health of the population.

Therefore, population health management has emerged as a new buzzword across the world, which needs to be understood by everyone, including the practicing doctors. Therefore, we have seen progressive changes in healthcare. Elsevier wants to increase value of healthcare by working together with the institutions, such as AIIMS, and influencing them by exposing them to the changes happening elsewhere.

Medical institutions can ensure quality medical care in the remotest corners by working with Elsevier. We must ensure ‘paradigm shift’ by moving away from reactive acute inpatient care to proactive chronic outpatient maintenance and preventive care. As a responsible healthcare stakeholder, Elsevier is ensuring this paradigm shift.

In order to ensure cost-effective quality care and increase patient throughput, we need to control variability.

Therefore, Elsevier’s guidelines and CDS solutions will play crucial role in restraining variability. We will witness better outcomes and reduced costs by reducing variability.

We have designed a range of CDS solutions to enable quality care and efficient delivery of medical services.

Our solutions are structured to help your caregivers, professionals and students improve practice, encourage broad and deep adoption of exceptional professional practice guidelines, and promote a culture of quality across one’s organisation. Elsevier Order Sets is an innovative, cloud-based solution that enables physicians, clinicians and informaticists to maintain, develop and deploy order sets in a collaborative environment. Order sets ensures consistent delivery of high-quality, costeffective care.

Which all countries are you focusing on for growing the reach of Elsevier?

We are really excited about emerging markets. We have full-time employees there. Just like we have to look for right institutions here, you can’t just go to the biggest opportunities. The healthcare system in China is not ready for some of the changes that India is ready for.

The Government of India is already focusing on e-health and digitisation of healthcare services. In terms of markets, India, Australia, Singapore, Thailand, Japan, etc. make sense to me.

The Middle East is the biggest emerging market because they have money and they want to be the best healthcare system. In such markets, people are voicing their concerns about change.

We see that India is ready for adopting changes. In reality, the Indian economy is one of the most stable economies

Key Takeaways • Litigation increasing worldwide and gaining awareness in India • Focus towards patient-centric approach • Standardisation of healthcare delivery • Strong clinical decision support system, a must • Elsevier’s Orders sets, ClinicalKey, etc. to transform research into patient care

Clinical Decision Support Tools

as it is not an oil-dependent economy.

Additionally, India has a government and leadership committed towards progressive reforms. As of Elsevier, we have a large community that lives here and knows this community very well.

What are your views on the need to have uniform legislations in Indian healthcare system? Please provide details.

Litigation is gaining awareness in India.

The change is going to be witnessed 10 years down the line. Credible and critical mass will steer the country towards such a change. The future is not about physicians, but patients who are the customers and the overall healthcare system. We are seeing a paradigm shift. People will not tolerate negligence any longer. One famous case of medical negligence can change the overall situation of healthcare.

What does future of healthcare in India looks like? And, what role will companies like Elsevier play?

We are already investing huge amounts of money in genomics because in another year we will need another set of products. A few years from now antibiotics would not be working for anybody, so we have to have different types of immune therapy. We have to put investment there. The key is that maybe it takes us 10 to 20 years to get the infrastructure everywhere where you think it is important, and then we will always have current, credible and evidence-based content. About 50 years ago, we were not doing what we are doing now and 5 years from now, the scenario will be different. As such, healthcare system is always going to change. Therefore, it will take some time with the committed government and physician leadership to get the right infrastructure and ensure cultural & philosophical shift in the way medicine is practiced. It does not matter how long it takes, what matters is that the entire process of change needs to start.

July / 2016 ehealth.eletsonline.com

47

Corporate Interview

BPL Medical Technologies

BPL Medical Technologies: Strives to be the Best Medical Device Manufacturing Indian Company Globally We are going for very high-standard future products, whether in the look and feel, software usage, etc. by initiating right partnerships & in-house R&D, shares Sunil Khurana, CEO & MD, BPL Medical Technologies exclusively with Kusum Kumari of Elets News Network (ENN) Please provide an overview of what measures are being undertaken by BPL Medical Technologies to diversify into new products and widen its geographical footprint.

BPL as a brand has been present in the medical devices space for close to 50 years. In August 2013, BPL Ltd decided to hive off this business to form a new entity BPL Medical Technologies Pvt Ltd (BPL Medical). This was the time when a new management team from across the industry was brought to give a direction and focus to this business.

Despite having one of the largest and uniformly spread distribution network and a large direct sales team, our revenues were flat. Therefore, we did a lot of internal brainstorming to analyse the products gaps and brought many new products in the existing segments and have also created new product segments over the past 3 years.

Imaging is one of the newly added segments where we partnered with a Korean company to bring co-branded ultrasound products. These machines are technically superior to a lot of products available in the market in the same price range. We have also entered in X-ray and C-arm products that are designed, conceptualised and manufactured in-house. These products are manufactured at our ISO 13485 certified facility located in Palakkad, Kerala.

48

July / 2016 ehealth.eletsonline.com

BPL Medical Technologies

During the last 3 years, addressing the gaps in our product portfolio has been the key focus area for us. I believe this will always be a focus area to keep an eye on technological advancements and bring products suitable for the Indian market. This is what keeps our 35-member research & development (R&D) team busy all the time.

How has the acquisition of the United Kingdom (UK) based Penlon assisted BPL Medical in terms of diversification of products and R&D? How far have you succeeded in leveraging their R&D facilities and products for creating worldclass products?

Penlon is a 73-year-old globally reputed brand in the area of critical care with presence in 96 countries. In order to strengthen our presence in critical care segment, we decided to acquire Penlon. This acquisition provides us a great platform to build ourselves as a strong brand in critical care segment.

We are hiring a few members to Penlon R&D which is continuously working on building anaesthesia machines and vapourisers. In the next 2 to 3 years, we expect a lot of new products from Penlon, which should complete the entire spectrum of products from lowend to high-end machines. We believe this is a great opportunity for Penlon to focus on markets, such as India and other developing countries, where they can leverage BPL Medical’s experience to create a big impact in the marketplace.

Which are the key segments where you would like to invest?

Please walk us through the key products launched by BPL Medical.

I started my career with X-ray machines and therefore have a natural passion for X-ray and C-arm portfolio. That said, there is an immense opportunity for these products available today due to limited

focus from multinational companies (MNCs) in this area. This segment is currently fragmented by a few small players that have limitation to expand.

We are focusing on this segment to manufacture quality equipment which would be used in operation theatres for surgical procedures.We have already started launching some of these products which have long development time due to proper regulatory approvals. Some of our products are

Lifephone Plus - A handheld wireless ECG device that captures patient data and transfers it to a mobile device

currently undergoing approvals from the Bureau of Indian Standards (BIS) and Atomic Energy Regulatory Board (AERB). We expect 5 models to come out in the market by the end of this year, which would go up to 25 models during the course of next 2 to 3 years.

These are high-quality future-ready products be it aesthetics, ease of use or overall quality. We are happy with the initial customer response that we are receiving and are confident to make a good impact in the market.

We have launched an interesting product in the m-health space called Lifephone Plus. This is a 12-channel mobile electrocardiography (ECG) device which weighs about 70 grams.

It is a handheld wireless ECG device which acquires the patient data and transfers it to a mobile device using Bluetooth. This data is then uploaded to the patient’s cloud server through which the doctor is able to access this data and provide consultation to his or her patient without having the patient to visit the centre every time. About 50 years back, we were one of the first manufacturers of ECG

Corporate Interview

machines in India. It would be difficult to find a physician even today who would not have been associated with BPL ECG machines during his or her career. We have put all this experience of developing ECG machines into this device and have developed this product together in partnership with a technology major. This is truly an innovation to my mind and is a product which is ahead of time. We have won many prestigious awards recognising this product.

Other than this, we continue to work on other products and are trying to upgrade their features in line with technology advancements. In our cardiology segment, we have added new ECG machines and defibrillators with improved features and connectivity. In our patient monitoring segment, we have addressed the needs of our customers by offering them multiple variants according to their needs. We have also added new features in our syringe and infusion pumps keeping our end users in mind.

We try to always stay close to our customers to understand their needs.

Overall, we develop affordable products keeping the Indian market in mind. This approach has helped us increase our footprint in the Indian healthcare business. Our products touch human lives and a robust quality management system remains the priority of the management.

Most of our products that we are marketing in India and outside India are CE certified. Therefore, there is no compromise on patient safety and quality of these products.

Despite increased penetration of smartphones in the Indian market, m-health services have not succeeded to a large extent. Please provide details.

Unless we have more and more people coming under the fold of m-health, this concept cannot succeed. For such products, we need to create awareness. If the Government of India

July / 2016 ehealth.eletsonline.com

49

Corporate Interview

BPL Medical Technologies

really wants to be benefitted from such products, then each healthcare personnel must have access to such a product. We are now following the advocacy approach by showcasing our products in all kinds of conferences, big institutes and corporate chain of hospitals. The feedback has been so far really good. Any new concept takes time for adoption, particularly in the Indian market.

Post successful global partnerships, are you willing to partner with start-ups within the Indian market?

Absolutely, if the products are meaningful and fit into our basket, we are always ready to incubate our partners. However, we would first like to test them in our own stringent manner in-house to check whether they fulfill our requirements. We are very open to such partnerships.

How strong and efficient is the after-sales service of BPL Medical in India and across the world? What new measures have been undertaken to make it timelier and hassle free?

After-sales service is a key differentiator in our line of business as we touch human lives. Due to my background of heading the service business in my previous organisation, I understand how critical after-sales service is. We have brought one of the finest people from the industry to BPL Medical to head our after-sales service. We have invested and will continue to invest heavily in training our team and our distributors on the after-sales service of our products. In fact, Penlon has trained this year so far three batches on after-sales service of their products. We are also investing in maintaining the required inventory of spare parts and using best logistics services to make sure these parts are available at the site in no time when a machine is down.

As any machine can fail, we need

50

July / 2016 ehealth.eletsonline.com

Key Takeaways • Filling the gaps within the portfolio • Added ultrasound, X-ray, C-arm & many products • Going for partnerships & in-house development to develop new products • Inducted one of the finest people to head the after-sales service • Has close to 35 R&D people (increased in 2.5 years) • Aims to be one of the `1,000 crore companies by 2020 to ensure to minimise the downtime of these machines so that the patient does not suffer. So far these trends are encouraging, but we continue to work in this area to increase our customer satisfaction. As an industry person, I know customer relationship does not end at sales but you need to ensure constant service support to get repeat business. This is a continuous journey and we want to consistently improve and upgrade our scale to deliver that.

What are the revenue targets for BPL Medical Technologies in the coming years?

We started this journey 3 years back and have witnessed a high compounded annual growth rate (CAGR) of close to 40 per cent. We aim to become `1,000 crore company by 2020. I strongly believe that revenues are a by-product of various aspects and working towards fulfilling these parameters be it products, geography expansion, improving distribution and service network. Our first approach is to keep all our customers very happy.

From 3 years from now, we aspire to be the best medical device manufacturing Indian company globally. In the products where BPL Medical operates, we want that our customers should see us as one of the finest choices for them.

Recently, the Government of India withdrew the Drugs and Cosmetics (Amendment)

Bill, 2013 and underlined the need to frame separate rules to regulate medical devices under the existing Act the Drugs and Cosmetics Act, 1940. What is your opinion on the entire debate?

I was until early this year the chairman of the Federation of Indian Chambers of Commerce and Industry (FICCI) in the medical devices side.

It is important to have a governing body in place to govern the medical device segment. I am happy that now pharma, which is a big industry, and its ministry is overseeing this medical device segment. The 100 per cent foreign direct investment (FDI) in medical devices has opened doors to the MNCs across the world lacking adequate resources and vehicles to access the Indian market. As there is a lot of confusion on difference between implantable devices and other devices, I am sure the recent decision of the Government of India will be very helpful. Medical machines need to be kept outside of other devices. With rules and regulations, more and more participation of technology is needed as we progress, such as a single window clearance and other reforms.

It will undoubtedly strengthen the Indian healthcare ecosystem. It will not be the first and the last initiative towards change. What comes will become the good reference point, followed by amendments.

Special Feature

Cover Story Smart Healthcare The concept of ‘Smart Care’ has emerged as the driving principle in the entire healthcare sector.

With the convergence of technology, sophisticated infrastructure, world-class facilities, first-of-its-kind innovations, etc., we are witnessing unimaginable enhancements in the quality and delivery of healthcare services.

Understanding the Ins & Outs of Pharmaceutical Industry Indian pharmaceutical industry is the third largest in terms of volume and thirteenth largest in terms of value. Most of the branded generics constitute nearly 70 to 80 per cent of the market. Moreover, it is largest provider of generic drugs globally with the Indian generics accounting for 20 per cent of global exports in terms of volume.

The recent relaxation in the norms of foreign direct investment (FDI) in the existing pharma companies or brownfield units will encourage mergers and acquisitions (M&A) and also enable cost reduction.

Why Choose eHEALTH Magazine?  Exclusive Interaction with Industry Experts & Policy Makers  Bridging the Gap between Companies and Decision Makers  Aggressive Promotion of magazine participants in Social Media  Ensuring Magazine Presence at all Healthcare Outlets across India  In-depth Market Research to get the right Industry Figures  Bytes from the Industry Experts to bring Authenticity to report



Corporate Interview

GSK Consumer Healthcare

GSK Consumer Healthcare: Creating Sensitivity-Free Life through Brand Sensodyne In just 5 years of its presence in the `6,700 crore Indian toothpaste market, Sensodyne has emerged as a leader in the sensitivity segment, shares Anurita Chopra, Area Marketing Lead – Oral Health, ISC, GSK Consumer Healthcare with Elets News Network (ENN) As such, oral healthcare is quite a neglected area in rural and semi-urban areas. How is GSK Consumer Healthcare planning to ensure affordable oral healthcare through right interventions across both rural and urban areas of India?

Rural areas are growing at three times of urban markets for us, with over 10 per cent of our business coming from these markets. The rural consumer recognises the condition and is looking for the effective solutions to manage this.

Sensodyne Rural programme includes activities, such as reaching out to rural medical professionals and chemists detailing about the condition and the solution.

Home-tohome sampling to rural consumers is an integral part of the programme that happens along with educating them about tooth sensitivity.

Please walk us through the range of oral healthcare products introduced by GSK Consumer Healthcare in recent times? What kind of evolution in

52

July / 2016 ehealth.eletsonline.com

consumer needs, especially in a market like India, propelled the manufacturing of these oral healthcare products?

Sensodyne is the world’s no. 1 toothpaste for dentine hypersensitivity (DHS) and is the fastest growing oral care brand from GSK Consumer Healthcare. In just 5 years of its presence in the `6,700 crore Indian toothpaste market, Sensodyne has emerged as a leader in the sensitivity segment. GSK Sensodyne has a vast product portfolio: Sensodyne Whitening – After the success of Sensodyne, GSK Consumer Healthcare is foraying into a new segment in the toothpaste market with the launch of Sensodyne Whitening.

This new toothpaste takes teeth “back to the best” by keeping a unique balance between sensitivity and restoring natural whiteness.

Sensodyne Base – Sensodyne Base consists of potassium nitrate, as clinical studies show potassium nitrate progressively reduces sensitivity over a period of weeks. Sensodyne is clinically proven to provide relief from DHS in 4 weeks. It is priced at `50 for 40 g and `100 for 80 g.

Sensodyne Rapid Relief – Sensodyne Rapid Relief gets to work in just 60 seconds. Rapid Relief is a quick response solution that creates deep, acid-resistant occlusions that prevent

GSK Consumer Healthcare

tooth sensitivity. In addition to this, regular use of Sensodyne Rapid Relief also ensures long-term protection against DHS. It is priced at `65 for 40 g and `120 for 80 g.

Sensodyne Repair & Protect – Sensodyne Repair & Protect provides a higher order benefit of repair as it repairs areas of the tooth that are susceptible to sudden sensitivity with daily use. Powered with patented NovaMin technology, a breakthrough clinically proven formula, helps in repairing vulnerable sensitive areas with the natural building blocks of your teeth. It is priced at `80 for 40 g and `150 for 80 g.

Sensodyne Expert Toothbrush – Sensodyne Expert Toothbrush has been designed for people with sensitive teeth. It is scientifically crafted with cross active bristles which provide effective cleaning of the teeth, up to 20 times slimmer bristle tips to clean hard-to-reach areas and a tongue cleaner for cleaning of the tongue.

Its broad ergonomic handle ensures comfortable grip and better reach.

We are aware that GSK Consumer Healthcare has significantly increased investments in the Indian market in terms of infrastructure, manufacturing outlets and in retailers. Please throw light on what kind of business collaborations & measures you are looking forward to accelerate the reach of your oral healthcare products.

Four out of five sensitivity sufferers continue to use normal toothpaste

Corporate Interview

GSK Consumer Healthcare - Overview • Operational in the Indian market since 2010 • Believes in continuously innovating to cater to various consumer needs instead of a specialist solution like Sensodyne. Our job is to accelerate trials of our product so that more sufferers can lead a life of no compromise. To do the same, we look for partners who can collaborate with us and drive this agenda harder.

What kind of research and development (R&D) and innovative procedures are followed while manufacturing oral healthcare products? Please provide details.

Sensodyne comes from the house of GlaxoSmithKline (GSK), one of world’s largest consumer healthcare companies with a heritage that goes back to over 160 years. GSK is a science-led global healthcare company with a mission, which is to help people to do more, feel better and live longer.

Science forms the core of GSK’s product portfolio, along with a relentless focus on innovation and customer. Sensodyne is one such brand which is dedicated to creating a future where every life is sensitivity free. Sensodyne has been available in the Indian market since 2010, starting with its base variant. Since then, it has continuously been innovating to cater to various consumer needs, such as quick comfort and also repairing of teeth. Within 2 years of its national launch, Sensodyne was available

Sensodyne Rural Programme • Reaching out to rural medical professionals • Connecting with chemists detailing about the condition & solution • Home-to-home sampling to rural consumers along with educating them about tooth sensitivity

in three variants that include Base Sensodyne, Sensodyne Rapid Relief and Sensodyne Repair & Protect and also extended to toothbrushes in 2013.

Looking at the wide disparity in the income distribution in India and lack of awareness, what kind of innovative marketing and distribution measures are being enunciated by GSK Consumer Healthcare to achieve the goal of pan-India coverage?

Sensodyne invested heavily in building awareness and educating the consumers about sensitivity through its extensive consumer outreach programme – chill tests, at various high-footfall areas asking people to drink cold water. The simple yet effective tests made people realise that they unknowingly suffer from teeth sensitivity which was leading them to not enjoy food and drinks which they could have easily done.

When engaged in a conversation with the brand promoters, people recalled that they had experienced short sharp sensations earlier too, but had never taken it seriously. Once their curiosity was piqued, the brand promoters explained the benefits of Sensodyne to the sufferers.

In another significant outreach programme, Sensodyne also redefined “engagement” with its key stakeholders – the dentist community in India. Sensodyne adopted a longterm engagement route with the dental community wherein its representatives visited the dentists more frequently and engaged with them more closely to detail the science behind Sensodyne’s range of products. This definitely helped the brand to build a stronger dental equity.

July / 2016 ehealth.eletsonline.com

53

Corporate Interview

Diabetacare

Diabetacare: Believes in Preventing Diabetes-Related Complications to Improve Quality of Life Established with an underlying desire to bridge the gaps in current diabetes management strategies, Diabetacare is a first 24x7 service dedicated to put people with diabetes in regular direct touch with physicians and specialists using mobile technology, enabling an organised diabetes management platform focused on prevention, as well as treatment. Dr Sanjiv Agarwal, Founder and Managing Director of Diabetacare, shares his entrepreneurial journey, healthcare technology platforms and evolving new models in healthcare, in an exclusive interview with T Radhakrishna of Elets News Network (ENN) Please share how and when your journey started as a medical practitioner.

I got trained as a doctor in Lucknow.

In 1990s, I did my MBBS and MD in Internal Medicine from King George’s Medical College, Lucknow.

Later I went to the United Kingdom (UK) in 1996 after doing Chief Residency for a year and did super speciality in

54

July / 2016 ehealth.eletsonline.com

Dermatology in the UK. I have been a consulting dermatologist for National Health Service (NHS) Hospitals, the UK for 20 years now. My association with NHS, the UK still continues.

What has prompted you to grow to be entrepreneur?

I always had interest in developing healthcare technology platforms (HTPs) and building models around it while joining as a consulting dermatologist for NHS Hospitals, the UK. My first venture was teleradiology. It became one of the largest teleradiology service providers in the UK. We won one of the largest contracts ever given out by the Department of Health, the UK in 2007 for providing 24x7 radiology reporting service to NHS Hospitals across the UK. This venture turned out to be a huge success within 6 years of establishment. I exited that business during 2011-12.

Later, I developed another platform in dermatology.

As part of this, I developed core dermatology services to

widen NHS, the UK in partnership with Hertfordshire Community NHS Trust. This set-up was involved services, starting from development of dermatology electronic medical record (EMR) System, staff training and accreditation programme along with setting up of clinical processes and quality initiatives. This venture is still running in NHS Hospitals, Hertfordshire, the UK. This has marked the beginning of my journey of setting up successful technology-enabled healthcare ventures across the UK and India.

When did you develop interest in diabetes? How different is your approach?

My interest in diabetes started in 201213. I saw the rising problem of diabetes prevalent all over the world. I saw certain gaps in diabetes and I classify these biggest gaps as “Six As”.

• Awareness: Overall, the awareness of the disease is very bad.

• Acceptability: Once people become aware, the acceptability of the disease is also delayed by a few years because people do not accept easily that they are suffering from diabetes.

• Access: There is poor access

Diabetacare

to quality care everywhere.

Nowadays people have access to doctors everywhere, who spend 5 minutes each time. However, for a chronic disease like diabetes, which patients are going to have for lifetime, 5 minutes of a doctor’s time or 25 minutes in a year is not good enough.

• Adoption: The adoption rate is low even for people who have seen a doctor.

• Adherence: The adherence required to a given advice is not available. This behaviour due to frequent change of lifestyle is very common among people all over the world and this is not unique for India.

• Affordability: Last and most important for India is affordability.

• These are the six pillars on which the model was devised.

The second step, which I thought through, was putting the processes in place. This exercise is always painful when you are developing the process because it takes a lot of time. However, if you have got processes in place and try to follow it up continuously, then you always emerge as a leader in the end because the chances of faltering and chances of error get reduced.

Personally, I always like to work on the processes. That is the beauty I have learnt in my practice for 20 years at NHS Hospitals, the UK. We looked at current patient care pathway in the country and developed our own patient care pathway. Now, we thought that how can we make both uniform.

Making uniform technology is the biggest boon nowadays. You have to adopt technology for uniformity and scalability. These are the two things, which are very important in business.

From uniformity perspective, we have developed Diabetacare technology tools that include a Diabetes EMR System, which is actually a Chronic Disease EMR System, currently catering to diabetes, hypertension, obesity,

Corporate Interview

Diabetacare - Key Takeaways • Developed Diabetacare technology tools for uniformity • Partnered with Vodafone to develop an end-toend connected glucometer • Aims to manage diabetes to delay complications • Follows the business approach of partnering with physicians & hospitals • Operates in India with four centres in Bengaluru, Cochin, Hyderabad & Delhi • Will commence operations within 3 to 6 months in the UK & Middle East cardiovascular diseases and whole of cardiometabolic syndrome diseases with clinical decision-making algorithms. We connected a lot of clinic-based devices into it. We have also connected certain home devices into it, such as a glucometer and blood pressure machine, which can send data directly to the EMR. The innovation that we did in that was that we had partnered with Vodafone to develop an end-to-end connected glucometer. As a result, the glucometer has got a customised Global System for Mobile Communications (GSM) SIM card, which conducts data transmission in a very secured manner, which is important for healthcare. As soon as the patient does reading at home, it sends the data directly to the server. We have also connected certain outputs into the system. Outpoint is being transmitted into a monitoring dashboard so that we can monitor the incoming data, which is being checked by a 24x7 contact centre set-up manned by diabetes experts. Additionally, output is happening at patient’s app and also on physician’s app. We took 2 years to create a suitable technology ecosystem. The technology ecosystem has got critical decision-making algorithms built into it.

That is how I started Diabetacare, a 24x7 diabetes care in 2013. Our approach towards

diabetes is very unique.

What is your aim or mission at Diabetacare?

Our aim is to prevent or delay diabetesrelated complications to improve quality of life of patients with diabetes.

I cannot cure diabetes. I can manage diabetes to delay complications.

Some of the leading complications caused by diabetes are blindness, amputation, early cardic arrest and dialysis. If we can prevent anyone going on dialysis machine for 2 years, I am saving him or her Rs 5 lakh per annum and saving his or her family from the hassle of going and coming for dialysis check-ups and saving nation quite a bit. I am passionate about developing the entire disease model. I want to ensure that when a patient walks through our clinic they get accessed by diabetes specialist nurses who are trained through our partner programme from the UK. We have got a permanent trainer from the UK, who is training these people in upscaling their skills from normal nurses or normal educators to diabetes specialist nurses or diabetes specialist educators. We have a robust programme adopted from the UK.

What is your approach for business growth?

Our approach for business growth

July / 2016 ehealth.eletsonline.com

55

Corporate Interview

Diabetacare

is partnering with physicians and hospitals. We partner with physicians and hospitals and provide them with components of our service. Today, we have 60+ partners and the number is growing.

For a company just 3 years old, Diabetacare has established quite a strong reputation. You are recognised for both your innovative business model and excellent service delivery. To whom will you give the credit?

I give credit to people, peoples’ training, processes and technology.

People: Our highly trained staff helps investigate, treat and educate patients. You’ll work with diabetes specialist nurses (DSNs), diabetes educators and foot care specialists.

Process: At Diabetacare, our staff screens patients for diabetes-induced or related complications, facilitate necessary intervention and activate 24x7 monitoring of their condition via our Diabetes Management Centre (DMC).

Technology: Patients will have access to our cutting-edge technology platforms, including: • DxNET™ – Patient appointment booking and partner clinic management tool • dCare Smart™ – Connected smart blood glucose and blood pressure monitoring devices • InTouch™ Physician App – Mobile application that lets you manage and monitor patients requiring extra care and attention Our expert team of doctors, healthcare specialists and scientists are united in our passion to improve diabetes treatment around the world.

Diabetacare is a medtech startup that helps people manage their diabetes through the use of technology and big data. It provides a diabetes monitoring and care service that has both connected devices, as well as

56

July / 2016 ehealth.eletsonline.com

a cloud-based solution which both doctors and patients can access. What is the success model?

As explained above, our people, training, processes and technology are unique. We had our own teething trouble initially. We keep improving our model. We have streamlined our model much more in the last 1 year. I feel our business model is right. Awareness needs to be increased. The main issue in India is the pain mechanism. Due to out-of-pocket expenses, people tend to delay treatment. This is too early to say that any model is a successful model because models are evolving now in the last 2 to 3 years. Altogether there are four to five major players whose business models are doing good. Diabetacare is one among them.

We were recognised at TechEmerge Health Innovation Summit, which was held in New Delhi on June 15, 2016.

Diabetacare was shortlisted out of 350 companies. We are among top 10 to go on stage. It is a big recognition for Diabetacare.

Does diabetes come under health insurance cover?

In India, diabetes does not come under health insurance, but it is available in other countries. It should also be done in India. The Government of India is talking a lot about diabetes in the last 2 years. However, what the Government needs to do is to create a regulation around it under special programmes and make sure that people avail the services.

What according to you is the game changer in diabetes?

As such, clinic-based models exists even in the UK. We have doyens of diabetes in the UK (Dr Mohan, Dr Vishwanathan, etc). Their set-ups are really good and in fact, they are better than us compared to what we have got at NHS Hospitals, the UK. Similarly, we tried to do this here in India. But the game changer is not

this. Just getting a physical centre in this age where you are asking people to come and travel so frequently you see that fallout will happen. Traffic is increasing so much every day. For a 10-minute appointment, patients have to travel 1 hour or more each time. The model has to be evolved. I feel remote patient monitoring model is a new way forward, which was started in the US.

How technology is helping you in diabetes service management?

Technology is playing a significant role in any given healthcare problem now. With chronic disease, technology’s role is much more to play. Today, technology plays 50 per cent of role in treatment while remaining 50 per cent is done by medical practitioners.

How is Britain’s exit from the European Union going to impact Diabetcare’s business as a lot of benefits of operating in the European market will be now taken away?

My opinion is that the development should not impact a company like Diabetacare. Overall, the market is volatile. When market is volatile, people will start spending less and government will start spending less.

It is very unknown future for next 2 to 3 years. In such a situation, risks are involved and similarly opportunities are available. Our plans for the UK are intact.

What are your future plans?

Today, Diabetacare is operating in India with four centres in Bengaluru, Cochin, Hyderabad and Delhi. These are owned by Diabetacare and operated by it. All these centres act like demonstration centres or hubs.

We shall commence our operations within 3 to 6 months in the UK and Middle East. We shall soon start one centre in Kanpur, India.

Telangana Government Initiatives

Aarogyasri Healthcare Trust

Aarogyasri Healthcare Trust: Building Hope by Saving Lives via Healthcare Schemes & Easy-to-Use App On the Google Play Store, our app has been rated 4.6 on 5. We have seen so far around 1.5 lakh downloads. We have 2 crore Aarogyasri beneficiaries, 11 lakh employees and 80,000 journalists, shares Dr M Chandrashekar, CEO, Aarogyasri Healthcare Trust with Sudheer Goutham of Elets News Network (ENN) What all healthcare schemes and services are being offered

by Aarogyasri Healthcare Trust?

Please provide details.

Presently, Aarogyasri Healthcare Trust is implementing three schemes.

The first scheme is Aarogyasri Special Treatment Scheme which aims to offer special treatment to the below poverty level families. Under this scheme, both private and public hospitals are empanelled under

58

July / 2016 ehealth.eletsonline.com

Aarogyasri Healthcare Trust. This scheme can be availed by poor patients having white ration card supplied by the Civil Supplies Department as a proof. Whenever a patient carrying a white ration card goes to a hospital, private or government, our Aarogyamithras as a functionary will register that patient’s details.

Post-examination in the hospital, the patient will be provided inpatient or outpatient treatment according to

their needs. The hospital will raise preauthorisation on the patient’s note and will be sent to the trust. Once the preauthorisation is approved, the hospital will perform the treatment on the patients. Post treatment, they will raise a claim through an online model.

After submitting the claim details, the trust will conduct the investigation and approval procedure. Once approved, the payment will be transferred online.

Approximately 2 crore people are the

Aarogyasri Healthcare Trust

beneficiary under this programme.

The second programme implemented by the Aarogyasri Healthcare Trust is ‘Employee Health Scheme’. This scheme covers state government employees and pensioners. Under this programme, charge less treatment is offered to all employees and pensioners of the state government. Under this scheme, cardiac treatment is provided by the trust to the employees or pensioners carrying the card in the hospital empanelled under the trust. As in the Aarogyasri Special Treatment Scheme, outpatient or inpatient care will be given according to the patient’s need with all formalities to be followed as in the earlier scheme.

In this total process, one lacuna is that the beneficiary does not know which hospitals are empanelled under the trust. They are also not aware of the kind of treatment available in these hospitals. Due to this information gap, we frequently get calls to our call centre.

Sir, you have successfully launched this app. Please enumerate the basic reasons behind launching this app and technical specifications of this app?

Almost 4 months back, we got this idea to make our services better by offering facilities to the poor and common man.

For certain, they are not aware where to go due to lack of facilities, especially during emergencies. For example, in cardiac cases, with the right combination of doctors and treatment we can have the right result at the right time. Therefore, we now offer an app which when downloaded can give

Dr Charlakola Laxma Reddy Minister for Medical, Health & Family Welfare, Government of Telangana

Rajeshwar Tiwari Principal Secretary for Health, Medical & Family Welfare, Telangana

a lot of information in patients’ hands.

On this app, our IT team and the TCS team worked together to create a multifaceted app. Interestingly, now even the central government and other state governments want to launch such an app. We are proud to have launched it before the Government of India. We launched this app post research in Hyderabad and tribal areas, such as Utnoor and Bhadrachalam.

Aarogyasri Healthcare Trust Schemes • Aarogyasri Special Treatment Scheme covers the below poverty level families • Employee Health Scheme covers state government employees & pensioners

Telangana Government Initiatives

This app was launched on the World Health Day by Dr Charlakola Laxma Reddy, Hon’ble Minister for Medical, Health & Family Welfare and Rajeswar Tiwari, IAS, Principal Secretary to Government, Medical & Health Department, who were instrumental in bringing this app for the people.

On the Google Play Store, our app has been rated 4.6 on 5. We have seen so far around 1.5 lakh downloads. We have 2 crore Aarogyasri beneficiaries, 11 lakh employees and 80,000 journalists.

This app is enabled with the tracking mechanism and provides a road map from the location of the patient to the hospital. One can approach the hospitals within a 10-km radius, which is really beneficial to both poor and during emergencies.

Another information available is the kind of specialities available.

We can get details about hospitals operating for a specific speciality.

These are very critical information available to the patient directly on the mobile to save lives. The availability of downloadable soft copy of health card will enable access to treatment even when the patient is not carrying card or does not remember the ID number. This is applicable for all schemes. Additionally, patients can know the status of approvals on their treatment. For any queries, they can directly contact the hospital.

All frequently asked questions (FAQs) will be incorporated in this application and there will be no need of intermediaries.

Even for registering complaints in case of denial of treatment, there is a section to register the details. In future, we are going to integrate the facility of ‘booking of doctor’ service.

Through the mobile, patients can book an appointment in a hospital. People can also send the feedback about the services provided in the hospital through this app. We are planning to introduce smart healthcare cards, which is an updated card that can enable any practitioners or doctors to access a patient’s health cards

July / 2016 ehealth.eletsonline.com

59

Telangana Government Initiatives

Aarogyasri Healthcare Trust

With the facilities to access information related to treatment and provision to register complaints, patients will no longer suffer.

Could you please throw light on how such an app is going to assist the state government in ensuring right patient monitoring?

We also plan to bring information in the local language. We have already instructed Aarogyamithras and the concerned people, who are the frontrunners stationed in the network hospitals, to immediately admit people who will show this app number. This app number makes a person eligible for treatment. Secondly, the treatment status and other details can be seen on the app, along with the provision

or medical history. The Telangana government is creating a database for all medical data to avoid carrying any physical copies. All diagnostic and major hospitals are being linked to this database.

So, now we are moving from e-governance to mobile-governance, according to the vision of our Prime Minister Narender Modi. Basically, this app aims to save lives in the golden hour, as in the last 1 hour many people succumb to injuries due to lack of information about hospitals, especially around the highways. Many people are suffering due to lack of information.

Mobile Application - Key Takeaways • Enabled with tracking mechanism • Provides a road map from the location to hospital (covers 10-km radius) • Offers critical information, facility to check approval status & facility to register complaints • Offers book an appointment facility • Out of 30% casualties, nearly 40% to 50% patients can be saved through timely action via app • Plans one trauma centre for every 100 km

60

July / 2016 ehealth.eletsonline.com

to discuss the status with the medical officer or doctor. This way we can plug the problem immediately. Patients can also raise complaints immediately. We already have a lot many queries and complaints being raised. Within 1 hour, we have resolved more than 60 per cent of the complaints. We have also added the FAQ section. The most common complaint was money collection and the second common complaints were about service deficiency. We have a strong 104 service. We are nowadays calling Aarogyasri beneficiaries at the village level, mandal level and district level to understand their problems. We are putting a lot of banners and a lot of investment. Even in cinema halls, railways and in other public areas we are conducting campaigns. Apart from these, we are sending text messages to the beneficiaries. Every patient’s data is captured. Once the data captured, only then we issue the card. We have 30 per cent of casualties due to head injuries.

With timely action, out of this 30 per cent nearly 40 to 50 per cent patients can be saved. Recently, the Telangana government has announced to go for one trauma centre for every 100 km.

TechEmerge Health Innovation Summit

TechEmerge Health Innovation Summit – Aims at Accelerating Adoption of Technology via Matchmaking International Finance Corporation (IFC) successfully conducted a 2-day TechEmerge Health Innovation Summit from June 15-16 in the capital city New Delhi, India.

The summit brought together young innovators with solutions capable of delivering care at a low cost & investment and experienced corporates and hospitals. The summit, which was the first-of-its-kind across the world, became an effective medium to expose the Indian healthcare stakeholders to innovations occurring at an unimaginable scale globally. In many ways, this event, as well as similar events, can play a crucial role in strengthening the healthcare and start-up ecosystems.

With India standing tall among all the Brazil, Russia, India, China and South Africa (BRICS) members, which are witnessing recession and political turmoil, the IFC has been absolutely clear right from the day the entire idea of ‘TechEmerge Health Innovation Summit’ germinated about conducting this event in India.

Clearly, IFC aims to lay the foundation of increased adoption of ‘innovative technologies’ in emerging markets.

With India lately witnessing a string of economic reforms under Prime Minister Narender Modi, which have encouraged private investment and increased the status of India as one of the most successful emerging markets, the success of the project in India will certainly establish the worthiness of such summits to be pursued in other geographies.

The summit gave scope to over 30 innovators, selected out of over 300 applications from 29 countries, to showcase and pitch their cost-effective solutions. These solutions when integrated in regular medical facilities can fill in many gaps prevalent in the system.

July / 2016 ehealth.eletsonline.com

61

TechEmerge Health Innovation Summit

Here Nikunj Jinsi, Global Head, Venture Capital Investments at IFC - International Finance Corporation, shares his inputs with Kusum Kumari, Elets News Network (ENN) I understand this is the first TechEmerge Health Innovation Summit being conducted world over. So, what was the entire idea behind the entire project?

The idea was to identify useful technology solutions, which does not have to be necessarily from a startup, it can be more mature companies or businesses that generally have trouble finding place in a market like India. We started thinking conceptually like where information and communications technology (ICT) comes as a convening power and where do we maximise our leverage. IFC, through our venture capital arm, get a lot of access to technology companies, of which many do not get funds due to a variety of reasons. We, through our mainstream investment services, have strong access to corporations in emerging markets, which we do not leverage as much we we could from a portfolio perspective. We also have a lot of access to customers who may not be our clients.

Though we had the option to conduct the entire summit in a big way or pilot it, we settled on to be a bit careful and pilot the entire programme. We identified strong demand and opportunity in health tech precisely because of technology component beyond any shade of

doubt. Technology allows business to leapfrog over legacy business.

Therefore, the leapfrogging effect of technology is important and the fact that there are ready clients in the space is also important. In India, we have several clients whom we have access to and there are several out there to whom we do not have access to. As long as we can try and bring them all to the table, healthcare is one sector where we can try. So this is a pilot and the first time IFC is launching this programme in one sector and one geography. The next step would be to broaden the geography and also look at other sectors. Another aspect of India is that it is never an easy market to operate in. On one hand, the problem is obvious and on the other hand, the solutions seem obvious but to implement is a huge task.

Therefore, if one can crack it in India, one can crack anywhere else.

What are the challenges in the Indian market in terms of the behavioural approach towards new innovations, regulations, etc.?

The biggest challenge is not so about relation, but by nature no one wants to pay for new goods and new services, especially in health people try to get services publicly.

TechEmerge Health Innovation Summit - Key Takeaways • Spread awareness • Accelerate the adoption of technologies • Learn how big companies can pilot or test products in their operations • Ensure matchmaking between big companies & innovators

62

July / 2016 ehealth.eletsonline.com

Therefore, for private operators to try out new technologies, these should be cost-effective. Although people are fundamentally ready to take more risks, there are no necessary incentives, especially if they are not losing clients, to invest in technologies and disruptive innovations. With a little bit of funding that we are making available through our sponsors, we are taking away that challenge by ensuring that these innovators have support for a 6–month period so that they can conduct a pilot and try out and test some of the new technologies and businesses out there. Post testing, the innovators can think whether they can accept it and try commercially.

This takes away a huge barrier. Most of the time, people are frugal and don’t want to pay for new technologies.

They also need to be convinced and we need to work upon lowering the thresholds. This behaviour is prevalent across the world.

Since both Israel and Finland are participating in TechEmerge Health Innovation

TechEmerge Health Innovation Summit

Summit, are they also funding the start-ups?

The reason they are participating because they ensured a lot of funding.

Naturally, we are managing it only as a secretariat. Indian health systems are ready to invest in pilots, so the over 100 one-on-one meetings arranged

by IFC will hopefully result into many different new business partnerships in which organisations will really take on new technologies. We use the donor pool money from these two entities to make it easier for them to try. The IFC does not get any economic benefit out of this. We are just a facilitator.

However, this is an important programme for us. We are not here to make just an announcement, but to build an ecosystem.

Dr Arvind Lal, CMD, Dr Lal PathLabs sharing his vision & inputs at TechEmerge Health Innovation Summit

Here Ruzgar Barisik, Senior Investment Officer, IFC/World Bank, shares his inputs with Kusum Kumari, Elets News Network (ENN) From where did you get the entire idea about TechEmerge Health Innovation Summit?

Was it inspired from the start-up trend in Finland and Israel or in India?

The IFC, an investment arm of the World Bank, works by investing in companies in developing countries.

I am part of IFC’s venture capital group. What we do is that we look for innovations and innovative technologies, especially those that can be really used in developing countries. I am based in Washington, DC and my team is all over the world.

We have got two people in India, two in Singapore and three in Beijing. We look for companies and start-ups only in global emerging markets. We have invested in a number of start-ups in India, such as Lenskart, Bigbasket, NephroPlus, Eye-Q, etc.

My day job is to go and find exciting innovations and technologies that

can be useful in developing countries.

We meet thousands of companies and start-ups that have something interesting to offer. Therefore, we are involved in making decisions whether we should work with these companies or not. The entire event is the result of the realisation that the IFC has already invested in a lot of hospitals, corporations, industrial companies, etc. in developing countries, which consume technologies. On one hand, we already have the best technologies around and on the other, we have already invested in a lot of organisations. TechEmerge emerged to spread awareness and accelerate the adoption of technologies, which will sooner or later come all over the world and to India as well. We picked up healthcare as the industry and India as the market, as we know that India needs healthcare innovations the most. Additionally, we are quite well aware that Indian market is a

difficult market to operate in, so if we can succeed in India, we can succeed anywhere.

Through this summit, we wanted to spread awareness about changes and innovations happening across the world. Since we had already

July / 2016 ehealth.eletsonline.com

63

TechEmerge Health Innovation Summit

selected the best 30 innovators from over 300 applicants, trust was already there among the hospitals and corporates that participated in this summit. Additionally, the summit enabled to learn how big companies can pilot or test these products in their operations. The hospitals will benefit from this forever. Overall, the IFC will ensure funding to test these products in these hospitals.

During the summit, there were 13 companies on stage, another 20 tech companies in the room and around 20 hospitals. There are around 100 one-on-one meetings conducted over two days. At the end, our goal is to ensure matchmaking between big companies and innovators, post consent and affirmation of likeness towards each other. IFC will ensure testing of these products over the next few months in these hospital’s operations, so that they are ready to put their own resources to include them in their operations.

How much time will IFC be giving to hospitals and technology companies for clinical trials and other procedures?

Criteria of Selection • Low cost • Current needs • Exposure to innovations It really depends on the technology.

There are technologies that are as simple as a device that works on its own and some technologies are sophisticated that need to be integrated into the data systems and people need to be trained on how to use them. We think most of the trials will be for a few months and some of them will be for 6 months. We hope not too many will go much longer than 9 months, but will definitely be less than that.

What were the criteria behind the selection of these innovators?

As Indian hospitals and companies aim at having cost-effective products or solutions capable of delivering more services, better healthcare and patient outcomes, cost was one of the main criteria. Secondly, we tried to determine the current needs of

More than 200 people attended the summit, including CEOs and senior representatives from Indian healthcare providers, CEOs/founders of health tech companies, etc.

64

July / 2016 ehealth.eletsonline.com

the hospitals. Thirdly, by observing technological advancements in Asia, Africa and America, we tried to figure out what other things the Indian hospitals need to know or be exposed to. Once we had figured out the above, we basically distilled our findings into few categories. In the Indian healthcare sector, diagnostics point of care in the field of diagnosis, patient engagement and physician education are basically trying to do as much as one can with a limited number of physicians. As India does not have enough physicians, clinics and specialists, IFC aimed at finding solutions that will increase productivity. In the end, most of these technologies are low-cost solutions that are IT-intensive and not hardware-intensive. These are not big devices. We are targeting mid-level medical facilities primarily because we think that drives the option.

What are the challenges for the foreign companies in India?

It’s very difficult for a young foreign company to come in the Indian market. The first problem is awareness and how to pitch the technology to the right person in the Indian healthcare sector.

Since these companies are not local companies, it’s one of the challenging tasks to convince the Indian healthcare stakeholders to trust their solutions. One needs to know how to put enough resources to come here on a regular basis as that what takes to sell the products to Indian hospitals. The bigger issue is distribution, making sure one can sell the products, scale products and services, etc. Therefore, in comparison to Indian and local companies, the foreign companies need more support. However, it’s equally challenging for the Indian companies as they too need to work upon their relationships and knock on every doors, etc. At the end, these are common problems, but become harder for foreign companies.

nSmiles.club

Start-Up

nSmiles.club: Offers Early Detection Tools to Reduce Mental Diseases by 30% We intend to bring a lot of awareness on all mental health illnesses in order to accelerate acceptance of mental health as a key health component as physical health is for happy living, shares Teju Nageswari, Co-Founder and CEO, nSmiles.club with Elets News Network (ENN) Please walk us through the reasons, both personal and professional, which propelled you to establish nSmiles.club?

There came a point in my life when I got into depression.

That’s the start of

me seeing value in counselling and therapy. Post recovery, we (my husband and myself) being engineers, did a thorough root cause analysis of what, where went wrong. We understood that mental health illness effects are so subtle and slow that it’s difficult to a common man to get the sense of it before it really starts impacting in a big way. We felt the need to educate others using technology as we are engineers. That thought gave birth to nSmiles.club, where our mission was to spread n (mathematical representation of number of) smiles in people’s lives.

I took formal training in coaching and counselling to be able to provide best psychology solutions. We created an app based on our learnings. Happy Being App has got more than 1.5 lakh downloads and was on global top charts. Those massive more than 45,000 of positive feedback across globe spoke good about the concept and the need for instant help. We worked on the feedback and created a prototype on a Startup Weekend.

As winners from Bengaluru, we participated in Global Startup Battle 2014 and were announced runnerup in Do the Kind Track (only startup from India so far). Later, while

designing our current assessment suites, to understand the behaviour and need for a product, we conducted interviews with more than 3,000 people in the urban population.

Increased stress is affecting young people to such an extent that it is impacting their behaviour that need urgent attention by both policymakers & decision-makers. How is nSmiles.club addressing this challenge?

Stress is called a silent killer when it starts being detrimental to health.

Stress is good when one can identify the reasons and the root causes along with coping mechanisms. Once you realise if your stress is self-induced or from outside sources and how it’s manifesting in your life, you will be able to better manage stress and is much easier to gain control. nSmiles.club has come up with an assessment suite called “Stress Analysis and Management Tool”, which that can help an individual measure their levels of stress from various sources, such as home, society, health and workplace, along with measuring their stress-coping patterns. The tool takes 30 minutes to complete the assessment and provides a detailed report on how good/moderate/bad is one’s current stress along with a selfdevelopment plan for managing stress by enhancing one’s six dimensions of

July / 2016 ehealth.eletsonline.com

65

Start-Up

nSmiles.club

wellness - Intellectual, Social, Physical, Emotional, Spiritual and Occupational.

“Stress Analysis and Management Tool” provides everything that’s so personal, private and confidential to you.

What is the difference between ‘mental health’ and ‘emotional health‘ according to you? Is the latter the initial phase of mental diseases?

They both are synonyms and imply the same. Since there’s a stigma associated with the word mental health, as a more less-stigmatised option, people use emotional health to refer to their mental health.

With so much social stigma attached to ‘mental health’ and even ‘emotional health’, what measures have been undertaken by nSmiles.club, as an effective intervener, to address the challenge of elevating mental diseases from social stigma category to general diseases?

As all our services are offered online, the tools allow convenience, privacy and confidentiality. It’s on a Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant system, so a lot of security measures are undertaken to ensure safety and privacy. All our psychologists and consultants have more than 10 years of experience.

All our assessments are highly handpicked, researched and clubbed to bring accurate, comprehensive analysis of an individual’s condition.

We take a lot of time in designing our solutions. One word we wish our

Key Takeaways • Offers Happy Being App (more than 1.5 lakh downloads & was on global top charts) • Received more than 45,000 of positive feedback across globe • Introduced “Stress Analysis and Management Tool” to measure levels of stress from various sources & stress coping patterns customers would associate with us is “Trust”. We are very proud when that’s get realised. Our customers trust us that we are there as their rock solid support when they need one and they necessarily don’t have to face the challenges life throws at them all alone. We intend to bring a lot of awareness on all mental health illnesses in order to accelerate acceptance of mental health as a key health component as physical health is for happy living. Currently, our total focus is on depression and anxiety. We wish to reduce 30 per cent depression and anxiety cases in India and equally reduce usage of psychiatric medication for depression and anxiety by providing early detection tools.

Please provide details of your assessment tools. Do you think people suffering from emotional crises or mental diseases are finally ready for assessment with the availability of digital tools that will ensure privacy?

To test the readiness of people on the subject of mental health and their acceptance for managing it on digital tools, we did experiments and the response was phenomenal. We had 1.5 lakh installs of our earlier app. People personally voted by going through

Mental Illness - Statistics • 87% of Indian urban families are stressed • 85% have strained relationships • 30% have marital problems • 30% addicted to substance

66

July / 2016 ehealth.eletsonline.com

all the process to make us win in the Global Start-Up Battle and later while piloting assessments also, we got similar response. Hence, we took enough measures to make it valuable of their time and money by making it a more comprehensive screening tool to check if their current stress levels are impacting their health, relationships, children, co-workers and happiness, especially for working professionals who are witnessing increased stress due to multitasking and rising expectations.

Overall, 87 per cent of Indian urban families are stressed, 85 per cent have strained relationships, 30 per cent have marital problems and 30 per cent addicted to substance.

Depression is number 1 occupational disease and stress is the number 1 lifestyle risk factor. The latest research from NIMHANS confirms 50 per cent of corporate professionals suffer from some kind of mental health disorders and 1 in 10 Indians are depressed.

Our Stress Analysis and Management Tool first identifies the stressors in your life and coping mechanisms.

Taking all your responses, it instantly provides a report that’s very non-threatening and detailed. Post going through a physical lab test, if one’s score is at risk, it shows as asterisk. Additionally, it identifies the need to reach out for external help if a couple of scores are at risk. For individuals who are already managing their stress at different levels well, the tool provides personal development and stress management through the wellness approach.

s

Biograph Horizon More within reach. siemens.com/biograph-horizon

1

Biograph Horizon™ offers premium PET/CT performance and is the smallest PET/CT system2 on the market, minimizing your initial capital investment without compromising on quality. The system gives you the flexibility to address a broader range of oncology, neurology and cardiac indications, so you can bring high-quality care to more patients while introducing new efficiencies and cost savings.

1

A better outcome3, a more productive day, a path to growth—it’s remarkable what Biograph Horizon can make possible.

For business queries, please email us at: hc_contact.india@siemens.com or you can call our Helpline: 1800-209-1800

3

Biograph Horizon is not commercially available in all countries. Due to regulatory reasons, its future availability cannot be guaranteed. Please contact your local Siemens organization for further details.

2

Based on competitive literature available at the time of publication.

Data on file.

Compared to non-hybrid imaging modalities. Addition of PET imaging changes therapy in 33% of cases (2009). The Impact of Positron Emission Tomography (PET) on Expected Management during cancer treatment, National Oncologic PET Registry, 115:410–418, PMID:19016303.

12th August 2016, New Delhi PSU Partner

Powered by

gyaNeSh PaNdey Chairman & Managing Director HSCC (India Ltd)

george kuruviLLa Chairman and Managing Director Broadcast Engineering Consultants India Limited (BECIL)

JaikaNt SiNgh Head- Partnership & State Alliance, National Skill Development Corporation New Delhi

aNJaN BoSe Secretary General Healthcare Federation of India

dr k k kaLra CEO, National Accreditation Board for Hospitals & Healthcare Providers, Quality Council of India

dr JiteNdar Sharma Director-WHO Collaborating Center for Priority Medical devices & Health technology Policy, NHSRC, MoHFW

raJiv kumar JaiN Additional CMD MoHFW Indian Railways New Delhi

dr deePak agarWaL Chairman- Computerisation & IT, AIIMS Delhi

dr d S raNa Managing Director / Chairman, Sir Ganga Ram Hospital, New Delhi

dr ShuChiN BaJaJ Founder Director Cygnus Hospitals Gurgaon

Jai PrakaSh dWivedi CIO Rajiv Gandhi Cancer Institute & Research Centre Delhi

NiraNJaN kumar ramakriShNaN CIO, Sir Ganga Ram Hospital New Delhi

Sumit Puri CIO Max Healthcare Gurgaon

ShuvaNkar PramaNiCk CIO Paras Hospitals Gurgaon

NaNdkiShor dhomNe VP-IT & CIO Manipal Health Enterprises Manipal Group, Bengaluru

guNJaN kumar CIO & Head Regency Healthcare Kanpur

Nikesh Singh Group CEO, Meenakshi Mission Hospital and Research Centre, Madurai

NeeraJ LaL Group COO Sunshine Global Hospitals Gujarat

Joy ChakraBorty COO PD Hinduja Hospital Mumbai

aLok khare VP-IT Jaypee Hospital Greater Noida

PuNeet ChaNdNa Collaborator & working Partner Tata Memorial Hospital

dr raJeSh guPta Head – Healthcare Solutions Medanta The Medicity Gurgaon

dr ravi gaur COO Oncquest Laboratories Ltd New Delhi

dr B r daS President - Research & Innovation, SRL Diagnostics Gurgaon