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DECEMBER 2019 | VOLUME 14 | ISSUE 10
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COVER STORY
#VisionHealth2024: Roadmap of Healthy, Happy and Empowered New India SPECIAL INTERVIEW
LEADERS PERSPECTIVE
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Jai Pratap Singh
Dr Nandakumar Jairam
Raju Venkatraman
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Dr Aloke Mullick
Dr Shuchin Bajaj
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Minister for Medical, Health and Family Welfare, Government of Uttar Pradesh
CEO, Chairman, and Group Medical Director, Columbia Asia Hospitals
SPECIAL INTERVIEW
Chairman-cum-Non Executive Director, Medall Healthcare
18 Group CEO, OMNI Hospitals
Alexander Laloo Hek
Minister for Health & Family Welfare Department Government of Meghalaya
INDUSTRY PERSPECTIVE
Dr Rakesh Gupta
Chairman Sarvodaya Hospital Group, Faridabad
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SPECIAL FEATURE
Rajiv Nath
Forum Coordinator of Association of Indian Medical Devices Industry (AiMeD)
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TECHNOLOGY PERSPECTIVE 46
Sandeep Jha
Vice President - Digital Health
Dr Santosh Pawar
Vice President - Healthcare Inspira Enterprise India Pvt Ltd
49 Dr Somesh Mittal Managing Director & Chief Executive Officer, Vikram Hospital
50 Abdullah Saleem Group CIO, OMNI Hospitals
Founder Director, Ujala Cygnus Hospitals
52 Dr Ajit Saxena Senior consultant Urologist & Andrologist, Indraprastha Apollo Hospitals, Delhi
54 Hemraj Parmar Group Chief Executive Officer, BR Life 55 Chander Mohan Malhotra Head - IT Projects, Sarvodaya Hospital & Research Centre, Faridabad
Growth of Surgical Robotics in India
Dr Aditi Karad
Executive Director, VishwaRaj Hospital
Editorial India on its Way to Develop Inclusive Healthcare Delivery Model India seems to be all set to transform the paradigm of healthcare delivery system, where accessible and affordable healthcare would be well within the reach of people of all strata of the society. With an objective to achieve universal healthcare goal, the Government is adopting multi-pronged approach to bridge existing wide gaps in the healthcare delivery system. With the right blend of digital technology and innovative practices coupled with active participation of private players, the Government is working on a robust strategy to create healthy, happy and empowered new India. In the wake of unprecedented increase in non-communicable diseases and lifestyle related issues, inclusive healthcare system is needed to ensure the well-being of masses. eHealth, which has been disseminating information through knowledge conferences with top-notch policymakers and healthcare experts discussing existing challenges and way out of the same, has endeavoured to set pitch for the goal of universal healthcare . Our latest Cover story ‘VisionHealth2024: Roadmap of Healthy, Happy and Empowered New India’ is based on the Government’s vision and planning of the next five years on how the Indian healthcare system would evolve in terms of providing inclusive care. The story does a reality-check on how different measures would be effective to augment delivery of services. The story does integration of different measures on front of IT and digital technology with respect to existing infrastructural and human workforce challenges. The latest issue also has special interviews of Jai Pratap Singh, Minister for Medical, Health and Family Welfare, Government of Uttar Pradesh; and Alexander Laloo Hek, Minister for Health & Family Welfare Department, Government of Meghalaya, who talk about different facets of healthcare and latest initiatives undertaken to improve delivery of quality care. The magazine also carries articles from top experts including Dr Nandakumar Jairam, CEO, Chairman, and Group Medical Director, Columbia Asia Hospitals; Dr Aloke Mullick, Group CEO, OMNI Hospitals; Dr Rakesh Gupta, Chairman, Sarvodaya Hospital Group, Faridabad; and Dr Aditi Karad, Executive Director, VishwaRaj Hospital, who shed light about visionhealth2024 and how technology and innovations could solve some of the obstacles if used in a prudent manner. We also have industry perspective by Rajiv Nath, Forum Coordinator of Association of Indian Medical Devices Industry (AiMeD), who underscores need of separate regulator for medical device industry. The magazine also has a special feature on Robotics which encapsulates scope and challenges of robotic surgery in India. The latest issue which underlines healthcarevision2024 also carries interview of Gyanesh Pandey, Managing Director, HSCC (India) Ltd., who unveils planning and strategy to bolster healthcare infrastructure across the country. With this bouquet of articles, special features and interviews, we hope this latest issue will invite an invaluable feedback of our readers.
Dr Ravi Gupta Editor-in-Chief eHEALTH Magazine and Founder Publisher & CEO Elets Technomedia Pvt. Ltd. ravi.gupta@elets.in
Cover Story
#VisionHealth2024: Roadmap of Healthy, Happy and Empowered New India
The paradigm of the Indian healthcare is witnessing brisk growth today due to recent advancement of technology and innovative solutions, which have not only helped to bridge infrastructural gaps but also led enriched healthcare experience to people at large. Despite technology-led Indian Healthcare giving hope to masses, concerted efforts on policy level is needed to bridge wide gaps in the delivery of healthcare services. In this light, Government is working on a mission in terms of robust planning and strategy to create healthy India where quality patient care will be within the reach of every single citizen of the country.bIn this mission, eHealth Magazine has also been organising health conferences in various parts of the country to get top policymakers, industry leaders and international experts under one roof to deliberate on different facets of healthcare ecosystem and playing the role of catalyst to drive transformation through knowledge platforms. Mukul Kumar Mishra of Elets News Network (ENN), tries to analyse the Government’s vision & strategy for laying strong foundation of healthcare, and associated challenges on different fronts.
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T
he Indian healthcare is at crossroads today with emerging technology and innovative practices coupled with active participation from both public and private providers giving positive insight about delivery of healthcare services to masses while at the same time it presents a number of paradoxes on front of infrastructure especially in primary care and overall clinical outcome. As India advances towards Rs 5 trillion dollar economy by 202425 and healthcare being one of the important components contributing to overall growth and prosperity of the nation, vision of the Government in terms of strategy and planning to create robust healthcare delivery system holds a huge significance. With a slew of measures, the Government has set the pitch; nonetheless, it will take some years before one could feel the real difference. A LITTLE INSIGHT ABOUT THE INDIAN HEALTHCARE INDUSTRY The healthcare industry is one of the fastest growing sectors in India, providing a plethora of
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opportunities to stakeholders of this field. According to a report by the industry body Assocham (Associated Chambers of Commerce of India) and research firm RNCOS, the Indian healthcare industry may see three-fold jump in value terms to $372 billion by 2022. The sector is expected to generate 40 million jobs in India by 2020. Over 100,000 jobs are expected to be created from Ayushman Bharat, the National Health Protection Scheme. “The affordable medical services have resulted in a growth in the country’s healthcare tourism, attracting patients worldwide and making India, the new ‘Medical Tourism Destination’,” says Dr Rakesh Gupta, Chairman, Sarvodaya Hospital Group, Faridabad. Holding health budget a major constrain Ishiqa Multani President, Sagar Group of Hospitals, says, “While India currently spends approximately 1.3% of its GDP on healthcare, its public spending on healthcare as part of its total expenditures is lower than any other Asian country with the exception of Pakistan.”
HEALTHY POPULATION HOLDS KEY FOR A PROSPEROUS NATION The Government has fair idea that till masses get reasonably well access to quality and affordable care, the larger goal to create healthy, happy and empowered India would not be accomplished. With this objective, the Government is toying with all possible ideas to make things improve, paving path for sustainable and inclusive healthcare facilities to people at large. Under the National Health Mission plan, the Government has clearly stated that it is committed to improve healthcare infrastructure in rural and urban areas for—reproductive-maternalneonatal –child & adolescent health (RMNCH+A), and communicable & non-communicable diseases. The NHM envisages achievement of universal access to equitable, affordable, and quality healthcare services that are accountable and responsive to people’s needs. Recently released report ‘Health Systems for a New India: Building Blocks— Potential Pathways to Reforms,’ by Niti Aayog speaks volumes about the Government’s intent to reform the
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NATIONAL HEALTH STACK ENVISIONS TO CREATE DIGITAL HEALTH INFRASTRUCTURE In a bid to develop robust digital and IT health infrastructure, NITI Aayog is also working on a plan called National Health Stack (NHS). The National Digital Health Blueprint (NDHB) is the architectural document for the implementation of the NHS. Experts believe the Government’s objective is to manage population health in better manner
leveraging analytics platform like Big Data and AI with Machine Learning. As per reports, unique health identification cards (IDs) would be provided to citizens so that health history of a person could be accessed at the click of a mouse. The idea is to aggregate data so that it would help patients, doctors, diagnostic chains and policymakers in order to make evidence-based interventions. GOVERNMENT’S MEASURES TO TACKLE CHALLENGES OF 5 AS Challenges of the Indian healthcare is mostly centred around 5 As-Accessibility, Affordability, Awareness, Absence or human workforce crisis, and Accountability. To improve record on this front, the Government is working on all fronts—planning to create robust digital framework, chalking out innovative ways, seeking partnership with private players to ramp up required healthcare infrastructure. With this objective, several initiatives have been announced like Ayushman Bharat and Pradhan Mantri Jan Aushadhi Yojana, capping of price of essential drugs and medical equipment, 100 percent FDI for pharma sector, medical device parks, and setting up of R&D centres to give a boost to the sector in holistic manner. “Government initiative like
CHALLENGES OF THE INDIAN HEALTHCARE IS MOSTLY CENTRED AROUND 5 AS--ACCESSIBILITY, AFFORDABILITY, AWARENESS, ABSENCE OR HUMAN WORKFORCE CRISIS, AND ACCOUNTABILITY. TO IMPROVE RECORD ON THIS FRONT, THE GOVERNMENT IS WORKING ON ALL FRONTS.
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Indian Healthcare sector. The report identified five focus areas of future health system --to deliver on unfinished public health agenda, change health financing away from out of pocket so spend into large insurers, integrate service delivery vertically and horizontally, empower citizens to become better buyers of health, and harness the power of digital health. Dr Shuchin Bajaj, Founder Director, Ujala Cygnus Hospitals says “Our contribution to inclusive healthcare development agenda and commitment to ‘universal healthcare for all’ mission, have to be an integral part of our service delivery within the entire healthcare ecosystem, by ensuring free medicines and discounts on pharmacy, consultancies and surgeries to the economically weaker population of the society.”
‘Prime Minister Health Scheme Ayushman Bharat’ along with other state sponsored schemes like CGHS, ECHS etc. provides good access of healthcare to the masses but probably at the cost of medical fraternity which is already paid low as compared to their counterparts across the globe,” Gupta says. “Many of the nation’s current challenges related to healthcare could be resolved by prioritizing preventative health and health education in our states and national healthcare programmes, and capitalizing upon the wide range of knowledge, skills, and experience within the private sector through collaborative initiatives,” Multani opines. TODAY’S EMPOWERED PATIENTS SEEK VALUE FOR MONEY IN TERMS OF CLINICAL OUTCOME As patients are getting empowered due to easy access to large swathe
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of information, healthcare service providers including both public and private one are expected to come up with smart ways to live up to their high expectations pertaining to patient care. A spurt in the incidences of lifestyle and non communicable diseases are making people seek quick and best care in hassle free manner. With the aim to cater informed patient, providers are leveraging modern-day technology trends and applications at smart hospitals to provide optimum care in hassle free manner. It is a matter of agony that patients don’t find facilities up to the mark at public hospitals, especially those which deal in tertiary care. Lack of infrastructure in terms of medical equipment and unavailability of required number of doctors and nurses are some of the possible reasons which jeopardize care delivery at government hospitals. In this light, patients veer towards private facilities which at times take toll on health of poor and vulnerable people. “About 60% of our healthcare expenses are out of pocket, which is one of the highest in the world. Such is the lack of trust in the public health system that not only do 80% of the wealthy seek treatment in the private sector, but a similar percentage of the poor also goes to private practitioners, even though the treatment may be of low quality and provided by untrained practitioners,” believes Dr Bajaj. “Patients have few feasible options: the private healthcare system is largely unregulated and often unscrupulous, while the public healthcare system lacks the staff, resources, and infrastructure necessary to provide adequate healthcare services to a large population,” says Multani. Dr Nandakumar Jairam, CEO, Chairman, and Group Medical Director, says, “The establishment of a
DECEMBER 2019
low cost, high efficiency, large volume model which enables the government and the private healthcare players to establish healthcare institutes of substantial capability to meet the healthcare needs of the masses, is needed.” “There is also a need for us to shift from an illness to wellness. The government has thought about it but many private healthcare players have not looked at wellness as a concept to reduce the burden of tertiary healthcare,” Jairam states. PRIMARY CARE NEEDS TO BE BOLSTERED TO REDUCE LOAD ON TERTIARY CARE HOSPITALS Primary care system is considered as first line of defence against disease. It includes the day-to-day care needed to prevent, maintain, or cure any health issues. Best part of primary care is that people get the services in their vicinity and they need not to go far away except in some exceptional emergency situation. The Alma-Ata Declaration, 1978 highlighted the role of primary care to boost inclusive healthcare system. Despite India is having a huge network of such centres, they are ill-equipped to treat patient who are often found to be whimpering about basic facilities—shortage of expert doctors and nurses, lack of basic
infrastructure including diagnostic equipment, and short supply of drugs. The sorry state of primary care in our country highlights the fact that administration needs to pay urgent attention to make things improve on this front. “We have a large scheme offering free dialysis to many communities, but we forget that more than three quarters of kidney failures are caused by uncontrolled diabetes and hypertension, which can easily be treated at the primary health centre level, if we have the will to do it,” Bajaj says. There are many successful models worldwide which could be replicated to provide preventive care to masses at local level. Family clinics in Brazil and polyclinics and offices in Cuba are good examples of systems with nationwide coverage. Cuba has one of the most effective primary healthcare systems in the world, whose centrepiece is the community-based polyclinic. HUMAN WORKFORCE AND RURAL CARE There is an old saying that any war can’t be fought well until one has got enough foot soldiers. Similar rule applies in healthcare as well. In view of India being one of the worst affected countries with NCDs and
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emerging infectious diseases, required number of skilled health workforce is needed. But available data says otherwise. India has shortage of an estimated 600,000 doctors and 2 million nurses, as per data. In addition, asymmetric distribution of doctors and nurses, their merit and qualification, their reluctant attitude to work in rural areas further aggravates situation. Though the Government has taken measures in terms of increasing seats in medical colleges & seats, and toying with the idea to incentivize skilled medical professionals to work in rural areas, it will take some time before it will produce rich dividends. “We must capitalize on the strength of our universities to encourage enrollment in the healthcare industry and to ensure that our graduating students should be given incentives to remain in India for their careers and to work in areas which are currently underserved,” Multani holds the opinion. Hemraj Parmar, Group Chief Executive Officer, BR Life, says “Government must adequately incentivise private healthcare providers to spur investments and extend good quality healthcare to the people staying in rural areas who cannot afford more expensive treatment available in bigger cities.
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Many state governments are going in for PPP projects to make healthcare more affordable, thus minimising risks to both the parties.” MODERN TECHNOLOGY INCLUDING ARTIFICIAL INTELLIGENCE AND TELEMEDICINE TO BE LIKE BIG SUCCOR TO AUGMENT CARE There are empirical evidences which prove that emerging technology have proved to be a game-changer in enhancing healthcare experience. In rural areas, these tools have played a vital role to bolster care. The industry is being disrupted globally with advancements in technology, new protocols and innovations in EHR, AI, Big Data, 3D printing, genomics, blockchain, AR/VR, wearables, telemedicine to name just a few. “While Artificial Intelligence (AI) is still in a nascent stage in the country, it holds immense potential to minimise costs while improving accuracy of diagnosis and consequently treatment. It’s slowly finding usage in radiology and oncology,” Parmar says. “Telemedicine and teleradiology are already finding usage in rural areas devoid of basic infrastructure, clinical talent and facilities,” he further states. Dr Aloke Mullick, Group CEO, OMNI Hospitals, says, “Today
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patient carries on his smartphone his ICD coded clinical problem list, diagnostic results, images, medication lists, allergies, and past discharge summaries. His whole healthcare experience gets simplified, and the smartphone becomes the center of his healthcare experience.” SINGLE REGULATOR FOR MEDICAL DEVICE INDUSTRY AND BIOMEDICAL RESEARCH HOLD KEY The Indian medical devices market is currently valued at approximately at $10 billion and growing at an average annual pace of 12-15%. But sad part is the industry is regulated by multiple regulatory bodies which create a lot of confusion and deter investment by foreign and Indian companies. There is a compelling need for a unified regulator for ease of doing business. “A strong and fair regulatory environment will help the Make in India campaign by encouraging the growth of this industry,” says Rajiv Nath, Forum Coordinator of Association of Indian Medical Devices Industry (AiMeD). Another area which needs immediate attention is biomedical research. The ICMR, the premier Government body for medical research has very few interventions -- in terms of new drug, vaccine, diagnostic test or treatment procedure -- developed by its hundreds of scientists over a period of last couple of years. Lack of adequate funding, infrastructure, manpower, wage disparity, paucity of relevant data are some of the reasons why health research in India is hamstrung. Issues are on many fronts and that needs concerted efforts. Nonetheless, a holistic approach is needed to develop an ideal healthcare delivery model where every single person would get quality care at their doorsteps. Hopefully, all the steps undertaken in this direction by the Government in coherence with private bodies will prove effective to create healthy and empowered India.
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‘Determined to Develop Accessible & Affordable Healthcare Across UP’ The Uttar Pradesh Government is leaving no stone unturned to foster its healthcare delivery system, enabling people at large to avail best services at their doorsteps. Despite huge challenge of infrastructure in terms of shortage of doctors and equipment, the State Government envisions to create best exemplary model of patient care, says Jai Pratap Singh, Minister for Medical, Health and Family Welfare, Government of Uttar Pradesh, in conversation with Arpit Gupta and Mukul Kumar Mishra of Elets News Network (ENN).
Q
As the health minister, tell us about various plans and strategies to boost healthcare delivery mechanism in Uttar Pradesh? Education and healthcare are two important factors which determine economic prosperity of a country. Around 60 percent of population
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still lives in rural areas in India. Since initial days when country got independence, policymakers should have prioritised these sectors to develop. But things didn’t happen as it was visualised. Nonetheless, after seventy years, BJP came to power at the Centre and State. Since then, it has been leaving
no stone unturned to create a healthy and prosperous India. Our objective is to facilitate accessible healthcare to 22 crore people of the State. I am taking stock of the situation at PHCs, CHCs, and District Centres. Services at many of these centres are not up to the mark. Our main focus is to improve infrastructure at these centres,
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enabling masses to avail quality and affordable care.
facilities to make them work in remote areas.
Q
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What is your prime concern in terms of improving infrastructure so that skilled medical professionals including doctors could facilitate care at primary centres? There is a standard process of availability of residential buildings for doctors, pharmacists, ward boys, associated with PHCs, CHCs, and district centres. The glaring issue is maintenance of old structures. We are taking all measures to improve facilities at existing centres in terms of availability of human resource—doctors, nurses, and technicians, required equipments, and maintenance of residents buildings, so that inclusive care could be facilitated to people. In interior areas, residential quarters are not in good shape. The Government’s first priority is to kick-start things at existing centres so that not a single person gets deprived of basic care. Subsequently, we will focus on old residential structures and ensure to get them functional. Doctors need to provide required
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Can a model district health centre be developed which would be cited an example and attract doctors? It is practically not feasible due to constraints at different levels. We aim for better functional district health centres and community health centres where basic medical care should be available 24/7. These may not be model ones, but at least stand up to the level of basic standard. At CHCs, now doctors, experts and high-end equipments are available. In addition, telemedicine, and surgery facilities are also being explored at these centres. If people can get primary care at these centre, only serious patients needed to refer to medical colleges and tertiary care hospitals.
Q
What measures need to be taken to improve situation in public hospitals which lack facilities, affecting patient care? India spends 1.4 percent of GDP on healthcare. It should be ideally three percent to ramp up infrastructure.
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Many of the hospitals have now improved on various parameters. They are being given good ratings by National Accreditation Board for Hospitals (NABH) for their overall performance especially in area of clinical outcome. The rating is an indication that people would get best facilities in these hospitals. We are trying to improve things on every front. It’s our moral responsibility to provide better healthcare facilities to people at large. For that, budget needs to be increased and allocated money should be spent in prudent manner. There has been a substantial increase in budgetary allocations in recent years since the government took reins.
Q
Uttar Pradesh was one of the worst performing States in recently released Niti Aayog Health Index report…Isn’t it disturbing as a Health Minister? The report indicates State’s performances on various health parameters. There are eight aspirational districts across the State. To take stock of the programmes implemented by the
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State Government, the Central government team visits here once in a month. They monitor various points of health indicators minutely. Their ratings indicate progress of various programmes and areas where the State needs to work upon. To provide holistic care to women and child, there are programmes like Janani Suraksha Yojana (JSY) and Pradhan Mantri Matru Vandana Yojana (PMMVY). Expecting mothers who are registered under the scheme get Rs 6,500, and free medicine, so that they could take good care of their own health and baby’s as well. After the birth of baby, we ensure proper nutrition to child and mother. The Government also makes available free vaccination to child on different interval of time. The State may not have performed well as per the expectations of Niti Aayog. But we will strive to improve our records in coming years.
Q
How digital tools are being leveraged to improve delivery of care in rural areas? Through telemedicine, we are leveraging IT technology to bridge communication gaps between patients and doctors. Patients are
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Q TILL DATE UTTAR PRADESH HAD ONLY 13 MEDICAL COLLEGES. IN LAST TWO AND HALF YEARS, A TOTAL OF 15 COLLEGES HAVE BEEN ADDED UP.
being given particular time slot when expert doctors sitting in cities like Delhi or Lucknow appear on the techdriven web screen and guide patients about clinical treatment. Best part of the technology is both patient and doctors don’t physically present at the location but communicate in better manner to exchange information. Telemedicine is very useful in the light of shortage of expert doctors in remote areas. The technology is already available at some of the CHCs and working to increase the facility.
There is huge a shortage of doctors all across the State. How is the Government planning to improve the situation? The Government understands the urgency to improve number of skilled medical professionals to boost patient care. We have made a committee in every district where doctors are invited to work in rural areas directly through walk-in-interview. Many of the expert doctors have joined through the process. The Government is also working on bidding process to recruit skilled professionals. Till date Uttar Pradesh had only 13 medical colleges. In last two and half years, a total of 15 colleges have been added up. Out of these, seven have become functional and rest eight are at various stages. In addition, the Centre has also directed us to establish 14 medical colleges and work is on full swing on that front. We have started signing a bond with all the undergraduates studying in the Government medical colleges. As per the bond, they will have to serve for two years in rural areas. These efforts will bear fruit soon which will ultimately fill gaps of shortage of doctors and other medical professionals in coming years.
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Q
The Government has banned many hospitals on the charge of forgery and irregularity under the Ayushman Scheme. What measures are being undertaken on this front? Yes, we are taking strong action against such hospitals. Many of such cases have come to the fore. But, when mega schemes like Ayushman Bharat are implemented on such a scale, some cases are bound to be cropped up. Important point is it needs to be tackled with iron hand.
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There are clear guidelines about whole process of treatment. Hospitals must be empanelled to provide treatment facility. Moreover, the coordinator guides the patients how to go about whole processes.
Q
Corruption is one of the biggest issues jeopardising system to facilitate delivery of service to masses. What is your viewpoint? Corruption can’t be eradicated by any vigilance system or minister or political leaders. It is ingrained within the system and can’t be wiped out. System can rein in but can’t stop it completely. Despite getting good salary and other perks some of the government officials are found to be involved in such practices. System can teach you a lesson not to resort in such practices through punishment, but ultimately it’s your own conscience that should stop you doing such things.
Q
It has been alleged that BJP government has stopped 108 ambulance emergency services…is it true? No, 102 and 108 numbers are very much active. A large number of people avail ambulance facilities through these numbers. GVK is our service partner and every month we review the response time. We get feedback from every district about
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Q
PPP is being perceived as pivotal tool to improve infrastructure under Centre’s Ayushman Bharat initiative. How do you analyse the statement in context of UP? Many of the private hospitals and NABH and Kayakalp accredited government hospitals have been empanelled under Ayushman Bharat scheme. There is a Government’s coordinator in these hospitals who ensures patients get required care under the scheme. People with Ayushman card get Rs 5 lakh treatment facility for 1400 diseases across these hospitals. We have a redressal committee as well which resolves issue pertaining to increased cost of any treatment facility. People are also coming to government facilities to avail quality care now.
WE ARE TAKING ALL MEASURES TO IMPROVE FACILITIES AT EXISTING CENTRES IN TERMS OF AVAILABILITY OF HUMAN RESOURCE— DOCTORS, NURSES, AND TECHNICIANS, REQUIRED EQUIPMENTS, AND MAINTENANCE OF RESIDENTS BUILDINGS, SO THAT INCLUSIVE CARE COULD BE FACILITATED TO PEOPLE.
response time and investigate if the response time increases or any other sort of issue arises. Service provider faces action if response time increases. We aim to make the service much more efficient in coming days.
Q
You recently took over as Minister in Health Department. Tell us what all three issues you zeroed in to focus upon on priority. First is shortage of doctors and the Government is working on plans to improve situation on this front. Second issue is paramedics staff who wants to be posted as per their choice of districts. These are backbone of care delivery system and play a vital role. Our priority is to convince these staff to move to those places where they are utmost needed. And last but not the least is to improve infrastructure to bolster patient care in remotest corner of the State.
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SPECIAL INTERVIEW
‘Meghalaya Striving for Equitable Access to Healthcare’
As 70 percent of population resides in rural areas in Meghalaya, accessibility and affordability are important issues that need to be tackled in prudent manner. However, with the right intent & strategy, and leveraging schemes like Megha Health Insurance Scheme (MHIS), the state has witnessed an envious progress in providing quality care to masses, says Alexander Laloo Hek, Minister for Health & Family Welfare Department, Government of Meghalaya, in conversation with Nisha Samant & Mukul Kumar Mishra of Elets News Network (ENN).
Q
What measures have been undertaken to boost healthcare infrastructure to bolster patient care? One of the important and key aspects of healthcare delivery system is availability of adequate infrastructure, which plays a vital role in enabling masses to avail better patient care. Additionally, for a state like Meghalaya where more than 70 percent of the population resides in rural areas, it becomes even more important to provide services in areas viable and accessible to the entire population; and that should not only concentrated in a few health centers and facilities. Public health facilities have often been marred by shortfalls in terms of both infrastructure and manpower; though not everywhere and not all the time. In fact, the Government has several schemes and missions that are being implemented under the National Health Mission which helps the state in constantly improving health facilities. While envisioning the Megha Health Insurance Scheme (MHIS), the Government of Meghalaya wanted to address this very issue of “shortfall” and “accessibility”.
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Q
Kindly elaborate about MHIS When MHIS was started, a Revenue Sharing Model was introduced which enabled public health facility to address issue of manpower and infrastructure; a fixed percentage was defined for upgradation of the health facility and incentive of staff (medical and non-medical). Initially, it was a big challenge to convince health facilities to start utilising the scheme with barely 60 facilities leveraging the scheme. But over a few years, things have changed. Practitioners from different parts of the state have observed the benefits of implementation and now more than 120 facilities are implementing the scheme. It has now become an additional support system, helping hospitals to upgrade and renovate their Operation Theatres, Wards etc. It addition, the scheme is proving beneficial in purchase of ambulances and medical equipment, purchase of generators in several CHC/PHC or even minor costs of purchasing medicines in case of shortfall. Because of the efforts in upgrading health facilities, they have been able to perform tests etc. at their own health
Alexander Laloo Hek Minister for Health & Family Welfare Department Government of Meghalaya
facility. There is no need to send a patient to a higher center.
Q
How has MHI proved to be a milestone in enhancing and enriching healthcare experience to people at large? In 2011-12, existing Central Government Health Insurance Programmes inadequately covered only a section of population belonging to marginalised categories (BPL) with
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ENROLMENT No. of households registered/ enrolled
MHIS I
MHIS II
MHIS III
MHIS IV (on-going)
1,99,815
3,46,548
4,36,788
4,09,752
Utilization
MHIS I
MHIS II
MHIS III
MHIS IV (on-going)
No. of Claims
41,894
79,041
1,51,941
79,327
16 Cr
53 Cr
99 Cr
57.88 Cr
CLAIMS
Amount Claimed
to converge the two schemes. Since 2019, the State Government is implementing MHIS IV in integration with AB-PMJAY.
Q
How has the partnership with private sector through a PPP mode helped to accelerate the process of developing universal health insurance in Meghalaya? In order to address the Sustainable
MHIS ENABLED CONVERSION OF LATENT DEMAND FOR HEALTHCARE INTO ACTUAL DEMAND FOR SERVICES BACKED BY BUYING POWER; TO ADDRESS THE GLOBAL ISSUE OF PEOPLE FALLING INTO POVERTY DUE TO CATASTROPHIC HEALTH EXPENDITURES
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SPECIAL INTERVIEW
a coverage limited to only secondary care or selective high cost critical care treatments. When the erstwhile Rashtriya Swasthiya Bima Yojana was implemented, only a section of Meghalaya’s population was being covered; leaving the remaining majority, most of whom are poor or just marginally non-BPL, without any financial security against catastrophic health expenditures which make it extremely challenging for the mass majority to have access to quality healthcare. The Government of Meghalaya, therefore, designed and implemented an innovative Universal Health Insurance where the State Government could partner with a private/ public insurer to share operational and financial responsibilities for contracting a network of public and private hospitals to provide technology enabled, equitable access to healthcare for Meghalaya’s three million plus people. The programme enabled the conversion of latent demand for healthcare into actual demand for services backed by buying power; to address the global issue of people falling into poverty due to catastrophic health expenditures. The objective of the scheme was to bring affordable and equitable healthcare within the reach of every resident in the state of Meghalaya. Started in 2012, MHIS built on the then existing Rashtriya Swasthya Bima Yojana (RSBY) framework to provide health insurance to all, the residents of the State, including existing categories of RSBY beneficiaries but excluding state and central government employees. Since 2012, there have been three phases of implementation of MHIS in convergence with RSBY. However, with the launch and introduction of the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (ABPMJAY), the state took the initiative
Development Goal No. 3, which includes Goal 3.8--that is “to achieve universal health coverage, including financial risk protection, access to quality essential healthcare services, and access to safe, effective, quality and affordable essential medicines and vaccines for all”; it becomes all the more important for Meghalaya to look at PPP models of implementation. For a truly Universal Health Insurance Scheme several factors have to be taken into account including– a. Extending the scheme to all citizens of Meghalaya b. Expanding coverage including tertiary care, OPD diagnostic and selective OPD care apart from secondary care. c. Availability of facilities to provide the services to all beneficiaries. Megha Health Insurance Scheme (MHIS), enables the state government to partner with an insurer (PPP mode) to share operational and financial responsibilities and make available a network of public and private hospitals across India to address the state’s healthcare needs. The PPP model has also bestowed beneficiary the power to choose where he would like to be treated, whilst also addressing Meghalaya’s scenario where a handful of private healthcare providers are able to address the tertiary care needs and a network of public health facilities across the state can address the OP care and secondary care needs.
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SPOTLIGHT - HSCC
Integration of Technology & Energy Efficiency HSCC Way of Building Hospitals
“Implementation of e-Health has been one of our major focus areas in recent past as we are aiming for a lot of vertical growth in coming years. We are currently in the process of implementing e-Health services for Republic of Mauritius and Surat Municipal Corporation,” says Gyanesh Pandey, Managing Director, HSCC (India) Ltd., in conversation with Souvik Goswami of Elets News Network (ENN).
Q
How is HSCC (India) Ltd performing after merger with NBCC? Let me clarify that HSCC (India) Ltd has not been merged with NBCC rather it has been made a subsidiary of NBCC. It is working as a separate company, thus maintaining its core area of operation i.e. health sector. As you are aware that the Strategic Disinvestment of similarly placed CPSU’s has been conceived to ensure the strategic guidance of the companies in identical field of operations to expand reach and scale up operations quicker, gain large number of new clients right away, and to provide a broader geographic footprint to operate. All these factors ultimately add
up to achieve growth goals faster. Despite initial coordination glitches related to finance & accounting standards and business model synergy, the transition has been smooth till now. HSCC has been able to overcome odds to maintain steady growth. We have been able to expand our reach by adding new clients. HSCC has achieved highest ever turnover of over Rs. 2000 cr. in the financial year 2018-19. We are also looking towards our parent company NBCC to scale up health sector business, filling up of business gaps to achieve higher growth in years to come. To sumup, our performance has been fairly steady till now despite harsh business environment, stiff competition and
Chandrapur Government Medical College, Maharashtra
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DECEMBER 2019
Gyanesh Pandey Managing Director, HSCC (India) Ltd
pressure on margins.
Q
How can new age technology be leveraged in effective manner when it comes to building hospitals? Technology adoption and modernisation is a major area where large number of public sector enterprises are lacking & thus losing their market position. Contrary to this, HSCC since its inception has always strived to introduce new age technologies for better patientdoctor- nurse & technician interface. Presently, by introduction of newer technologies, we are looking forward to integrate various healthcare delivery platforms such as primary healthcare
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SPOTLIGHT - HSCC
AIIMS, Rajkot
facilities, general hospitals, tertiary hospitals, drug ware houses & medical teaching facilities with sole aim to enhance operational efficiencies, better patient care and plugging pilferages and wastages. Energy efficient green hospitals are in the core of our design philosophy. We are designing and delivering paperless hospitals by introduction of latest IT tools. This transition has its own share of challenges as well as resistance. The main challenge in introduction of new age technologies
is its acceptability, adoptability and invariable usage by stakeholders. To mitigate this challenge, HSCC has developed detailed training modules to introduce various stakeholders to newer technologies. We at HSCC not only construct technologically advanced hospitals but also conduct training to range of hospital professionals in hospital IT, specialised hospital services like CSSD, fully Integrated modular OT’s, Medical Gases Manifold System, state of art kitchen & laundry equipments,
Q
Shed some light on major projects undertaken by HSCC in recent past? In recent past, HSCC has completed a number of healthcare & research facilities in different parts of the country in time bound manner. These are National Cancer Institute (NCI) for AIIMS New Delhi at Jhajjar, Super Speciality & Emergency Blocks for Safdarjung Hospital (doubling the existing bed strength of the hospital), Kalpana Chawala Government Medical College at Karnal for the Haryana Government, State-of–theart GMP compliant animal vaccine manufacturing facility at Pune for the Government of Maharashtra, National
Cancer hospital, Mauritius
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pneumatic tube system, medical Equipments, modern electrical & HVAC systems, advanced fire alarm & fire fighting systems, hospital cleaning & hygiene etc. Implementation of e-Health has been one of our major focus areas in recent past as we are aiming for a lot of vertical growth in coming years. We are currently in the process of implementing e-Health services for Republic of Mauritius and Surat Municipal Corporation.
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SPOTLIGHT - HSCC
Eye Hospital, Mauritius
Institute of Animal Bio-Technology at Hyderabad, Super Speciality Hospitals (at 19 locations) spread all across country under PMSSY, Super Speciality Hospital for IIT Khargpur, Power Grid Vishram Sadan at AIIMS, New Delhi under CSR funding etc. Lately we have also started construction of Chandrapur Government Medical College for Government of Maharashtra and Neuro-Science Centre for PGI Chandigarh. AIIMS Manglagiri, AIIMS Kalyani, AIIMS Nagpur & AIIMS Raebareli, are at the advanced stage of construction. Recently awarded AIIMS Rajkot is another prestigious project for which we are working in time bound manner.
Q
What are the land mark projects executed by HSCC outside India? Besides above, HSCC has also designed, constructed & delivered overseas project ‘New ENT Hospital’ for Republic of Mauritius. This 110-bedded paperless world class hospital has been completed in a very tight schedule of 15 months including supply and installation of ultra modern medical equipments. Mauritius is an important client and we have been entrusted responsibility to revamp whole healthcare infrastructure. Construction of ‘New
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Cancer Hospital’ is also at the advance stage of completion.
Q
You are now the longest serving head of PSU. What is your vision for HSCC? Indian health sector, which was of US$73.92 billion in 2011, is growing at a tremendous pace owing to its strengthening coverage, services, and increasing expenditure both by public and private players. It is expected to grow at a compound annual growth rate of 16 percent to US$280 billion by 2020, throwing open a host of opportunities for HSCC. The future plans essentially relate to effectively utilising company’s resources – inherent strengths and its core competencies – by adopting a multipronged approach including: • Acquiring competencies in public health and management consultancy, and enhance delivery capacity in traditional areas of its business. • Health facility management through PPP modelling. • Training of Healthcare manpower particularly paramedics, nurses & doctors and introduction of newer technologies through collaborations. • Leveraging core competencies in other infrastructure projects as well.
HSCC HAS DEVELOPED DETAILED TRAINING MODULES TO INTRODUCE VARIOUS STAKEHOLDERS TO NEWER TECHNOLOGIES. WE AT HSCC NOT ONLY CONSTRUCT TECHNOLOGICALLY ADVANCED HOSPITALS BUT ALSO CONDUCT TRAINING TO RANGE OF HOSPITAL PROFESSIONALS IN MANY AREAS LINKED WITH PATIENT CARE INCLUDING HOSPITAL IT, SPECIALISED HOSPITAL SERVICES LIKE CSSD.
• Increasing geographical spread and visibility across the country; and also explore new markets abroad such as Africa & far East. • Diversifying company operations into building engineering & maintenance services of the buildings designed & engineered by HSCC; development of information technology; undertaking turnkey consultancy for high-end & mid-end modular operation theatres, Medical Gas Manifold System and Oxygen Concentrator System, CSSD, laundry, kitchen from concept to commissioning; In doing so, the HSCC expects to maintain a high-growth path, attained over the last 7-8 years, and becomes a Rs. 5000 cr company in next 2-3 years.
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LEADER’S PERSPECTIVE
Gazing into the Crystal Ball—The Next Decade for Healthcare T he changes in Indian healthcare over the last three decades have been substantial; in the 80’s there was an establishment of corporate hospitals, the bigger the better kind of concept was very strongly there. Soon, it was realised, that while private healthcare of this kind enables urban healthcare and healthcare for those who can afford, it does not satisfy the requirements of the large Indian population in the rural & semi-urban setting as they cannot afford it. In the more recent times, the government is looking at ways to ensure health of the masses, not just by their own initiative but by a joint effort between the government and the private healthcare players. Therefore in my opinion, the next decade will be ruled by partnership
between various stakeholders. The establishment of a low cost, high efficiency, large volume model which enables the government and the private healthcare players to establish healthcare institutes of substantial capability to meet the healthcare needs of the masses, is needed. This is not an easy undertaking and the experience of various other countries clearly shows that the insurance-based healthcare projects have always fraught the danger of a highly demanding financial impact which may dent the economy. The initiative of the Prime Minister is laudable but I think there will have to be several versions before it matures to see the light of day. This ambitious project which is perhaps the biggest project in the world is
Dr Nandakumar Jairam CEO, Chairman, and Group Medical Director, Columbia Asia Hospitals
there to stay but the manner in which it is guided is extremely important. LET ME STATE SOME CLEAR AREAS: 1. It is important to note that it is impossible for private healthcare players to provide care below their own cost. While cost can be curtailed, there is a certain point at which further cutting of costs impinges on the quality of care and hence detrimental to the very product of insurance that the government is so keen on establishing. Therefore, a suitable solution which enables a win-win situation between the government, the private healthcare player and the insurance is the need of the hour.
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DECEMBER 2019
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nursing schools. There is also a need for us to shift from an Illness to Wellness. The government has thought about it but many private healthcare players have not looked at wellness as a concept to reduce the burden of tertiary healthcare. To many, this may not be priority but it is important that the government looks at more plans to ensure that even the private healthcare players invest substantially in the wellness of the population because if one understands the disease burden prevalent today, it is based upon non-communicable diseases. This is expensive in its treatment and fraught with various other complications that are financially very impactful. Therefore if the government pushes for wellness and preventive health, then these complications will reduce in number. Simultaneously, the cost of care will also reduce which in turn will be better for the society. There is one clear point to be noted, that is the need for wellness or treatment programmes to be evidence based. While the government is very strong on evidence-based and the need for it, I don’t believe it has percolated to the private healthcare players or private medical
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LEADER’S PERSPECTIVE
2. The clear requirement for the stakeholders of healthcare to work together, i.e. the medical device manufacturers who have substantial interest in growing their business in India should invest into healthcare along with healthcare providers so that there is a lower investment burden on each player involved in this entire process. This will enable a greater confidence in private healthcare to invest in rural and semi-urban India. 3. Monitoring, accountability and quality of care that is extremely important in this entire scenario. While the government has taken very strong and laudable steps in this regard, it is the implementation part that is most important. While we talk about all these issues, it is also fair to state there is a widening skill gap which the government is addressing by starting newer medical & nursing colleges. However, it is important that while the quantity of people may improve, there has not been enough emphasis on quality of people who are being produced, which is vital for the sustenance of healthcare. The issue needs immediate attention and should be addressed simultaneously while improving the medical and
THE ESTABLISHMENT OF A LOW COST, HIGH EFFICIENCY, LARGE VOLUME MODEL WHICH ENABLES THE GOVERNMENT AND THE PRIVATE HEALTHCARE PLAYERS TO ESTABLISH HEALTHCARE INSTITUTES OF SUBSTANTIAL CAPABILITY TO MEET THE HEALTHCARE NEEDS OF THE MASSES, IS NEEDED
practitioners which is indeed counter-productive to the very fact of preventive care. These are some random thoughts of someone who has been in the area of healthcare for more than four decades, while as I stated, gazing into the crystal ball can only give you thoughts, what is reality will unfold as we look-in and walk the next years into healthcare. I am confident that with the intelligence and the capability that is available in India, healthcare will move forward and become as strong as is required. Not only to provide care but also to be an economic driver and an employment opportunity to many people. As a born optimist, I am sure that whatever is mentioned above will be addressed and we will see a HEALTHIER, HAPPIER and a BETTER COUNTRY with our people being looked after well, by both government and private healthcare. The writer is Dr. Nandakumar Jairam, CEO, Chairman, and Group Medical Director, Columbia Asia Hospitals.
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DECEMBER 2019
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LEADER’S PERSPECTIVE
Medall — Catering Patients with Quality & Affordable Diagnostics Services With an objective to cater people with better diagnostic facilities, Medall has carved niche in preventive care space. Its mission is to provide top quality diagnostic services in cost-efficient manner so that people of all strata can easily afford the facility to insulate themselves from emerging NCDs and lifestyle diseases, says Raju Venkatraman, Chairman-cum-Non Executive Director, Medall Healthcare, in conversation with Gopi Krishna Arora & Mukul Kumar Mishra of Elets News Network (ENN).
Q
Medall has emerged as one of the biggest brands in diagnostic field today and is known for delivering excellent services to people at large. Tell us about its journey and mission? Our mission is to bring affordable, high quality diagnostics to underserved area and make it available at the doorstep. Last year, we touched over one crore customers in urban and rural areas. We innovate and also bring proven technology and tests with turnaround time of 4 to 8
hours. We have expanded our test offerings which include molecular biology, infectious diseases and the journey continues to make diagnostic services accessible and affordable.
Q
Precision and accuracy are two important hallmarks which define quality of services of any diagnostic company…How do you read the statement in context of others in diagnostic field? With over 1 lakh labs in the country, quality is a major concern of the Raju Venkatraman Chairman-cum-Non Executive Director, Medall Healthcare
industry. Customers are not aware of the quality testing done by organised players like us. It is a serious issue and there are no easy solutions to regulate quality. 70% of the treatment in this country is dependent on diagnostic reports. It is difficult for our customers to differentiate players and pretenders. This issue has been raised at the highest level of Government and we all have to find a solution as an industry body.
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DECEMBER 2019
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Q
Tell us something about SASH… how does it help one to keep update about health of vital organs? Stay Aware Stay Healthy (SASH) is a great health screening product. It is designed to give health score of major systems in our body and an overall health score. It is priced at Rs.640/- and provides metabolic age, liver score, kidney score, heart score, thyroid score and overall health score by measuring vital parameters like BP, BMI, resting metabolism and series of blood function tests. We are finding several young people with early indicators of liver, kidney and older people with arthritis and thyroid related complications. The tests are carefully chosen by leading consultants. The reports are very unique and available in multiple languages like Tamil, Hindi, Kannada, Telugu, and English. Major impressions and lifestyle modification recommendations are given so that patient can improve their overall health score. We also have a mobile app for people to watch their health trends over years. Communities and companies can call our help desk and we can arrange camps in their preferred sites. Healthy India cannot be the responsibility of the Government alone and we all must become proactive and learn to
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LEADER’S PERSPECTIVE
Q
The company provides facility of different packages plan like ‘Master Health package’ and Senior Citizens package’. Elaborate a little about the same. Medall, with its unique integrated diagnostics capabilities, offers Silver, Gold and Platinum packages to all age groups. Prevention implies early detection of diseases and many abnormalities can be cured with lifestyle changes, diet and exercise or some medication. With prevalent NCD challenges in our population, it is important for people to avail these health checks. Heart, liver, kidneys are among the organs that are getting affected. It is important, that awareness of preventive health check is being promoted by the government and companies. Our Medall Health Monitor and Privilege package for 2 people in the family is well received by the customers. 80 percent of the customers have repeated the health check as this is very easy and affordable. This includes X-ray, USG, mammo (for women), and battery of blood and urine tests. We have saved several hundred lives by early detection. With our life expectancy going up, it is important to have good quality of life. These packages help in monitoring all the vital organs.
WITH PREVALENT NCD CHALLENGES IN OUR POPULATION, IT IS IMPORTANT FOR PEOPLE TO AVAIL THESE HEALTH CHECKS. IT IS IMPORTANT, THAT AWARENESS OF PREVENTIVE HEALTH CHECK IS BEING PROMOTED BY THE GOVERNMENT AND COMPANIES.
manage our health like we manage our finances.
Q
You are already working with many State Governments including Andhra Pradesh and Jharkahnd to do value addition in the diagnostic field...is there any collaboration plan with other States? We have made a significant impact with our PPP projects in AP and Jharkhand. We are evaluating many states as the opportunity arises.
Q
As a diagnostic company, Medall rules in South Indian market…what is your expansion plan to explore North Indian markets? We have a lot of work to be done in reaching the 250 million people in the states we serve. We are looking to partner with entrepreneurs and collaborate with existing labs in the northern states.
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TECHNOLOGY PERSPECTIVE
Access Health Digital’s Social Entrepreneurship Accelerator
A
CCESS Health International is an international think tank and advisory group with eight offices across the globe. The organisation’s focus areas include healthcare delivery, healthcare performance, healthcare quality, health finance, health policy, research; health insurance, states, capacity building and ACCESS Health Digital (for Universal Health Coverage). ACCESS Health Digital works as a strategist arm for all digital health initiatives of ACCESS Health International in India. ACCESS Health Digital has been working closely with public and private partners over the past year, to support the creation of a harmonised roadmap for a comprehensive and integrated Digital Health platform for India. The team has conducted extensive research on ways, the Indian health system can leverage technological advancements and transform into a digitally driven healthcare system. AN OPPORTUNE TIME TO BEGIN With recently released National Digital Health Blueprint (NDHB) by the Ministry of Health and Family Welfare (MoHFW), a clear roadmap is being established to implement a common platform to not only integrate existing applications in the
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health domain but also consolidate the data which has existed in silos, either in public or private healthcare facilities, in India. In order to enable healthcare industry to converge and transition smoothly from non-standard healthcare industry to a standardised, open yet secure Industry; ACCESS Health Digital has launched the Social Entrepreneurship Accelerator (SEA) programme. THE ACCELERATOR AIMS TO: • Drive a federated, technology model that can provide required freedom of choice across different stakeholders yet ensures common standards across the country. • Accelerate adoption of the national digital health blueprint [NDHB] standards and other Government of India notified digital health standards including metadata and data standards [MDDS], systematised nomenclature of medicine
[SNOMED], electronic health records [EHR], fast health interoperability resources [FHIR]. HOW SEA PROGRAM WILL HELP NDHB ADOPTION Access Health Digital has defined “Minimum Viable Product Definitions (MVPs)” namely the eObjects and Microservices. These MVPs are white labelled product definitions that bundle all the NDHB recommended standards in their design specifications. These MVPs are designed by considering deep domain specific knowledge of healthcare applications and processes. These MVPs have been given to the startups and product vendors / participants willing to comply with NDHB standards and become the torch bearers and join the SEA programme. The SEA aims to serve as the seed crystal to help start the crystallization process in the market. This SEA programme will enable evolution
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BUSINESS NEED AND OBJECTIVE OF SEA PROGRAMME: ACCESS Health Digital first wrote the concept of the eObjects in the book ‘Health Systems for New India’ published by NITI Aayog. The same eObject concept was detailed out for National Health Agency (NHA) over the last one year. The eObjects now form the heart of the PMJAY 2.0. The Government is promising a faster turnaround time in payments if the claims are submitted in the standard eObjects format. This is the financial lever that will change the game in the healthcare market. Now it is in the interest of the providers to change their HDIS and send the claims in standard eObjects format. Obviously, this creates an opportunity for the digital startups and existing HIS vendors to build eObjects into their products. ACCESS Health Digital further created HDIS MVP (Minimum Viable Product) based on Microservices Architecture to fulfil the eObjects need. This is a clear breakthrough innovation coming out of its own independent research. The
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digital startups and HIS vendors can now comply to the eObjects needs by building the Microservices into their information model or by creating a bolt-on layer on their existing system. THE OBJECTIVES OF THE SEA PROGRAM ARE FOUR-FOLD: • Minimum Viable Product Definitions (MVP) for various care delivery settings across primary, secondary, tertiary and health insurance segments • Stamp of Confidence, ACCESS Health Digital (AHD), SEA will put its stamp on the products that adopt the MVPs. SEA will strongly position the early adopters in its network as NDHB Standards compliant products. • Mentorship to provide technical and functional mentorship for implementation of the Minimal Viable Products (MVPs) into the partner products and help build the micro services and Application Programming Interface (APIs) together with the product teams of the (SEA) community. • Market Access, AHD, SEA will act as a catalyst for providing market access in terms of positioning the products for relevant request for proposals (RFPs), tenders, new projects and business partnerships. Thus, AHD is building an accelerator: a sandbox for innovation and to accelerate adoption of NDHB standards: START-UP BOOTCAMP FOR SEA COMMUNITY ~ BECOMING A REALITY The SEA Community has initiated the accelerator programme for all the product vendors who have already signed up. The SEA member community comprises revenue stage, private digital healthcare tech startups, hospital information
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ACCESS HEALTH DIGITAL WILL WORK WITH NATIONAL RESOURCE CENTRE FOR EHR STANDARDS [NRCES CDAC PUNE] AND SOFTWARE TESTING AND QUALITY COUNCIL [STQC] TO HELP THE SEA MEMBERS FOR THEIR NDHB COMPLIANCE AND CERTIFICATION.
TECHNOLOGY PERSPECTIVE
of an open source community and will create a support group that will help each other implement the MVP definitions. Access Health Digital will mentor and create the first cohort of NDHB adopted products by extending domain specific and technical support to this open source community. ACCESS Health Digital will work with National Resource Centre for EHR Standards [NRCeS CDAC Pune] and software testing and quality council [STQC] to help the SEA members for their NDHB compliance and certification. Wherein NRCeS is the single point of contact for assistance in developing, implementing and using EHR standards in India, and STQC is the software testing and quality council in the country.
systems vendors and Government managed healthcare delivery information systems. NRCeS is the knowledge and resource partner to SEA community. The uniqueness of the SEA programme is that both the public and private healthcare stakeholders have come together to kickstart the adoption of NDHB standards in their respective healthcare delivery information systems [HDIS] products. The members of the cohort are torchbearers of the very first open source community that is emerging in front of them. WAY FORWARD: Over the next six months, the Accelerator will have 15-20 digital startups and a few HIS vendors compliant to NDHB standards and ready to send the clinical, encounter, discharge summary and billing data in standard eObjects format for provider-to-provider and providerto-payer communications. A new Digital Health Ecosystem is on the anvil! Welcome to the Future.
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LEADER’S PERSPECTIVE
Healthcare Technology 2025: The Great Healthcare Disruption H ealthcare technology in India and APAC, as in worldwide, is reaching an inflection point where it is poised to disrupt an industry that has stubbornly avoided getting disrupted. As old industries like retailing, books, music and television have been disrupted, the healthcare industry is facing its moment where technology driven disruption is at its doors. Surprisingly, this time the disruption might not start in North America! It might happen right here in Mumbai and Hyderabad! DISRUPTION Many industries that were disrupted by technology continued to think that they could not be disrupted. Even technology products like the early smartphone (BlackBerry etc) thought they were on top of their game and failed to see trends already visible in their industries (like touch interface and apps) that were ultimately going to disrupt them. Most disruptions do not happen overnight; they show enough presence and trends that are not picked up by the incumbents. Countries like India are ripe candidates for disruption due to three main reasons: 1) An educated and technology aware critical population mass. 2) Economic imperative to shortcut and leapfrog the incremental growth process, and 3) A reasonably well developed non risk averse entrepreneurial ecosystem.
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I present two proofs of the above: 1) Bharati AirTel investing $ 1 billion on a mobile billing and CRM system, when the industry was still looking at cordless phone options, and 2) The explosion in app delivered food retail. Healthcare has defied disruption forces for the simple reason that the key stakeholders (the doctors) are uniquely averse to change. As part of their professional training they are taught to take all new things with a huge pinch of salt, as it might hurt their patients. The status quo is the norm for them. They’re following age old Aristotlean wisdom that change in the way you treat patients, unless well proven through collaborative studies that last SEVERAL DECADES, can hurt the patients. That’s the reason today you can book a lovely mattress on an app and get it delivered at home, whereas to see a physician you need to stand in a physical queue to pay the consultation charges! Yet, three things are happening that will very soon force the doctors’ hands into changing the way healthcare is delivered: 1. The economic imperative – as healthcare becomes private it becomes loss averse and keeps looking for innovative ways to reduce costs through whatever means. A big cost on society is hospital infections and treatment side effects. Are we willing to wait for decades before the next
Dr Aloke Mullick Group CEO, OMNI Hospitals
incremental gains come or we use big data analytics to get actionable pointers in a few years? 2. The increasing movement towards fixed price payments by all payers, including those paying out of pocket. This ensures that the costs mentioned earlier are all borne by the hospitals, and 3) Patients are increasingly getting frustrated by the paper-based eco system of hospitals. They struggle to get their own data, struggle to stand in a queue, or talk over phones to book appointments, struggle to get prescriptions dispensed in a pharmacy queue etc. The list is endless, and typically VERY IRRITATING for a populace which has got used to click based consumption of services. We will now look at a few
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technology trends, some of which are decades old and available, which are very likely to disrupt the healthcare delivery space over the coming decade in India and Asia. EMR/EHR AND BIG DATA Without getting into the semantics of how they are different (I will call both as EMRs), this is an industry whose time has come. Earlier it was great technology which was however VERY EXPENSIVE. A million dollar (minimum) sticker price was a strict no-no for hospitals struggling to nudge their EBITDA into two digits. Besides, the desktop based Chronic Disease Management with Connected Devices Let’s look at some data: 1. 65% of APAC ageing population has at least two chronic diseases (Frost & Sullivan) 2. India, Indonesia and Vietnam contribute 10% of world’s ageing population, 65 years and above. (Frost & Sullivan) 3. Worldwide 500 million monitoring devices are in use currently. (Frost & Sullivan) 4. 2.5 quintillion bytes of healthcare data is created every day (IBM) 5. Global IP traffic is 1.2 ZB per year with increasing smartphone contribution (CISCO) 6. There are more than 85,000 health and fitness app developers. (Frost & Sullivan) 7. There are nearly 40 million smartphone healthcare apps in use. (Frost & Sullivan) 8. Global revenue from healthcare apps $ 13 billion. (Frost & Sullivan) 9. Connected IOT healthcare monitoring devices by 2020: 20-30 billion. (Frost & Sullivan) 10. Healthcare data is currently doubling every 24 months. (Frost & Sullivan)
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interfaces were depriving the clinician from valuable eye contact time with his patients. Luckily Indian tech entrepreneurs have a fix now: a mobile based EMR, as powerful as the desktop based one, infinitely more usable by the doctors (its another app among the 100s that he/she already has on her phone) AND available on a very reasonable subscription fee. These EMRs will also have virtual ICU and patient portal functions enabling the doctor to view critical patient data remotely (and give treatment orders) and the patient to book his visit remotely, and even conduct a doctor’s consultation, remotely via video conference, and pay for ordered lab (with home sample collection) and ordered medications (with home delivery). Suddenly, the million dollar costs have evaporated and the EMR has become affordable, usable, and converting the hospital/doctor interface closer to Amazon’s retailing experience. Through the patient
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portal, the patient carries on his smartphone his ICD coded clinical problem list, diagnostic results, images, medication lists, allergies, and past discharge summaries. His whole healthcare experience gets simplified, and the smartphone becomes the centre of his healthcare experience, like in retail. I see a huge spurt in adoption even by mid-tier hospitals and a spurt in providers of such technology. As adoption increases, over a few years Indian patient algorithms will be able to guide us into newer treatment paradigms and shorten the treatment evolution cycle from few decades to few years. I rest my case. This will begin re-imagining the chronic diseases management industry as soon as some business savvy investor releases hardware in India at Indian price points with huge volumes.
The writer is Dr Aloke Mullick, Group CEO, OMNI Hospitals.
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LEADER’S PERSPECTIVE 32
Digitalised Primary Healthcare — A Panacea for Healthy & Happy India
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ndia is a land of deep inequalities. On the one hand we are sending probes to Mars with the latest cutting edge technology, on the other, we are struggling to provide a reliable public transport system to our teeming urban swathes. On the one hand, we have condominiums, villas and gated communities, and on the other we have sprawling urban slums. DIGITISATION A KEY TO BOLSTER CARE On the one hand we have arguably the best technology minds in the world, on the other, we are struggling to make digitisation an integral part of our healthcare scenario. As we stress on globalisation and privatisation, a quarter of our population is slipping through all safety nets, to land in debt and the resultant poverty. Almost 60 million people slip below the poverty line every year due to affordable healthcare costs. We have more than a quarter of a billion people living under the burden of diseases which costs USD 30 Billion, or 5 percent of its GDP. About 60% of our total healthcare expenses are out of pocket, which is one of the highest in the world. Such is the lack of trust in the public health system that not only do 80% of the wealthy seek treatment in the private sector, but a similar percentage of the poor also goes to private practitioners, even though the treatment may be of low quality and provided by untrained practitioners.
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Dr Shuchin Bajaj Founder Director, Ujala Cygnus Hospitals
SOME UNFORTUNATE STATISTICS REFLECTING THE STATE OF AFFAIRS: • One quarter of hospitalised Indians slip below the poverty line because of hospital expenses alone. • Hospitalised Indians spend more than half of their annual expenditures on healthcare. • More than 40% of those hospitalised borrow money or sell assets to cover expenses. • The poorest 20% Indians have more than twice the rate of mortality, malnutrition and fertility of the richest 20%. India’s 2024 vision of reaching a USD 5 trillion economy can be achieved only if we are a Happy and Healthy Nation, i.e we put all our focus on mental, social and physical well-being of our citizens. Cygnus Hospitals, as an organisation, is
committed to change the paradigm of healthcare delivery from a fee for service sick care model to a managed healthcare delivery model where everyone is able to get access to the highest quality of healthcare services, irrespective of their financial or social status. To address this gap in our healthcare delivery, the perception would be to first take care of the affordability, and thus the budgetary provision of the National Health Plan providing Rs 5 lakh insurance cover to 50 crore Indians seems the panacea that we have all been waiting for. But is it really the answer? PRIMARY HEALTH SYSTEM SHOULD BE FOCUS AREA Rather than spending the little money that is available for the health budget on insurance schemes that benefit only corporate hospitals, it would be more prudent to spend the same amount of money on improving our crumbling primary health system? Has digitalisation made this onerous task, which earlier involved trying to send reluctant doctors into far flung villages, easier? We are spending a little over 1% of our GDP on healthcare. Regardless of the growth numbers presented by the various agencies to us, be it 6% or 8% or 9%, the health budget more or less remains the same. We have left the core areas of our development, i.e. health and education, at the mercy of the easily corruptible and frequently
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EXEMPLARY MODELS ACROSS THE GLOBE Countries like Thailand, Brazil, Sri lanka, Turkey etc., which were way behind us at the time of Independence, have surged ahead of us in all outcomes and indices, by their focus on primary healthcare in their initial years of development. Why have we not been able to do it? Have we been spending the wrong way? Have we forgotten that the foundation for development are not airports, flyovers or roads, but Health and Education, which all governments have been neglecting completely. We have also forgotten that poverty has a multi-dimensional impact, related to sanitation (including access to clean drinking water), nutrition and housing. Lack of these will continue to create an unsustainable disease burden for the community. An unhealthy community, suffering from diarrhea and malnutrition, cannot lead to a fast-growing healthy economy. INCLUSIVE HEALTHCARE NEEDED Our contribution to inclusive healthcare development agenda and commitment to ‘universal healthcare for all’ mission, have to be an integral part of our service delivery within the entire healthcare ecosystem, by ensuring free medicines and discounts on pharmacy, consultancies and surgeries to the economically weaker population of the society. We also have to mobilise the larger community on various facets of health awareness through health/medical camps for rural outreach on issues such as diabetes, joint replacements, emergency medical first-aids, maternity, cardiology, preventive care etc. leading to socio-economic justice and poverty alleviation.Our limited amount of money has to be invested intelligently in a way that we get maximum returns. Primary Healthcare, which
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focusses on preventing people from getting sick, is the only way out of the morass that we are in. Every time we set up a Cardiac Cath Lab in a small town, I always ask this question from the people who are at the inauguration. “Would you want to have a heart attack and be treated really well at our centre, or would you rather not have a heart attack at all?” Unsurprisingly, the answer is always the same. Nobody wants to have that heart attack. But expectedly, our government machinery refuses to see this. We have a large scheme offering free dialysis to many communities, but we forget that more than three quarters of kidney failures are caused by uncontrolled diabetes and hypertension, which can easily be treated at the primary health centre level, if we have the will to do it. DOCTOR CENTRIC CARE MODEL SHOULD BE REPLACED WITH PATIENT CENTRIC ONE We can look at the example of the National Health Scheme (NHS) of the UK, where more than 85% of diabetics, hypertensives and COPD patients are treated at the primary care level. This figure was less than 15% in the early 1980s. The progress made by the NHS is largely due to their focus on primary healthcare and empowerment of General Practitioners and Nurse Practitioners. So, what is stopping us from treating people at the village level? Infrastructure is one of the major reasons. It is very difficult to attract doctors to work in villages when more than 25% of our PHCs don’t even have electricity and water connections. In the absence of overall urbanisation, lack of schools and recreation facilities also are a dampener to the relocation plan of doctors to small towns and villages. So how can digitalisation help in this scenario? We have to forget the doctor centric healthcare scenario,
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and focus on the patient centric one, with the doctor available for consultations digitally as per need. UPSKILLING HEALTH PRACTITIONERS TO AUGMENT PRIMARY CARE We should keep in mind that for our 650 thousand villages, we have more than one million ASHA workers. Why can’t we upskill them and give them the support of diagnostic and pharmaceutical decision making through digital means? Digiceuticals is an upcoming field which has the potential to transform healthcare delivery completely. If the ASHA worker can impart nutritional education to school girls, we can prevent a lot of malnourished children, which later, go on to suffer from various disorders like obesity, hypertension and diabetes. Digital platforms can easily help in this endeavour. We should also look at upgrading our nurses into nurse practitioners and involving the Ayurvedic and Homeopathic practitioners in healthcare delivery to underserved communities. Digital platforms can help in upskilling these health practitioners, and move them from the periphery of healthcare delivery to the centre of the action. We have to flip the balance of healthcare from curative, which in fact is sick care, and takes up more than 80% of the total health expenditure of the country, to preventive healthcare, which currently uses only 9% of the total health expenditure. Sustainable Development Goals lay a lot of emphasis on health, but the sheer size and scale of our country means that the success of global goals to a large extent depends on the progress made by India.
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incompetent, private sector.
Writer is Dr Shuchin Bajaj, Founder Director, Ujala Cygnus Hospitals.
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INDUSTRY PERSPECTIVE
Affordable Healthcare in India: Financial Challenges and Strategies
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ndia’s healthcare sector is defined by striking contrasts: while it offers hospitals and universities which are shining examples of progress and are globally-lauded for their innovative contributions, citizens in rural and low-income areas are woefully underserved when it comes to accessing affordable quality healthcare. The complexity of India’s financial challenges in the healthcare sector are compounded by the nation’s federalist approach to healthcare policies, practices, and funding wherein individual states maintain control over their state’s healthcare spending and resource allocation. While there is the potential within this model to empower states to make the health of their citizens a priority, bureaucracy and an unwillingness to collaborate has resulted in a national healthcare system which is inconsistent and unreliable. We cannot delay addressing this substantial deficit by developing a national public healthcare infrastructure that will ensure the successful delivery of quality care to all citizens. NCDS A BIG CHALLENGE Without such a system in place, we will continue to face the social and economic challenges which arise when our poorest and most vulnerable citizens receive little or no healthcare services. India is in the midst of a public health crisis dominated by a rise in non-communicable diseases such as
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cancers and respiratory illness, which are worsened by a lack of diagnostic and treatment options. In addition, and perhaps most damning, the lack of preventative care in India has contributed to infant mortality and under-5 mortality rates, which is unacceptably high. Many patients have been hindered by a lack of insurance while even those with insurance coverage for the private sector have avoided seeking care because of the staggeringly high out-of-pocket expenses associated with hospitalization and treatment. Research conducted by Prinja, Kaur, and Kumar (2012) found that approximately 25% of hospitalized patients were pushed toward the poverty line due to the expenses of their treatment. Patients have few feasible options: the private healthcare system is largely unregulated and often unscrupulous, while the public healthcare system lacks the staff, resources, and infrastructure necessary to provide adequate healthcare services to a large population. While India currently spends approximately 1.3% of its GDP on healthcare, its public spending on healthcare as part of its total expenditures is lower than any other Asian country with the exception of Pakistan. State and central governments combined yearly spending per capita on healthcare is less than 1500 INR approximately, and this severe lack of funding has had serious ramifications for the well-being of India’s populace
Ishiqa Multani President, Sagar Group of Hospitals
and the stability of its healthcare system. UNIVERSAL HEALTH COVERAGE Universal Health Coverage has long been proposed as a solution to many of India’s current problems regarding infrastructure, funding, and access within the healthcare system. Under proposals adopted by the High Level Expert Group on Universal Health Coverage, this approach to healthcare spending would ensure equitable access to healthcare for all Indian citizens and would provide the public health services which are necessary to implement preventative health programmes across the nation. While the government might not be the only provider of healthcare services under a universal coverage plan, state and central government would cover schemes to ensure that no citizen would lack healthcare.
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COLLABORATION BETWEEN THE PRIVATE AND THE PUBLIC SECTOR As such, we are in the unique position to have the wisdom and experience of many healthcare professionals, educators, researchers, and entrepreneurs available to us. Collaborations between the private and public sector could serve as a stepping stone to address the staggering inequities which currently exist within India’s healthcare system. Much in the way that India has innovated to create a thriving medical tourism industry, so too must the nation harness its capacity for innovation to create opportunities for healthcare affordability for all citizens. The private sector has set a remarkable example in its marriage between corporate social responsibility and public health, launching campaigns which address issues such as access to safe drinking
water and maternal/child health. Nevertheless, the burden for developing realistic healthcare strategies cannot be borne by the private sector alone; rather, a collaboration between the private and the public sector may be the best solution to this substantial challenge. HUMAN WORKFORCE Primary among these challenges is a lack of our greatest resource: doctors, nurses, and other healthcare personnel, especially in rural, remote, and low income areas. India currently has a number of excellent universities which are producing knowledgeable and driven healthcare personnel with the potential to be leaders in their field. We must capitalize on the strength of our universities to encourage enrollment in the healthcare industry and to ensure that our graduating students have incentives to remain in India for their careers and to work in areas which are currently underserved. We must ensure the creation of a strong and dedicated national healthcare system which can work in tandem with the states to oversee resource allocation and the implementation of a national public health programme which will address preventative health. Many of the nation’s current challenges related to healthcare could be resolved by prioritizing preventative health and health education in our state and national healthcare programs, and capitalizing
INDIA IS IN THE MIDST OF A PUBLIC HEALTH CRISIS DOMINATED BY A RISE IN NONCOMMUNICABLE DISEASES SUCH AS CANCERS AND RESPIRATORY ILLNESS, WHICH ARE WORSENED BY A LACK OF DIAGNOSTIC AND TREATMENT OPTIONS.
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Under the HLEG proposal, all citizens would be entitled to universal healthcare which would be provided under a national health package offering primary, secondary, and tertiary care. In fact, announcement of Ayushman Bharat, one of the most ambitious health mission’s Universal Health Coverage has achieved. Patient autonomy would be preserved because there would be the option of public sector facilities for services or private providers. India is fortunate to be a leader in healthcare innovation and education.
upon the wide range of knowledge, skills, and experience within the private sector through collaborative initiatives. It is near-impossible to create a sustaining, accessible, and affordable healthcare system without a strong healthcare infrastructure. Leadership is clearly required from our government to create a collaborative system which makes use of India’s ample talent in the healthcare industry to generate innovation and distribute healthcare resources throughout the nation. Our capability to innovate is our greatest strength, but affordable healthcare innovations must not get mired in the bureaucratic morass which alltoo-often hampers positive change initiatives. We must embrace free enterprise and open collaborations between the private and public sector because, in the long-run, the economic, social, and political well-being of India is dependent on a healthy populace. Writer is Ishiqa Multani President, Sagar Group of Hospitals. Views expressed are a personal opinion.
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PPP PERSPECTIVE 36
ZHL--The Fastest Emergency Medical Care Provider in India Z iqitza Health Care Limited (ZHL) has been one of the leading players in India’s Emergency Medical Services industry since 2005. It was set up by a group of young professionals, who recognised the need for an organised and networked ambulance service system in India, to respond effectively to all kinds of medical emergencies. Whether it’s an accident or a major ailment, Ziqitza recognises that the first few minutes are critical in saving a life. Recognising this need, and realising the gap that existed in the Indian market, the founders began the journey to create the best emergency response service in India, at par with the capabilities and operations of 911 in the United States of America, and 999 in the United Kingdom. ZHL regularly partners with state governments and the National Health Mission (NHM), to operate the 108 helpline for medical emergency services for the general public. Over the span of 14 years, the company has grown exponentially, from being a start-up with 10 ambulances, to become a wellestablished corporate entity with a fleet of 3300 ambulances, and almost 10,000 employees across the country. Working to provide emergency services is a passion-driven career path, and needs a team of highly motivated and skilled professionals. Understanding this need in a country as vast as India, and realising the lack of training institutes and centres, ZHL set out to remedy the situation at hand. They have been extremely active on this front,
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by setting up their First Responder Programme and training over 3,33, 204 personnel till date. The healthcare enterprise’s range of services can broadly be categorised into three segments – Public Private Partnership (PPP), Healthcare Solutions to Corporate and Patient Transfer Ambulance Service. PUBLIC PRIVATE PARTNERSHIP: ZHL has partnered with various state governments to provide emergency services through helpline numbers, ambulance services and MMU’s. The 108 helpline number connects people to the emergency ambulance service that is equipped to provide basic life support and advanced life support, along with oxygen cylinders and electrocardiography (ECG) machine along with basic first aid. The 108 Ambulance Service has made primary healthcare accessible to the most interior part of the state and has enabled in increased institutional deliveries and reduced MMR &
IMR. The other helpline numbers 104 that connect users to the service. The 104 helpline number is set up in collaboration with the National Health Mission (NHM) in the state of Odisha. The helpline is intended to provide medical assistance for several minor physiological illnesses, ailments, and mental distresses, along with directory information, details on health schemes, a grievance redressal mechanism, and many more. MMUs are Mobile Medical Units that have helped mobilise healthcare to conduct screenings, basic diagnosis and in some instances provide complex medical treatments closer to people’s homes. Inspite of the difficult terrain, low connectivity, or institutional barriers, medical care can be made available to people across socio-economic groups, with minimum expenditure and relatively lesser operations and management responsibilities, as compared to those required by fully functional hospitals.
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Madhavi Kapoor, Corporate Client, Mumbai “By partnering with Ziqitza HealthCare Ltd., we have been able to entrust them with the responsibility of prompt healthcare provision as they have the experience of operating and managing over 3000 Ambulances in India. The entire team is extremely professional and their knowledge of first aid on site has left us impressed.” – Prem Agarwal, Entrepreneur, Jharkhand “When my wife went into labour, we had called an ambulance and rushed to the hospital in Ranchi. At this time, I was unaware but my wallet had fallen inside the vehicle and on reaching the hospital, we were left helpless. However the staff in the ambulance immediately returned the wallet and we were able to make the necessary payments to the hospital. We are really grateful for the immediate services rendered and appreciate the honesty that the staff displayed.” – Vicky, Madhya Pradesh “I hail from Jaora in Madhya Pradhesh, and when I needed blood for a friend of mine who was critical, we were unable to source it. When I called the 108 helpline, they immediately offered help and sent an ambulance, because of which, we were able to get the required blood and save his life.”
strives to cater to customers through its award-winning ambulance services. These ambulances are used for conducting patient transfers for both emergency and non-emergency scenarios. Our trained staff plays a pivotal role in saving people’s lives by using high-end technology and processes in order to transfer patients to the hospitals efficiently in case of medical emergency, outstation transfers, events or scheduled visits. Transferring patients within the golden hour increases the chance of survival to a great extent and thus, aid is given to hospitals to start treatment, so that no time is lost in managing the process of patient transfer. A legacy of care in EMS 5,00,000 4,50,000
3,00,000
2,00,000
People Served
HEALTHCARE SOLUTIONS TO CORPORATE ZHL also provides services to corporates, which contain a portfolio of curated offerings for them. These include provision of a doctor and an ambulance at the worksite, telehealth partners, outsourcing health centres and conduction of wellness at workplace programmes. With these services, businesses can focus on their core operations while leaving the concerns of employee health and fitness in the hands of ZHL. Through telehealth partners, employees gain
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access to 24/7 expert medical advice for routine consultations, emergencies and second opinions. Access to onsite doctors, nurses and ambulances helps keep accidents at bay and helps employees get medical assistance immediately. This initiative has enabled to reduce healthcare cost of the corporates and has also increased employee loyalty. PATIENT TRANSFER AMBULANCE SERVICE Being India’s fastest provider of Emergency Medical Services, ZHL
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Testimonials of customers who had first-hand experience of our service delivery
No. of Ambulances
No.of Trained Workforce
No. of People Trained Through FRP
OUR STRENGTHS • Trained Crew , Call Centre People • Set Up of Call Centres • Fabricating and Setup of Ambulances • Quality Checks and Controls • Reports and Analysis ACHIEVEMENTS For the many services administered, and the dedication with which ZHL carries out all tasks, the healthcare provider has received many accolades. ZHL has been conferred a number of prestigious awards over the years, some of which include the following: • Express Public Healthcare Awards – 2018 • Health Care Sabha Award For Most Effective PPP – 2017 • Limca Book Of Records For Most FRP Men Trained – 2016 • Cims Health Care Award For Best In EMRS – 2016 • Times Of India (Toi) - Social Impact Award – 2013 • Godfrey Philips Bravery Award – 2007
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‘Technology to Drive Enriched Patient Experience in 2024’
T
he Indian healthcare sector is one of the fastest-growing industries and is expected to advance speedily during 2019 – 2024. Aging and growing population, greater prevalence of chronic as well as lifestyle diseases, exponential advances in innovation, advent of digital technologies, growing health awareness, vital government initiatives and changing attitude towards wellness and preventive healthcare is expected to uplift healthcare services demand in the future. INDIA – THE MEDICAL TOURISM DESTINATION Healthcare in India has undergone huge transformation in last two decades, attaining an advantage over its associates in the West in terms of cost for high-quality medical services offered. The affordable medical services have resulted in a growth in the country’s healthcare tourism, attracting patients worldwide and making India, the new ‘Medical Tourism Destination’. Moreover, the nation has also emerged as a hub for R&D activities for international players due to its relatively low priced drugs, devices, medical equipment, and clinical research. ROLE OF TECHNOLOGY The coming decade is going to witness another revolution in the healthcare across the globe, so as in India due to increasing adoption of
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technologies like Electronic Medical Record (EMR), Business Intelligence (BI), and Artificial Intelligence (AI) that will help the organisations to streamline their operation and improve organisational efficiency making it less dependent on ‘Manpower’. The use of ‘Telemedicine’ and ‘Electronic ICU’ concept has already made an impact for better accessibility of healthcare in remote areas. Healthcare providers are also focusing on the technological face of healthcare delivery in order to standardise the quality of service delivery, control cost and improve patient engagement. Digital-based Health Awareness, Electronically acquired Medical Record, Mobile Healthcare are some of the technologies gaining wide acceptance in this sector. GOVERNMENT INITIATIVES The government aims to develop India as a global healthcare hub by initiating several policies supporting affordable healthcare. An initiative like ‘PPP – Public Private Partnership’ is going to evolve as another service delivery model by the state. As per PPP, the infrastructure in terms of land and building is provided by government - which it has in plenty and mostly lying idle, equipment skilled manpower along with day to day operation offered by the private partners, making it a win-win
Dr Rakesh Gupta Chairman Sarvodaya Hospital Group, Faridabad
situation for all. The scheme is already running successfully in many states & districts, in field of diagnosis imaging, dialysis and much more. The ‘Quality Council of India’ has initiated the standardised healthcare which is a good step for allopathic clinics, small healthcare organisation, eye centers and private & government hospitals. The government of India is promoting concept of ‘Made-inIndia’ which has helped healthcare industry with production of affordable medical equipment at lower cost. PRIVATE HEALTHCARE SECTOR – UPGRADING THE WORLD The private hospitals have a strong presence in India’s healthcare sector. It has emerged as a vibrant force in
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India’s healthcare industry, lending it both national and international repute. Large investments by private sector players are likely to contribute significantly to the development of India’s hospital industry. One important factor contributing to rising medical tourism in India is the population of well-educated, polished, English-speaking medical staff in private hospitals and diagnostic facilities. Other than essential requirements, private healthcare providers are also making efforts to provide luxurious services. For example: pick and drop services for the patient and luxurious arrangements for patient attendees in the hospital improving the overall experience. Indian Healthcare Sector is poised to grow and is expected to rank amongst the top three healthcare markets in terms of accessibility and affordability by 2024 considering these factors. BREAKING THE FLAWS Despite of these bright prospects, India may lag behind because of some obstructions, which must be removed. Government initiative like ‘Prime Minister Health Scheme
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- Ayushman Bharat’ along with other state sponsored schemes like CGHS, ECHS etc. provides good access of healthcare to the masses but probably at the cost of medical fraternity which is already paid low as compared to their counterparts across the globe. Increasing number of medical colleges opened by government, churning out less experienced and low quality doctors initially may make up for the numbers but the deteriorating trend of medical education and the quality of doctors that will be available is a huge concern for senior clinicians in the medical education sectors. Government can and should definitely help in evaluating the price of drugs and medical devices, but the official charges of any medical service should commensurate with the skill and experience of the doctor and the complexity of the procedure. The standardisation of healthcare is much required, although its being tried by other government agencies but it is full of anomalies and absurd rate pattern forbidding the good players to participate in the schemes.
Writer is Dr Rakesh Gupta, Chairman, Sarvodaya Hospital Group, Faridabad.
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LEADER’S PERSPECTIVE 40
Indian Healthcare Sector– Making Giant Leap in Delivery of Care
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ndia is one of the world’s largest democracies and the way it makes a mark on the global map being a powerful and emerging economy, it gives positive insight about the future prospect of the country. Healthcare, being India’s one of the largest sectors both in terms of revenue and employment, has witnessed huge transformation in the last decade. Latest technology and innovative digital tools have led the Indian healthcare delivery system to get evolved in terms of providing enriched healthcare experience to masses especially on front of clinical outcome. With the Government undertaking many measures to bolster patient care and private players playing equally pivotal role, the sector is making giant leap to enable people at large to avail accessible and affordable healthcare. The healthcare sector is projected to become 8.6 trillion by 2022. The unprecedented growth of the healthcare sector is due to a range of factors including spike in noncommunicable diseases, a considerable increase in income of the middle class, more awareness, quest for quality care, and easy access to service providers. Healthcare ecosystem comprise of hospitals, medical devices, clinical trials, outsourcing health insurance, medical tourism and medical equipments. We have well trained medical professionals that are cost competitive as compared to Asian and Western countries. The healthcare sector is expected to grow manifold by the next five
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years. Due to the increased awareness of the consumers about the quality of healthcare, the expectation of the consumers is skyrocketing and they are demanding top class care. There is significant growth in the healthcare system due to increased investment in the health sector. The government also seems to be determined to provide quality health for all. With this objective, the spending is set to be increased to 2.5% of the gross domestic product by 2025. Also, with the insurance sector growing, the population is expected to spend through insurance rather than out of their own pockets. Even though the healthcare sector is growing, there is low accessibility and affordability for most of the population as the insurance coverage is less plus the costs of healthcare are also rising. Some of the biggest factors for limiting healthcare accessibility include-1. We have 7 beds for 10,000 population whereas globally it is 26 beds. 2. There are more medical professionals in the urban area than in the rural areas/villages where a large strata of our population lives with low accessibility to healthcare. 3. The insurance coverage is also very low as compared to other countries leading to increase in out-of-pocket expenditure taking toll on the patients. 4. There is a shift in disease pattern from communicable to noncommunicable diseases like diabetes
Dr Aditi Karad Executive Director, VishwaRaj Hospital
and cardiovascular disorders. The cardiovascular diseases are the highest known cause of the death especially in the younger age group in India. The way technology is making impact, the time has come when just doctor-patient engagement is not enough. With continuous technological growth, the healthcare industry is going to be more based on “Value based care “ outcomes in coming days. New trends as per Vision2024 would be– 1. Healthcare will go mobile. 2. New strategies to deliver low cost healthcare will be on the rise. 3. New drug pricing models will be unveiled. 4. Behavioral healthcare will see more acceptance. The writer is Dr Aditi Karad, Executive Director, VishwaRaj Hospital.
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INDUSTRY PERSPECTIVE 42
‘Medical Devices Need Separate Regulatory Framework’ I ndia imports 80-90% of medical devices of the $15 billion market, the vast majority of which are unregulated for quality and safety. While many of these products may have regulatory certifications in other countries, the reality is that a considerable number of them are being exported from countries that do not regulate their exports. Currently, the medical devices market in India is over $15 billion (Rs 105, 000 crore) and projected to grow to $50 billion by 2025. It is the fourthlargest market in Asia. Thirty years have gone by since the 1st medical device was regulated as a drug in 1989. A comprehensive regulatory framework is nearly in sight with the Draft Medical Devices (Safety, Effectiveness & Innovation) Bill from NITI Aayog to be shortly proposed as a separate law. Our policymakers in Health Ministry were surprisingly undecided
DECEMBER 2019
and seemed to be in no urgency to usher in a ‘Patient Safety Medical Devices Law’ to protect patients, even after the recent ICIJ implant files or J&J incident, or the most recent ban on Trans-vaginal Pelvic Mesh by USFDA. As the Ministry of Health & Family Welfare (MoH&FW) had been surprisingly very reluctant to draft a separate law preferring to attempt to amend the Drugs Act, and CDSCO has a conflict of interest to empower itself, the industry watchers are waiting with anxiety the details of the Draft Medical Devices Bill that Niti Aayog is reportedly working upon in consultation with other stakeholders, departments and ministries to address the regulatory vacuum & the national patient safety concerns. Devices do need to be regulated but the two draft and two final notifications recently issued by MoH&FW on October 18th, has
Rajiv Nath Forum Coordinator of Association of Indian Medical Devices Industry (AiMeD)
indicated notifying all medical devices that are engineering products as ‘medicines’ under the Drugs & Cosmetics Act from December 2019. Contrary to this, roadmap being defined in cover note from the Secretary does not entail migrating these to a separate ‘Medical Devices Act in due course (as being drafted by Niti Aayog) and seems to be an independent parallel action. This uncoordinated announcement is causing huge confusion and apprehensions amongst domestic manufacturers especially of Medical Electronics. While one notification talks about a reasonable transition period of 3-4 years another notification to regulate ultrasound equipment gives only one year. Moreover, there’s no mention of a separate Act. At present only 24 out of over 6,000 medical devices are
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regulated by being notified as drugs. DEVICES ARE ENGINEERING ITEMS AND NOT DRUGS It’s imperative to have a separate law as devices are engineering items and not medicines — a MRI or CT Scan machine by no stretch of the imagination can be called a drug, and, so, continued attempts to regulate devices as drugs is illogical and incorrect unless assured that it is a temporary measure. A beginning was made to correct the anomalous situation with the introduction of the Medical Device Rules in 2018. These rules have risk proportionate controls correlating to the risk classification of devices. Similarly, the law and penal provisions need to be riskproportional as you can’t have the same penalty for a manufacturing failure of a pair of spectacles as for a contact lens or for an intra-ocular lens. Patient safety is more complex
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with devices where the same are a shared responsibility of the manufacturer, medical practitioners, product user and the regulator. The Drugs Act itself needs reforms as it does not uniformly and equitably regulate quality from state-to-state in the absence of a national singular regulatory authority and there is no point of replicating this limitation for devices too. The recent J&J episode showed the limitations of the Drugs Act, and the Drugs Controller was initially seem to be handicapped to discipline overseas manufacturers. Medical Devices has failed to attract investors to put up factories. Why? Can a competent builder from Mumbai, experienced enough to make a 90-storey building, risk starting the construction of a 70-storey one in Gurgaon if the building bylaws there don’t permit construction of over 36 floors only under hearsay that said bylaws are under amendment or will he wait? Similarly, medical devices manufacturers need to know the legal requirements, in a predictable manner. This will attract overseas and Indian investments. Presently, investors
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INDUSTRY PERSPECTIVE
shy away from an unpredictable, incomplete and incorrect regulatory environment. This will also attract investments not only in manufacturing but in the much needed supportive eco system of Testing Laboratories and Certification Bodies and competent Quality Assurance personnel and Regulatory experts. In the absence of regulations, domestic manufacturing suffers as a surgeon is unsure of trying an unregulated device from a start-up on a live patient. MEDICAL DEVICES NEED A COMPETENT REGULATORY BODY Policymakers while beginning to view devices and drugs differently, need to ensure these are of high quality and safe. They must consider regulating devices under the ministry of health as done for food. Food is not regulated under the Drugs Act or under DCGI, or the CDSCO, but has a FSSAI with a Secretary level chairman and CEO. While many of the manufacturers of the 24 categories of already notified devices are ok to be regulated under a familiar CDSCO but wish it to revamped with a medical devices specific division and appropriately needed competent staffing by
engineers & scientists, a vast majority of the manufacturers of devices that are currently not regulated prefer to seek a separate national regulatory body which will not view Devices from the prism of Drugs , as reportedly envisioned in the NITI Aayog draft Bill. The government should stick to earlier assurance given to the industry by the MOH&FW in 2016 of four steps—starting with the Medical Devices Rules (MDR), initially experimenting with a few electronic devices. The MDR is to be amended as per experience gained after six months of introduction and the simultaneous drafting of a Medical Device Bill to be reviewed by us & other stakeholders, and passed by the Parliament. It should be accordingly tweaked in order to migrate to an eventual Medical Devices Law. The National Accreditation Board of Certification Bodies is already accrediting certification bodies for voluntary quality assurance (the Indian Certification for Medical Devices (ICMED) scheme) under the QCI (Quality Council of India). Incentivizing ICMED certification by the QCI will help Indian manufacturers in capacity building
A STRONG AND FAIR REGULATORY ENVIRONMENT WILL HELP THE MAKE IN INDIA CAMPAIGN BY ENCOURAGING THE GROWTH OF THE MEDICAL DEVICE INDUSTRY.
for voluntary compliance to quality standards, thereby ensuring global competitiveness and enabling the smooth transition to mandatory compliance under the proposed draft Medical Devices Bill from the Niti Aayog. A strong and fair regulatory environment will help the Make in India campaign by encouraging the growth of this industry. Right from trade margin rationalization to ensuring a separate set of legislations and regulatory frameworks to govern the medical device sector and everything in between needs to be looked at afresh to galvanize domestic manufacturing. If we are serious about placing India as a top global medical devices manufacturing hub, then one needs to understand that piecemeal reforms will not work and continuing to attempt to regulate Devices as Drugs under Drugs Act without an assurance of migrating to a separate legislation will do more harm than good to Make in India campaign. The writer is Rajiv Nath, Forum Coordinator of Association of Indian Medical Devices Industry (AiMeD). Views expressed are a personal opinion.
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Inspira Enterprise – A Digital Solution Provider
Designing Robust, Flexible and Scalable IT Solutions
M
umbai-based Inspira Enterprise is a leading digital transformation enterprise that integrates bold thinking, path breaking technologies and years of expertise to transform businesses and organisations around the world. Established in 2008, its expertise lies in Digital Healthcare, Cyber Security, Internet of Things (IOT), Networking and ANKIOS. The enterprise is a single platform exclusively dedicated to next-gen digital transformation-Blockchain, Intelligent Automation, Big Data & Analytics and Cloud Computing technologies. ALL ABOUT INSPIRA DIGITAL HEALTH Mission and vision of Inspira Digital Health is to contribute and lead the digital revolution in the Indian healthcare paradigm, based on citizen centricity, quality of care, better
Sandeep Jha
Vice President - Digital Health Inspira Enterprise India Pvt Ltd
access, universal health coverage, and inclusiveness. All these aspirations can be realised mainly by leveraging the power of disruptive technologies. In the context of India, with its size and diversity, this mammoth task requires a holistic,
Inspira offers a dynamic suite of solutions and services that extend beyond the continuum of care to help you operate your organisation, improve workflow efficiency, engage your community in its own well-being and, most importantly, continually advance patient care.
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Dr Santosh Pawar Vice President - Healthcare Inspira Enterprise India Pvt Ltd
comprehensive and interoperable digital architecture. Inspira is one of the leaders in today’s digital health space with big ongoing and completed projects. HOW INSPIRA DRIVING THE DIGITAL HEALTH MISSION Our nation is currently facing a population health challenge of unprecedented scope because of the increasing obligation to properly address healthcare costs that are rising exponentially and, simultaneously, a nation of individuals whose health status is lower than the previous generation and continuing to decline. Technology can save lives - it has been demonstrated, time and again. Luckily the extent of what technology can do to save lives is increasing at a significant rate. And How Inspira is leading Digital Transformation which is taking place swiftly in the healthcare
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l Inspira is transforming public health by digitally revolutionising large Government Hospitals, Medical College and Public Health Facilities like Municipal Corporation of Greater Mumbai, Vardaman Mahavir Medical College & Safdarjung Hospital, Coal India, NIEGRIMS Shillong, Chitranjan National Institute of Cancer Kolkata, Govt of Seychelle, Vadodara and Dahod Smart City Digital Health, and Kalpana Chawla Medical College, Karnal, Haryana. The consolidated value of all digital health projects is more than $20million. l Implementing India’s largest single Healthcare IT Infrastructure project “Development of Campus wide Digital Network Solution” with AIIMS (All India Institute of Medical Science, Delhi and Jhajjar Campus) of worth $8.5 million.
TECHNOLOGY PERSPECTIVE
INSPIRA—A ONE STOP CENTRE TO FILLIP DIGITAL HEALTH INFRASTRUCTURE
l Inspira is driving digital mission along with the Government digital India initiative and converting manual process carried out by healthcare organisations to digital with clinical workflow-based process. Till date, 20K+ beds have been transformed to digital. l Millions of patients have got opportunity to take charge of their health and decide when action is needed. The accessibility to their own personal data has created a demand for greater transparency from healthcare providers. l Inspira is contributing towards employment generation directly and indirectly with their Digital Health initiative and vision to help India becoming the world’s largest Digital Health enabled country. Today, more than 10K Healthcare users are leveraging Inspira’s Digital Health platform. l Inspira’s R&D and Innovations are need-based and focuses on market trends, Govt Policies\Global and key initiatives taken in the past for transforming healthcare domain to digital like WHO Global Strategy on Digital Health, National Digital Health Mission and EHR guideline of India. industry. The healthcare providers focus on offering exemplary patient experience through technological innovation and communication, where Inspira is driving the initiative with very high speed and in just six years we have been able to deliver and manage the below. Healthcare Large FOR & Turkey Projects SUCCESS USE CASES DIGITAL PUBLIC HEALTH
Municipal Corporation of Greater Mumbai (MCGM) Project Synopsis MCGM is medical hub of Maharashtra that serves more than 15 million OPD patient annually and has almost 100% bed occupancy. We have deployed centralized with multi-tenant architecture on cloud hosted HIMS catering 6000+ concurrent users for 42 modules with 25 speciality EMR, which has a blend of AI to convert Speech to Text and applying AI. It has been integrated with SAP and other external Health Programmes. Key Deliverable Solution s HIMS | EMR | Patient Portal | PACS | Cloud DC DR | SAP Integration | SCM | Pharmacy
VMMC & Safdarjung Hospital, New Delhi Project Synopsis Safdarjung is 1500 bed tertiary care hospital associated with medical college. It serves 3000+ OPD patient per day and has 120% bed occupancy rate and 600+ Animal bite OPD. It is turnkey O&M project with Data Centre, Networking and Application along with Manpower. The HIMS is deployed in premise and has 500 concurrent users. It has Drug Database integrated site with complete SNOMED CT terminology used in CPOE. Key Deliverable Solutions HIMS | QMS | PACS | IT-Infra | FMS | LIS | SCM | Patient Portal | Pharmacy
Coal India Limited, Kolkata Project Synopsis HIMS with PACS project to be deployed across 21 CIL Hospitals across India with more than 2000 bed. It has been getting deployed on distributed architecture with on-line and off-line operation and integrated with SAP HANA. Data synchronize architecture with local and central with Single Sign On (SSO) getting implemented. It will be having more than 2500 users across the CIL's Network Hospital and Dispensaries. Key Deliverable Solutions HIMS | PACS | Cloud | LIS | SCM | Patient Portal | Pharmacy | Mobile App
Kalpana Chawla Government Medical College, Karnal (Haryana) Project Synopsis KCGM is 500 bed tertiary care hospital associated with medical college. It serves 1000+ OPD patient per day. It is turnkey O&M project with Data Centre, Networking and Application along with Manpower. The HIMS is deployed on premise and has 200 concurrent users, along with education and library management system with Remote Consultancy tool Telemedicine which enables medical student to see live consultancy. Key Deliverable Solutions HIMS | Telemedicine | QMS | PconsulACS | IT-Infra | FMS | LIS | SCM | Patient Portal | Pharmacy
400+ Health
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TECHNOLOGY PERSPECTIVE
Healthcare Large & Turkey Projects
Chittaranjan National Cancer Institute(CNCI), Kolkata Project Synopsis CNCI is 500 bed super specialty Oncology hospital. It is Green field turnkey O&M project with Data Centre, Networking and Health Application along with Manpower. The HIMS is deployed on premise and has 200+ concurrent users. Onco EMR has been tailor made for CNCI with Drug Database (CIMS) Integration along with 30+ HIMS modules. Key Deliverable Solutions HIMS | Onco EMR | PACS | IT-Infra | FMS | Mobile App | Patient Portal
Dahod Smart City(DSC), Dahod Project Synopsis DSC has 200 bed hospital with 10 IOT enabled digital clinic connected through telemedicine software to the hospital. The Public Health solution with EHR and telemedicine solution is hosted on Smarty City Cloud. Access to patient EMR is provided to local private doctor for continuum of care.
Vadodara Smart City(VSC), Vadodara Project Synopsis VSC is first of its kind in Digital Public Health within a Smart City which covers entire primary and secondary care which is closed to 34 PHCs managed by 250 ANM worker.
Key Deliverable Solutions HIMS | Patient Administration | EMR | Pharmacy | SCM | LIS & RIS | ADT | Patient Portal | Telemedicine
Key Deliverable Solutions EHR | Patient Administration | ICT Infra | Mobile App for Healthcare workers
ANM workers has been provided with tablet-based public health solution which covers entire National Health Programmes and Public Health Modules.
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Seychelles Country wide Health Information System Project Synopsis It is country-wide Digital Health project which encompasses automation of all Government hospitals, Pharmacy and Clinics across the country, which are integrated with existing Health Programmes. The project focuses on Population Health management with easy access and transparent view of healthcare to its citizens through Patient Health Record. Key Deliverable Solution HMIS | EMR | Pharmacy | SCM | LIS & RIS | PACS | HR | BI | Patient Portal | Mobile App 16 1 300 Hospital
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O SOLUTIONS u r H e a l t h cOFFERED are Products
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Inspira offers a dynamic suite of solutions and services that extend beyond the continuum of care to help you operate your organisation, improve workflow efficiency, engage your community in its own well-being and most importantly, continually advance patient care. It is committed to serve as your trusted healthcare advisor to help your organisation navigate the everchanging healthcare landscape and achieve better outcomes.
Our Healthcare Products
Lifeline Enterprise HIMS Integrated Enterprise Solution for Healthcare providers with Consolidation of clinical data and financial management to cater to multi-speciality hospitals with more than 45+ modules
Chatbot
Population Health Management Population Health refers to the distribution of Health outcome within a population. It comprises health determinants that influence distribution, and the policy and interventions that impact the determinants.
Lifeline E-Claim
Lifeline EMR/EHR
Lifeline CardioScience
Lifeline Telemedicine
Specialised Electronic Medical Records collecting complete Patient Health information, clinical Diagnosis along with procedures, services and prescription.
An application having an ability to serve a Cardiac physician with all
Web-based Remote consulting application with real time integration with Medical device. connecting patients to specialists for clinical healthcare from remote locations.
Lifeline M Health
required patient characteristics, cardiac symptoms, diagnosis, risk factors with extensive score grids.
Lifeline Patient Portal
Lifeline Lab In Bag
• Creates potential loop for feedback the quality and safety of patient KEY UNIQUE FUNCTIONALITY FOR A chatbot is a programme designed Entire healthcare revenue cycle A Mobile App integrated with EMR, to simulate conversation with human Links various hospitals branches/ A portable point of care (IoT) device, process management, including care by reducing between medication and PUBLIC HEALTH allows doctors and healthcare users, especially over the Internet. entities for online registration and health-related providing real-timeresearch lab quality results determining patient eligibility, professionals to view patient 80% of businesses plan on having a appointment system through HMIS by analyzing the patient’s blood and and actual practice. collecting their co-pay, coding claims medical errors. • chatbot Inspira’s healthcare information, for timely decisions for by 2020. Chatbot services in applications and provides patients their online routing the results to EMR for correctly, tracking claims, collecting patient treatment plans and care. healthcare are used such as book reports. physician view for quick treatment. • Provides the backbone of technical provide a suite of clinicalpayments systems and following up• on Stimulates consumer education appointment, lab report, billing, and denied claims. services etc. infrastructure for leverage by and patients’ involvement in their for healthcare professionals with national and state-level initiatives. own healthcare. the best of tools to perform their • Reduces health related costs. • Increases efficiency by eliminating work effectively and efficiently. • Provides level of interoperability unnecessary processes and • Inspira’s Healthcare solutions among EHRs maintained paperwork. offer a full spectrum of Hospital by individual physicians & • Provides caregivers with clinical Management System with 40+ organisations. decision support tools for more modules, services and solutions effective care and treatment. from patient care to revenue cycle • Eliminates redundant or management and supply chain Article is written by Sandeep Jha, Vice unnecessary testing and improves management to the electronic health President - Digital Health & Dr Santosh public health reporting and record (EHR) and much more. Pawar, Vice President - Healthcare, Inspira Enterprise India Pvt Ltd monitoring. • Provides a vehicle for improving
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F
rom the past few years, the healthcare sector is witnessing a huge transformation, with technology and innovative tools playing a pivotal role in enhancing care. As per the latest report, in the last two years, private healthcare sector is experiencing dip in profits, making the sustainability a big challenge. In contrary to what private healthcare is witnessing, Vikram Hospital has become the head turner and is leading the sector with an EBITDA growth from 2% to 20%, which is to reach 25% in a matter of time. This has largely been achieved by focussing on various channels and by use of technology to increase business and reduce cost. This growth story is not a page pulled out from the fairytale’s books, but due to year on year growth for the last three years. This has been achieved after years of adherence to industry’s best practices in terms of sustainable healthcare by delivering high quality care and improved public health in an environment friendly manner and by introducing innovative technology within the facility if and when required. Although, in healthcare sector, technology is progressing, for many people, access is dropping across the country due to high out-of-pocket expenditure being a major roadblock. Changes in wealth distribution, aging populations, and increasing burdens from chronic conditions also exacerbate these issues. To ensure sustainability without impacting the cost and quality of treatment, the promoters of the hospital should focus on avoiding unwanted capex expenditure
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especially on medical equipments. They should use technology and latest innovations to reduce OPEX cost. With regard to CAPEX, today the healthcare market is flooded with latest technologies and with varied price ranges. One should look into buying / investing in a technology depending upon patient requirement and need of the hospital. One should not unnecessarily invest into higher technology if it doesn’t fit into patients’ need and requirement. For example, to run a hospital in tier-2 and tier-3 city, the optimum requirement could be sufficed by having a MRI machines with 0.5 – 1.5 tesla against 3 tesla. Same can be looked into for all other equipments and instruments bought at the time of starting the hospital. At Vikram Hospital, we have optimised OPEX cost by introducing technology to control inventory, special focus on material cost, manpower cost, power and fuel cost (green energy like solar / wind power, low power consuming LED bulbs, rainwater harvesting, e-bills, e-prescription etc), administrative and marketing cost. There has been a drastic savings by undertaking above measures leading to reduction of cost from 67% in 2017 to 52% in 2019. Technology has significantly helped us in improving patient and attendants’ satisfaction. We have introduced a dedicated helpline number 1111, which in case of need is used by the patient or attendants to raise all kind of service requests. The request raised by the patient is automatically forwarded to respective departments through a software module whereby automatic alerts,
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TECHNOLOGY PERSPECTIVE
‘Prudent Selection of Technology Vital for Sustainable Healthcare’
Dr Somesh Mittal
Managing Director & Chief Executive Officer, Vikram Hospital
escalations are done by the system itself without any human / manual interface. The analytics provided by the software helps us to find the Root Cause Analysis for any service deficiency. This has helped us in increasing our patient satisfaction score from 65%to 92%. We, at Vikram hospital feel that there is enough scope of profits in healthcare. What is needed is to identify right levers like medical and non-medical manpower cost, power & fuel cost, administrative cost, marketing cost, material cost etc. where currently private healthcare are losing profits. Vikram Hospital is a 262-bedded flagship hospital located in Bengaluru which provides high-quality patientcentric healthcare programmes, leading to optimal outcomes and increased patient satisfaction.
Writer Dr Somesh Mittal is Managing Director & Chief Executive Officer, Vikram Hospital
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TECHNOLOGY PERSPECTIVE
Importance of People, Process and Technology (PPT) framework in EMR Implementation
B
ased on the experience in last need to balance the three and maintain two decades, I came to know good relationships among them. that top class technology stack Having said that, the organisation may not be required to achieve the should always emphasize to have the organisational goals to automate their right people on board and put the right business processes to scale-up the processes for all the work-flows and customer satisfaction, customer delight, then map it with the technology to provider and patient experiences. On achieve the project goal toward business the other hand, most of the digital optimisation which ultimately in force transformation projects fail miserably as to achieve the customer satisfaction and they are being delivered as technology customer delights. originated projects. Whereas, as per Technology is expensive and does my study and experience, technology not always offer a high return on is the component to map with right investment, so it’s important to ensure people and process to achieve the it runs smoothly. Make sure that end Technology Perspective business goals. The below picture would users know how to use the technology Page-2 Importance of People, Process and Technology (PPT) framework in EMR Implementation illustrate the percentage of people, you acquired — if they don’t or if the Based on the experience in last two decades, I came to know that top class technology stack may not be required to achieve the organisational goals to automate their business processes to scale-up the customer satisfaction, customer process and technology methodology technology doesn’t integrate well with delight, provider and patient experiences. On the other hand, most of the digital transformation projects fail miserably as they were being delivered as technology originated Whereas, as per my and experience, technology is by the right sets of people, which enables theprojects. success story ofstudy the processes the component to map with right people and process to achieve the business goals. The below picture would illustrate the percentage of people, process and technology methodology of the EMR EMR deployment project.which enables the success storyorganisation won’t create value from its deployment project. original investment in the project. In healthcare domain, especially EMR deployment project fail many times as these projects have been treated as technology project instead of people and process driven and as a result the adoption of the application never scaled-up in the Indian geographic as it was supposed to be. Finally, the end user (patient) and provider (hospital) could have never maintained a longitudinal medical The diagram shows that The above diagram shows that 70%above of the component responsible to deliver the project is not technology, it is therecord of individual patient. people and the processes which have more role to play for any IT project in health informatics domain to meet the EMR deployment is clinician driven theTherefore, component to However The project deadline with70% quality of delivery. technology responsible was never a challenge. as standalone methodology, people, process, and technology are necessary for the organisational transformation to achieve project whereby the people and process deliver project is maintain not technology, it them. Having organisational efficiency. You need tothe balance the three and good relationships among said that, the organisation should always emphasise to have the right people on board and put the right processes for all the play awhich vital role to define the workflow people andto the processes work-flows and then is mapthe it with the technology achieve the project goalwhich toward business optimisation ultimately in force to achieve the customer satisfaction and customer delights. with ease of use and then transform it have more role to play for any IT Technology is expensive and does not always offer a high return on investment, so it’s important to ensure it runs smoothly. Make sure that end users in knowhealth how to useinformatics the technology you acquired — if they don’t or ifto the technology the simple technology to ensure the project domain doesn’t integrate well with processes by the right sets of people, organisation won’t create value from its original investment in the project. utmost users are on the board to adopt to meet the project deadline with In healthcare domain, especially EMR deployment project fail many times as these projects have been treated as thecould changes. quality delivery. Therefore, technology technology project instead of people and process driven and as a result the adoption of the application have never scaled-up in the Indian geographic as it was supposed to be. Finally, the end user (patient) and provider (hospital) Nodriven matter how sophisticated wasanever amedical challenge. However, could have never maintained longitudinal record of individual patient. Theas EMR deployment is clinician project whereby the people and process play a vital role to define the workflow with ease of use and then transform it technology you have introduced to standalone methodology, people, to the simple technology to ensure the utmost users are on the board to adopt the changes. EMR based digital transformation process, and technology are necessary for the organisational transformation to (health informatics) project, if the process are not put in order by the achieve organisational efficiency. You
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Abdullah Saleem Group CIO, OMNI Hospitals.
right sets of people then it will be a nightmare to scale-up the adoption of the EMR across the organisation as partial implementation of EMR will not help either to the provider or patient to ensure the continuity of care with quality at the hospital. To execute such project, there are too many technology options to choose; from both license and open source resources but getting the people with right experience who can define the complex to simple processes which could be mapped with the technology to get the better ROI and organisational goals is always a challenge to the industry/ product based companies. However, deployment of EMR at a hospital is a big change management initiative which refers to the process by which the hospital undertakes variations in their business strategies, and process in order to become more patient centric. For any healthcare provider / hospital, change management is critical whereby people, process, and technology are married
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and goals. Putting a proper process in place is critical to ensure the team is prepared for the change taking place.
together to achieve better adoption rate from the end users to achieve the following: • One-point access to personal health record anywhere, anytime • Better communication between patients and care providers • Avoid replication of records • Reduce medical errors • Cost reduction for patients • Better patient care PEOPLE: KEY ELEMENT OF THE PROJECT It addresses to bring knowledge, skills, and process abilities & competencies. It is all about staff training, awareness, and competent processes. EMR’s deployment depends on the people involved with clinical and nonclinical operation, beginning with the senior leadership, and requires getting them on board. If the planned change isn’t communicated effectively, correctly or within the right amount of time, disconnect can occur, hindering even the most carefully planned improvements towards the application adoption. The organisation must assist employees to adjust their mindsets to achieve the transformation. PROCESS: SUCCESS OF THE PROJECT It addresses the business needs, and the workforce and competencies required to meet these. It is all about management systems, the best practices and governance framework. It is essential to ensure that right processes and SOPs are in place to support the organisational or digital transformation. For transformation activities to succeed, process is key. Make sure that all the end users are thorough with the business processes
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TECHNOLOGY: ENABLER FOR DECISIONMAKING It addresses tools, and techniques used to communicate and to make the work efficient. Technology is the final piece of the puzzle that can bring everything together and help keep everything aligned. The right transformation tools can help organisation to maintain compliance in a rapidly changing global landscape, as well. After mapping the process / transformation in technology, it makes more ease of use to run through the process which gives the expected outcome efficiently & logically, and as a result, it satisfies the patient and provider both. As a concept, people, process, and technology refers to the methodology in which the balance of people, process, and technology drives action: People perform a specific type of work for the organization using processes (and often, technology) to streamline and improve these processes. This methodology can help to achieve harmony within an organisation and is most often used when deciding whether to purchase or implement new technologies. As it has been agreed by the product owners that EMR implementation is clinician lead project therefore, clinical users always look forward to having the ease of use based system in place, and it could not be achieved if right people could have designed the work-flow with simplicity and map it to the technology components. As a result, users would have a feeling that application which they are using is much easier, faster than paper and no training needed which automatically enables all the clinical users to adopt the digital transformation without making major efforts by the organisation in the terms of change management because the clinical users start getting the clinical dashboard on their finger tips for taking the clinical decision at the point of care, and also refer these data for their thesis and research papers. Writer Abdullah Saleem is Group CIO, OMNI Hospitals.
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TECHNOLOGY PERSPECTIVE
Genesis & Scope of Robotic Surgery in India
T
he first robot was a pale shadow of the present robot and was installed at Escorts Hearts Institute by the ever dynamic Dr Naresh Trehan. The year was 2001 and it was initially installed for cardiac surgery. From `Mars of India` was the caption we used for the first ever robotic surgery workshop in Asia. The year was 2005 and the surgeon was a jolly young chap by the name of Vipul Patel who flew down from Florida, USA to demonstrate four live cases of robotic prostatectomy and two cases of robotic pyeloplasty. Such was his expertise that to this date, urologists remember it as one of the memorable seminars. It took another five years before the robot landed on the Indian soil, spurred by vattikuti foundation. Indeed, the vattikuti foundation lead by Prof Mahendra Bhandari popularised Robotic Surgery in India. It is to their credit that in the next five years, 4,000 procedures were
performed robotically by Indian surgeons using 3rd generation robots in 35 academic institutions. Today, Robotic Surgery has proven to be of immense value particularly where the access is difficult by conventional techniques as in the case of deep pelvic surgery. Presently, the robot is being routinely used in paediatric surgery, ENT, Thoracic & vascular surgery, abdominal surgery, gynaecology. But perhaps it is in urological procedures that the advent of robotic surgery has made the maximum impact. Better outcomes have been seen in patients who have undergone robotic radical prostatectomy and ureteric reimplantation. Robotic surgeries result in less blood loss. The minimally invasive robotic approach is slowly becoming the standard of care for many surgical procedures. In future, there might be a chance
Dr Ajit Saxena Senior consultant Urologist & Andrologist, Indraprastha Apollo Hospitals, Delhi
for the surgeon to programme the surgical procedure and simply supervise while the robot carries out the surgery. Already, advances are happening in robotic surgery in new tissue anastomosis procedures, improved robotic instruments and digitally integration of the existing robotic technologies in many disciplines of surgery. Fusion of CT scan or MRI during surgery will help the surgeon to exactly identify the pathological area thus improving accuracy in removing abnormal tissue. Coupled with Artificial Intelligences, the scope of robotic surgery is phenomenal, indeed mind boggling. The writer is Dr Ajit Saxena, Senior consultant Urologist & Andrologist, Indraprastha Apollo Hospitals, Delhi.)
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DECEMBER 2019
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TECHNOLOGY PERSPECTIVE 54
Impact of Technology Disruption on Affordability and Workforce Management
I
ndian healthcare industry is at the crossroads and technology is the driver and equally a harbinger of disruptive change. With the launch of Ayushman Bharat, affordability is the new mantra to cater to the healthcare delivery for the 500 million new people. It is well-nigh impossible to cater to the healthcare needs of such a large population without leveraging technology which is changing at a breakneck speed. The industry is being disrupted globally with advancements in technology, new protocols and innovations in AI, Big Data, 3D printing, genomics, blockchain, AR/VR, wearables, telemedicine to name just a few. Much of this technology is yet to be harnessed optimally while the hype rules the roost. The Government of India has recently imposed price caps on stents, implants and many critical life saving drugs. This has immensely dented the profitability of the providers. The question often being asked is how the providers extend affordable and safe healthcare delivery with all the regulatory pressures. More than 65 percent of India still lives in rural areas. Healthcare delivery especially accessibility is perennial issue in these areas. Could technology help in providing access to the large masses still living in rural and tribal areas? If yes, how and at what cost? We must find innovative models to provide affordable healthcare to the rural masses. Many firms are already working on such an initiative. Profit cannot be the only motive and the government must adequately incentivise the private healthcare providers to spur
DECEMBER 2019
Hemraj Parmar Group Chief Executive Officer, BR Life.
investments and extend good quality healthcare to the people staying in rural areas who cannot afford more expensive treatment available in bigger cities. Many state governments are going in for PPP projects to make healthcare more affordable, thus minimising risks to both the parties. Telemedicine and teleradiology are gaining traction. Upgradation of facilities in tertiary care government hospitals (district hospitals) can take care of major surgeries and high-end tertiary, and later quaternary care. Currently these hospitals are lacking in even the basic infrastructure and clinical talent. While Artificial Intelligence (AI) is still in a nascent stage in the country, it holds immense potential to minimise costs while improving accuracy of diagnosis and consequently treatment. It’s slowly finding usage in radiology and oncology. In radiology, many firms in India are using it to interpret MRI, CT & USG tests faster and more accurately. In oncology, AI usage has made notable
contributions. Manipal Hospital group has installed IBM Watson with limited usage but as the technology evolves and democratizes further, costs are likely to come down further. AI is also likely to take away some of the repetitive jobs requiring minimal human intervention without prejudice to patient safety or outcomes, especially in the radiology and laboratory departments. All fears on total replacement of manpower through infusion of advanced medical technology seem preposterous and unfounded for the next few years, especially in India, although it will be the future soon. Telemedicine and teleradiology are already finding usage in rural areas devoid of basic infrastructure, clinical talent and facilities. But one factor that has remained constant in India, vis-Ă -vis other advanced healthcare markets; it is human touch. Indian healthcare consumer (patient) still loves the touch and feel of a doctor. So, while we introduce newer technologies to our healthcare delivery, we must factor in personalised care and human intervention to cater to their unique needs. Overall the country is trudging on the right path and we are going to see much more disruption in medical technology, clinical and operational protocols to ensure safe, ethical and affordable healthcare delivery with excellent outcomes and superlative patient delight.
Writer is Hemraj Parmar, Group Chief Executive Officer, BR Life.
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ndian healthcare industry is going to witness a huge transformation with the advent of ‘National Health Mission 2020’ – which aims to provide an amalgam of Technology and Genomics for Advanced level of Healthcare Services. TECHNOLOGICAL ADVANCES – DIAGNOSIS & MEDICATION ACHIEVING NEW MILEAGE Merger of Technology in Healthcare Industry can bring a breakthrough alteration in the traditional methods of Patient Data Management, Diagnosis and Treatment, improving and saving countless lives. Precision Medicine is “an emerging programme for disease treatment in the path of tech-merged clinical practices. It is a customisation of healthcare, with medical decisions, treatments, and practices specifically designed for individual patient. It allows doctors to select patient treatments based on a genetic understanding of diseases. Such type of special medicine is dependent on patients’ data; therefore, electronic health records will be a must-thing in the coming years. Wearable Electronic Devices along with Nanotechnology is going to open new realms of possibility for advanced clinical monitoring gadgets that are wearable directly on the skin. Such devices can prove to be a breakthrough in treating wide span of critical diseases using skin-mounted sensors as diagnostic tools. Artificial intelligence (AI) in healthcare is another path-breaking tool which focuses in analysis of complicated medical data using critical algorithms and software based technology.
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AI programmes can be applied to practices such as diagnosis processes, treatment protocol development, drug development, personalised medicine, and patient monitoring and care. Internet of Medical Things (IoMT), an amalgamation of medical devices and applications, connect to health care information technology systems through online computer networks. It can reduce unnecessary hospital visits and the burden on health care systems by connecting patients to their physicians and allowing the transfer of medical data over a secure network. DIGITAL FACE OF HEALTH RECORDS Healthcare professionals throughout the world are discovering the “next big thing” i.e. impacting medical practices and hospitals – Electronic Medical Records (EMR). It can securely share electronic information with patients and other clinicians, helping doctors to diagnose patients more effectively, with reduced medical errors, and deliver safer care. TELEHEALTH – FASTER HEALTHCARE CIRCULATION Tele health, which uses digital information and communication technologies, such as computers and mobile devices, to deliver health care services at larger extent is another area that should be promoted to address large rural population of India that is still deprived of good healthcare facilities due to old accessibility and affordability issues of healthcare. PATIENT DATA SECURITY With changing time, we can expect an emergence of more secured electronic
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health records of patients in India by 2025 with adoption of ISO 27001 based security framework by healthcare providers as well as technology solution providers. Laws like Health Insurance Portability and Accountability Act (HIPAA) are required so that safety and security for patient data could be ensured at the national level. Similar kind of security should be delivered by the manufacturer of different bio medical devices so that after the penetration of 5G and IOT in healthcare ecosystem, less causality should be reported due to distinct Cyber espionage.
TECHNOLOGY PERSPECTIVE
‘Digital Tools to Play Vital Role in Enhancing Care’
SMART HOSPITALS IN NEXT FIVE YEARS Big data analytics will be required by healthcare providers to get adhoc analytics and different patterns from patients’ disease perspective . AI will be used for better diagnosis and prediction of cardio and other critical disease future pattern, prediction for patients who will be at primary stage of similar kind of critical diseases. At present, important issue in the Indian healthcare is ‘under dose’ and ‘over dose’ of medicines due to which many patients are getting affected. Going forward, the technology based electronic patient records in combination with AI- based clinical system will help the doctors in choosing the right drugs, based on patient medical history.
Writer is Chander Mohan Malhotra, Head - IT Projects, Sarvodaya Hospital & Research Centre, Faridabad.
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DECEMBER 2019
55
SPECIAL FEATURE
Growth of Surgical Robotics in India
The treatment utilizing prescriptions for the keeping up wellbeing came into picture a lot prior. In those times, fighting and battling systems were educated among normal people, with the aim to spare the realms from adversaries, and the treatment of wounds shaped during these preparation periods were later named as medical procedures. The method of surgery did not exist during the period of physicians such as Pythagoras etc. who promoted kayacikitsa. The contribution in the field of surgery, by our country is indeed very profound. Sugandh Bahl of Elets News Network (ENN) throws light on the challenges and the current market trend of robotics surgery in India. SURGERY IN INDIAN TRADITION Surgery has been widely used in Indian medicine. In the Ancient World, Indian surgeons performed the most elaborate operations. Over 121 different steel instruments were used to sew up wounds, drain fluid, remove kidney stones and to perform plastic surgery. What is the one thing which has accompanied human since the beginning? Nonetheless, it is development. Human has undergone all sorts of development. Be it technical, economical or social; curiosity and need of human has led to consistent discoveries and inventions. One of the prominent sectors where the need of expansion has always been felt is the sector of medical treatment. New and effective ways for diagnosis and treatment are being continuously worked on to reduce the risk, cost and enhance the overall results. Robotic surgery is one of the most advanced forms of surgeries that are surfacing in medical sector. Robotic surgery has indeed marked the beginning of revolution in surgeries. What is the one thing which has accompanied human since the beginning? Nonetheless, it is development. Human has undergone all sorts of development. Be it technical, economical or social; curiosity and need of human has led to consistent
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DECEMBER 2019
discoveries and inventions. One of the prominent sectors where the need of expansion has always been felt is the sector of medical treatment. New and effective ways for diagnosis and treatment are being continuously worked on to reduce the risk, cost and enhance the overall results. Robotic surgery is one of the most advanced forms of surgeries that are surfacing in medical sector. Robotic surgery has indeed marked Talking about an ever going tradition, advancement in science has been the most ongoing process. With automation swiftly picking up as a trend across sectors, India’s surgical robotics market is estimated to expand to a decent level in India. Remote Healthcare is currently starting to get speed in India. There are a great
deal of endeavors being placed in by the legislature to build the extent of automated medical procedure in India as the market is tremendous. Among some of the key triggers for this growth will be the increasing incidence rate of chronic diseases, a rise in geriatric population, and more demand of advanced technologies, including minimally invasive surgeries and miniature robotics. Further, there is probably going to be a significant push coming through subsidizing from different administrative associations for research and development (R&D) exercises in the cutting edge careful mechanical frameworks. TALKING ABOUT THE PROS AND CONS The next level of technological advances, the report says, might completely
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remove human contact during surgeries. The future robotic surgery systems might allow a greater distance between surgeons’ control console and the patient. Simply put, that means it would be possible to conduct robotic surgeries with the patient in a nearby clean room without any human contact or interference. According to Dr. Ajit Saxena Pioneer, Urology Robotic Surgery, Senior Consultant Urologist & Andrologist Indraprastha Apollo Hospitals, “this futuristic surgery enables the robot to replicate the surgeon’s hand movements while simultaneously minimizing tremors. Today, Robotic Surgery has proven to be of immense value particularly where the access is difficult by conventional techniques as in the case of deep pelvic surgery. Presently, the robot is being routinely used in paediatric surgery, ENT, Thoracic& vascular surgery, abdominal surgery , gynaecology . But perhaps it is in urological procedures that the advent of robotic surgery has made the maximum impact. Better outcomes have been seen in patients who have undergone robotic radical prostatectomy and uretericreimplantation.” Surgical robots allow precision to the surgeons who can operate with control and enhanced dexterity even during the most complex procedures. The more advanced robotic surgery systems of the future would be capable of replicating the tactile feel and sensation a surgeon experiences during the traditional invasive procedures. That would enable surgeons to gain better precision and advantages of minimally invasive procedures. Also, these could be done without losing the sensory information that helps in making judgments during robotic surgeries. Discussing the disadvantages, robotic surgery is a costly suggestion under the most favorable circumstances. The significant expense of introducing a mechanical
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medical procedure framework can expand the expense of a surgery. Surgical robots are costly to maintain, and their operation requires additional training, which is also expensive. Exact numbers are difficult to come by, but in general, a surgery utilizing a da Vinci surgery robot will cost between $3,000 and $6,000 more than a traditional laparoscopic procedure. Additionally, One of the most huge issues with automated medical procedure is the issue of inertness — the time it takes for the robot to complete the specialist’s directions. It takes a couple of seconds for the computer to speak with the mechanical arms. While this isn’t an issue for routine medical procedures, it makes it hard for specialists to react rapidly to issues that happen during the activity. ROAD AHEAD There are number of Indian health facilities which tends to offer automated surgeries. This figure has become stunningly in the course of recent years, and there are some significant strides in such manner. Notable mentions include the Bengaluru-based Vattikuti Technologies which is promoting the adoption of da Vinci in India. However while the quantity of Indian wellbeing offices offering automated surgeries has become amazingly in the course of recent years, various difficulties remain. Doctors and clinicians should be increasingly mindful of the innovation, preparing should be progressively available, and costs are still high. Qualifying specialists for use on automated medical procedure stays a significant detour to reception. As per Kumar, specialists require specific preparing and affirmation from Intuitive Surgical. For specialists situated in India, these administrations that aren’t especially simple to acquire or moderate. With the correct mastery and innovation, the focal points can inevitably beat the impediments. Correspondence dormancy is as of now the greatest obstacle to defeat to enable this innovation to hold a progressively unmistakable spot in the restorative network. Regardless of whether the expense of the methodology hinders the mix in medical clinics, medical procedures with automated machines will keep on getting increasingly ordinary, permitting progressively exact microsurgeries with improved exactness.
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