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asia’s first monthly magazine on The Enterprise of Healthcare

volume 7 / issue 5 / May 2012 / ` 75 / US $10 / ISSN 0973-8959

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Vikas Kharage

Mission Director, National Rural Health Mission, Maharashtra p-40

The Cover of Fortune India needs workable and scalable model of health coverage for protecting the poor

Ajay Bakshi

CEO, Max Healthcare p-36

RSBY Aarogyasri

Jitesh Mathur

SR Director – Patient Care, Clinical Informatics and Ultrasound Philips Healthcare India p-26

ini Yeshasv

Anil Swarup

DG of Labour, Ministry of Labour & Employment, Government of India p-20


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volume

07

issue

05

contents

ISSN 0973-8959

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cover story The Cover of Fortune

India needs a RSBY like scalable model for providing healthcare protection to the poor, who are mostly working in the unorganised sector, and are bereft of institutional support systems

20 Anil Swarup DG of Labour, Ministry of Labour & Employment, Government of India

By Dhirendra Pratap Singh

Special focus

Inclusive Growth is New Mantra Dhirendra Pratap Singh, Elets News Network (ENN)

Insured by the State

Dr T.S. Selvavinayagam, Joint Director of Health Services, Government of Tamil Nadu

16 18

40

In Conversation N Eswaranatarajan

Head of Operations & Technology, ICICI Lombard

Expert Corner

Malti Jaswal

Consultant – Health Insurance

Jitesh Mathur

Sr Director – Patient Care, Clinical Informatics and Ultrasound Philips Healthcare India

22 24 26

Munta Suresh Babu

30

V Balakrishnan

31

General Manager - Patient Monitoring & Life Support Solutions, Mindray Sr. Vice President, Schiller India

Anthony Rozario L

Vice President Marketing (CCD), AKAS Medical

Dr K V Krishnan

Practice Head, Life Sciences, Mindteck

32 33

S Jayadeep Reddy

33

Nikil Rao

34

CEO & MD, e health Access Pvt Ltd General Manager, Dräger Medical Technologies

Dr S C Garg

DCCMS, SARR Clinic Soft

35

Tech trends Monitoring that Counts

Dhirendra Pratap Singh, Elets News Network (ENN)

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36

28

42

hospital ceo interview Ajay Bakshi CEO, Max Healthcare

state focus Vikas Kharage

Mission Director, National Rural Health Mission, Maharashtra

RIS-PACS

Positioning Healthcare for the Future with RIS-PACS Anoop Verma, Elets News Network (ENN)

48 58 50 52

In focus

Dr Ashish Dhawad CEO, Medsynaptic Pvt Ltd

Rohit Kumar

Managing Director-South Asia, Elsevier Health Sciences at ClinicalKey Launch

case study

True Web Based Pacs Brings Immense Benefits

zoom in

Kandasamy Sankaran

Director and Delivery Head, Health Services, CSC India

Hard Talk

54

The Accelerators in Healthcare

telemedicine

56

Taking Healthcare to Rural India Through Telemedicine Interview: Puneet Gupta, President - Sales & Marketing, Intellisys Technologies & Research Limited


asia’s first monthly magazine on The Enterprise of Healthcare volume

07

issue

05

May 2012

President: Dr M P Narayanan

Partner publications

Editor-in-Chief: Dr Ravi Gupta consulting editor: Ashis Sanyal

Editorial Team

Web Development & Information Management Team

Group Editor: Anoop Verma

Dy. General Manager – Strategy: Raghav Mittal

Health Product Manager: Divya Chawla Principal Correspondent: Dhirendra Pratap Singh Research Assistant: Shally Makin

Sr. Executive Officer - Web: Ishvinder Singh

governance Manager – Partnerships & Alliances: Manjushree Reddy Senior Correspondent: Rachita Jha Research Assistant: Sunil Kumar

Sr. Executive Officer – Information Management: Gaurav Srivastava Associate Developer: Anil Kumar Information Technology Team Dy. General Manager – IT: Mukesh Sharma Executive-IT Infrastructure: Zuber Ahmed Finance & Operations Team

education Research Analyst: Sheena Joseph Senior Correspondent: Pragya Gupta

General Manager – Finance: Ajit Kumar

Sales & Marketing Team Manager – Marketing: Ragini Shrivastav National Sales Manager – digitalLEARNING: Fahimul Haque Associate Manager - Business Development: Jyoti Lekhi, Amit Kumar Pundhir Assistant Manager-Business Development: Rakesh Ranjan, Shankar Adaviyar, Puneet Kathait Sr. Executive - Business Development: Ashad Mofiz

Associate Manager – HR: Sushma Juyal

Legal Officer: Ramesh Prasad Verma Sr. Manager – Events: Vicky Kalra Associate Manager – Accounts: Anubhav Rana Executive Officer – Accounts: Subhash Chandra Dimri

Subscription & Circulation Team Sr.Manager – Circulation: Jagwant Kumar, Mobile: +91-8130296484 Sr Executive - Subscription: Gunjan Singh Executive - Circulation: Ashok Kumar Design Team Team Lead - Graphic Design: Bishwajeet Kumar Singh Graphic Designers: Om Prakash Thakur, Shyam Kishore Trainee Graphics: Meenakshi Rajput Editorial & Marketing Correspondence eHEALTH - Elets Technomedia Pvt Ltd Stellar IT Park, Office No: 7A/7B, 5th floor, Tower - 2, C-25 , Sector 62, Noida, Uttar Pradesh 201301, email: info@ehealthonline.org ehealth does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. ehealth is published by Elets Technomedia Pvt. Ltd in technical collaboration with Centre for Science, Development and Media Studies (CSDMS) Owner, Publisher, Printer - Ravi Gupta, Printed at Vinayak Print Media, D-320, Sector-10, Noida, UP, INDIA & published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP, Editor: Dr. Ravi Gupta © All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic and mechanical, including photocopy, or any information storage or retrieval system, without publisher’s permission.

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Guest Editorial

Impetus to Inclusive Growth The new wave of universal health coverage, or UHC, has touched a large number of countries, all studying how to establish government-funded healthcare programmes. This concept has particularly taken off in a number of Asian and African countries . India has emerged as the front runner. Against less than 5 percent of Indian population covered under health insurance till a few years ago, it has now gone beyond 25 percent. Making a significant contribution is the Rashtriya Swasthya Bima Yojana (RSBY) that was initially aimed at providing health insurance cover to the poorest of the poor in India. The benefits are now being gradually extended to other categories of workers. The idea behind the conception of RSBY was to design a health insurance scheme based on experience with such schemes in the past and taking into account the characteristics of those that were sought to be covered initially. The target population of the scheme was looked at very closely, before implementing it. As this segment comprised below poverty line BPL families that were by and large illiterate, a cashless and paperless scheme was put in place. Further, as a large number of these beneficiaries migrated in search of employment, the scheme was designed in such a way that they could avail benefits all over the country. RSBY provides the participating BPL household with freedom of choice between public and private hospitals and makes him a potential client worth attracting on account of the significant revenues that hospitals stand to earn through the scheme. It is a pioneering effort in terms of putting in place a business model for a social sector scheme with incentives built for each stakeholder. This would facilitate expansion of the scheme as well as its long run sustainability. This is perhaps the only scheme where IT applications are being used on such a large scale in rural settings. Such applications impart transparency to the operations as the scheme rides on a sophisticated Key Manage-ment System (KMS). It empowers the beneficiary, who has the option to choose from a large number of public and private hospitals all over the country. During the last few years, India has witnessed a plethora of new initiatives, both by the central Government and a host of state governments in the field of health insurance. One of the reasons for initiating such pro-grammes can be traced to the commitment that the governments in India have made scale up public spending in healthcare. The special issue on health insurance is an attempt to explore various ways of redefining health insurance in India and to identify the roadblocks for taking the healthcare services to the masses. We are very happy to be presenting this issue.

Anil Swarup Director General for Labour Welfare Ministry of Labour & Employment Government of India

may / 2012 www.ehealthonline.org

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volume

07

issue

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may 2012

asia’s first monthly magazine on The Enterprise of Healthcare

Tweeting eHealth DFID @DFID_UK #StephenOBrien: “conflict & food insecurity is leading to a #humanitarian disaster”. Mahesh Bhatt @MaheshNBhatt The services of an Indian surrogate mother to carry a pregnancy: $6,250. Western couples seeking surrogates outsource the job to India. Sachin Kalbag @SachinKalbag Landmark surgery in Mumbai to help 10-month-old baby boy born with two sets of legs, genitals and some internal organs.

inbox Helpful information. Lucky me I discovered your site by accident, and I’m stunned why this accident did not took place earlier! I bookmarked it. Nayan On “Pharma and healthcare marketers evolve cautiously towards mobile media” Very good decision of government lunch this yojana in Maharashtra. All semi class and under below powerty people take benefit this medical scheme. We are thankful to government. Mahesh Kharat on “Rajiv Gandhi Jeevandayi Arogya Yojana launched in Maharashtra”

Weight of the Nation @WeightOfTheNtn Official tweets inspired by @HBODocs’ “Obesity is the biggest threat to the health, welfare and future of this country.” Sucheta Dalal @suchetadalal Just 120 km from mumbai woman dies of cardiac arrest treking for bucket of water. Maharashtra in grip of tanker mafia. V call this development. New Scientist @newscientist Brain not wired to link numbers and space, study based on remote Papua New Guinea tribe. Jane Dreaper@janedreaper Hope the mobile phones story got an airing this morning. Big report, important issue. No convincing evidence so far of health risks. Prabhu Chawla @PrabhuChawla Why are our MPs afraid of debating inflation, unemployment, water shortage, farmers suicides and health issues? doctor at large @doctoratlarge I don’t see why doctors have to be morally upright. For treating diseases you only need knowledge, skills & understanding of human behavior. This blog is magnificent. I really like studying your posts. Stay up the great work! You know, lots of people are searching round for this info, you could aid them greatly. Duke Robinson on “Philips launches veradius neo mobile c-arm” Cool posting, I must say look ahead to posts by you. Rameesh Arora on “India needs a giant leap” Perfect know-how! I have been looking for something like this for some time currently. Thank you! Deneka Ogely on “India needs a giant leap”

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Growth Galore Health insurance has now become fairly widespread in the country. The most serious upsurge in breadth of coverage has come about in the last four years, when the government made serious efforts to introduce health insurance for the poor. Given the fact that the government is committed to upscale expenditure on health from the present 1 percent of GDP to 2-3 percent, the central and state governments have started devising plans for spending the additional resources through an array of innovative schemes. Health insurance, no doubt, has emerged as an important financing tool, as it promises to mobilise some resources from the people themselves i.e., those who buy insurance. But health insurance, which strengthens demand side, makes sense only when the supply of healthcare is reasonably well developed. Where this is not so, health insurance is meaningless. The supply of healthcare in the rural and remote areas of country is far from satisfactory. In India, private health insurance has resulted in cost escalation and inequity in health financing pattern. The cost-effectiveness of healthcare provided by the private sector could be questioned. This is likely to be the case in a country that depends heavily on fee-for-service in a large and an unregulated private sector healthcare. If stringent regulatory structures and effective implementation mechanisms are put in place, the deleterious effect of voluntary private health insurance can be ameliorated to some extent. The patient monitoring market is an expanding and profitable sector in the global healthcare industry. Driving growth in this segment are wireless and ambulatory monitoring and micro electromechanical systems, which are leading to more flexibility in the system. Most of the demand, in the global market, is originating from the emerging economies. India and China are forecast to grow faster than average, as they are driven by rise in the number of hospitals and large chronic disease populations. PACS implementation is slowly catching up in India with more hospitals aiming towards a paper-less environment. The Indian PACS market is estimated to beUS $5.5 – 6 Million. The increasing proportion of imaging modalities that generate images in digital form has lead to the development of digital image management systems. Such systems referred to as Picture Archiving and Communication Systems (PACS) are emerging in clinical and radiological environments. Hope you find this issue informative and enjoyable.

Dr. Ravi Gupta ravi.gupta@elets.in

may / 2012 www.ehealthonline.org

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Cover Story

The

of

Cover

Fortune

India needs a RSBY like scalable model for providing healthcare protection to the poor, who are mostly working in the unorganised sector, and are bereft of institutional support systems By Dhirendra Pratap Singh, Elets News Network (ENN)

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Cover Story

E

vidence that we can gather from reliable sources provide a rather worrying picture of the average expenditure being incurred per hospitalisation. According to one study, in 2004, the average hospitalisation expenses of uninsured in India was about ` 11,553. For the year 2009-10, the mean hospitalisation expenses of the private health insurance industry stood at roughly Rs. 19,637 per annum. Mean hospitalisation expenses in Tamil Nadu and CGHS schemes is around ` 33,720 and Rs 25,000 respectively. Currently, there are three central government health insurance schemes run by two ministries (CGHS by the Ministry of Health and Family Welfare) and (ESIS and RSBY administered by the Ministry of Employment and Labour). These three models independently facilitate healthcare treatment for different sets of population whereas levels of care differ. Health insurance as a tool to finance healthcare has very recently gained popularity in India. While health insurance has a long history, the upsurge in breadth of coverage can be explained by a serious effort by the Government to introduce health insurance for the poor in last four years.

Universal Health Coverage It might seem surprising, but just as the world is recovering from the most serious financial shock since the World War II, governments around the world are engaging in serious discussions on how to expand health coverage. This new wave of universal health coverage, or UHC, has touched nearly 100 countries. All these na-tions are now conducting studies on how to institute governmentfunded programmes for healthcare. This concept is taking off in populous countries and traditionally UHC “blind spots,” such as Indonesia, China, India and South Africa. These four countries account for 40 percent of the world’s population. Unlike the US, emerging economies are not buying the argument that healthcare is largely the re-sponsibility of individuals and businesses, with a public provision relegated to special interests, includ-ing the elderly, veterans and the indigent. Health insurance is one of the fastest growing businesses in general insurance.

Dr RD Lele

Director, Nuclear Medicine Dept, Jaslok Hospital & Research Centre

“The poor do not need charity, they need micro finance support” McKinsey forecasts an ` 25000-30000 crore health insurance market by 2015, at a CAGR of 25-30 percent. The health insurance industry, worldwide has benefitted immensely with the implementation of information technology, which offers a win-win situation for all. This session discussed enhancing equity by bringing healthcare to the masses. In India, private health insurance has resulted in cost escalation and inequity in health financing pattern. The cost-effectiveness of healthcare provided by the

private sector could be questioned. This is likely to be the case in a country that depends heavily on fee-for-service in a large and an unregulated private sector healthcare. If stringent regulatory structures and an effective implementation mechanism are put in place, the deleterious effect of voluntary private health insurance can be ameliorated to some extent. India in the last three years (since 2007) has witnessed a plethora of new initiatives, with the central government and a host of state governments entering the bandwagon of health insurance. One of the reasons for initiating such programmes can be traced to the commitment that the governments in India have made to scale up public spending in healthcare. Given the commitment to upscale government expenditure on health (central and state governments put together) from the present 1 percent to 2-3 percent of GDP, the central and state governments have been devising plans for spending the additional resources through innovative schemes. Among others, these include enhanced access and availability of essential healthcare services, protecting households from financial risk through schemes such as, National Rural Health Mission (NRHM), and Rashtriya Swasthya Bima Yojana (RSBY). The State specific initiatives include Rajiv Aarogyasri (Andhra Pradesh), Kalaignar’s Insurance Scheme for Life Saving Treatment (Tamil Nadu), Vajapayee Arogyasri & Yeshasvini programs in Karnataka.

P. Rammohan

Managing Director, Healthsprint Networks Pvt.Ltd

“With a growing backlog of claims the market is ripe for IT solutions that reduce a company’s operating costs and improving customer experience”

MAY / 2012 www.ehealthonline.org

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Cover Story

Health financing challenges • Increase in healthcare costs • High financial burden on the poor • Need for long term and nursing care for senior citizens • Increasing burden of new diseases and health risks • Due to underfunding, preventive and primary care and public health functions are yet to meet their objectives

The way ahead • Creating awareness on Rights & Responsibilities • Data Pool – Regulator as a repository • Standardisation of Cost • TPAs • Increased Tax benefit • Removal of Service Tax • Standardisation of definition – a right step ahead • Standard Pre-Existing exclusion defined • Gradation of Health service providers • Pool for Senior Citizen • Renewability / Portability • Compulsory Health Benefits for organised sector • Government role on mass healthcare initiatives

Health insurance, no doubt, has emerged as an important financing tool as it promises to mobilise some resources from the people themselves i.e., those who buy insurance. But health insurance, which strengthens demand side, makes sense only when the supply of health care is reasonably well developed. Where this is not so, health insurance is meaningless. The supply of healthcare in the rural and remote areas of country is far from satisfactory. Although public healthcare centres are pervasive, these centres have degraded overtime in most states due to lack of funds, accountability and other reasons. Any attempt at introducing health insurance for the poor must also be accompanied by revival of healthcare facilities at these centres. Says Dr RD Lele, Director, Nuclear Medicine Dept, Jaslok Hospital & Research Centre, “Income secu-rity and health security are two sides of the same coin, especially for the poor who are at the heart of MFIs. My recommendation to government is upgrade RSBY card to my bronze card and provide micro finance to BPL Indians. The poor do not need charity, they need micro finance support.” He adds, “I visited Taiwan in 2010 to see at first hand the National Health Insurance of Taiwan working successfully since 2004. All 23 million citizens of Taiwan have universal health insurance. Each citi-zen has electronic health record, computerised prescription and links to clinics and hospitals. Taiwan health insurance is mak-

Dr Nishant Jain

Sr. Technical Specialist (Health Insurance & Health Finance), GIZ - Social Protection

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“RSBY monitoring on a day to day basis has led to policy corrections to make it more realistic. Monitoring has been greatly enabled by technology”

ing losses since preventive Healthcare is not integrated with health insurance. Mumbai, Thane and New Bombay together have a population of 23 million. We can do better than Taiwan in this respect by combining preventive health care with health Insurance.”

IT in Health Insurance The Internet is a vital link to increasing functionality and interconnectedness for sharing data and information. Hospitals and physicians need quick response to verify health benefits coverage of their patients and status of transactions. In addition, Internet functionality of a business process and its related data facilitates a payer’s ability to increase customer satisfaction by providing Web access to healthcare providers for submitting pre-approvals and claims electronically. Initiatives by government of India like legalising digital signatures for use in e-commerce bring in credibility and accountability in enabling web transactions for health insurance. With Central and State governments rolling out social insurance programmes, the eco system is moving towards customer centric outcomes. Says P. Rammohan, Managing Director, Healthsprint Networks Pvt. Ltd, “Payers around the world share the same concern – how to stay competitive while healthcare costs are on the rise. In the past, many companies approached this challenge by trying to roll out premium rate increases to their cus-tomers. This strategy is being met with resistance from employers and retail consumers. With a growing backlog of claims and continually rising costs of administrative processes and medical care, the market is ripe for IT solutions that reduce a company’s operating costs and improving customer experience during a claim process. He adds, “For those considering adopting technology solutions, the decisions range from identity management, automating claims processing and using intelligent adjudication and score card systems. Among the high priorities are predictive analytics as a tool for underwriting processes.” Industry analysts believe the level of automation in a payer’s business processes is now becoming the key suc-


Cover Story

Expertise in All Stages of Health Insurance Life Cycle with Large deployment for Central, State Government and Private Health Insurance Schemes I Sprint: Health Insurance Payer Solutions

MAY / 2012 www.ehealthonline.org

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Cover Story

cess or failure factor within the sector. In addition to outdated paper processes, studies show that many payers are affected by a high inefficiency factor in the automated systems they currently use. Often, they achieve less than 50 percent of the possible efficiency in their backoffice systems simply because they are unaware of benchmarks and what they should be able to accomplish. Buyers, therefore, must understand not only what technology solutions to adopt, but also how to mitigate risks in those business solutions as existing technology evolves or new technology emerges. Highlighting the role of Rashtriya Swasthya Bima Yojana (RSBY), Dr Nishant Jain, Sr. Technical Specialist (Health Insurance & Health Finance), GIZ - Social Protection says, “RSBY has been able to meet the desired expectations. The scheme was designed meticulously by keeping the characteristics of the beneficiaries into consideration. It has initiated experiments out-patient care as well by empanelling general practitioners. RSBY has initiated experiments out-patient care as well by empanelling General Practitioners.” He adds, “RSBY monitoring on a day to day basis has led to policy corrections to make it more realistic. Monitoring has been greatly enabled by technology.”

Health Insurance in India • Government is both Financial and Service Provider in Health Sector in India • Government spends only 1% of GDP on Health • Government is suppose to provide free health care to the population across India with their own infrastructure at different levels • People spend on an Average ` 3000 even when they are hospitalised in a Government hospital • Though the facilities per se are free but a lot of these expenditure is related to the medicines, diagnostic tests, food, transportation etc. • To take care of these expenditures people often have to borrow money or sell assets • 7.6% of households fall BPL due to healthcare payments. • Very Low penetration of Health Insurance (Less than 100 million people covered with health insurance till 2007)

Dr Siddharth Agarwal Executive Director, Urban Health Resource Centre

“A person from poorest quintile of the population, despite more health problems, is 6 times less likely to access hospitalisation than a person from richest quintile”

The Health Insurance Portability On 10 February, 2011, the insurance regulator, IRDA (Insurance Regulatory and Development Authority), issued a notification which would allow any health insurance customer to shift from his existing insurer to any other insurer he deems to be better than his current one. Portability will mean greater competition within the health insurers to retain customers which will compel them to constantly improve their efficiency standards in terms of customer engagement and relationship along with the service levels. Under the portability regime, pre-existing diseases (PED) are transferable. This comes as a respite to policyholders who bear with deficient service for fear of losing their PED cover. If the customer shifts to a location where new insurer does not have an office, she/he has the luxury to continue with the new insurer.

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Health insurance portability allows the customer to switch to a different health insurer with benefits from previous insurer being carried forward. While the process seems quite simple for the customer, the execution for the health insurance providers will not be without obstacles. There is the possibility of the customer shifting to the next cheapest option available. Also the provider will need to develop a more robust electronic customer data management system as per the mandatory requirements for sharing of customer information. With the possibility of the customer shifting to another insurer year-on-year, the only major way for the companies will be to provide a robust network of hospitals and coverage’s along with superior customer service. By providing this to the customer, they will be able to retain their

more profitable and loyal customers. Health insurance scheme for the poor should take care of not just the inpatient or hospital care, as designed in the proposed scheme, but also of the outpatient care. It is often suggested that insurance be provided only for inpatient care and that outpatient care be left outside the ambit of insurance. The reasons given are: that people can, by and large, afford out-patient care because it is relatively inexpensive; it is the inpatient care that pushes them into debt trap. Ideally, both inpatient care and outpatient care must be covered, and the decision of whether or not a patient needs hospitalisation should be professionally made. For this reason the UNDP sponsored experiments on community based health insurance, launched recently, has addressed the issue of outpatient care as well.


Special Focus

Inclusive Growth is New Mantra The Rashtriya Swasthya Bima Yojana (RSBY) has witnessed unprecedented growth. It is now being heralded as the largest open health insurance programme, not only in India but also worldwide By Dhirendra Pratap Singh, Elets News Network (ENN)

I

ndia is rapidly transitioning from a large, rural and agriculture-based economy to a modern, entrepreneurial, economy, which is ready to take a place of pride in the community of world’s leading nations. The advent of an array of latest communication technologies ensure that the transformation is widely visible to our entire population, whether they are part of the growth story or not. As the nation grows, there are new demands for better healthcare services. Over the years, the government has substantially changed the strategy by which it seeks to achieve the goal of universal healthcare. The Indian state has started focussing less on direct interventions; the concentration is on developing initiatives that are use modern technology and at times private capital to bring benefits to the people.

Insuring the nation Rather than provide healthcare solely through the government-run Primary Health Centres, the state is implementing the Rashtriya Swasthya Bima Yojana, which allows the poor to receive healthcare from recognised private as well as government hospitals. RSBY has been launched by Ministry of Labour and Employment, Government of India, to provide health insurance coverage for Below Poverty Line (BPL) families. The objective of RSBY is to provide protection to BPL households from financial liabilities arising out of health shocks that involve hospitalisation. Beneficiaries under RSBY are entitled to hospitalisation coverage up to ` 30,000/- for most of the diseases that

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RSBY provides the participating BPL households with freedom of choice

require hospitalisation. Government has even fixed the package rates for the hospitals for a large number of interventions. Pre-existing conditions are covered from day one and there is no age limit. Coverage extends to five members of the family, which includes the head of household, spouse and up to three dependents. Beneficiaries need to pay only ` 30/- as registration fee while Central and State Governments pay the premium to the insurer selected by the State Government on the basis of a competitive bidding. RSBY provides the participating BPL households with freedom of choice, between public and private hospitals. Thus the BPL households become a potential client worth attracting on account of the significant revenues that hospitals stand to earn through the scheme. The scheme has been designed as a business model for a social sector with in-

centives built for each stakeholder. The insurer is paid premium for each household enrolled for RSBY. Hence, the insurer has the motivation to enrol as many households as possible from the BPL list. This will result in better coverage of targeted beneficiaries. A hospital has the incentive to provide treatment to large number of beneficiaries, as it is paid per beneficiary treated. Even public hospitals have the incentive to treat beneficiaries under RSBY, as the money from the insurer will flow directly to the concerned public hospital which they can use for their own purposes. Insurers, in contrast, will monitor participating hospitals in order to prevent unnecessary procedures or fraud resulting in excessive claims. The key feature of RSBY is that a beneficiary who has been enrolled in a particular district will be able to use his/ her smart card in any RSBY empanelled


Special Focus

hospital across India. This makes the scheme truly unique and beneficial to the poor families that migrate from one place to the other. Cards can also be split for migrant workers to carry a share of the coverage with them separately.

Monitoring RSBY is evolving a robust monitoring and evaluation system. An elaborate backend data management system, which can track any transaction across India and provide periodic analytical reports, is being put in place. The basic information gathered by government and reported publicly should allow for mid-course improvements in the scheme. It may also contribute to competition during subsequent tendering processes with the insurers by disseminating the data and reports. RSBY is being pushed on a bigger stage. The Unorganised Workers Social Security Act 2008 further extends this scheme, along with other life insurance and pension schemes, to large parts of the non-BPL population. The National Advisory Council wants to expand the RSBY into a National Health Entitlement Plan that guarantees universal free access to both in-patient and out-patient care (currently, the RSBY is limited to the former). This could have severe fiscal and growth implications down the road.

Central India In Chhattisgarh, the smart card issued under Rashtriya Swasthya Bima Yojna (RSBY) for providing healthcare cover to people living below poverty line will now be used for the distribution of grains at cheaper prices through public distribution system. Though the scheme turned out to be a flop in Uttar Pradesh, Delhi and Maharashtra, Bharatiya Janata Party-ruled Chhattisgarh is going to implement the scheme. Chhattisgarh government has made all arrangements for providing cheap rations to the smart card beneficiaries through the PDS. As per the plans, the 64 KB health smart card providing ` 30,000 health cover to BPL families will have the records related to the grains distributed through government-run ration stores. Ration card number and the detailed description related to the distri-

Future Focus Areas for RSBY

• For expenditures beyond ` 30,000 different State Governments are linking with other funds/ schemes • RSBY provides them a platform to transparently deliver this • Improving the quality of service at the hospitals • Government of India has designed a Quality management system • Evolving a robust back-end database management • Capacity Building at each levels for all the stakeholders • Cover OPD linked with RSBY (Experiments going on) • Store Health data on the smart card with proper security • Use the Smart Card for other targeted interventions

bution of grain will be registered in the card. Interestingly, this will help in bringing transparency in the PDS. The Centre-sponsored RSBY provides ` 30,000 annual health cover to about 28 million families in the country. According to sources, the scheme has been running successfully in many states, but it has received poor response in UP, Delhi and Maharashtra.

Jammu and Srinagar It is now operational in the prime districts of Jammu and Srinagar. The state government also plans to implement the scheme in other districts within a year. The project was launched by the central government some years ago, but was unfortunately not implemented in Jammu and Kashmir then. About 24 percent of Jammu and Kashmir’s population lives below the poverty line. This scheme would ensure they receive timely medical aid, especially during emergencies.

North East Mizoram has made it mandatory for every doctor to serve two years in remote areas. Now, doctors do not mind serving in remote areas since they have a fixed tenure of two years. A total of 110 healthcare officials were recruited in 2009 and 2010 and posted to rural areas. The results are self-evident. Malaria deaths have come down from 119 in 2009 to 31 in 2010. Admission of pregnant women in hospitals for delivery has increased from 65 percent in 2008 to 76 percent in 2010. Mizoram is also the only state in the North-east to have a government eye bank. Now, every registered poor patient

gets treatment worth ` 1 lakh free in government hospitals. The critically ill get free treatment of up to ` 3 lakh.

Smart cards to deliver life insurance cover The government will use smart cards issued for the Rashtriya Swasthya Bima Yojana, or RSBY, to also deliver life insurance cover to the poor. The finance ministry will ride on the RSBY delivery mechanism to provide life insurance cover to the poor under the Jan Shree Bima Yojana. There are a large number of RSBY beneficiaries who are so far not included under JSBY, but they will now get covered. As we expand the RSBY scheme to more unorganised sector workers, it will also help spread the JSBY scheme. The decision to incorporate the JSBY in the RSBY card is at present being examined by a technical team which will make the required changes in technology. The government has already approved increasing the capacity of the RSBY card from 32 KB to 64 KB to store more information.

Great relief to poor An investigation into the Rashtriya Swasthya Bima Yojana (RSBY) has suggested that the open health insurance programme provides a great comfort to the economically poorer strata of society. Under the RSBY, over 26 million family groups have been insured and the hospitalisation costs of over 3.5 million people have been borne. The bottom line is that the RSBY has witnessed unprecedented growth during the last few years. Now it is being recognised as the world’s largest open health insurance programme. may / 2012 www.ehealthonline.org

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Special Focus

IT Intensive

The investigation shows that contest has pushed the reward down even though claims proportions have increased. The Government has set a ceiling price of ` 750 per family for RSBY.

However, the median reward per family has actually come down to around Rs 500-550. In states like Himachal Pradesh and Uttarakhand, the reward is under Rs 400 per family.

For the first time IT applications are being used for social sector scheme on such a large scale. Every beneficiary family is issued a biometric enabled smart card, which holds data pertaining to fingerprints and photographs. All the hospitals empanelled under RSBY are IT enabled and connected to the server at the district level. This will ensure a smooth data flow regarding service. President Pratibha Patil, in her recent address to Parliament, said it was expected that the RSBY scheme will be expanded to 70 million families by the end of the Twelfth Five Year Plan, which begins from the current fiscal. The finance ministry has already allocated ` 1,500 crore for the RSBY scheme for fiscal 2012-13, against just ` 360 crore allocated last year. Even the last year’s allocation had been increased through supplementary grants.

Insured by the State Dr T.S. Selvavinayagam, Joint Director of Health Services, Government of Tamil Nadu, tells us about the Chief Minister’s Comprehensive Health Insurance Scheme

I

n order to bring to fruition the objective of universal healthcare for the people of Tamil Nadu, the Government has issued orders for implementation of new insurance scheme, in the name of Chief Minister’s Comprehensive Health Insurance Scheme. United Indian Insurance Company Ltd., was selected to implement the scheme and paid premium at the rate of ` 497 per family per annum. A sum of ruppes750 crores has been allotted for the scheme during this financial year 2012-2012. Persons with income ceiling limit below ` 72,000 per annum are eligible under new scheme. The sum assured is rupees one lakh per year, per family, along with a provision to pay up to ruppes1.5 lakh per year, per family, for certain specified 77 procedures. Hence up to four

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lakhs converge being provided to each family in four years. The new scheme will cover 1016 procedures, which include 23 important diagnostic procedures and 113 follow up procedures. For identifying the beneficiaries under the scheme, 64 KB scosta certified smart card is generated using the existing data base (of previous scheme) and distributed. Additional new enrolment is done through district Kiosk established in the district collectorate. We intent to cover around 1.34 crore families under the scheme and as on 23 April, 2012, we have printed 72, 05,550 smart cards, which are now being distributed. By prescribing minimum required criteria hospitals are being empanelled to serve under the scheme. Eight hundred and one hospitals have been empan-

elled; the number including 98 Government Institutions, including all Government medical colleges and district headquarter hospitals. All the hospitals must undertake at least one health camp in a month to screen the public under the scheme. The scheme was inaugurated on 11.01.2012 by the state chief minister and as on date (23.04.2012), 35957 persons have benefited. The approved amount for the beneficiaries is rupees 94, 09, 98,306. 1800 425 3993 (a 24 hours toll free number) is available for the benefit of the public. By dialling this number they can get all the details about the scheme. District level monitoring and grievance committee is established under the chairmanship of District collector to ensure smooth functioning of the scheme. The details of the scheme is also available at www.cmchistn.com


In Conversation

“RSBY

Model is Quite

Revolutionary� Anil Swarup, Director General of Labour, Ministry of Labour & Employment, Government of India, has translated a dream into reality by conceptualising a remarkably innovative and dynamic policy - Rashtriya Swasthya Bima Yojana (RSBY). With its approach to implementation at variance with the past efforts, the scheme not only avoids the pitfalls of the earlier schemes, it goes a step beyond and provides a world class model. In an interaction with Dhirendra Pratap Singh, he shares his perspective on this unique health insurance scheme. He also throws light upon the role of IT in streamlining this scheme. Excerpts:

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In Conversation

What are the remarkable achievements of RSBY in the recent years? The scheme provides cashless treatment of up to `30,000 annually to a family of five at empanelled government and private hospitals through smart cards for a token annual premium of `30. The scheme initially targeted only below the poverty line (BPL) families, but is now being extended to unorganised workers such as coolies, rickshaw pullers and miners. We are happy that use of smart cards became the basis of RSBY. Smart card technology helps in the identification of beneficiaries through biometric system. We have seen in the past that large number of schemes in our country have had trouble, because the beneficiaries were not clearly identified and there was no foolproof method of proper identification. Rashtriya Swasthya Bima Yojana (RSBY) has generated greater demand from women who tend to neglect their health because of financial reasons. The scheme is being implemented almost by all state governments targeting universal coverage of the entire BPL population in India. Andhra Pradesh is implementing this scheme, despite its own insurance scheme Aarogyasri. How has the implementation of IT helped in developing and facilitating various processes of RSBY? RSBY is an IT enabled scheme. It will lead to healthy competition among public and private healthcare providers and lead to real improvements in health infrastructure especially in rural areas. When the person goes to a hospital for treatment, the data is verified with the data on chip and it enables the offline system. Smart called also helps to ascertain whether there is sufficient amount available in the card or not. The strength of the scheme lies in the fact that it is a social welfare scheme, in which the profit made by the various stakeholders acts as a catalyst. The smart card is portable and valid in all the network hospitals throughout the country. This ensures that all the migrant workers from the states of U.P, Bihar,

The strength of the scheme lies in the fact that it is a social welfare scheme, in which the profit made by the various stakeholders acts as a catalyst

Orissa and West Bengal are never denied medical attention even when they are working miles away from their homes. As per current data, 28 million cards have been issued to poor families in 330 districts in 27 states. Government extended its benefits to building and other construction workers, Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS) beneficiaries, street vendors, beedi workers and domestic workers. How do you see the role of private sector to achieve the goals of RSBY? The fact that private groups are interested in participating in RSBY by paying premium proves that the scheme is also a successful business model. The trend of private hospitals coming up in districts where there were none before - bolsters the view that government should move into healthcare financing rather than run hospitals. RSBY is today considered a successful public/private partnership model in terms of outreach and sustainability and may well become a precursor to other schemes in the social sector. I believe that RSBY model of public private partnership in the social sector can become a precursor to other schemes. This partnership is on display at villages where a team of technicians from a third-party associate, or subcontractor, of the insurance company, village health workers, the headman and district health officer work together to enrol villagers.

How do you see the future of such health insurance schemes in a nation like India? This is the first time India’s power in IT technology is being used to run a national social security programme. RSBY is rated as one of the top 18 schemes by an international body; it has been also appreciated globally. It is appreciated by International Labour Organisation and G-20 labour ministers’ conference held in Washington. Under RSBY, the beneficiary has the flexibility to choose the hospitals, both in the private and public domain, anywhere in the country. He is not tied down to a delivery point as in case of almost all the public sponsored social welfare schemes. The National Rural Employment Guarantee Scheme (NREGS) ties him down to a particular project and the Public Distribution System (PDS) to a shop. The beneficiaries under these schemes have no choice. By giving the beneficiary a choice under RSBY, so that he may determine the delivery point, the beneficiary is empowered. What are the challenges in implementing RSBY? To reach out to the beneficiaries is a major challenge. Another, challenge is capacity building. We have seen some fraud cases during the implementation. We are taking care of those faults. In case of fraud control, everyday this data flows through the net. They are able to see the trend on daily basis. In this way they can verify that in which hospital what goes wrong. We can access data, analyse data and then take action. What are your future plans? The RSBY has started with below poverty line families and now it is going beyond BPL. It is extending to the street vendors. It has been extended to MGNREGA beneficiaries and beedi workers. Railway Ministry is going to extend this scheme to railway portals and postal department. I believe that RSBY is the first ever business model for social sector in our country. Actually, we must understand that fortunes can also be made by working for people at the bottom of the pyramid. may / 2012 www.ehealthonline.org

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In Conversation

“IT is Leading to Wider Outreach of Our Services” ICICI Lombard has a vision for health insurance sector, wherein the entire claim process can be made paperless and capable of providing results in real time, according to company’s N Eswaranatarajan, the Head of Operations & Technology. In conversation with Dhirendra Pratap Singh, he sheds light on the role of IT in Indian health insurance industry

Tell us about your views on Rashtriya Swasthya Bima Yojana (RSBY). Technology is the most effective tool that is utilised to reach the masses. We were the pioneers in using a Smart card which is the base product on which technological interventions are done to ensure it reaches the right beneficiary in the BPL segment through Rashtriya Swasthya Bima Yojana (RSBY). One of the largest mass health insurance programmes in the world, RSBY provides health insurance to five members of every BPL family. The biggest USP of the RSBY scheme is the empowerment it provides to the beneficiary. By being an RSBY smart card holder, the beneficiary has the freedom to choose

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from the empanelled private as well public hospitals to avail the best possible treatment for his family. The scheme has been successful in delivering health cover to the economically challenged households across India. This scheme provides health insurance cover to the head of the household, his spouse and up to three dependent children or parents. As part of this scheme, smart cards embedded with biometric technology are issued to the beneficiary family. The fingerprints and photographs stored on the smart card facilitate accurate beneficiary validation and ensure that they get cashless access to medical care across empanelled public and private hospitals. The usage of biometric technology guarantees that each beneficiary has a unique identification, enabling validation of the medical claim balance available and foolproof authentication. The smart card reduces hospital and other administrative costs and the need for cumbersome admission procedures at hospitals, thereby providing a sustainable platform for the delivery of cashless health insurance at remote rural locations. RSBY also has a robust monitor-

ing and evaluation system that can track all transactions happening across the country and provide periodic analytical reports. We received The Golden Peacock Innovation Award, 2011 for the RSBY scheme. ICICI Lombard was recognised for deployment of biometric card technology to implement the scheme, which helped the Government of India to execute rapidly. We have utilised an in-house claim settlement team to take care of the IPD claims and small sized OPD claims from every part of the country and ensuring timely claim is paid to beneficiaries, Hospitals and OPDs. Also, rural POS has been placed in OPDs to ensure OPD Claims are settled in a cashless manner. Various Innovation projects like OPD on RSBY platform or Smart Card for Weaver policy with Ministry of Textiles are underway to ensure scalability of such policies and widening of the coverage What kind of opportunities do IT vendors have in health insurance sector? The health insurance industry provides various opportunities to the IT vendors.


In Conversation

As market leaders, we have pioneered the use of technology to most rule-based tasks in the insurance servicing space. From policy administration systems and underwriting solution to providing online access to the products sold by the industry, IT is driving the wider outreach of our services and driving down the costs. This obviously is for the benefit to the consumer. Today the industry provides products on-line without a human interface. E-channel has emerged as a formidable marketing platform for insurance solutions. Health IT has also led to connectivity solutions that connect health providers to insurance companies, hence speeding up the underwriting process. Technology today provides a seamless health profiling and risk assessment tool that also has long-term archiving and easy electronic recall. ICICI Lombard has a vision for the health insurance business wherein the entire claim process can be made paperless and real time between the healthcare providers, beneficiaries and insurance companies. This would be only possible through an efficient Health IT system. What kind of growth is Health IT witnessing? What is your market share? Hospitals and other healthcare businesses are realising that IT is a necessary ingredient for ensuring quality healthcare delivery and providing distribution width to reach new markets. The uses now range from enabling basic tele-medicine to the electronic sharing of complicated medical diagnosis between continents. Technology has also solved the previously existing heath limitations imposed by geographic segmentation. Today, IT companies are offering wide ranging solutions from simple connectivity to cutting edge medical interventions. The high quality imaging resolution in the medical diagnostic environments are enabling early diagnosis and precise interventional care. There is tremendous scope for further use of sophisticated technology in the healthcare space. We are the largest health insurance player in the private sector space. Our constant endeavour in developing our IT efficiencies

through significant investments in technology has been one of the major contributors in achieving this position. What are the challenges being faced by the healthcare companies in India today? The current healthcare infrastructure in India is inadequate and underdeveloped. The overall number of beds, physicians and nurses is low compared to other developing countries and international averages. The situation is worse in the case of tertiary beds and specialist physicians. The quality of healthcare is poor due to the dominance of unqualified practitioners and sub- optimal facilities. An additional 750,000 beds are required (from 1.5 million today to 2.25 million in 2013), of which 150,000 beds need to be tertiary beds. The number of doctors and nurses enrolled in medical colleges and nursing schools will have to triple over in the next 10 years. Moreover, the IT infrastructure available in 60 percent of the provider networks in the country is basic and mostly primitive in its versions. Today, the preventive healthcare market for over 160 million people largely funded by the corporate or government sector. To overcome these challenges and bring about the necessary changes, bulk of the investment will need to be made by the private providers. How do you think IT in healthcare has transformed the way treatment procedures are carried now? Technology has had a major positive impact in specificity, efficiency and quality of patient care. In India where the Health Industry lacks hugely in man power, video conferencing by specialists in case of

The current healthcare infrastructure in India is inadequate and underdeveloped. The situation is worse in the case of tertiary beds and specialist physicians

complicated cases has assured spread of apt medical advice even to remote locations. Doctors now have instant access to patients’ medical records on the go. The diagnostic reports are directly emailed and messaged to the doctor in case of abnormal findings, facilitating quick response. Technology today has even created the ability of beaming vital statistics from an ambulance to the ER team prior to the arrival at the casualty ward. What is your prediction for health IT market in the next 5-10 years in India? What are the growth contributors in the industry? As per Zinnov Management Consulting, currently, annual IT spends in hospitals in India is approximately $191 million and will touch $1.5 billion by 2020. A mid-size hospital in India spends between 1 and 1.5 percent of its turnover on IT, while a large hospital spends nearly 2 percent on the same. As the healthcare sector becomes more receptive to technology, numerous opportunities will open up for SCC (secondary care centers) and new entrants focusing on this space. SCCs can create a niche for themselves in areas like mobile health, embedded systems, developing low cost advanced devices, interface solutions, medical imaging, telemedicine and cloud based solutions. Enterprise mobility will be a major growth driver. Opportunity will also be created through the Cloud. The cloud enables a mid-sized company to develop a technology that can address a large audience, without investing upfront in expensive infrastructure. At the same time the cloud can enable smaller units like nursing homes to access and use technology generally available only to large enterprises. The phenomenal success of the telecom sector has set the stage for a similar explosion in the healthcare technology sector. Major government initiatives like the UID, the state data centres and broadband present a great opportunity for the Indian IT industry to provide the much needed quality and reach in healthcare delivery may / 2012 www.ehealthonline.org

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Expert Corner

It’s Time to Act Now Fraud is a big threat to healthcare and health insurance both, says Malti Jaswal, in conversation with Dhirendra Pratap Singh

H

ealth insurance has witnessed healthy growth during last decade. With gross underwritten premium of more than ` 13,000 crore, it takes second place, after motor insurance, in the general insurance segment. However, the growth, largely driven by high cost of private health care and out of pocket expense, has been accompanied by high loss ratios on one hand and customer dissatisfaction on the other. Measures taken by the insurance industry in recent times – sound underwriting, better pricing (especially the correction in pricing for group health covers), effective contracting with healthcare providers (fixed procedure costs, preferred networks etc.), efficient operational management have resulted in some improvements. But more such initiatives are needed in future. One of the emerging areas of concern relates to prevalence of fraud and abuse in health insurance, a fall out of multiple factors - unchecked growth of private healthcare providers without a regulator, public apathy to insurance fraud (perceived as victimless), inadequate and ineffective laws, miss-selling by insurance intermediaries, ambiguous contracts and insurance products, nonstandard medical protocols and practices etc. to name a few. Thus along with growth of health insurance, the fraud has also been growing, there are no exact estimates in the absence of industry level studies. Different experts peg fraud element to be in the range of approximately 5 to 20 percent, which translates into a whopping figure of around `750 crore to ` 2500 crore per annum. A colossal waste! Fraud in health insurance is not an India specific problem, it exists all over the world, including the developed countries like US, UK, Canada etc.. What

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Malti Jaswal Consultant – Health Insurance separates India from these countries is absence of response and treatment of healthcare fraud in terms of laws, stringent action and persecution of fraudsters, allocation of resources to detect and prevent fraud in major way. Here in India, there is no definition of fraud under IPC, nor any recourse to deal with same beyond Section dealing with ‘cheating’, Clinical Establishments Act yet to be adopted by all states, the journey to effective laws, statutes, anti-fraud forums as obtaining in the US, UK, Canada etc. appears a long drawn one. In the interim, it is for the insurance industry to deal with the issue in best possible manner. Health insurance fraud is perpetuated in various ways, primarily through healthcare providers in the form of excessive/inflated billing, phantom bills, falsifying records, use of unnecessary diagnostics, expensive drugs and surgical procedures, conducting multiple procedures etc. Fraud may also happen in connivance with customer, insurance intermediary or employees of insurance company or TPAs. Another dimension to fraud control has recently been added by the government sponsored health insurance schemes where the key objective is to ensure accessibility of healthcare for the poor beneficiary in time of need. The approval processes as regards to providers have been kept

as liberal as compared to mainstream commercial health insurance; it is a kind of free regime, open to gross misuse. The insurance industry and the regulator both now seem to be seized of the serious proportions the issue has assumed. IRDA recently issued circular on fraud policy and reporting by the insurance companies. It had earlier in 2011 floated RFP for analysis and reporting of industry wide fraud trends in health insurance. It is indeed high time for the insurance industry to act decisively to detect, prevent and deter fraud. It impacts healthcare as well as health insurance, making both inefficient and unaffordable, sometimes with dangerous health outcomes for the concerned person as well. A holistic approach the issue needs to be adopted which includes: • Defining fraud and abuse in insurance contracts, scoping and classifying acts of fraud on part of various parties involved • Defining whole gamut of response to fraud – warning, penalties, punitive action, legal recourse, pursuit of recovery of money, boycott, etc. • Forming anti-fraud forum to share information, data of fraudulent customers/providers/intermediaries (anti-fraud bureau), pursue joint action against fraudsters, form surveillance teams to nail the culprits, facilitate whistle blowers, liaise with medical bodies like MCI, local associations • Adopting better techniques, IT enabled tools and skilled manpower, forensic experts to investigate cases of fraud, to collect hard evidence • Pressing for effective laws with policy makers, the issue needs to be brought to the discussion table with active involvement and support


Conference, Exhibition, Awards July 2012 Yashwantrao Chavan Pratishthan, Nariman Point, Mumbai

Maharashtra’s Most Definitive Healthcare Event Event Objectives • • • •

Create a vibrant platform for senior industry leaders to share knowledge Provide opportunity of mutual learning among industry players Showcase existing success stories and best practices in healthcare industry Germinate new business ideas and winning strategies

Session Topics & Themes • • • • • • •

Market opportunities and growth patterns of Maharashtra’s healthcare industry Technology strategies and roadmaps for modern hospitals Investment needs and prospects Emerging business models in healthcare Best practices in hospital management and operations Quality control and service excellence Managing human resource issues in healthcare industry

Who should attend • • • • • •

CEOs, CMOs, CFOs, CIOs, CTOs of healthcare organisations Health Secretaries and senior government officials Senior administrators, HODs and business managers of hospitals Investors from private equity and venture capital firms Vendors and suppliers of hospital materials, technologies, equipments and devices Healthcare consultants and experts

For Enquiries, Contact, Divya Chawla divya@elets.in, +91-8860651643

For updates, visit: mhs.eletsonline.com


In Conversation

Jitesh Mathur SR Director – Patient Care, Clinical Informatics and Ultrasound Philips Healthcare India

Patient monitoring and ICUs is a very attractive segment in India. Philips has a very large portfolio of products in this segment, which includes high cost products and low cost products, which are extremely affordable and competitive

“Our Ever-expanding Patient Monitoring Portfolio Meets the Diverse Needs of all Levels of Healthcare Set-ups” 26

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In Conversation

Philips continues to be the leader in the Indian patient monitoring market, year after year. What is your success mantra? Philips is a global leader in patient monitoring and we have been able to maintain the leadership position in India, as well. Our products and technologies, such as IntelliVue patient monitoring series, are far ahead of competition. Our patient monitors present high technical capability to users to take care of patients in the ICU in a manner, which is far ahead of what the other companies are doing. Our team here is highly trained and professional and has been able to install patient monitors throughout the country. We, currently have more than 40,000 patient monitors installed across India. Further, some of the clinical decision support technologies that we put in our monitors enable the clinicians to deliver better care as, in addition to giving diagnostic information, they provide protocols and pathways, which can be used to treat patients in a better manner. We are introducing new products in high-end and low-end segment almost every year. What is the size of the Indian patient monitoring market and what is your share? The estimated patient monitoring market in India is roughly valued at over Rs 275 crore and we enjoy a majority share in it. What are the latest trends and technologies in the patient monitoring market? The latest trend in patient monitors is clinical decision support system (CDSS). This enables patient monitors to guide doctors by using special algorithms on what needs to be done. For instance, we have ST Map for cardiac patients, which helps doctors to take quick decision on changing drugs or the treatment plan. Another emerging feature is wireless networking both in the high-end and lowend. Many times there are big hospitals that already have their ICUs constructed and don’t want to break the walls for setting-up LAN cables. So these monitors can be installed in the ICU with mission critical wireless networks so that data is

not lost. We have installed good number of wireless monitors across the country. In smaller hospitals, because of paucity of space, LAN cabling is difficult so they also want their monitors to be mobile rather than being stationary. We are able to provide these wireless monitors that can be moved around easily. How difficult it is to cater to a costsensitive market like India? We have a very large portfolio of products, which includes high cost products and low cost products, which are extremely affordable and competitive. For instance our Goldway patient monitor and SureSigns series are high-quality patient monitors developed for emerging markets like India. Even the high-end IntelliVue series has a portfolio to pick from, as per requirement. Important point here is no clinician wants to compromise on quality of life critical equipments. Hence, our objective is to make the quality available to every segment. Our USP is the product quality, technology and number of installations we have across India. We have gained a lot of expertise and we are introducing many new products every year. Our motto is once a Philips user will always be a Philips user and we use the same motto in our customer servicing. We have a huge inventory of parts and our engineers are very profoundly trained. Our prices are very market oriented. As we are selling in high volumes we are able to offer better pricing to the customer. How does your client list looks like. Our key clients include Fortis Healthcare, Max Healthcare, Apollo Group, Lilawati Hospital, BM Birla Hospital, Narayana Hrudyalaya, Yashoda Hospital, Bombay Hospital to name a few. We are also present across medium and small hospitals and nursing homes across the country. What are the challenges and opportunities for patient monitoring vendors? Patient monitoring and ICUs is a very attractive segment in India. More and more ICUs are being built. As patient awareness is increasing, physicians’ aware-

ness is also increasing. If at all critical care is to be provided, patients prefer going to at least 10-12 bedded fully functional ICU. While on the one hand existing hospitals are expanding and building more ICUs, smaller hospitals are also building ICUs to take better care of patients. Monitoring is also going out of the hospitals. Most of the good ambulances have patient monitors installed so transport is a big application. In anesthesia segment, more and more OTs are being created and patient monitors are being installed. Customs duty on imported monitors is still very high. In fact there has been an increase of one percent in the recent budget. This puts unnecessary pressure on the cost and although we absorb as much cost as possible, yet some of it is transferred to the market and then customers have to bear the additional cost. What initiatives is Philips taking in the healthcare IT space? We are fast expanding into telemedicine 2.0 instead of the earlier platforms that were being used. Healthcare IT is applications are being used in a big way in ICUs. We are looking at electronic records inside ICUs, which are called charting systems and these charting systems can maintain 100 percent record of the patient electronically. In a usual hospital or ICU, patient records are maintained on paper, and nurses make manual entries after monitoring all equipment. Now, we can connect all equipment to a charting system and the charting happens electronically, which reduces chances of medical errors. What are your future plans? We are introducing a lot of new products and we are looking at supplying new patient monitors to the market. We will be launching our MX700 and MX600 series of patient monitors very soon. We will also launch our eICU solutions, which will help hospital groups manage multiple hospitals and ICUs centrally. New electronic charting systems and customer decision support tools are also on the cards. We are also introducing a host of products in the value segment. may / 2012 www.ehealthonline.org

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tech trends

Monitoring that Counts

With large quantum of demand originating from the emerging economies, the activity in the global patient monitoring market seems to be up for a tectonic shift

By Dhirendra Pratap Singh, Elets News Network (ENN)

N

ovel patient monitoring systems are being developed to meet the demands of an aging global popula-tion. A few of these latest technologies include wireless communication systems that ‘sort’ the vast amount of data collected to enable modern systems take a succinct overview of the patient’s condition. The data becomes readable for portable and ambulatory monitors; web-based access to the patient re-cords is also facilitated. There are systems that can transfer data to an electronic medical record (EMR), and also enable full-service outsourcing to clinicians, who evaluate the data and send a report to the at-tending physician. There is also a constant rise in demand for continuous pulse oximetry monitoring. Technologies such as sophisticated algorithms, reduced level of false alarms, ease-of-use and flexibility of the remote alarm management solutions, ability to adjust the alarm levels on a patient by patient basis and easy to follow patient vital sign display at the central nursing station, are just some of the aspects that can enable healthcare workers to provide better care. With most of the demand originating from the emerging economies, the centre of the global patient monitoring market activity is up for a huge shift. India and China are forecast to grow faster than the average, driven by rise in the number of hospitals and large chronic disease populations. In India, estimated patient monitoring market size is roughly around `.230 crores. In all, five crucial product segments have been identified in this market, which include —multi-parameter

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patient monitors, wireless and ambulatory patient monitors, remote patient monitoring, non-invasive blood pressure monitors and micro-electromechanical systems. The growth in the patient monitoring market is driven mainly by wireless and ambulatory monitoring and micro electromechanical systems. Growth in the market for patient monitoring is also driven by increasing awareness among medical pro-fessionals. The rise in the number of patients suffering from chronic diseases is also fuelling the growth. The patient monitoring market is forecast to grow by 3.8 percent annually until 2015 to reach US $7.2 billion. A significant feature of the market is that certain segments within patient monitoring are developing rapidly, as compared to others, and are expected to follow similar growth patterns in future, as well. However, there are other segments that have yet not reached that level of growth and development. This has created unequal development of different segments as some are progressing faster than the others. Reports identify, wireless and ambulatory monitoring and micro-electromechanical systems to be the key segments driving growth globally. Demand for effective monitoring products and increased acceptance of technologies aimed at the homecare setting will be the key factors influencing and driving the penetration of products currently in pipeline. The market opportunity being significantly high, the products and technology landscape could see the emergence of a host of new companies with a stronger pipeline portfolio.


ov


Expert Corner

“Remote Web and Cellular Viewing is an Emerging Trend” Government’s increased focus on healthcare is an excellent opportunity for reliable monitors at good price point What is the market size of patient monitoring equipment in India? What are the key factors driving growth? The Indian Patient Monitoring Systems market size is estimated to be USD 65 million and forecast to grow at a Compound Annual Growth Rate of 15 percent. The overall market is driven by advanced but cost effective technologies. The key growth drivers of this market are: corporate hospitals expanding their network to tier 2 and 3 towns with increased focus; rises in healthcare expenditure; government initiatives to improve healthcare delivery; growing awareness of health insurance. What are the major segments in this market? What is their respective share of the overall patient monitoring equipment market? The Patient monitoring market can be segmented in to value, mid-end and high-end monitors. Value segment being a simple non-invasive monitoring of ECG, NIBP and Pulse Oximetry - where the price is the key factor. High-end witnesses an advanced technologies by having IT solutions integrated , viewing the patient diagnostic reports on patient monitor by connecting to the hospital information system, wireless connectivity and providing the modularity to have no limitation of adding any parameter with latest user interfaces like touch screen, remote keypad etc. where the clinical excellence and technology are the prime drivers. Mid-End is the segment which is more

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Mindray, GE, Spacelabs, Nihon Kohden, L&T, Schiller, BPL, Draeger etc.

Munta Suresh Babu General Manager - Patient Monitoring & Life Support Solutions, Mindray prominent and maintaining a steady growth by balancing the price and features. The value-wise high-end dominates with 46 percent share, mid-end and value with 37 percent and 17 percent respectively. The volume-wise value and mid-end segment each account for 40 percent share while high-end segment accounts for 20 percent. Who are the leading vendors in this space in India? What is their respective market share? Philips is leading this market by sustaining its number one position in this space. Other prominent players are

What are the latest and most innovative technologies available in the market of patient monitoring? Real-time data transmission from the ambulances to the hospitals by using the latest 3G technology helps doctors to suggest an immediate treatment, pre-plan and prepare for the treatment in advance. Remote web and cellular viewing is an emerging trend in the patient monitoring field that enables the specialists being anywhere in the world to access the vital patient information to provide the consultation. What are the major challenges faced by patient monitoring equipment vendors in India? What are the key opportunities? As there is no regulatory body in India that regulates the quality system, like SFDA in China and USFDA in US. There are many companies with a short term focus flooding the market with products; many of them are of sub-standard quality at a very low price. Differentiating the quality products and realising the value for quality has become a huge challenge in the market. Opportunities for healthcare sector in India are tremendous. Bed to population ratio in India is far behind from many developing countries. Government’s increased focus on healthcare is an excellent opportunity for the reliable monitors at a good price point.


Expert Corner

Future Consists of Integration of HIS Data More parameters have to be in place to enable doctors to have better knowledge of the condition of their patients, says V. Balakrishnan, Sr. Vice President, Schiller India What are the ways by which the strategically designed workflow in patient monitoring systems will lead to improvement in productivity and boosts the efficiency of healthcare? Multi-parameter patient monitor gives a comprehensive haemo-dynamic data through which the condition of a patient can be known. If a multi-parameter monitor is with wireless central station connectivity, then the patient can go for a check-up in the same vicinity and the data will not get lost on the central station. So here there is no requirement of para medical staff to disconnect the monitor. The comprehensive multi parameter haemo-dynamic data on the central station can be sent to the Doctor’s GPRS enabled handset from where he can check the condition of the patient online. The medical opinion can be obtained within seconds. The central station stores the data of various parameters of a monitor continu-

ously, so it acts as black box and a record keeping device. Telemetry devices are of various parameters and can transmit data directly to HIS and from where it can be sent to anyone, giving it an advantage over other devices.

government owned healthcare institutions? Narayana Hrudyalaya, Bengaluru; CHL Apollo, Indore; AIIMS, Delhi; PGI, Chandigarh, and few others are our key clients.

What are the challenges that you face while selling and installing such systems in India? The major challenge that we face would be the lukewarm attitude towards new technology that certain hospitals seem to have developed. HIS & HL 7 compatibility is in infancy stage in India as the major business contributors, which are the mid segment private hospitals, Government and semi Government institutes continue to avoid investing in software solutions. It is time for the hospitals to warm up to new technologies.

What is the future of patient monitors? Do you see such systems are becoming a tool for a coming together of different technologies, including knowledge databases and diagnostic reference systems? The future consists of integration of between HIS data and Haemo-dynamic data. Patient monitoring systems should be capable of providing more ideas to the doctors as well as the patient. The process of real body checking should become more efficient. More parameters should be implemented by the doctors to know the patient’s condition better. More medical facilities should be combined to provide a more comprehensive system of treatment to the patients.

Who are the key users of your systems in India? Are you also supplying your systems to

Catch up with Latest news, articles, interviews and case studies at www.ehealthonline.org may / 2012 www.ehealthonline.org

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Expert Corner

“Patient Monitoring Market is Still Growing� Patient monitors will have wireless connectivity to central stations, where patient data can be stored for longer periods of time

meters, single para monitors, whose market size is ` 10 crores; para monitors, with market size of around 25 crores; and there are the Para & Higher End Monitors, with market size of 90 crores. Who are the leading vendors in this space in India? Leading vendors are Phillips, GE, L&T, BPL, Schiller, AKAS, Maestros, and many Chinese players have also entered in the market.

Anthony Rozario .L Vice President Marketing (CCD), AKAS Medical What is the market size of patient monitoring equipment in India? What are the key factors driving growth? There is no authentic information for the market size, but my own estimate is that it could be in the range of ` 300 crores. The CAGR is expected to be around 12 percent over next 3 to 5 years. The CAGR is low because of the dropping prices of electronics goods, but increase in volume could be around 15 percent. What are the major segments in this market? What is their respective share of the overall patient monitoring equipment market? Patient monitoring can be classified into the following major segments - Pulseoxi-

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What are the key specifications of the latest patient monitoring equipment? Today customers are looking at EtCO2, gas monitoring options in patient monitors. Wireless connectivity to central monitors and data storage capabilities are a must. What are the latest and most innovative technologies available in patient monitoring space? Amongst the innovations in patient monitoring, we have features like, remote monitoring, patient data integration and management, telemetry, external device interfacing, device connectivity etc. Some worthwhile parameters include facilities like Glucometry, ICG Monitoring, DPM CO2, etc. What are the major challenges faced by patient monitoring equipment vendors in India? Chinese monitors, which are available at really low cost are a challenge for manufactures who are creating quality products that can only be sold at higher prices.

What is your share of the overall patient monitoring equipment market? What is the USP of your products? AKAS Monitors are branded as TRAZE and we have a share of about 2.5 percent in the segment that we cater to. We have been offering 5 year warranty for our products and this by itself is a proof of the quality and durability of our products. After all, a product that carries a warranty of 5 years must be really durable. Who are the key users of your systems in India? Are you also supplying your systems to government owned healthcare institutions? Our key users are in the middle segment. Yes we have also been supplying to quite a few government owned healthcare institutions in the country. How do you see the future of patient monitoring equipment market in India? What are the emerging trends and technologies? Market is still growing and the single para monitors will fade away. The 5 para monitor and the higher end monitors are growing in volumes. Emerging trend is that the patient monitor will have wireless connectivity to central stations, which can store the patient data for longer periods of time. This sort of capability facilitates electronic recording. The data can be remotely accessed by the central nursing station. The doctor can login to the system from any part of the world and check the medical status of the patient.


Expert Corner

Technology that Cares Patient monitoring technologies promise to deliver great results

Dr K V Krishnan Practice Head, Life Sciences, Mindteck The area of health care is no longer contained within the four walls of hospitals. Health and clinical issues as well as patient management are now more accessible even as persons are not physically present for treatment, monitoring and check-up. This has become possible with telehealth as well as telemedicine and home patient monitoring technologies that promise to deliver great results and more efficiency in terms of healthcare.

Most of the instruments such as BP monitors and Glucose monitors are quite user friendly. The accuracy of results depends on the user’s knowledge as well. If the instructions provided by the manufacturer are well followed, they are bound to give dependable results. Reproducibility can be checked for confirmation by repeating the measurements. New technologies in remote patient monitoring bear the potential to combat soaring healthcare costs and personnel shortages, and reduce hospitalisation times. The applications can range from monitoring a person’s heart rate while working out on a treadmill in a fitness club to transmitting a patient’s telemetry readings to a nurse over the Internet. In this model, the patient requiring care can be in a remote location, typically at home, from where he/she can be connected to the wide range of home care applications

which send relevant data to a central server. This central server in turn is accessible to the referring physician who can monitor and diagnose the patient without the need for physical presence near the patient. Lack of standardisation; lack of global regulatory policies governing technology usage; low awareness levels among patients and issues surrounding security of patient data also contribute to delay in adoption lifecycle. According to medical and health experts, there will be a continuous growing demand for these technologies. This is mainly attributed to the aging population and the elderly people. Since the elderly population is more prone to chronic diseases and ailments they are in dire need of an effective home health monitoring system as compared to being admitted in institutions which can be very expensive.

“Our Prime Focus is Easy and Affordable Access of Doctor” With patient monitoring systems medical database becomes an effective tool in better treatment of patient with informed decisions As we deliver home healthcare telemedicine Applications and devices, we may not be directly catering to patient monitoring needs in hospital, but our focus in to reduce the hospitalisation cost by looking and post surgical care with home healthcare monitoring devices which will be the future of healthcare. Current monitoring devices need to have ambulatory blood pressure as well. Currently no motoring devices have data storage or medical record storage technology which will be crucial for a doctor to analyse the patient health condition and recovery status. Our devices are equipped to record the data where doctor will have access to previous days’ reports at a glance which in turn helps in boosting the productivity. Current patient monitoring devices does not integrate with HIS and data is

not recorded in digital format. Currently we are deploying our touch screen kiosks for communication with a doctor at residential and corporate premises and we have not started marketing them in health monitoring devices space. India is one of the world’s most lucrative healthcare markets. In fact it’s the most competitive destination with advantages of lower cost and sophisticated treatments, according to latest findings by a report published in February 2012, by market research firm RNCOS. The hospital and diagnostic centre in India has attracted foreign direct investment (FDI) worth US$ 1,183.04 million, while drugs & pharmaceutical and medical & surgical appliances industry registered FDI worth US$ 9,170.24 million and US$ 514.08 million respectively, during April 2000 to January 2012..

S Jayadeep Reddy CEO & MD, e health Access Pvt Ltd may / 2012 www.ehealthonline.org

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Expert Corner

Emerging technologies in Patient Monitoring Systems Patient monitors should be standardised, scalable and mobile across all care units

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uture of patient monitoring is clearly based on IT integration, data access and capture from across hospitals and remote access from any point within the hospital or across globe. Protocol based standardised charting solutions saving on time and effort of care giver, recording the information flawlessly for future access and meaningful interpretation for clinical as well as costs evaluations. Today’s technologies talk about information access at bedside bringing together Vital signs, Information from HIS/ CIS, Laboratory results, Radiology images, etc at Acute Point of Care to accelerates clinical decision-making, improve care delivery and facilitate consultation between clinicians at the bedside including industry’s best technologies. Patient monitors should be standardised, scalable and mobile across all care units. This enables flexibility in staff utilisation, reduces training time. Scalability of patient monitors accommodate all acuity levels and patient types within and across departments, upgrades and expands with ease, supports the sharing of assets, helps build a tailored solution as the demands grow – smoothly and without redundancy. Standardisation, scalability and mobility also saves time preparing patients for transport and for their return, monitoring same parameters in transit as at the bedside, optimises staff and equipment utilization. This increases patient safety and productivity. Patient monitors should have device Integration to consolidate monitoring and therapy information for a better view of patient’s care state at a single point, providing a more complete view of decision-relevant patient data, supporting rapid treatment and generates more comprehensive chart-ready documents, automatically.

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Nikil Rao General Manager, Dräger Medical Technologies They should be IT enabled and open a pathway between patient monitoring and hospital IT systems which delivers highest performance, builds on existing, non-proprietary hospital infrastructure, offers literally infinite connectivity through open architectural design, connects effortlessly across multiple sites and finally allows system growth through a partnership between hospital IT department and Medical equipment supplier’s professional Services.

Bristol Royal Infirmary Healthcare costs a lot of money – and critical care is where a significant percentage is spent. That’s why healthcare managers are scrutinizing that particular part of the business. As a result, hospital intensive care units are being pressured to provide evidence of the quality of care they provide. Today’s ICUs are under a financial microscope. According to Dr Tim Gould, a visionary intensivist and critical care consultant at the Bristol Royal Infirmary (BRI) in Bristol, England, “The government is

starting to want to see value for money. Also, many intensive care organisations in different countries now have to come up with quality outcome measures that can be used to quantify how good an ICU is in terms of value. One measure is mortality, but the government also wants to see metrics regarding patient safety and quality of care.” Long realising the value of research, Dr. Gould wanted to be able to look at certain patient groups to see if various steps the ICU was taking – or not taking – had an effect on outcomes. He also realized that it’s virtually impossible to do that kind of research on paper.

Moving away from paper In 2005, the BRI needed to replace outdated patient monitors in its General ICU. Dr Gould, who then was Clinical Director of General Intensive Care, wanted to add a clinical information system within that replacement cycle because he was interested in taking the first step in replacing paper-based charting. He also wanted to be able to automatically collect information for research from devices such as patient monitors, ventilators, lab and fluid management systems, as well as manually collected data on medication, intervention and assessments. The BRI asked Dräger to install Infinity® Omega Plus patient monitoring systems in the 16-bed General ICU. The solution included an electronic charting system, the precursor of the Innovian® clinical information system. Innovian replaced the ICU’s manual charting, which consisted of a big A3 paper chart at the foot of every bed – one per day, per patient. So if a patient had a four-week stay, for example, the records were spread across 28 individual charts. Using that data for research was virtually impossible.


Expert Corner

Medical ICT Applications

A Renaissance ICT supported ‘Medicine’ shall serve in leveraging healthcare standards in present day world By Dr S C Garg

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hrough the use of information communication technology (ICT) and interactive intelligent agent support system software,the professionals shall be greatly facilitated world over , to overcome most of the limitations in the way of perfected clinical decision making. Such an option was impossible to achieve in pre-computer era, additionally technology shall constitute regular refresher of disease fundamentals / principles, which otherwise drop out of memory with passage of time or being rare in use. ICT supported ‘Medicine’ shall serve in leveraging healthcare standards in present day world, ushering in new era of comprehensive and interactive medical knowledge deployment, diagnosis finding, utilizable in clinical teaching & learning methodologies. Future users of this integrated technology shall be professionals, paramedics, patients and and even laypersons. The benefits and outcomes of ICT as may be speculated as astonishing in clinical & educative functionalities of the profession. Comprehensive knowledge management in Digital formats and its interactivity through ICT use shall be instrumental in leveraging healthcare performance in countries for communities, which are the cherished goals of WHO as projected in “WHO Global Knowledge Management Strategy.

International Scenario Since the dawn of allopathic era there has been exponential growth of vital medical databases,which has resulted in human limitations or even incapacitation in the way of handling of available medical knowledge, for which deployment of’ Programmed Medical Knowledge’ as instrument of Medical Information Communication Technology ( ICT) is

utmost essential for ‘perfected professional performance’. Since handling of intricate medical problems involves limitless permutations and combinations which are impossible to achieve through mind and memory applications alone. Accurate and brisk diagnosis is the sheet anchor of clinical performance. Without use of ICT it shall be impossible to root out imperfections or errors, which are global concerns. WHO is emphatic about promoting excess to comprehensive,high quality ,relevant ,targeted information products of ICT through knowledge management strategy for leveraging eHealth in countries for fostering an enabling environment((WHO, 2004, 2005)) and for bridging know do gaps which are major concerns. The human limitations in diagnosing were expressed by founding father of ‘Medicine’ (Osler , 1919). These limitations are even relevant today when 100,000 had died due to diagnostic errors (Press-pass, 2004) , and 2 billion dollars losses had occurred through clinical errors (Alberti, 2001) with added delays in clearance of bed occupancies. Information and communication technology needs to be component of any plans and strategies for health system reforms as suggested by (WHO, 2008), having large potential for transforming healthcare services in 21 st century. Tele-education and programmed medical information can reach remotely placed professionals and learners in developing countries through Internet constituting potent medium for “Doctors beyond Borders” for vast exchange of information and knowledge (Orbinski. 2000), contributing to much needed improvement in availability of healthcare around the world .The developing coun-

tries are aiming at developing further ICT technology for use in undergraduate curricula or for clinical usage, but for infrastructure limitations (William et al. 2010).

Economic Factors In times of recession or even otherwise, there is a limit of available resources which can be infused into healthcare services, and all round costs of healthcare are escalating in comparison to economic growth, hence the necessity of using ICT, for minimising loss of resources as achievable through accelerated disposals with accuracy, as integral part of healthcare (Snowball, 2007) 46 Introduction of ICT at institutional or at university levels may be inducted through policy, which can instrumental in constituting renaissance in present or even future healthcare services delivery. Medical ICT enabled technology for knowledge management and its deployment as clinical support system for practices and its inclusion in educational methodologies shall be of immense utility world over, as savior of lives and resources. The policy makers are the key holders for implementing this wonderful option for added glory to the profession. Times should not leave profession wanting.

About the Author The author is DCCMS at SARR Clinic Soft may / 2012 www.ehealthonline.org

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hospital ceo interview

“Indian Doctors are More Technology Savvy than the US Doctors” Max Healthcare is working towards making quality healthcare available to every person in India through adoption of innovative technologies. Ajay Bakshi, CEO, Max Healthcare, in conversation with Divya Chawla & Shally Makin, speaks about the key issues that affect the Indian healthcare industry today

As CEO of Max Hospitals, what is your vision and strategy for growth? Max is one of the best and most respected hospital networks in India; we are mostly focused in North India, which is a part of our strategy. What should really matter in a strategy is how you are adding value to your customer or patient. To a patient it doesn’t matter whether a hospital has 8,000 beds or 10,000 beds. What really matters is the quality of healthcare services provided. We don’t necessarily want to be the largest and the most profitable as profits are the requirement of doing a business but it does not imply that we keep 30 – 40 percent margin at the cost of everything else. What really matters to us is quality of care and quality of experience that the patient and the family undergoes in our hospitals. I am a doctor myself and I recognise how important it is and how difficult it is to deliver quality healthcare on a consistent basis. So my vision is not different from our Chairman’s vision, which is to build the best hospital net-

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work not only in the country, but also in the whole of the South Asia. We have had really a rapid growth in the last 6 months. We are moving from the 900 beds footprint, mostly in the NCR region, to 1900 beds footprint beyond NCR region, mainly in north India. We have opened 3 new hospitals in the last 6 months, including one in Shalimar bagh (300 beds), one in Mohali (200 beds) and one in Bhatinda (200 beds). We are also coming up with a hospital with more than 200 beds in Dehradun. Now, we are putting in place the systems, processes and measuring mechanisms to get the quality. We are very fortunate that we have some of the best doctors with us so the quality improvement will be easier to implement. Quality improvements will come from more scientific applications of management principles. Like improving the workflow when the patient comes to the front office till the time when he gets admitted. So there is process re-engineering and process re-design techniques that need to be done. Likewise there are many

things which we can be done in a better way by bringing in management principles from other industries. What is your procurement strategy in terms of material and manpower? As I said, our end objective is quality, so the reason for having multiple hospitals is to deliver better quality to more people. For this, we need to have real connectivity between these hospitals. There is a theoretical concept that you should be able to procure in a combined way because the procurement cost or the material cost is one of the largest costs. There is a second concept of accessing better talent because you are so large. If I have a hospital in Coimbatore, it needs to compete with other hospitals in Coimbatore. I won’t be able to hire a doctor in Coimbatore because I am a large network. The doctors’ was of thinking is very clear—is this hospital giving me a fair, cleaner and a better deal than the other hospitals? So procurement synergy is hard to get in a large disconnected network.


hospital ceo interview

Ajay Bakshi CEO, Max Healthcare

may / 2012 www.ehealthonline.org

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hospital ceo interview

We have well described Shatabdi strategy, which means that wherever Shatabdi train runs, we are happy to establish a hospital. This strategy also leads to greater connectivity of people, products like pathology specimens, processes and information and the patients. Patients should be able to move up and down

What is the role of ICT in hospitals? How far have you implemented it in your hospital? We are very well connected through the electronic network; we have electronic health records in all our new hospitals and in Saket. This allows the patient related information to be transmitted across the network. We have well described Shatabdi strategy, which means that wherever Shatabdi train runs, we are happy to establish a hospital. This strategy also leads to greater connectivity of people, products like pathology speci-

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mens, processes and information and the patients. Patients should be able to move up and down. The patient can be sent from Dehradun to Delhi, if there is some facility which is not there in Dehradun. Please brief us about the various technologies, software applications, medical and diagnostic equipments being used in the hospital to providing effective healthcare. We are the most advanced chains in the country in terms of electronic health records. We have implemented this in our 7 hospitals already and the rest are under implementation. We store everything for the patients so he does not have to worry about keeping his records safe and stored. So this adds tremendous value to the doctors as well as to the patients. Max has also digitised the records of its own departments. When doctors use the electronic health records for prescription for in-patient ordering, the system can pick up the errors of medication because it is very smart. If you go to the US, there are millions of medication errors in hospitals and there is a statistical data which shows that more than 100,000 patients die in the US because of medication errors. In India we don’t have the data to be honest. The reason is modern medication is very complex, patients have 4-5 diseases at a time and have 6-7 specialist taking care of them. So our system can pick up drug interactions and alerts and warn the doctors so that they can immediately mend the mistakes. This is very hard to do in a manual system. Around 1700 hospitals up and running and we have operationalised those beds very quickly and we have a plan which we will. 200 will come online in May. So that will compliment to the whole no. of 1900 beds across. How do you see the advancements in the field of technology in healthcare last few decades? How do you see the challenges in adoption of new technologies in health sector? We feel that Indians are very technology savvy. There are more than 700 million cell phones in India today. Even Indian doctors are more technology savvy than the US Doctors. So we have a right playground, not every player has to decide how he has to play, so technology has a big role to play. It is a philosophical issue but there is a disconnect between the technology field and the healthcare field. Healthcare is a very deep vertical branch. It takes you 15 years to be a surgeon. It takes 20 years to be a good neuro surgeon and you are so busy learning this stuff that you don’t understand IT or online wesites or what internet can do to do your job better. If you do an industry analysis, banking is the most advanced industry in terms of leveraging technology for doing day to day operations. Do we have a healthcare ATM? Why cannot we have it? How hard it is to have it? You can dispense coke in a machine manually, you can do blood pressure readings manually remotely. Nobody has invented healthcare ATM where you can go, get your BP or sugar taken and some doctor can see you and dispense medicines.


15 - 16 June 2012, Le MĂŠridien, New Delhi

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state focus

Vikas Kharage Mission Director, National Rural Health Mission, Maharashtra

Initiatives in NRHM Maharashtra The state unit of the NRHM has implemented a comprehensive e-file system which has enabled it to function as a completely paperless office. It has also led to quicker and better decision making and considerable savings in terms of money and time

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he Maharashtra office of the National Rural Health Mission (NRHM) has implemented an e-file system and is the only office without a single physical file in Maharashtra. The NRHM has been in the forefront of launching the e-file system programme in order to give better transparency and access to information on public administration processes which has been the thrust area of e-governance in the State. The Government of Maharashtra has been one of the pioneers in

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promotion of ICT and e-Governance in India and this initiative is a continuation of this approach. The Public Health Department is also implementing the e-file system in their offices at Mumbai and Pune. In the initial phase, 250 user ids for Mumbai and Pune offices were issued, including those for topmost officials in the Mantralaya. The digital signature so processed is valid for two years and is implemented with no cost for government offices except for customisation charges. The

entire project was implemented at a total cost of `19 lakh, including the expenses on creating an IT infrastructure for offices. A dedicated fibre optic line was connected to the Mantralaya in order to improve connectivity between the Departments. The connection used for the project has been provided by RailTel and is a 10 Mbps line.

Features of the e-File System The e-file system comprises of a systematic and stepwise process of distribution


state focus

ency in office procedures unlike manual systems. This leads to a faster decisionmaking process. No file can be missed or removed as it is copied on three back up servers. Monitoring is also easy as the system has provision for generation of many different kinds of reports. Previously, only 25-30 files were processed per day but with such integrated platform we now process around 70-80 files. ASHA are increasing taking part in majority of the health services provided to patients, particularly in tribal and remote areas. It is proposed to give awards to good functioning ASHAs. For provision of awards, the criteria will be : ASHA with good record keeping, consistent performance and higher compensation. In one district, 3 ASHA at district level and 2 ASHA per block will be given awards. Function will be organised under the chairmanship of President Zilla Parishad. Considering the services expected to be delivered, ASHA needs to get support from village, various health functionaries and health institutions. Therefore a strong network has been developed amongst all the stakehold-

Telemedicine is a rapidly developing application of clinical medicine where medical information is transferred via telephone, the Internet or other networks of day to day correspondence, managing the inward/outward documents, movement of files followed as well as remarks and decisions by the senior officers. All of this is implemented through an online system. A file can be transferred from one Department to another within minutes – a saving of 15 days compared to a situation when it would have been moved in the physical format. The file status can now be tracked easily. The software also allows use of regional languages, thus making it extremely user friendly. Implementation on a secured web-based system enables the officers to clear the files even if they are on tour. It saves time as well as enables faster file movements and brings transpar-

ers. NRHM has published guidelines regarding support mechanism for ASHA. Maharashtra has developed support mechanism as per the guidelines.

Rural Health Village health sanitation water supply and nutrition committee -VHNSC are established in every revenue village. VHC is provided with untied fund which has to be utilised for IEC, household survey, preparation of health register, organisation of meetings at village level, etc. Untied fund is made available through NRHM Flexible Pool Fund. Maharashtra has started upgrading the health institutions to IPHS since last two years. As per GoI guidelines, PHCs will be first

upgraded to 24Ă—7 PHCs and then to IPHS. Similarly, Hospitals will be first upgraded to FRU and then to IPHS. Telemedicine is a rapidly developing application of clinical medicine where medical information is transferred via telephone, the Internet or other networks for the purpose of consulting, and sometimes remote medical procedures or examinations. Telemedicine may be as simple as two health professionals discussing a case over the telephone, or as complex as using satellite technology and video-conferencing equipment to conduct a real-time consultation between medical specialists in two different places. In Maharashtra, all the 23 District Hospitals are connected with telemedicine network since 2009-10. During 2010-11, telemedicine facility is extended to 33 SDH/RH (one per district except Mumbai). These facilities are called patient node. These nodes seek expert services from 6 speciality nodes, out of which 3 are situated in Mumbai, and one each at Pune, Aurangabad and Nagpur. It has been observed that solar power system is very helpful at PHC level. There is severe electricity problem in state. IPHS health institutions require continuous power supply. Inverters are procured from Untied funds. Budget for express feeder is provided through User Fees collection and only deficit budget is paid through IPHS funds.

Online Payments In partnership with ICICI Bank, an online payment gateway has been integrated with the system. The integration was completed within eight days by a team of IT specialists. All the 472 banks across Mumbai and Pune have been linked through e-banking and the funds allocated to various districts can be thus tracked. It is now planned to introduce SMS alerts for transactions. We are also looking to engage 70-80 users in the health department by next year along with the Directorate of Health Department and all eight circles including all Deputy Directors. (In conversation with Shally Makin) may / 2012 www.ehealthonline.org

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RIS-PACS

Positioning Healthcare for the Future with RIS-PACS On the level of research, medical science is pushing the front and a range of amazing technologies are emerging, one of which is RIS-PACS. Great leaps in this vertical have been made during the last few years. Private companies and government owned entities are investing in quite a number of impressive research projects that are devoted to further enhancing the scope of RIS-PACS By Anoop Verma, Elets News Network (ENN)

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IS-PACS solutions are not only easy-to-use, they are also capable of being integrated on system-wide basis, they are highly intuitive, uncomplicated and user friendly. Many of the solutions are scalable, which means that they can grow according the needs of the institution where they have been installed. Patients can hope for much better service with RIS-PACS solutions. Whenever, the patient moves to another part of the

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country, and changes doctors, his or her medical information can follow digitally. This reduces the need for repeat exams and eliminates the physical transport of medical images and files. In order to gain an insight into the RIS-PACS solutions that are being installed at Indian hospitals, eHEALTH magazine interacted with few prominent stakeholders of the industry. What follows is the grist of the conversations that we have had with these stakeholders.


RIS-PACS

Delivering

Integrated Healthcare Solutions

“Magnum RIS-PACS caters to multi-site, multi-specialty hospitals, and also to independent diagnostic centres,” says Malav Kapadia – Vice President – Sales, HealthFore Tell us about the initiatives of HealthFore in the RIS-PACS space. HealthFore, a division of Religare Technologies, is focused on healthcare with the core purpose of being a provider of choice for delivering integrated healthcare solutions through innovative use of ICT. We offer transformational B2B and B2C solutions to both healthcare providers and consumers; solutions built on leading edge technology and backed by significant domain expertise. HealthFore’s offering, Magnum RIS-PACS, is an enterprise class, FDA approved, imaging solution. It is a comprehensive and fully-integrated web-based digital imaging and information solution for hospitals, clinics and diagnostic centres. We have a varied installation base for Magnum RIS-PACS. We cater to multisite, multi-specialty hospitals, and also to independent diagnostic centres. When it comes to Indian hospitals and other healthcare institutes, what are the key RIS-PACS requirements? The key requirements within an Indian Healthcare provider are as follows: • DICOM enabled advanced modalities – most of the latest equipment’s are DICOM compliant and there are few non DICOM modalities which can also be connected with sophisticated DICOMISERS. • Good connectivity – Highly reliable, fast and secure network connectivity. • Diagnostic DICOM workstations

that would be used by Radiologists for viewing, processing, analyzing, and reporting the studies. Digitizers to digitize films, in turn enabling a smooth transition from film to filmless. Support staff- Highly experienced IT personnel to provide quality support and maintenance

What challenges do you face while selling and installing your RIS-PACS solutions in India? There is lack of good infrastructure with good internet connectivity especially in the rural areas. We also face difficulties because at times the hospitals are reluctant to invest in latest technologies. There is lack of knowledge within the market about RIS – PACS and the transformation that it can bring about in the radiology department. Then there is also the issue of standardisation, which requires a system of interoperability between vendors. Tell us about your expectation from the government. We would like the government to make a provision for supporting healthcare IT infrastructure. There has to be a clear, coordinated policy from the government to promote healthcare IT. There must also be funding and tax rebates to enable adoption across all verticals. The healthcare fraternity must also be sensitised on the advantages of HIT. The government must also look at establishing data and system standards.

Who are the key users of your systems in India? Are you also supplying your systems to government owned healthcare institutions? Within the radiology space, Radiologists, Transcriptionist, Quality Control managers, Receptionists, Radiographers and IT Administrators are the key users of our RIS-PACS solution and Yes, HealthFore does provide to government owned healthcare institutions. What is the market size of the healthcare IT industry in India? Can you tell us the cost of installation of your solutions? According to a report by Springboard Research, India has the fastest-growing healthcare IT market in Asia, with an expected growth rate of 25 percent, followed closely by China and Vietnam. The Indian medical technology industry is forecast to grow from US$2.7 billion in 2008 to US$14 billion in 2020, as many Indian and overseas medical technology companies are developing innovative products for Indian market. The Indian healthcare IT market has seen the evolution of many models to cater to the needs of the local market. The cost for our solution could start right from INR 20 lacs and could go all the way to INR 1.5 Cr based on the number of modalities, modules required, type of storage, support, upgrades planned, integration with legacy solutions, need for disaster recovery etc. MAY / 2012 www.ehealthonline.org

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RIS-PACS

Stable, Scalable and Easy to Manage RIS-PACS Solutions “A fully integrated workflow involving RIS that is seamlessly integrated with HIS can result in enhancement of exam throughput by 30 – 50 percent a year after the installation,” says Suresh Ranganathan, General Manager, Agfa HealthCare (d) Efficient archival & retrieval of reports and images etc.

What are the focus areas of the RIS-PACS solutions that you are providing? We are entirely focussed on engaging with premium healthcare institutions that require enterprise level RIS-PACS solutions. We are also dedicated to introducing simple and robust mini-PACS solutions for diagnostic centres and small hospitals. We believe that the synergy of imaging, clinical knowledge and information technology will create a unique momentum for healthcare professionals to improve efficiency and safety of care delivery to their patients. When it comes to Indian hospitals, what are the key RIS-PACS requirements? In our experience, key requirements that large health care institutions look for in an enterprise level RIS - PACS solutions include the following: (a) Image distribution within the wards, OTs and clinicians. (b) Additional functionalities on Single reporting workstations like Voice recognition for reporting & personalised clinical tools (c) Work-flow improvements to crash turnaround time for patients

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What are the ways by which the strategically designed workflow in RIS-PACS leads to improvement in efficiency of healthcare? A well designed RIS-PACS solution can lead to the following benefits: (a) A fully integrated workflow involving RIS that is seamlessly integrated with HIS can result in enhancement of exam throughput by 30 – 50 percent a year after the installation. Therefore, from a hospital CEO/Management point of view, this is a key productivity driver. (b) Powerful clinical applications and tools like Voice Recognition greatly improve the radiologist’s capability to provide high quality diagnosis. Centralised Reporting and remote viewing allows faster and collaborative decision making which in turn benefits diagnostic outcomes. Can you give us one example of how your RIS solutions have proved advantageous for patient? Agfa Impax RIS solutions can accommodate robust Voice Recognition systems which helps the Radiologist to dictate the report and have immediate conversion to text. This in turn helps to reduce patient turnaround time. What challenges do you face while selling and installing RIS-PACS solutions in India? We face multiple challenges. There are issues with the quality of network infrastructure. The hardware environment is rapidly changing, as India is a fast growing healthcare geography. Understand-

ably, there exists a priority to manage and tap growth opportunities. Productivity improvement initiatives like RISPACS have to compete with growthoriented capital expenditure projects for funding. In what ways can the UIDAI initiative be useful for healthcare practitioners in India? Several sectors of the Indian economy have expectations from the UIDAI project. In the healthcare context, UID could be a universal tool for patient identification. Successful implementation of UIDAI can be the foundation for a new Electronic Medical Record initiative from Government of India. Who are the key users of your systems in India? Are you also supplying your systems to government owned healthcare institutions? There are some prestigious hospitals in the private domain that are users of Agfa Impax systems - Hinduja Hospital and Jupiter Hospital to name a couple. The Central Government owned, Sree Chitra Thirunal Institute of Medical Sciences & Technology, Thiruvananthapuram, have been using the Impax RIS - PACS solution for the last 6 years. Do you see RIS becoming a tool for a coming together of different technologies, including knowledge databases and diagnostic reference systems? RIS is helpful in defining the workflow for the Radiology department. Besides, the role of RIS is very important in successful PACS installations as well as clinical decision support systems.


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RIS-PACS

Healthcare Solutions Hosted on Cloud “The RIS/ PACS market in India has boomed over the previous year, with a number of PACS players tripling or quadrupling their revenues,” says Dr. Mallika Kapoor, MD, Director, NextGen eSolutions. Many healthcare organisations, particularly corporate hospital groups, government bodies, and well-funded Greenfield hospital projects are looking to create Digital Hospitals, which are often hosted on cloud based platforms. Although it is difficult to pinpoint the reason for this shift, it is in part due to the changing mindset of Indian Hospitals. This shift marks the turning point for Health IT as a whole in India.

Creating digital hospitals Contrary to popular belief, a Digital Hospital is not an impersonal collection of gizmos and computers; it is a place where more personal, high quality care is delivered to patients, with IT acting as a backbone. IT, when used correctly increases the availability of care providers at the patient’s bedside, while reducing errors and improving care quality. In this new world, the lines between different healthcare applications (such as PACS and HMIS), hardware, networking, RFID, etc is becoming increasingly blurred, and hospitals are hesitant to co-ordinate and integrate software and hardware provided by different vendors. NextGen eSolutions has redefined itself as a Health IT Solutions Provider. Our vision is to connect patients, care providers and hospitals seamlessly, so that health information is accessible anytime anywhere enabling immediate high quality care. Recently a multinational corporate healthcare group made its foray into India with ambitious plans to launch 200 diagnostic and disease management centres, with a rollout planned over 3 years. With its extensive healthcare experience in more than 25 countries, this group realised the need for a domestic IT partner very early on – a partner who would deliver a comprehensive solution, and had a finger on the pulse of the Indian Healthcare Industry. They chose NextGen eSolutions (NGES) from a host of providers, as their strategic partner. Over 3 years, NextGen eSolutions (NGES), will customise and rollout a multi-locational, web-based solution, complete with tele-PACS, EMR, and a patient portal with a PHR. This “Digital Clinic Solution” will be hosted in a single data centre, and will provide the spine of an information highway linking care providers, hospital management, and individual patients, through a central data repository. Together, the components of this digital clinic will allow information to be accessible any-

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where, anytime, as relevant to each individual, thus fundamentally changing the fabric of healthcare delivery.

Initiatives from government The Indian Government is making major investments in IT over the next few years. Among other initiatives, it is considering to pass a bill which mandates that all public services are delivered through electronic means. As a precursor to this initiative, it is in the process of constructing the framework of an information super-highway, with a goal to connect each Gram Panchayat through fibre-optic network within the next 2 years. Programmes to reduce maternal mortality and infant mortality have already been implemented across many states, though an IT based infrastructure. An interesting example of where a tele-PACS solution has been leveraged to aid diagnosis and management is the KIDROP programme inKarnataka. This programme is targeted at diagnosing and managing Retinopathy of Prematurity (ROP) in preterm infants using ophthalmic images, which are transmitted through a PACS solution for an expert consult.


RIS-PACS

The Market for RIS-PACS Solutions in India is Price Sensitive “While the growth of healthcare Industry and HMIS adoption have surged ahead, policy development by the government has not kept pace,” says Suchet Singh, CEO, Srishti Software.

What is the focus area of RIS-PACS solutions that you are providing? The focus of RIS-PACS Solution is ease of use, price-performance and virtualisation of patient image records. Our RIS-PACS virtualisation solution delivers simultaneously medical collaboration between specialists at different locations. This helps in multiple faculty consultations including remote locations especially in cases involving multiple organs injury. By integrating to OT cameras, live OT images can be streamed live for cross consultations. Virtualisation is of tremendous help in Medical Tourism by enabling referring doctors to view the same images that the remote doctor is viewing. The RIS-PACS Solution makes life of a PACS administrator a lot easier, as there is only one server to maintain. When it comes to Indian hospitals and other healthcare institutes, what are the key RIS-PACS requirements? Indian hospitals and healthcare Industry in general happen to be price sensitive. Hence, the key requirement is that the solution should be cost competitive. Other than that it is also necessary that the solution should have interface with third party applications, it should offer ease to use for end users and it must conform to global standards of healthcare.

What are the ways by which the strategically designed workflow in RIS-PACS leads to improvement in productivity? Indian market is price sensitive. Hence, one of the key expectations that a RISPACS solution is expected to fulfil is operational cost. Since, these solutions store images electronically, hospitals save a lot on operational costs. With RIS-PACS, hospitals can vastly improve their efficiency. Since these solutions enable attaching patient medical records and report electronically to their files, it is easier for doctors to send them within the hospital to experts / consultants for second opinion. They can also store for their record and reference. Also, electronic storage of data enables healthcare institutions to store the images in their archive and can be revisited by them at any point later for reference without the fear of physical damage to reports. Can you give us one example of how your RIS solutions have proved advantageous for patient? The best example is that it enables patient x-rays and other images to be digitally attached to patient electronic medical record and be sent outside or within the hospital to consultants/experts for second opinion within minutes.

In what ways do your RIS-PACS solutions get integrated with the external HIS solutions? Our RIS-PACS solution can be completely integrated with external HIS solutions. The system uses what is called an ‘Integration Engine’ and an ‘Enterprise Service Bus’ to communicate to third party software. To put it simple terms, Integration Engine acts as a platform for the HIS Solution and the third party software to communicate by converting both their languages into a common language. After conversion, the Enterprise Service Bus communicates the meaning to each side and aides them to understand and work in sync with each other. What challenges do you face while selling and installing your RIS-PACS solutions in India? While we have not faced any particular challenge in selling our solution, we have had certain challenges while implementation. Implementation of RIS / PACS sometimes requires integration with third party solution. For this, we are dependent on appropriate technical support from the vendors of the third party for the smooth integration. Any inadequate support and coordination leads to delay in the implementation time line and would create a possible risk to the project. MAY / 2012 www.ehealthonline.org

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In Focus

“RIS-PACS Result in a Major Gain for the Hospitals” With a RIS-PACS system, a hospital can schedule patients according to available slots and actually perform more studies due to improved efficiency, says Dr Ashish Dhawad, CEO, Medsynaptic Pvt Ltd What are the focus areas of the RIS-PACS solutions that you are providing? What is the mission and vision of your organisation? We are focused on making solutions like RIS-PACS, affordable for all hospitals. Implementing a PACS was considered cost prohibitive and was exclusively deployed at very few hospitals in the past. In the last few years, Medsynaptic has helped to democratise the situation so that the benefits of technology are available, even to the smallest hospital. At the same time, we have made sure that lowered cost does not reflect older technology or poor service. In fact our PACS is considered as one of the most technologically advanced product both by customers and competitors. And that is backed by an efficient and responsive support service team which helps us build strong partnership with clients. That is why we are the leader in RIS-PACS systems in India. What are the ways by which the strategically designed workflow in RIS-PACS leads to improvement in productivity and boosts the efficiency of healthcare? Properly designed workflows can optimise the functioning of any hospital and provides effective delivery of healthcare. With a RIS-PACS system, a hospital can schedule patients according to available slots and actually perform more studies due to improved efficiency. Radiologists can read more studies in a PACS environment, provide better reports with comparison etc as the images are easily retrievable. Patient data flows seamlessly from HIS to Modalities to PACS reducing data entry effort and errors. All these result in a major gain for the hospital both in revenue and productivity. Can you give us one example of how your RIS-PACS solutions have proved advantageous for patient? There are many instances where hospitals, doctors and patients have benefitted due to immediate access to our Medsynapse PACS. To give a specific example, one of the leading hospitals in India had treated an international patient and this patient forgot to carry the CD of his CT Scan back to his country. On reach-

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ing London, the patient had to undergo an emergency procedure and the surgeon needed immediate access to his images. They contacted the hospital back in India but sending the CD physically would have been time consuming. Plus the number of images was in thousands and given the importance of data security, the images could not be transferred over email/ftp etc. The hospital is running Medsynapse PACS and they provided a temporary login to the surgeon who could immediately access the PACS sitting in his office (being web based, does not require any software installation or configuration). Surgery was successful and a patient’s life was saved. In what ways do your RIS-PACS solutions get integrated with the external HIS solutions? A good RIS-PACS is not just meant to connect together the radiology department and display images but it should also be capable of seamless integration with disparate systems within and outside the hospital for an efficient workflow. Medsynaptic is one of the unique organizations which has successfully integrated its PACS with multiple HIS/EMR systems across the world. Our Medsynapse PACS is capable of integrating with both HL7 and Non HL7 systems using different pathways. What are the challenges that you face while selling and installing your RIS-PACS solutions in India? Fortunately with the increasing experience of IT and Radiologists in PACS, there is more awareness in the community. But still there are challenges and with time I am sure they will become less. Many times there is a mismatch in the expectations of the end users like radiologists, clinicians and IT staff vis-a-vis the Management regarding the solution they would like to deploy. Management is more budget and brand oriented whereas end users want a solution which they can easily deploy, utilize efficiently and has the features to serve their needs. What is needed is a balance between the two. Lot of our customers expect customisation in the solution which we do offer and is one of our key advantages.


Case Study

True Web Based Pacs Brings Immense Benefits Implementing the Medsynapse RIS-PACS system had been immensely beneficial for GCRI radiologists and referring physicians

G

ujarat Cancer & Research Institute (GCRI) established in 1972, is an autonomous body jointly managed by Government of Gujarat and Gujarat Cancer Society (GCS). GCRI is also recognised as a major Regional Cancer Center by Government of India and is a premier institute in the field of cancer care and research in the world. It has 650 indoor beds and is the largest Cancer hospital of the country. GCRI supports more than 2,00,000 outpatients, 20,000+ inpatients, 15000+ radiation treatments and close to 75,000 imaging and radiology examinations every year. GCRI had an earlier generation of MiniPACS system which was no longer being supported by the principal company. The system was not able to cope up with the increasing number of studies and workload and in 2010 GCRI was looking for a replacement solution which could be deployed across the hospital. The hospital is fully equipped to cater complete range of diagnostic imaging with Digital Radiography, Ultrasonography (USG), Colour Doppler, Multi slice Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Mammography, PET-CT Scanner, Nuclear Medicine and Interventional radiology. While looking for a PACS system, GCRI had multiple challenges – latest technology, scalable solution, should support the high volume workload, customization to suit their workflow, should support teaching & research activities, data migration from

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existing solution and good local service. Plus all of these challenges had to be overcome within their budget.

Solution After evaluating various PACS vendors, GCRI decided to deploy Medsynapse RIS-PACS at their hospital. Medsynapse is a true web based PACS and is developed by Medsynaptic Pvt Ltd, the leader in Indian RIS-PACS market. While making the decision, the radiology department, management and IT made sure that each of their expectations are met by the solution. GCRI based their decision on several factors including the capability of Medsynaptic to offer a technologically advanced and scalable solution as well as rapid deployment. Medsynaptic completed the implementation and data migration including hardware delivery within a span of 2 months. Some customised workflows which had been requested were also delivered within a short period of time. Along with the PACS a solution for providing Teleradiology and advanced visualisation like 3D was also deployed. Medsynapse PACS was connected to all the modalities and all departments including wards, OPDs, OTs etc were able to view images and reports online. Staff training was completed according to the schedule and the system went live in a record time.

Benefits After deploying Medsynapse RIS-PACS, GCRI experienced several benefits like –

True web based experience providing easy access to images/reports to all users across the hospital • Improved workflows and faster reporting • Cost reduction by going filmless • Increased collaboration amongst staff and improved productivity • Comparisons with old studies (important for cancer patients) and searching the large volume of data at the click of mouse • Integrated, flexible reporting system with templates, electronic signature and transcription module • Dashboard for IT department to monitor all activities in the system • MIS reports to get statistical data regarding studies, TAT, radiologist productivity etc • Ability to create image library and report text search engine for research purposes • Advanced visualization tools including MIP/MPR, 3D etc • Teleradiology facility for remote reporting from any part of the world In conclusion, implementing the Medsynapse RIS-PACS system had been immensely beneficial for GCRI radiologists and referring physicians. Medsynapse was easy to deploy and integrate and the features and technology helped improve workflows and patient care. Medsynaptic has proven that it is possible to install a fully functional enterprise PACS providing high performance and reliability even in complex hospital environments.


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Zoom In

“Technology is an Enabler for Empowering Patients� CSC is a global leader in providing business solutions and services across key industry verticals such as healthcare, banking, insurance, manufacturing and government. Kandasamy Sankaran, Director and Delivery Head, Health Services, CSC India, in an interaction with Divya Chawla, talks about emerging issues in healthcare sector

Please give a brief overview of CSC and its footprint in the health IT space in India. CSC is a USD 16 billion Fortune 200 company, based in Falls Church, Virginia. We are a global leader in providing business solutions and services across key industry verticals such as healthcare, banking, insurance, manufacturing and government. CSC has healthcare operations and service delivery capabilities in 15 Countries. In operation for over half a century now, CSC today works out of 94 countries, including India. We leverage optimal resource mix to provide solutions for our clients; this includes healthcare subject matter experts (SME), technology experts, product experts and delivery experts. We have a

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successful IT Application outsourcing track record, have provided multi-provider governance and vendor consolidation solutions to lower cost for our clients. In emerging services, we provide Mobility, Cloud and Cyber security to healthcare organisations. What is your view of the advancements in the field of health IT over the last decade? Which areas of healthcare have mostly been benefited through such technologies? Healthcare in India is one of the largest sectors in terms of both revenue and employment with a total value of more than USD 34 billion which is roughly 6 percent of the GDP and it will grow to USD 40 billion by 2012 according to a PwC Report on Healthcare. The Indian healthcare industry has been looking at leveraging technology solutions and

recent developments in technology for outreach of quality and affordable healthcare services, particularly in rural areas and in areas outside metros. The health IT market adaptation in the last decade is based on the market segment, i.e. amongst providers (hospitals), payers, life sciences and medical devices companies. We have seen better adaptation of enterprise systems such as ERP, CRM, and SCM in the Tier 1 and MNC Pharma companies. The larger provider (Hospital) market segment has been rapidly deploying HIS and ERP systems. The Healthcare IT advancement in the mid to small market segments is mainly with critical department systems or any revenue generation application areas. Proliferation in healthcare business has brought along its own set of problems. Healthcare organisations have invested in Health IT systems with a short term or need based view which in turn have caused issues of scalability and resulted in frequent replacement or upgrade of IT systems. Now, the focus has shifted to parameters such as scalability, reliability, se-


Zoom In

curity and maintainability while making IT investments. Going forward organizations are looking at cost reduction in operations, globalisation, audit or compliance adherence as the drivers to gain a competitive advantage, In the recent years, we have seen evolution of the Unique Identification (UID) which also enhances the role of health IT by laying the foundation for national integration and sharing of critical patient and health related data such as electronic health records through use of National Health Information exchanges that cover urban and rural segments. The opportunity for India is that it can leapfrog legacy to adopt the latest technological advances - cloud, mobility for Health IT programs that include HIS, CPOE and building of Health Information exchanges. This will help to gather the clinical and patient information that can be used to perform healthcare analytics to ensure better healthcare outcomes. What is your perspective on the importance of health IT innovation in India? The past few years have seen the evolution of several technology areas like Telemedicine, Cloud Computing, Mobility and other medical devices that have helped in Health IT innovation. Telemedicine is a fast growing trend in India and with the support of IT, satellite and fibre optic network, Telemedicine provides specialized healthcare to remote corners of the country. The Cloud Computing model can also be leveraged innovatively in healthcare-, one area where cloud computing is aiding healthcare is data access, particularly for medical images and clinical data. Mobility has also given rise to innovations like mHealthcare applications which help consumers in India to take better care of their health and also get health related information through their mobile phones. In recent trends, we have phones on a wide range of technology such as android that have many free downloadable health related applications that one may use to monitor their wellness. Steering wellness through technology

is catching up as an area for Health IT innovations. Technology is the enabler for empowering patients to take better care of their health; wecan also accelerate early diagnosis for earlier detection and treatment of diseases. For example, Glaucoma leads to blindness, which can be halted if detected early on. We now have technology such as a device called a tonometer that puffs the eye with air to determine intraocular pressure, done during an annual eye exam. Unfortunately, pressure varies widely during the day, so there is only a small chance that the symptom presents itself exactly at the time of the annual exam. Give us your views on the implementation of EHR/EMR in Indian healthcare scenario, as per the global standards? Indian Healthcare organisations have the advantage of leapfrogging into latest EMR systems that are scalable and proven in other parts of the world. Some countries such as US have a government regulation with incentive to adapt EMR, but in India the healthcare organisations are adapting EMR due to various reasons such as improving clinical, operational benefits, helping with medical audits, these help their business and also are ahead of their competitors. Again, there are no specific national or state standards for EMR in India; hence the adaptation varies based on the enterprise and also limitation of the vendor providing the EMR software. As the hospitals mature and evolve, we can envision creating foundational building blocks to success that will help with Healthcare Measurement (quality, safety, outcomes and cost) and integrated electronic medical records. What is the portfolio of health IT products that CSC is currently offering in India? What is market opportunity of this segment in India? CSC’s Healthcare Group, which serves healthcare providers, health payers, pharmaceutical and medical device manufacturers, and allied industries around the world, is a global leader in transforming the healthcare industry

through the effective use of information to improve healthcare outcomes, decision-making and operating efficiency. CSC has healthcare operations in fifteen countries. We are rated highly by healthcare analysts. CSC has developed and currently provides numerous as-aservice solutions to health plans, payers and life sciences companies, with a focus on health informatics services that help organizations manage, interpret and act on complex data. What has been your marketing and business strategy in India? CSC has a matured healthcare business and has been in several countries over the past 35 years; we have a large client base in healthcare and bring our global expertise to our clients in India. Our healthcare business strategy covers all healthcare sub-segments that include provider (hospitals), payers (health insurance), and life sciences. We have a range of healthcare IT products and services that will meet Healthcare organisations business and IT needs. CSC offerings include infrastructure (data centre, hosting), HIS and ECM software, enterprise applications (ERP, CRM, ECM), custom applications and technology services and BPO areas. We are in early stage market development in India and have been in touch with several healthcare organisations to understand their business and IT needs. What are your future plans? In the coming years, we look forward to enhance our client base and increase our presence in provider (hospitals), payers (health insurance) and life sciences organisations (i.e. pharma and biotech). We are looking at increasing our addressable market using health IT innovation, we plan to better understand our client needs in India market and build new products or services that will help healthcare organizations have better information that will lead to better decisions and healthcare outcomes. We are keen to contribute to areas such as Patient Safety, increasing quality and efficiency of care and making it affordable to a larger section of society. may / 2012 www.ehealthonline.org

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hard talk

The Accelerators in Healthcare Barcode Readers make sure that patients receive the correct medications at the correct time by electronically validating and documenting medications

By Dhirendra Pratap Singh, Elets News Network (ENN)

A

ccording to the American Journal, published by American Medical Association, there are 225,000 deaths per year in the US due to unintentional medical errors. While no Indian data is available on this topic, the Indian government after realising this concept, set up the National Initiative on Patient Safety in the All India Institute of Medical Sciences a couple of years back. Incorrect identification of patients often results in medication errors, misdiagnoses and on rare occasions it can result in an invasive procedure being performed on the wrong patient. In order to prevent these serious clinical errors, RFID-enabled patient identification and tracking systems are used, wherein the patients are given a wristband with a RFID chip that stores the unique patient ID and other relevant medical information. The caregiver uses a hand-held RFID reader or a PDA to access elec-

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tronic patient records, cross-check the medication dosage prescribed, and updates the record with observations and comments on diagnosis in real-time. Patient identification and location assistance tools from the world of RFID can be very useful for care providers, especially in cases of long-term care, mentally challenged patients, and newborns. Recently Max Healthcare introduced the Bar Coded Medication Administration (BCMA) in its hospitals across Delhi, Bhatinda and Mohali. Barcode readers prevent human errors in the distribution of prescription medications at hospitals. It makes sure that patients receive the correct medications at the correct time by electronically validating and documenting medications. This technology has the potential of becoming a catalyst for new efficiencies and enhanced services for healthcare service providers. Hospitals and medical facilities seeking competitive

advantage can make use of barcode readers to optimise their workflows, improve productivity, reduce operating costs, and provide better patient care. It could help prevent patient identity mix-ups, medication errors, and also reduce thefts of expensive mobile medical equipments. BCMA could help streamline the tracking and recording of the available inventory efficiently and accurately. This will help hospitals in maintaining optimal stock of medical inventory on a real-time basis and reduce the overall inventory cost by maximising resource utilisation and creating the scope for having ‘just in time inventory’. Barcode-enabled identification of specimen, blood samples and management of transfusion can be helpful in achieving significant improvements in preventing errors, during transfusion and laboratory processing. It is also conducive for saving valuable time. Pharmaceutical companies loose


hard talk

“BCMA Following the Principle of ‘5 Rights’ Reduces the Chances of Medication errors” there is a movement of materials involved, to the extent that a medicine being given to the patient can be bar coded and read through barcode reader for accuracy as to the drug type, batch no, expiry etc.

How do you see the advancement in field of Barcode Readers in recent years? Surely, over a period of time there has been an increase in the use of barcode readers. Our most common experience with the barcode readers is during the billing process at shopping stores. But its usage is not confined to the consumer industry; it has been in use in other industries as well, including healthcare. Barcode readers are a new concept in healthcare in India and are not very extensive so far, but it’s bound to increase in the days to come. It is mainly used wherever

Please give a brief about installation of Bar Coded Medication Administration in Max healthcare. How is it useful in reducing medication errors in healthcare delivery? The Bar Coded Medication Administration (BCMA) has been installed as a part of our electronic health records programme. It helps us electronically document a patient’s records. In the system the order for medications are put by the Physician on the basis of which the pharmacy sends the doses required for the next 24 hours. The drugs dispensed are billed by reading the barcode on each medicine, which includes the Generic salt in medicine, brand name of medicine, batch no and expiry date. The drug barcode is again scanned at the time of administration to the patient, to ensure that the right medicine is given to right patient at the right time in right dose and right route. The patient’s identity is established by scanning the barcode on the wrist band at the time of drug administration. This close loop medical administration ensures the five Rights. And these 5R’s of drug administration ensures safe medication for the patient. The barcode also enables alerts on allergy reactions.

substantial revenue every year due to drug counterfeiting. Counterfeit drugs might pose serious health risks to patients due to the possible use of substandard and dangerous ingredients. Use of barcode readers in packaging of prescription drugs can counter instances of drug counterfeiting; identify fake, tampered, recalled or expired drugs. This will enable verification of their authentic-

ity throughout the supply chain, from the point of manufacture to the point of dispensing, thereby resulting in money savings for the industry and ensuring safe medication for the patients. Though the application space of barcode readers is growing and gaining popularity, its acceptance and adoption in healthcare is not without challenges. Though the costs of readers and tags

Dr Neena Pahuja Chief Information Officer, Max Healthcare Institute Ltd.

What are the challenges in the adoption of new technologies in Barcode Readers? The packaging and standard bar codes on medicines and equipment need to be standardised to reduce the costs of Bar Code Administration. Healthcare industry faces a few challenges in the use of barcode technology; principal among them is the absence of barcode on drugs. Also bulky devices hinder access to bed ridden patient. There is also the absence of barcode standard for healthcare in India. What is the future of Barcode Readers in achieving improvements in patient care applications? Many new applications are being developed today for improving the levels of patient care and safety. Administering medication to the patient as part of treatment also involves a risk of errors, which can make a difference between life and death of the patient. BCMA following the principle of ‘5 Rights’ definitely reduces the chances of medication errors. For the delivery of safe healthcare, barcode tech-nology provides a way to track actions and material involved in the care of the patient. The technology helps in tracking material from procurement to consumption/administration. Additionally, we expect the mobile devices to mature to a level to read the barcodes on vendor pack-aged medicines. We may then have a barcode reader for medications in every mobile phone and tablet.

are decreasing, implementation of such systems might still require substantial capital investments. This needs to be re-duced for wider acceptance of such systems in the healthcare industry. Potential adopters like hospitals with thin IT budget might not be keen to consider barcode systems, unless the costs are more affordable and there is assurance of better performance. may / 2012 www.ehealthonline.org

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Telemedicine

Taking

Healthcare

to Rural India Through

Telemedicine

Telemedicine is a potentially miraculous method that promises improvements to healthcare delivery systems, bettering quality and access

I

nterest in the field has increased dramatically in India. It is not just private healthcare institutions that are investing in creating of new telemedicine solutions, the central and the state governments are also showing interest. The Planning Commission has made numerous suggestions for using telemedicine solutions, during the 12th Five Year Plan period, for improving healthcare services in the remote parts of the country. If Planning Commission has its way, healthcare practitioners could be using software applications such as Skype for telemedicine. The Planning Commission report says, “Computer with Internet connectivity should be ensured in every primary

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health centre within this Plan period; sub-centres will have extended connectivity through cellphones, depending on their state of readiness and skill set of their functionaries. The availability of Skype and other similar applications for audio-visual interaction makes telemedicine a near-universal possibility and could be used to ameliorate the professional isolation of health personnel posted in remote and rural areas.” The health ministry has also identified telemedicine as a major thrust area. Only 25 percent of India’s specialist physicians reside in semi-urban areas, and a mere three percent live in rural areas. As a result, rural areas, with a popu-

lation approaching 700 million, continue to be deprived of proper healthcare facilities. Further the availability of hospital facility is very low in rural areas. Thus, the early successes of telemedicine pioneers have led to increased acceptance and proliferation of telemedicine.” Telemedicine has various aspects including TeleConsultation, TeleDiagnosis, TeleEducation, TeleTraining, TeleMonitoring and TeleSupport and incorporates complete information about patients’ medical record (in the same hospital or any virtual hospital online). Telemedicine system is well suited for disaster management as it is even more reliable, than the physical system.


Telemedicine

Telemedicine will Transform Rural India “The Telemedicine market in India is has witnessed significant growth owing to its potential of providing the world class clinical and medical services to distant and rural locations,” says Puneet Gupta, President - Sales & Marketing, Intellisys Technologies & Research Limited Tell us about Intellisys’s plans for development of telemedicine in Indian market. Through our Vennfer healthcare solution, patients can have remote Teleconsultation with doctors. Vennfer can be put to efficient use for following healthcare purposes: 1. Telemedicine a. Tele - consultation ( Direct clinical, preventive, diagnostic, therapeutic, treatment, consultative & follow-up services) b. Tele - monitoring (Remote monitoring of rehabilitation services) c. Tele - mentoring ( Education to patients & healthcare professionals) d. Tele – presence ( Remote assistance in surgery) 2. Continuing Medical Education 3. Administration Give us an overview of how telemedicine industry is evolving in India? The Telemedicine market in India is has witnessed significant growth. The industry has garnered the support of not only the private organisations that are investing in Telemedicine, but also of the government. The growth momentum of Telemedicine market will be driven by the inadequate healthcare infrastructure and shortage of hospitals and doctors, especially in the rural areas. The global market of Telemedicine is valued at $9 billion and is expected to grow at double digit rates over the next 5 years. What is the area of healthcare that telemedicine must focus on? The Telemedicine solutions comprise of following aspects - Teleradiology, Teleconsulting, Telemonitoring and Telesurgery. Teleradiology, which is the electronic transmission of radiographic images from radiologist sitting at the distant lo-

cation from one location to another for interpretation and consultation, has the largest share among all the segments of Telemedicine. Essentially Telemedicine must become a complete diagnostic and treatment medium for patients and doctors. For this the Telemedicine Solution must be able to send Test reports like X Ray, ECG etc. to doctors for a comprehensive professional advice and diagnosis. What kind of response do your telemedicine solutions see from rural areas? Rural areas will be benefit hugely from Telemedicine, as through such solutions, the rural population gets access to top class doctors, who are generally based in cities. So, the response from the rural areas has been overwhelming in the last couple of years. In the near future Telemedicine will allow rural areas to have access to the best doctors in the country. Have you developed solutions that can facilitate relief work during disasters? With the advancement of wireless and satellite connectivity across the states of India Tele-consultation from a disaster affected area is now possible throughout many parts of India through a web streaming portal and by using any IP camera connected to a normal laptop. The Government is also thinking of setting Telemedicine kiosks across many railway stations and live ambulances with the readymade Telemedicine kit

and conferencing facility available in those mobile vans. Vennfer even makes Teleconferencing from remote disaster affected areas by using high speed Datacard. What policies can the government take to facilitate the growth of the industry? Government should set up Telemedicine facilities across India. The SWAN backbone should be strengthened to enable dedicated high speed network connectivity to facilitate seamless Teleconferencing across India. The Indian government in its 11th Five Year plan (2007-2012) has allocated 2000 million Rupees (about $50 million) to Telemedicine. According to the ministry of health and family welfare, the necessary infrastructure in the form of satellite and high speed broadband is already in place in large parts of the country. may / 2012 www.ehealthonline.org

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news review

Elsevier Launches ClinicalKey, a Breakthrough ‘Clinical Insight Engine’ Powered by Elsevier’s Smart Content, ClinicalKey can understand clinical terms and discover the most relevant medical content based on clinicians’ searches

E

lsevier, a provider of medical content and solutions, has launched ClinicalKey, the next generation of online clinical information resources. ClinicalKey draws answers from the largest collection of clinical resources, covering every medical and surgical specialty—eliminating physicians’ reliance on less accurate sources. ClinicalKey’s content includes more than 700 textbooks and 400 top medical journals that provide clinically relevant evidencebased answers, as well as expert commentary, MEDLINE abstracts and select third-party journals. “Physicians are always constrained for time, they want their answers quickly,” says Dr Jonathan Teich, Elsevier’s Chief Medical Informatics Officer. “By reducing the time it takes to find the best answers and providing trusted, more comprehensive content, we’re able to help clinicians spend more time with their patients to achieve better outcomes.” As Elsevier’s new ‘clinical insight engine’, ClinicalKey provides faster, smarter access to the relevant online clinical answers physicians seek. After conducting market research with more than 2,000 physicians, Elsevier designed ClinicalKey to meet the three key search requirements that physicians demand: • Comprehensive – ClinicalKey includes answers based on the largest proprietary collection of online clinical resources. The answers represent every medical and surgical specialty and information at all levels, from expert opinion to primary data. Re-

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teams. With one click they can share a paper, chapter, image, or video via email.

Smart Content

Rohit Kumar

Managing Director-South Asia, Elsevier Health Sciences at ClinicalKey Launch sources include textbooks, journals, monographs, videos and images. • Trusted – ClinicalKey provides access to the latest peer-reviewed and evidence-based information available from Elsevier, a world-leading provider of science and health information. • Fast – With its unique technology, ClinicalKey’s speed-to-answer is unmatched, providing more relevant answers to clinical questions than those provided by any other conventional clinical search engine. Information found on ClinicalKey can be easily shared. The built-in presentation maker allows physicians to dynamically communicate the latest medical and surgical information to colleagues and care

ClinicalKey is powered by Elsevier’s Smart Content, tagged with EMMeT (Elsevier Merged Medical Taxonomy), which enables ClinicalKey to understand clinical terms and thus discover medical content that is the most relevant. It can also find content that will normally be missed by other search engines. Elsevier’s Smart Content has been designed to understand the vast number of relationships between clinical concepts. By organising these relationships in a hierarchical manner, it guarantees that ClinicalKey provides specific, targeted results to physicians’ questions. The tool allows clinicians to filter search results by clinically meaningful subcategories (content type, specialty, and by relevant clinical categories like treatment and diagnosis). Specialty-specific tools enable physicians to quickly go from topic overview to in-depth specialty information to meet clinical challenges. ClinicalKey will initially launch with an institutionally focused product whose primary users will be clinicians at hospitals, healthcare systems and medical schools. Beginning in Q3 2012, Elsevier will market an individual clinician version. “ClinicalKey is part of Elsevier’s continuing efforts to help clinicians improve quality and efficiency through the smarter use of healthcare information,” says Jim Donohue, Elsevier’s Managing Director, Global Clinical Reference.


policy Watch

US wants India to lift import ban on dairy products

Tamil Nadu Chief Minister opposes national panel for health

The US has sought to impress upon India to lift the ban on American poultry products, arguing that they do not pose a human health risk as is being asserted by India. “The United States maintains that the presence of paratuberculosis in dairy products does not pose a human health risk, and India should not make elimination of this bacterium a condition for issuing a sanitary export certificate for US dairy products,” the US Trade Representatives (USTR) has said in a report. Since 2003, it said, India has imposed unwarranted SPS (Sanitary and Phytosanitary) requirements on dairy imports, which have essentially precluded US access to India’s dairy market, one of the largest in the world. For example, India requires the US Government to certify that any US-origin milk destined for India has been treated to ensure the destruction of paratuberculosis, which according to India, is linked to Crohn’s Disease. “Despite repeated requests from the United States, India has not provided scientific evidence to substantiate this assertion, and has declined to take into account evidence to the contrary submitted by the United States,” the report said. The Indian import certificate for pork requires that importers make an attestation that the imported pork does not contain any residues of pesticides, veterinary drugs, mycotoxins, or other chemicals above the MRLs prescribed in international standards, the report said. However, these certificates fail to identify specific compounds and their corresponding international limits, the USTR said.

Tamil Nadu Chief Minister J Jayalalithaa on Thursday expressed her “vehement objection” to the National Commission for Human Resource for Health (NCHRH) Bill, 2011, saying it “undermines” the powers of the State governments. The Bill, now referred to the Standing Committee on Health and Family Welfare by the Rajya Sabha, effectively puts the leadership and decision making process with regard to medical, dental and paramedical education in the “hands of about 25 persons, all of whom are nominees of the Central Government”, she said in a letter to Prime

Minister Manmohan Singh. “This undermines the powers of the State Governments, which are left with no role to play in policy issues related to human manpower planning, curriculum and course design as well as approval of new institutions offering courses in medicine and allied disciplines”, she said.

Healthcare spend to rise to 2.5 percent of GDP The Planning Commission in their document- “Faster, Sustainable and More Inclusive Growth: An Approach to the 12th Five Year Plan”, aims at raising the total public health expenditure to 2.5 percent of GDP by the end of the Twelfth Plan. According to World Health Statistics 2011 published by World Health Organisation (WHO), the total expenditure on health as a percentage of Gross Domestic Product (GDP) in 2008, for India is 4.2 percent as compared to expenditure on health in respect of some select developing countries, e.g. China 4.3 percent, Bangladesh 3.3 percent, Indonesia 2.3 percent, Malaysia 4.3 percent, Pakistan 2.6 percent, Sri Lanka 4.1 percent and Thailand 4.1 percent.

National debate needed on universal health coverage Universal health coverage (UHC) has now been widely adopted by Canada and many other developing countries both as a developmental imperative and the moral o b -

ligation of a civilised society. India embraced this vision at its independence. However, insufficient funding of public facilities, combined with faulty planning and inefficient management over the years, has resulted in a dysfunctional health system that has been yielding poor health outcomes. India’s public spending on health — just around 1.2 per cent of GDP — is among the lowest in the world.

As the world grapples with the combined challenges of economic slowdown; the increasing globalisation of the economic system and of diseases; and growing demands for chronic care, the need for universal health coverage (and a strategy for financing it) has never been greater. Jan Swasthya Abhiyan called for a national public debate on the proposed universal health care system, saying that such an important issue

cannot be rushed through and its various strands need to be understood, discussed and commented upon widely by the people. “Definition of a clear, transparent and time-bound road map for strengthening and expanding the public health system while improving its functioning and accountability; this must include allocation of adequate, and enhanced budgets,” a JSA statement said. MAY / 2012 www.ehealthonline.org

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corporate updates

Prathap Reddy’s Apollo Group to invest `1,500 cr in Ahmedabad Apollo Hospitals Group will invest Rs 1,500 crore on increasing the number of its beds to nearly 11,500 by March 2014, said Dr Prathap Reddy, Founder-Chairman of the hospital chain “While we had a full fledged hospital functioning in the city, we believe Ahmedabad needed an acute heart facility where intervention procedures could be carried on 24x7. The new facility will come up by July for which we have hired project consultant company to draw a plan for us,” said Prathap Reddy, chair-

man of Apollo Group of Hospitals. In Gujarat, where Apollo Hospitals and Cadila Pharmaceuticals Ltd have a 50:50 partnership, the duo has decided to launch an additional cardiac clinic by July this year at an investment of Rs 15 crore. They are also considering setting up one or two more hospitals in Gujarat, at a distance of nearly three hours from Ahmedabad, he said. Nationally, by March 31 2014, the group is looking to add 2,500 beds at an investment of `1,500 crore. By end of

2012 alone Apollo intends to take up the total number of beds to 10,000 across its 56 hospitals. Apart from expanding its 200 bed capacity at Apollo Hospitals Ahmedabad to 400, the group will also add four more clinics in Gujarat to its current six in the near future. While it has a 50:50 partnership with Cadila Pharmaceuticals for its operations in Gujarat, Apollo is taking the alliance international into countries like Kenya, Ethiopia and Uganda.

Technology

At the Cutting Edge in Human Anatomy Medical informatics experts want to bring the digital revolution to studying human anatomy. The BioDigital Human is a three-dimensional, fully interactive visualization program. While it won’t completely replace old-fashioned dissection, its users can explore a human body in ways not possible with a cadaver, much less a medical atlas. With traditional anatomy atlases, “you’re at the mercy of what they’ve created for you. Here, you can manipulate it yourself,” said New York University anatomy instructor Victoria Harnik, who helped design the BioDigital Human. Unlike cadavers, the digital body can be explored again and again. Real dissections are one-shot deals. BioDigital tissues and organs are also la-

beled so users can see how they connect to other parts of the body. The zoomable, rotatable computer-animated human is also linked to educational resources, like MEDLINE, that have information about medical conditions associated with their object of interest. Ultimately the program could be used by patients to better understand their bodies, and also as a promotional tool for generating interest in science-related careers, said BioDigital Human developers Mark Triola and Jonathan Qualter, who presented the project April 11 at the TEDMED conference in Washington, D.C.

Health insurance planned by Nasscom A 2.5 million people industry will be now benefited with the first of its kind initiative by an industry body. Nasscom with Oriental Insurance plans for health insurance plan for IT sector. This plan will substantially bring down the cost of providing insurance for small and medium businesses. Nasscom’s Techie-Health Plan has already committed over 200 companies to join the plan. The initiative plans to target 1,000 SMBs under the scheme in 15 months. There are different kinds of plans according to the number of employees in the company. A company with up to 100 employees will be offered a 30 person to 50 person cost savings and will have a cover of up to Rs 3 lakh for employees and

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their spouses and children. On the other hand, the cost of the plan for a 100-employee company would vary between Rs 1.5 lakh and Rs 9.5 lakh based on the plan. The benefits will also vary as per the premium for additional or advanced plans and will fairly cover even preexisting ailments, maternity and new-borns Insurance broking company Medimanage and third party administrator Mediassist will also be involved in implementing the scheme. With the healthcare costs increasing looking in to the private care, the insurance becomes a necessity to avail the best of the treatments. Nasscom is all set to showcase the plan and popularize the health insurance to those who seek better healthcare services.

Japan’s Mitsui picks up 26 percent in Max NY Life

Mitsui Sumitomo Insurance Company (MSICL) of Japan acquired a 26 percent stake in Max New York Life (MNYL), the country’s fourth largest private life insurance company, for `2,731 crore. This is the second largest deal in the Indian insurance sector after Reliance Life sold its 26 percent stake to another Japanese insurer Nippon Life at about ` 3,062 crore last year. As per existing regulation, a foreign partner can hold only up to 26 percent stake in an insurance joint venture. After the deal, MNYL will be renamed as Max India Insurance Company. However, MSICL will have two representatives on the board of the new joint venture company. Under a complex agreement entered into by the firms, New York Life will sell 16.63 per cent of its holding to MSI. The remaining 9.37 percent would be sold to Max India for ` 182 crore. Max India will then sell the 9.37 percent stake to MSI for ` 984 crore.


technology

EMR

Electronic Medical Records to be 30 percent of global EMR markets in 2015 EMR is a part of healthcare information technology that is used to make paperless computerized patient data in order to increase efficiency of hospital systems and reduce chances of errors in medical records. A substantial growth rate (more than 16 percent) of global healthcare IT spending is expected to push EMR development all over the globe. It is estimated that Healthcare Information Technology (HCIT) market will exceed $25 billion in 2015. EMR is the major segment that is driving its growth. The rising demand for healthcare cost containment and need to improve quality of healthcare service are driving the growth of the Worldwide EMR market. The global EMR Market is expected to grow from $4,355 million in 2009 to $9,957 million in 2015, at an estimated CAGR of 14.9 percent from 2010 to 2015.

Detecting flu epidemics using Social Media With the recent rise in popularity and scale of social media, a growing need exists for systems that can extract useful information from huge amounts of data. There are some innovations where the issue of detecting influenza epidemics could be addressed. Last week, the swine flu (H1N1) toll in green city Bengaluru went up to six. A 30 year old woman succumbed to the virus. There was some confusion as the civic body suggested she suffered from swine flu while the private hospital denied it. There has been a similar case in Chennai where a hospital failed to notify the authorities about a swine flu case.

Social Media: A cure for what’s ailing healthcare Hospital volunteers foster positive patient relations and do wonders to increase patient and family satisfaction. In this environment of budget cuts, the importance of volunteers is even more evident. A new book, The Volunteer Management Handbook: Leadership Strategies for Success, edited by Tracy D. Connors and released last month, contains a wealth of information. Of particular interest is an entire chapter, “Social Media and Volunteer Programs,” written by Nancy Macduff. There’s a free summary of the chapter available as a pdf on the publisher’s site. In the chapter, Macduff shares statistics from studies by the Nonprofit Technology Network (NTEN) that help set the stage for using social media in volunteer relations. Of the sectors where nonprofit organizations operate, 14.5 percent are in health care. Macduff wrote, “It is clear that nonprofits and likely their volunteer programs see marketing and fundraising as

appropriate uses of social media, but there seems to be timidity about crossing into other areas of usage such as blogs for volunteers to share experiences, Wikis to manage projects or meetings, or a Facebook page only for volunteers.” Macduff advocates the use of social media to strengthen volunteer programs, and sites NTEN’s 2010 study that reported the reasons nonprofits do not use social networking sites: 47 percent say ‘‘lack of expertise,’’ and 32 percent say ‘‘insufficient budget.’’ The last finding, “insufficient budget,” is exactly the reason using social media to strengthen hospital volunteer programs makes so much sense. Social media programs, once implemented, can be run with extreme cost efficiency.

Retail health clinics: Filled with hope With the increasing use of health information technology, retail health clinics (RHCs) are quickly moving from being clinics of convenience to being helpful partners in the overall healthcare system. This beefed-up use of technology makes it easier for patients to keep their doctors looped into their health history. Data reported by the American Academy of Family Physicians has estimated a $40 service in an RHC could potentially cost more than double that in a doctor’s office, $120 in an urgent care facility, and $325 in an emergency room. Given that 16 to 27 percent of clinic patients have

no health insurance, based on a 2011 RAND report, and only 39 percent have an existing relationship with a primary care provider, the lower cost could be beneficial not only to the patient’s pocketbook, but in the prevention of potentially future healthcare costs associated with developing chronic conditions. The clinics are a more affordable avenue for people who need care, but find themselves outside of the healthcare system. “Retail health clinics are a huge convenience to patients,” said Mary Griskewicz, senior director of health information systems with the Healthcare Information and

Management Systems Society (HIMSS). “They can be screened, get their flu shot, have a rash examined, and all of this is usually within 20 feet of the pharmacy where they can get medication.” The population of RHCs seems to have ballooned after two years of nearstagnant growth. Between 2010 and 2011, the number of these clinics rose by 11.2 percent to 1,355 nationwide. And, this trend shows no signs of slowing. Retail giants, such as Walmart and the grocery store chains Kroger and Safeway, have launched RHC efforts within the last year. MAY / 2012 www.ehealthonline.org

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Research Researchers find hospital residents more efficient with smartphones than pagers Since 1949, pagers have remained one of the most commonly used technologies among all hospital personnel. However, researchers in the United Kingdom are looking to change this. They recently assessed whether a new wireless system can decrease some of the efficiencies of pager systems in hospitals. The researchers designed their wireless system to address a problem which occurs in health systems throughout the world. The problem being that most health care personnel work during regular 9 to 5 work hours, but patients are in the hospital much longer (16 hours longer during any given day). As a result, there is a drop in hospital services after regular work hours. The researchers also indicated that with decreased work hour standards for their junior doctors (same as residents in the US), there is an even greater drop

in services in the hospital. In the UK, this night time drop in services is being managed by an initiative called “Hospital At Night” in which senior nurses triaged night time problems and coordinate existing hospital resources in an effort to improve clinical care and decrease any potential safety problems associated with having more junior people in charge at night. The Hospital At Night project is run mainly with landlines which lead to a number of inefficiencies that impact patient care. The main problem is a common scene in hospitals relying on landlines for communication. Clinical care is delayed by the nurse coordinator constantly paging doctors and waiting on their responses. Another problem is that junior doctors

often waste time searching for a landline to use. These problems lead to delays in clinical action being taken. Also, there has been low morale for the senior nurse coordinator who spends all night talking on the phone and not engaging in clinical care and truly using her/his skill set. As a result of these problems, the researchers realized that a better approach was needed.

Index of People and Organisations People Anil Swarup, Director General Labour Welfare, Ministry of Labour & Employment, Government of India 7 Dr RD Lele, Director, Jaslok Hospital 11 P.Rammohan. Managing Director. HealthSprint 11 Dr Nishant Jain is Sr. Technical Specialist (Health Insurance & Health Finance), GIZ 12 Dr Siddharth Agarwal, Executive Director, Urban Health Resource Centre 14 Dr TS Selvavinayagam, Joint Director of Health Services, Government of Tamilnadu 18 N Eswaranatarajan, head of Operations and Technology at ICICI Lombard 22 Malti Jaswal, Health Insurance Expert 24 Suresh Babu Munta, GM, Mindray 30 V Balakrishnan, Sr. Vice President, Schiller India 31 Anthony Rozario. L, VP, Marketing, AKAS Medical 32 Dr KV Krishnan, Practice Head, Mindteck 33 Nikil Rao, General Manager, Dräger Medical Technologies 34 Dr Ajay Bakshi, Max Healthcare CEO 36 Vikas Kharage, NRHM, Maharashtra 40 Malav Kapadia, Vice President - Healthcare IT at Religare Technologies 43 Suresh Ranganathan, GM, Agfa Healthcare 44 Mallika Kapoor, MD, NextGeneSolutions 46 Suchet Singh, CEO, Srishti Software 47 Dr Neena Pahuja, CIO, Max 55

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Organisations Rashtriya Swasthya Bima Yojana (RSBY) 7 Department for International Development (DFID) UK 8 Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) 8 Jaslok Hospital 11 Health Sprint Networks Pvt. Ltd 11 The Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) 12 Urban Health Resource Centre 14 United Nations Development Programme (UNDP) 14 Insurance regulatory and development authority (IRDA) 14 Directorate of Health Services, Government of Tamilnadu 18 Ministry of Labour & Employment, Government of India 20 ICICI Lombard General Insurance Company 22 Mindray Medical International Limited 30 Schiller India 31 AKAS Medical 32 Mindteck 33 Dräger Medical Technologies 34 Max Healthcare 36 NRHM, Maharashtra 40 Religare Technologies 43 Agfa Healthcare 44 NextGeneSolutions 46 Srishti Software 47


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