Technology Public Health: Novembe 2007 Issue

V O L U M E 2 | I SSUE 11 | NOV E MBER 2007

ISSN 0973-8959

A Monthly Magazine on Healthcare ICTs, Technologies & Applications

Rs. 75

COVER STORY

eHealth and Public Sector Reforms in India PHARMA TECH

IT@Pharma Innovations DEVELOPMENT DIMENSION

Wi-Fi for Eye Care in Rural Tamil Nadu EXPERT CORNER

Aspects of Telemedicine for Healthcare Delivery IN CONVERSATION

Dr Samuel Yeak Chief Medical Informatics Officer, Tan Tock Seng Hospital, Singapore POWER HOSPITAL

Tan Tock Seng Hospital Singapore PERSPECTIVE

Play on! Virtual Reality Games for Smoking Cessation ZOOM IN

10 Best Practices for Selecting EMR Software

w w w .e h e a l th o n l i n e . o r g

Technology@ Public Health

www.ehealthonline.org your one-stop portal on healthcare ICTs

Catch Up With Latest News

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The pulse on Asia's e-Health

w w w . e h e a l t h o n l i n e . o r g | volume 2 | issue 11 | november 2007

COVER STORY

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eHealth and Public Sector Reforms in India

Dr. Tarun Seem, NRHM

PHARMA TECH

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IT@Pharma Innovations Dipanjan Banerjee, eHealth

DEVELOPMENT DIMENSION

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Wi-fi for Eye Care in Rural Tamil Nadu

Dolly Ahuja, eHEALTH

PERSPECTIVE EXPERT CORNER

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Aspects of Telemedicine for healthcare delivery

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Play on! Virtual Reality Games for Smoking cessation

Dr. Brenda K. Wiederhold, Virtual Reality Medical Centre

Anurag Dubey, Frost & Sullivan

IN CONVERSATION

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India would have to look at interoperability and common repositories in order to share information Dr. Samuel Yeak, Chief Medical Informatics Officer, Tan Tock Seng Hospital, Singapore

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20 Exclusive Interview ZOOM IN

Dr. Samuel Yeak Chief Medical Informatics Officer, Tan Tock Seng Hospital, Singapore

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10 Best Practices for Selecting EMR Software

Don Fornes, Software Advice

NEW S R EV I EW

INDIA NEWS 18

WORLD NEWS 24

BUSINESS NEWS 26

POWER HOSPITAL

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Tan Tock Seng Hospital, Singapore

November 2007

PRODUCT PROFILE

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EVENTS DIARY

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

Contributions to eHealth magazine could be in the form of articles, case studies, book reviews, event report and news related to eHealth projects and initiatives, which are of immense value for practitioners, professionals, corporate and academicians.

We would like the contributors to follow the guidelines outlined below, while submitting their material for publication: ARTICLES/ CASE STUDIES should not exceed 2500 words. For book reviews and event reports, the word limit is 800.

AN ABSTRACT of the article/case study not exceeding 200 words should be submitted along with the article/case study.

ALL ARTICLES/ CASE STUDIES should provide proper references. Authors should give in writing stating that the work is new and has not been published in any form so far.

BOOK REVIEWS should include details of the

book like the title, name of the author(s), publisher, year of publication, price and number of pages and also have the cover photograph of the book in JPEG/TIFF (resolution 300 dpi). Book reviews of books on e-Health related themes, published from year 2002 onwards, are preferable. In the case of website, provide the URL. THE MANUSCRIPTS should be typed in a standard printable font (Times New Roman 12 font size, titles in bold) and submitted either through mail or post.

RELEVANT FIGURES of adequate quality (300 dpi) should be submitted in JPEG/ TIFF format.

A BRIEF BIO-DATA and passport size photograph(s) of the author(s) must be enclosed.

ALL CONTRIBUTIONS ARE SUBJECT TO APPROVAL BY THE PUBLISHER.

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

Ms. Jayashri Kulkarni’s name on page 18, October 2007 issue was wrongly spelt as Jayanthi Kulkarni. The error is since regretted.

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Volume 2 | Issue 11 | November 2007

PRESIDENT

Dr. M P Narayanan

EDITORIAL Public Healthcare Delivery – finally getting the midas touch (of tech)!

EDITOR-IN-CHIEF

Ravi Gupta MANAGER - eHEALTH

Dipanjan Banerjee mobile: +91-9968251626 email: dipanjan@ehealthonline.org RESEARCH ASSOCIATES

Susan Thomas Dolly Ahuja SALES EXECUTIVE

Arpan Dasgupta mobile: +91-9911960753 email: arpan@ehealthonline.org DESIGNED BY

Bishwajeet Kumar Singh Om Prakash Thakur WEB

Zia Salahuddin Santosh Singh SUBSCRIPTIONS & CIRCULATION

Manoj Kumar (+91-9210816901) manoj@ehealthonline.org EDITORIAL CORRESPONDENCE

eHealth G-4 Sector 39 NOIDA 201301, India tel: +91-120-2502180-85 fax: +91-120-2500060 email: info@ehealthonline.org

PRINTED BY

Vinayak Print Media, Noida Gautam Buddha Nagar (U.P.) India does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. is not responsible or accountable for any loss incurred, directly or indirectly as a result of the

P

ublic healthcare system in India may very well be in for some major positive change soon !

The XIth Five Year Plan has made ‘health’ the top priority. In the Union Budget for 2007-08, fund allocation for health and family welfare sector has been hiked by 21.9% to Rs 15,291 crore, while that for National Rural Health Mission (NRHM) programme has been stepped up from Rs 8207 crore to Rs 9947 crore.

With the Government realising the importance of embracing technology to deliver primary healthcare services to the remotest corners - there opens up a web of immense opportunity for all players providing healthcare solutions and services. The cover story by Dr. Tarun Seem, Director, NRHM talks about his vision and ideas in this regard.

National Population Stabilisation Fund (NPSF/JSK) under Ministry of Health & Family Welfare, has developed an exhaustive repository of Health GIS maps (embedded with detailed health statistics) for almost all of India (except NorthEast and Himachal Pradesh), and is willing to partner with private players for its usage in planning and management of healthcare delivery. With plans to start a call center and a virtual resource centre, NPSF is all set to use ICTs in a big way.

Telemedicine is changing healthcare delivery dynamics by providing means for extending health services to all. An industry analyst from Frost & Sullivan, explains this in ‘Expert Corner’, while taking stock of initiatives taken so far in India.

The ‘Development Dimension’ section takes a close look at an innovative project of Aravind Eye Hospital which prevents unnecessary blinding, by using telemedicine in villages of southern India.

The ‘Perspective’ section shows how innovative use of technology, such as, Virtual Reality Games using Cue Exposure Therapy (CET) can help in treating addictive behaviours causing adverse health impacts.

Selecting the right medical software, impacts the practice of medicine. We ‘Zoom In’ on an innovative website providing free consultation, comparative analysis, price quotes and product demo for facilitating doctors and service providers in their purchase decisions for medical software.

It is our pleasure to announce the launch of yet another section in our magazine. From this issue we are introducing ‘Pharma Tech’ – a dedicated space for technologies and solutions for pharma and life sciences industry.

To begin with, we have assessed the feasibility of IT solutions in achieving operational and business challenges for the increasingly competitive pharma sector.

information provided.

Do let us know how you enjoyed this issue! is published by Centre for Science, Development and Media Studies (CSDMS) is published & marketed in collaboration with Elets Technomedia Pvt. Ltd. (www.elets.in) © Centre for Science, Development and Media Studies www.csdms.in

November 2007

Ravi Gupta Ravi.Gupta@ehealthonline.org 5

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COVER STORY

eHealth and Public Sector Reforms in India In this paper, we take an overview of primary health care scenario in India, the contours of health sector reforms agenda under the National Rural health Mission: the principles of eHealth, possible loci of synergy under NRHM and possible technology options for accelerated health sector reforms in the country.

Dr. Tarun Seem, Director, NRHM

(Personal views of the author, article does not reflect government policy)

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ndia has achieved multifaceted socio-economic progress since Independence. There is however, globally, a shift in the Government’s approach in favour of universalisation and entitlements. This is where India has much to catch up.

The health indicators in India have shown a steady improvement over the years.

Source: Economic Survey 2005-06

HEALTH SECTOR REFORM IN INDIA

Health sector reform involves fundamental change in policy and institutional arrangements. All aspects of the sector from manpower to infrastructure to logistics to monitoring to participation of stakeholders are subject matter of this process. Health sector reforms have come centre stage since 1980s essentially from frustration of the citizens in receiving any semblance of health care from the public system. By 1990s the process had taken concrete shape.

In India, the health sector reforms broadly cover the following areas : • Reorganisation and restructuring of existing government health care system • Involving Community in health service delivery and provision • Health Management Information System • Quality of care Health sector reform is not new to the policy maker in India.

Since middle of the Tenth Five year Plan (2004 -05 onwards) however, the process has taken on unprecedented urgency.

Health sector reform is now one of the flag ship agendas of the Government of India.

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NATIONAL RURAL HEALTH MISSION

Health care is now one of the thrust areas for the Government of India. The Government mandates an increase in expenditure in health sector, with main focus on Primary Health Care from current level of 0.9% of GDP to 2-3% of GDP over the next five years. The National Rural Health Mission (NRHM) which is the main vehicle for giving effect to the above mandate was launched in April 2005. NRHM is an overarching umbrella initiative which subsumes the existing programmes of Health and Family Welfare and seeks to be the omnibus vehicle for sector wide reform in India.

NRHM has the following vision:• Implemented throughout the country with special focus on 18 states with weak public health indicators and / or weak infrastructure.

• Improve availability of and access to quality health care especially in rural areas for poor and vulnerable sections of the population.

• Build synergy between health and determinants of good health like nutrition, sanitation, hygiene and safe drinking water.

• Mainstream Indian Systems of Medicine in Public Health system.

• Increase the absorptive capacity of health delivery system to enable it to handle increased allocations.

• Decentralise the planning process to the community.

The NRHM also revisits the Community Health Worker (CHW) strategy in India after 1982 when the support of VHG scheme was transferred to the states effectively bringing it to

Chart 1: Integration of IT interventions, Source: www.ehealthonline.org

www.ehealthonline.org

However, this change over to digital way of thinking in the health sector has rather high initial costs. The licensing terms and conditions, bilateral and interconnection agreements, non-existence of regulations, security and trade issues are serious bottlenecks which need to be addressed.

India is the ideal setting for telemedicine assisted health care. We already have a strong fiber backbone and indigenous satellite communication technology with large trained manpower in this sector. Various state governments, departments of the Government of India, private institutions and NGOs have been running a number of eHealth projects over recent past with successful outcome. In this scenario, a country level eHealth plan is long due to steer eHealth.

The enhanced allocations for eHealth over the XI Plan can be used for the following major activities to accelerate and expand the reach of the architectural correction in the health system which is envisaged under the NRHM: Training, Education & Capacity Building

Chart2: ICT Chart with actors of NRHM, Source: www.ehealthonline.org

an abrupt end. The CHWs reappear in Public Health in India in the form of the Accredited Social Health Activists (ASHA).

NRHM raises enormous demands on the training and capacity building infrastructure. e-Enabling the training infrastructure assists in optimal utilisation of the capacities.

A tele training centre is accordingly envisaged at the National Institute of Health and Family Welfare (NIHFW).

The Medical Colleges can be networked with the district hospitals and nursing institutions for CME and in service trainings.

KNOWLEDGE AS TOOL OF GOVERNANCE

Governments are by nature information intensive organizations. Rapid and sweeping technological advances over the last few years have radically redefined the abilities of Government to hold information. The empowerment of hitherto unsung stakeholders in the info transactions has created new framework for info management. Health sector has most to benefit from governance processes in which Information and Communication Technology plays a significant role.

eHEALTH IN INDIA

eHealth offers some ready products for accelerating the health sector reforms in India. The shortage of infrastructure, manpower and services in health sector in India is mainly attributable to the large gap in overall development between rural and urban areas. This gap levies substantial disincentive on health manpower for working in rural areas. eHealth offers a good option wherein a significant proportion of patients in remote locations can be successfully managed locally with advice/ guidance from specialists in cities, without having to travel far. This allows linking patients in remote areas to urban standard services without delinking urban service providers from their mileu. The arrangement offers easier, cost effective consultation, prescription mechanism and allows a referral chain. e-Enabling also improves depth, range and refresh rate for disease surveillance and response.

November 2007

Union Budget 2007-08: Allocation for National Rural Health Mission has been stepped up from Rs 8207 crore to Rs 9947 crore.

Source: www.moneycontrol.com

Monitoring

The lack of a functional MIS at various levels has been a critical shortcoming in the health sector in India.

Much of this problem can be conclusively solved using IT solutions. Under NRHM, monitoring and evaluation, using ICT tools is planned so as to create smart data corridors which are usable by both the planners and the implmentors.

GIS Resource Mapping

The preparation of District Health plans under NRHM presuppose the availability of updated information regarding the health sector resources. This includes the location of health facilities (both public and private sector), medical investigation centres and labs, training centres, trained manpower. The geo spatial mapping capacities in the country offer a major tool for addressing this critical issue. Many states including Gujarat, Rajasthan, Orissa etc. have made good progress in this area. Under NRHM this activity is proposed to be undertaken for a country wide roll out.

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COVER STORY

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EHEALTH AND PUBLIC SECTOR REFORMS IN INDIA

MAPPING PUBLIC HEALTH STATUS IN INDIA: Ms. Shailaja Chandra, Executive Director, National Population Stabilisation Fund, speaks with eHEALTH team The “Jansankhya Sthirata Kosh” (JSK) (National Population Stabilisation Fund) has been registered as an autonomous Society established under the Societies Registration Act of 1860.

JSK has to promote and undertake activities aimed at achieving population stabilisation at a level consistent with the needs of sustainable economic growth, social development and environment protection, by 2045.

The Union Health Minister heads the General Body of the JSK and the Secretaries of the Ministries of Health and Family Welfare, Department of School Education & Literacy, Women and Child Development, Planning Commission, Rural Development, and the State Health Secretaries are members of the General Body of JSK. Besides this the General Body comprises demographers, representatives of Industry & Trade, NGOs, medical and para-medical associations, general citizens, institutions etc. JSK is expected to run as a civil society movement.

What is the main focus of JSK? JSK was set up in 2003 to promote and support the Schemes, Projects, and initiatives that were to meet the unmet needs for Contraception and Reproductive and Child health. Rs. 100 crore were put in relief bonds in 2003, and the interest thereon has become available for us to work with.

Please share with us the structure and road map proposed for JSK? Our memorandum says, civil society has to be involved, if we want to see change. And for the civil society to get involved, they have to see some actual work being done; which they might feel needs encouragement.

So first and foremost, JSK has to carve a niche area, which goes beyond what governments and NGOs are already doing.

Our governing board consists of government officers who are supposed to act as umpires and facilitators, and civil

society partners which comprises FICCI, CII,renowned NGOs, demographers, preventive medicine experts, medical specialists, paramedics, nurses, so that we get a blend of professionals backed by government, so that no one sector becomes the over-riding interest group.

What prompted you into taking up this novel initiative of mapping of health facilities using GIS maps?

We are supposed to raise donations and resources for which we’ve been given 100% tax exemption. But you cannot raise resources till you yourself show that you are capable of using resources.

So in the last one-year we had to plan initiatives and start implementing them because no one will take you seriously till you show something on the ground. And I must say that we have been supported very strongly by our governing board. They have allowed JSK to be as innovative as we wished.

What kind of response have you seen in the different parts of the country after your GIS mapping initiative?

The purple areas on the GIS maps show areas where nobody has been working not even the NGOs. (On the other hand) I have visited talukas where people want to get a vasectomy done but don’t know where to go. If we give the service they come in large numbers. On one day in Gujarat in one district alone, they had done 1000 vasectomy operations. The motivators in these places were ANMs, anganwadi workers, self-help group people, peons and sweepers in the primary health centres. The health secretary was very encouraging which motivated them enormously.

The response we got in Gujarat was spectacular, MP was also very good, some parts of Rajasthan have also shown some initiative, but other northern states have not taken off...

Service Delivery

Other Activities

Several ICT enabled service delivery initiatives in the areas of Cancer network, Ophthalmology services, disease surveillance are already in operation in many states. These are proposed to be scaled up and supported by the Govt of India. A formal protocol for tele consultations and a regular tele health helpline is also proposed.

The networking of all major hospitals with the district hospitals, CHCs and PHCs would substantially enhance the reach and range of services available to the citizens from the public system. The large number of mobile medical units can also be e-Enabled so as to expand the range of services which can be made available through them.

The large number of eHealth initiatives are already operating in the country (either under the State Government patronage or in a private institution). These are proposed to be evaluated and examined for support under the GoI ehealth efforts.

The scaled up shift over to digital method of thinking in the development sector would however need to be a cautious transition. There are several obvious pitfalls in digitalization of governance and public sector service delivery. The most important being, accentuation of the existing analogue divide with an additional digital divide. Furthermore, the acceptability of eHealth as a viable initiative would need to be developed amongst the service providers. A study of existing telemedicine initiatives has pointed out that eHealth

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cases and pay upfront. JSK is willing to do any handholding required, such as if they want to transport people from the purple areas, then JSK will support it as a pilot project to see if that really has an effect. JSK is willing to pilot one or two districts; if it works then the programme can be upscaled.

Having the GIS mapping for the whole country, it is possible to use the maps to pinpoint areas that deserve our focused attention.

We have done mapping to show where the total fertility rates are very high. The southern states, Himachal and Punjab have reached the fertility rate that the national population policy prescribes which is 2.1. The green states are soon going to achieve it.

The red ones are going to take years to stabilize.

What role do you foresee for the private players in the healthcare sector?

There are plenty of new options for contraception, but we don’t have enough people trained to provide services.

What we need is for private providers to be first trained to use certain skills and then to pay them to carry out these new methods. The government scheme is now very generous. It allows private providers to partner such projects. If JSK can partner with a private provider, empanelled with the state, instead of the per case cost he receives for single cases, JSK is willing to let him do a hundred

Please share with us some future initiatives that you have planned for JSK. We have planned to set up a call centre, which would give information on sexual health and everything to do with women’s and men’s health, from adolescence to infertility and menopause.

All this information is available on our portal, and is in the process of being translated into Hindi. One also has the facility to even do a comparison of the different kinds of contraceptives/family planning methods available.

All this information is helpful if you are web-savvy which some may not be, so we want to set up a call centre. Such people can then pick up an ordinary phone and have a normal conversation with an actual person not some automated recording. There will obviously be with a disclaimer that it does not substitute for a doctor’s consultation.

We are now in the process of looking for a BPO to run it and for recruiting capable people to act as communicators.

We have also organised events in the past, where we have brought a large

sessions are most likely to be cancelled (primarily) due to non availability of the doctor at the remote or the expert end for conducting the session.

It would therefore be necessary to create a strong sense of motivation among doctors and design eHealth programmes on basis of felt needs. There would also be need for regular monitoring, follow ups and independent evaluations of the initiatives. The contours of ownership of eHealth initiatives in respective division, state or institutions would need to be clarified. It would also be necessary to set up e-Literate management structures to support the day to day requirements of eHealth initiatives in public health setup.

IT enabling of health sector can take on a life, logic and legitimacy of its own. In this process, the real issues of health November 2007

number of people from the purple (high fertility) areas where we setup sessions encouraging them to go back and become the ambassadors for these issues of gender discrimination, early marriage and population stabilisation.

We are also trying to encourage the district collectors; we are trying to get industry involved by using their hospitals (through FICCI). We’re also trying to see if we can work directly with the panchayats.

We are also setting up a Virtual Resource Centre, which would have audio visual material, film clips, images, posters which are on a meta- database so that anything (audio-visual) that comes gets uploaded; films on female foeticide, and related subjects.

What kind of help and infrastructure did you have on the technical front for the GIS initiative?

National Informatics Centre (NIC) has been very helpful. On the technical front, they gave us the server free of cost; in fact this whole thing was created

by NIC. They had the GIS maps and the census data, and on my asking they said that one could superimpose the same data on the maps but they just did not have the time to do that. So I found them someone they agreed to train, but it was all done under their supervision and of JSK. And we had the ranking of the districts done side by side, with bar charts by a young demographer straight out of International Institute of Population Studies.

For more information on National Population Stabilisation Fund log on to www.jsk.gov.in

delivery and other health sector necessities would have to be prevented from becoming subordinate to the technology.

The digitalization of public health delivery system would therefore need to be patient centered rather than technology centered. Never the less, the public health system in India can no longer afford to delay a large scale shift to eHealth.

Clearly, the NRHM has created the right environment for this transition.

Dr. Tarun Seem Director, NRHM Ministry of Health and Family Welfare email: tarun.seem@nic.in

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uccess parameters of pharma companies are typically attributed to their R&D productivity and ‘time-tomarket’ of productised innovations. Quite obviously, they have a high dependence on data and information – often with massive requirements for high volume storage capacity and powerful applications for data mining, data management, analysis, extraction and compilation at various levels of drug discovery, development, clinical trials, compliance submissions and commercialisation process.

With relatively long product-discovery and development cycles (ranging from five to fifteen years) for pharma sector, and increasingly stringent enforcement of patent expiration timelines – companies need to take faster and flawless decisions at every phase of the business in order to ensure sustained success. In this context, pharma industry have started to foresee the differential advantage of IT deployment that can leverage their entire value chain, from research lab to consumers - eventually leading to market success.

Functional areas of IT application in pharma and life sciences sector: • Clinical Trial & Scientific Data Management • Electronic Data Capture (EDC) • Electronic Content Management (ECM) & Workflow Automation • Regulatory/Compliance Management IT CHALLENGES IN PHARMA

IT challenges for a typical pharma company primarily entails the following operational areas • R&D Productivity Management • Data Handling & Information Management • Safety and Regulation Compliance • Alliances/Collaboration Management • Work Process Efficiency 10

R&D productivity management - is crucial for companies in order to possess requisite knowledge for taking informed-decisions regarding high value investments in drug development, and reduce risks through timely entry or exit decisions.

Data Handling & Information Management - is one of the most important aspects of pharma companies, to ensure accurate capture, storage, management, administration and access of data/information across research and business groups. Invariably, it also pertains to issues of knowledge management, information security and IP protection.

Safety and Regulation Compliance – is yet another critical area for pharma industry and serves good for drug developers if they can use advanced informatics to detect early signals and trends, or construct predictive modelling and in-silico techniques.

Alliances and Collaboration – is a continuously evolving and a high value-add aspect of pharma business that deals with partnership management and seamless collaboration between internal and external collaborators. Virtual collaborative platform for multi-locational competence teams proves to be highly effective.

Work Process Efficiency – is one of the primary criteria for business success in pharma sector. Focus on core research or business activities need to be increased by automating routine, repeatative and manual work.

APPLICATIONS IN PHARMA IT

In a typical pharma enterprise, IT can come into play almost entirely along the organisational workflow and can prove to be a critical success differentiator in certain areas. Considerable advantage has been brought in by dramatically reducing time-line for drug design and development; lowering research cost (through in-silico testing technologies); and depreciate financial risks with efficient prediction-optimisation models, derived through robust software applications.

Computer Aided Drug Design (CADD) technology is revolutionising drug discovery by delivering powerful ‘molecular modelling’ capabilities. CADD technologies www.ehealthonline.org

PHARMA TECH

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Pharmaceutical companies are vying with each other to keep time and costs down, to reach the market earlier with a superior product that is competitively priced. They need software and products that are tailored for bioresearch, biopharma and biomedical applications, in order to keep their products, processes and pricing competitive... India with its track record in the global IT market is ideally positioned for growth in the Bio-IT (Source: www.outsource2india.com)

perform computerised analysis of molecule-protein interactions, virtual bio-chemical experimentations and efficient lead optimisation techniques, which delivers far greater advantage over traditional methods.

Some important application areas of molecular modelling are as follows: • Virtual Screening – computerised screening of molecular databases against disease-causing protein, for fast and efficient lead generation • Sequence Analysis – computer based exploration of genetic and protein sequence, for similarity or dissimilarity finding within bioinformatic databases, and estimation of compatibility based on level of sequence match • Homology Modelling – three dimensional modelling of amino acid configuration in protein molecules for facilitation in drug research and design •

Global bio-informatics market is projected to grow at an annual rate of 15.8%, reaching US $3 billion by 2010.

assessing biological properties and construction of new models for deriving desirable substances from known compounds/ligands Drug Bioavailability & Bioactivity – software based estimation and analysis of absorption, distribution, metabolism, excretion and toxicity (ADMET) characteristics of new drugs for finding their biofeasibility prior to clinical trials

(Source: RNCOS ‘Bioinformatics Market Update 2007’ ) INDUSTRY TREND

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• •

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Quantitative Structure Activity Relationship (QSAR) – statistical modelling of molecular structure in compounds for estimation and prediction of chemical and biological activity Lead Optimisation – software assisted optimisation of structural and bio-chemical characteristics of potential drug leads for better drug development and design Similarity Searches - exploration of compound databases for searching similar molecules based on multi-parameter criteria including molecular structure, sequence and electro-static properties Pharmacophore Modelling – computer generated three-dimensional atomic modelling of compounds for

For all such applications, high-end softwares and highcapacity computing device and servers are a definite prerequisite. Increasingly, pharma companies are embracing IT and deploying enterprise-wide capacity to retain competitive edge in the drug discovery market.

Approximate estimation of the drug discovery software market in India is pegged between $1.5-2.0 billion. However, the market is expected to grow much more in the coming years as more players emerge into this industry, riding on the outsourcing wave.

Dipanjan Banerjee, Manager, eHealth dipanjan@ehealthonline.org

www.ehealthonline.org

Christian Medical Association of India Kerala State Pollution Control Board

RAJIV GANDHI CENTRE FOR BIOTECHNOLOGY

Catholic Health Association of India - Kerala

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DEVELOPMENT DIMENSION

Wi-ďŹ for Eye Care in Rural Tamil Nadu With an estimated 15 million visually challenged people, India is home to the largest blind population in the world. The main causes are cataracts, diabetic retinopathy, and glaucoma. Thanks to the new technology used at Aravind Eye Hospital, Theni - thousands of villagers are now able to receive timely eye care.

Dolly Ahuja, eHEALTH

Aravind Eye Hospital is using the long-distance Wildnet technology to connect skilled ophthalmologists in its main hospital in Theni with technicians in remote eye-care centers in poor villages in southern India. By 2008 it expects to reach 1 million residents.

Formula

Results

Modified Wi-Fi Media Access Control (MAC) protocol + directional antennae + routers= signals+6Mbps speed over distance of 40 miles.

Thus emerged the new WiFi over long distance (WiLD) or the Wildnet

Real time eye exams are conducted at Vision centres with doctors present in Theni; where the direct connection is 150 times faster than the old dial-up modem; and where the operation cost is practically free (as compared to $200 annually in the old system) after installation cost of $1800.

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he Wi-Fi System now provides high bandwidth transferring high quality video imaging over long distances.

Developed under the Technology Infrastructure for Emerging Regions (TIER) project, by a research team at the University of California, Berkeley and Intel Corporation in collaboration with Aravind eye hospitals, this technology is low cost and connects over long distances.

The network at Aravind Eye Hospital, Theni allows its specialists to have a video conference of high quality with patients at 9 clinics in remote areas.

It all began in the year 1976, when driven by compassion, Dr. G. Venkataswamy soon after his retirement at the age of 58 years, formed GOVEL Trust and founded the Aravind Eye Hospital.

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Named after Sri Aurobindo, Aravind Hospitals carry forward the 30 year crusade to fight needless blinding in Tamil Nadu.

They had a financially sustainable model of providing low cost treatment to large numbers. They gradually spread to a network of 5 Hospitals in Madurai, Theni, Tirunelveli, Coimbatore and Pondicherry.

CHALLENGES

Large population, lack of infrastructure, low per capita income, diseases and illiteracy.

Despite this progress, it was felt that 70% of vulnerable population was in the villages and out of reach. Hence came the concept of Village Vision Centres to provide basic eye care via online video-conferencing. This idea ran into trouble www.ehealthonline.org

Intel long range WiFi system presentation

due to lack of Internet Service Providers; low cost service; and fast dial-up speed.

LOOKING FOR OPTIONS

“The information technology revolution holds tremendous potential for addressing problems in developing countries,” said Professor Eric Brewer, UC Berkeley (Computer Science) and Director of the Intel Research Berkeley lab.

Cataract surgeries in progress at Aravind Eye Hospital

Recce began in August 2004 at AEH Theni. The work was initiated through Berkeley’s Technology and Infrastructure for Emerging Regions (TIER) project. TIER is sponsored by UC Berkeley’s Center for Information Technology Research in the Interest of Society (CITRIS.) Wimax technology for long distance communication, although a ready option could not be used due to its high cost.

The other option was Wi-Fi or the 802.11 networking standard, defined by a set of international standards limiting its range to 200 feet.

SOLUTION

The Engineers at Berkely tried to adopt Wi-Fi for long distance by adding Antennae. This entailed having a point to point wireless connection, like microwave links, as radio signals need a particular direction.

November 2007

With collaborative efforts by University of Berkeley, Intel and the Hospital, Wi-Fi over Long Distance (WiLD), was developed. The system was installed in a vision center in the village of Ambasamudram, about seven miles from the Aravind hospital in Theni. It was up and running by 2006. At present the Aravind Eye Hospital at Theni is connected with many outlying clinics in Tamil Nadu. They may be as far as 5 or 15 fifteen kilometers with stations placed in line of sight.

According to Dr Namperumalsamy, Chairman Aravind Eye Care System, more people can be served at an affordable cost.

Currently the nine Vision Centres linked to Theni serve more than 50,000 people. Each centre is managed by 3 paramedical technicians. Around 2,500 patients interact with doctors via video conference, every month. In cases where a closer exam or surgery is required, the patients are given hospital appointments.

The Hospital is expected to double its remote patient volume in the next 12 months and add 20 more clinics to the network by the middle of 2008.

Trained paramedic examines patient at a visual centre Very soon a million people in the state of Tamil Nadu will have access to low-cost eye care.

The Wi-Fi link up and expansion of network has already started showing effects.

A study by the Aravind Eye Care System shows that 85% of the male patients and 58% of female patients got back their jobs after treatment. This may as well be termed ‘A positive impact on the health of the Indian Economy’.

This is may be a cost effective way for communities to get conn-ected the world over, when a high-speed networking is found within 50 miles. Apart from the initial cost, there is little running cost as very little power is required to run the system, which incidentally can even run on solar.

The Research was funded by National Science Foundation.

Marratech AB donated the video-conference application.

Small Wildnets have also been built in Ghana and the Philippines for promoting rural Internet.

Wildnet complements already existing technologies like WiMax, cellular broad-band, satellite, or Wi-Fi. Resource Acknowledgments www.aravind.org www.berkeley.edu/news/media/releases www.intel.com/research/eyecareindia.htm http://members.forbes.com/global Dolly Ahuja, Research Associate, eHealth, dolly@elets.in

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EXPERT CORNER

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Aspects of Telemedicine for healthcare delivery Telemedicine has changed healthcare delivery dynamics in the interest of extending health services to all individuals and eliminating time and distance barriers.

Anurag Dubey, Frost & Sullivan

T

elemedicine is delivering healthcare services to the remotest locations with the use of information and communication technologies. It is exchanging medical information amongst physicians and patients in remote locations with the help of technologies like Local Area Networks, ISDN (Integrated Services Digital Network) and VSAT (Very Small Aperture Terminal), Virtual Private Networks.

Telemedicine has changed healthcare delivery dynamics in the interest of extending health services to all individuals and eliminating time and distance barriers.

TELEMEDICINE WORKS OVER TWO TYPES OF TECHNOLOGY CONCEPTS

•

•

Real time/two-way interactive technology – also called synchronous telemedicine, where an interactive consultation between doctor and patient takes place in real-time using video conferencing equipment.

However, other peripheral devices (like electronic stethoscope or tele-otoscope) can also be attached to the entire setup to aid the interactive patient examination. This method has been successfully used in internal medicine, psychiatry, cardiology, pediatrics, obstetrics and gynecology, and neurology, to name a few.

Store and forward technology – also called asynchronous telemedicine, typically involves transfer of medical data (like x-ray images, ECG signals etc.) to a doctor at a different location for diagnosis or consultation offline.

This method is commonly used in radiology, pathology and dermatology.

TRENDS

Currently, telemedicine is being used for various reasons such as e-consultation – for Cardiology, Gynecology, Pediatrics, and other vital parameters, remote monitoring of critically ill patients in homecare or hospital set-ups and e-Education in medical sciences.

TECHNOLOGICAL ADVANCEMENTS/ TRENDS

The key focus of advanced technologies in telemedicine is to create an easy user interface for the patients at the point-of-care. With the introduction of advanced monitoring devices in the market patient monitoring at a remote location is getting easier at both the physicians’ and patients’ end.

Healthcare providers are setting up wireless networks to enable physicians and nurses to share and access critical patient information over the network without being present at the actual point-of-care, helping in faster information flow leading to quick decision-making and improved patient care.

Telemedicine in India • •

• •

TELEMEDICINE HAS TWO BUSINESS PERSPECTIVES

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Social perspective - to extend health services in rural and remote areas.

Commercial perspective –to use as a marketing outpost especially for private sector healthcare providers

Telemedicine started in India in the year 2000 with Apollo’s Aragonda project in Andhra Pradesh.

There are around 400 telemedicine centers across India and approximately 50 specialty hospitals are linked to these. Apart from this there are around 100 tele-ECG centers supported by various specialty hospitals.

An estimated 0.15 million patients have been provided online consultation by various Government and private telemedicine centers.

Around 4000 patients have been thrombolised by telecardiology services.

In the future, telemedicine applications will use ‘unified communications’, which means all disparate communication systems like audio, video, web-access and data would be integrated into one stand-alone monitoring system. www.ehealthonline.org

There have been a lot of advancements in patient care in home, hospital and mobile environments as well.

For home care services there are home monitoring solutions for patient’s vital parameters. More compact versions of these solutions are the wireless home monitoring devices, which can be used by patients at home, office or while in transit.

There are plenty of new innovative technologies that help fill gaps in the processes like CPOE (Computerized Physician Order Entry) and e-Prescribing, which makes the process of patient care much easier for physicians and nurses.

A CPOE application substitutes physical medical records with an electronic template where the physicians can issue orders for therapy and procedures electronically, saving time in patient care. These advanced technologies are helping in extending fast and to-the-point healthcare services and also enhancing the productivity and efficiency of healthcare providers.

GROWTH DRIVERS

The key drivers for Telemedicine projects are: • Huge rural population - With almost 70 percent of India’s population living in rural areas and 90- 95 percent tertiary health centers located in metros / mini-metros, there is an enormous need for telemedicine projects, to reach out the remotest of areas with healthcare services.

• The Time-lag factor - The time-lag between the occurrence of medical need and delivery of the medical services, makes the requirement of Telemedicine facilities even more imperative.

• Cost Effectiveness – With the increasing cost of healthcare services, telemedicine is an effective way for providing cost effective care services by saving on travel and time.

• Technological Innovations – new technological innovations are providing easy-to-use devices and applications thus reducing the call-for-expertise to operate and manage these devices.

• Breaking Geographical Boundaries – telemedicine set-ups have broken distance barriers and have helped healthcare services to extend outreach to remote locations.

• Knowledge enhancement – telemedicine will give opportunity for remote doctors to enhance their clinical knowledge over a period of time by having expert opinion for patients.

CHALLENGES

Some challenges faced by the telemedicine service providers are: • Technology integration, that is, successful interfacing of medical equipment and networking • hardware and software, satellite connections etc.

• Difficulties in achieving the last mile connectivity • Availability of skilled manpower resources (both medical and non-medical) at remote locations November 2007

Telemedicine and its Uses • • • • • • •

• •

Teleconsultation – real time consultation with patients in presence of remote doctors for various specialties like pediatrics, gynecology, neurology, cardiology, etc.

Teleradiology and Telepathology – consultation and reports for radiology services and pathology tests conducted at remote locations.

Telecardiology – online consultation, real time ECG transfer e-ICU – real-time monitoring of remote ICU through multi-parameter monitors Tele-Asthma – monitoring Pulmonary functions remotely and providing consultation based on results.

Tele-Psychiatry – providing psychiatric counseling and consultation by experts through video conferencing Tele-Dermatology – providing diagnosis and consultation based on images of patient’s ailments Data protection and security issues Cost-benefits of the project and of course the adequate patient traffic at the remote centers

WORK DONE SO FAR

In India, many Government and private hospitals have taken initiatives for implementing telemedicine projects.

To name a few: Indian Space Research Organization – pioneer in conceptualizing and implementing telemedicine projects across the country in private and government organizations.

ISRO has been providing VSAT connectivity, hardware, software and telemedicine services to various organizations.

It has also started setting up Tele-health / Tele-education facilities at Village Resource Centers across India to increase the outreach to more number of rural villages.

Some major Telemedicine programs are also being run by the following organizations: All India Institute of Medical Sciences(New Delhi), Apollo Hospitals (Hyderabad), Aravind Eye Hospital (Madurai), Army Hospitals, Fortis Healthcare (Delhi), KLES Hospital (Belgaum), L. V. Prasad Eye Institute (Hyderabad), Manipal Health Systems (Bangalore), Max Healthcare (Delhi), Narayana Hrudayalaya (Bangalore), Navy Hospitals, PGI (Chandigarh), Sankara Nethralaya (Chennai), SGPGI (Lucknow), Space Hospitals (Chennai), SRMC (Chennai), Tata Memorial Hospital (Mumbai).

State Government Telemedicine projects have been implemented by the following states: Karnataka, Tamil Nadu, Madhya Pradesh, Chhatisgarh, Rajasthan, Jammu and Kashmir, Pondicherry, Kerala, Gujarat, West Bengal, and the north eastern states, etc.

Anurag Dubey Industry Analyst, Healthcare Practice Frost & Sullivan

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NEWS REVIEW

INDIA

Apollo Hospitals finally comes to Mumbai Apollo Hospitals Group, in a bid to further expand its healthcare business has firmed up its plans for establishing a presence in Mumbai.

One Equity Partners, the private equity arm of the J P Morgan, will reportedly be the financial partners for Apollo’s foray into the city. One Equity Partners has invested in Apollo Health Street, Apollo’s healthcare and IT BPO. The Apollo Group plans to build 4-5 medical facilities in the city, which would offer upto 2,000 beds within around two years, and has reportedly acquired land in Navi Mumbai and Thane for its projects.

A new entity, named Western Hospitals Corporation Pvt Ltd, will reportedly look after the Mumbai projects. The group is using the JV route to enter Mumbai, which was the only metro city in which Apollo did not have a presence, since most hospitals in Mumbai are run

by Trusts.

21st Century Health gets Narayana Hrudayalaya Project Narayana Hrudayalaya, Bangalore and Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, two of the largest cardiac super-speciality hospitals in India have partnered with Mumbai-based 21st Century Health Management Solutions (21st CHMS) to implement state-of-the-art Advanced Imaging System (AIS).

While the conventional PACS system revolves around improving radiological viewing and reporting efficiency, the 21st Century Health’s AIS delivers cath-lab, 2D-echo, radiology images and Electronic Medical Record to a unified interface for the clinicians.

Cardiac consultants, interventional cardiologists and surgeons will get access to images from a wide variety of modalities at various stages during the assessment and treatment of the patient, improving their clinical decisions as well as the speed.

A conventional RIS/CIS/PACS implementation of this scale would have cost at least INR 3-4 cr (approx. USD 1m) at each hospital.

Government promises health insurance for poor workers

The Govt. of India is bringing in a Health Insurance Scheme (HIS) for the unorganized sector workers who constitute 93% of the country’s 400 million workforce; and who, because of low affordability take recourse to inadequate and incompetent medical treatment. The HIS would be implemented in phases.

Initially workers living Below the Poverty Line (BPL) are to be covered in next five years.

The centre will allocate over INR 750 crore in 2008-09. Each year 120 districts across the country would be selected by the State Governments.

The beneficiary can avail healthcare facility at any of the notified hospitals without any cash transaction up to INR 30,000 p. a. for a family of 5, on floater basis. This comes at no cost to him as the estimated annual premium of INR 750 to be paid to the health insurance provider would be shared by the Central and State Governments in 75:25 ratio. Beneficiary would be issued a smart card costing INR 60, borne by the Central Govt. The card would be valid even if the worker migrates to another state.

The beneficiary would, have to pay INR 30 p. a. as registration/ renewal fee, in order to demand the service as a matter of right.

All pre-existing diseases would be covered.

The NCT of Delhi is the first State to operate the Scheme to be followed by Maharashtra.

India’s left demands separate ministry for pharma sector Stating that the growth of the estimated 12-billion dollars Indian pharmaceutical industry has been hampered by multiple authorities, Communist Party of India (Marxist) has asked the government to create a separate ministry for the sector.

In a letter to Prime Minister

Manmohan Singh, CPI (M) leader Sitaram Yechury called for his intervention “to encourage this sunrise industry”. Stressing that the large but fragmented Indian pharmaceutical sector has to deal with complex issues, he said it could be tackled by a specialised and dedicated administration.

GE Healthcare gets approval for India’s first radiopharmacy centre A unit of General Electric Co., GE Healthcare Technologies Ltd, has received approval from India’s Atomic Energy Regulatory Board, for setting up the country’s first radiopharmacy centre.

The centre, located at Noida near New Delhi, is expected to start operations this December. It will manufacture and sell socalled nuclear medicines used in patients for advanced diagnostics. Nuclear medicines, or radiopharmaceuticals, are isotopes that are injected in patients for taking images of the functioning of organs such as the heart, kidney and liver using advanced scanners and other imaging machines. This advanced diagnostic system helps to detect symptoms of diseases ranging from coronary artery to Alzheimer’s.

Since making these isotopes involves radioactive components, a prior approval from the Atomic Energy Regulatory Board (AERB) was required.

Indian hospitals and nuclear medicine centres import isotopes for scanning. Since these isotopes have a decay period of 6-72.5 hours, they lose at least half of their life by the time they can be administered to the patient. Hence, managing the logistics of imported isotopes has been difficult, and it has typically resulted in high overhead costs as well as a severe shortage.

GE is already a major player in the Indian diagnostic imaging systems market. It plans to open other such radiopharmacy centres in Mumbai, Bangalore and Hyderabad in cooperation with large hospitals.

According to GE, setting up of such radiopharmaceutical centres will propel the market for nuclear medicine procedures in India to grow at a rate of 15-20% every year, up from 10% now. The Noida centre will cater to some 100 hospitals in the region. GE is also tying up with Tata Memorial Hospital in Mumbai and Healthcare Global at Bangalore to cater to these cities through a similar distribution channel.

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www.ehealthonline.org

More V-sat mobile units to connect hospital network from Space Telemedicine Space Telemedicine, which has already networked with 57 leading hospitals in India, (including seven in Tamil Nadu), will soon launch 600 mobile V-Sat units, to connect the smallest towns with major super speciality hospitals across India, in what is claimed to be the largest telemedicine initiative in Asia.

The company will place 600 mobile V-Sats in Tier II and Tier III cities, towns, villages and remote areas, with the intent to move the clinical information rather than the patient. The concept, is that, depending on the need and availablity of specialists, the local general practitioner can choose from scheduled live interactive consultation,

where the specialist is available at a pre-fixed time.

Besides on-demand live interactive consultations, during emergencies, there is also ‘Store and Forward Consultations’, where the local general practitioner forwards patient records and diagnostic test reports, receives specialist opinion and then gives the diagnoses to the patients at a later date.

Free and Open Source Software to track epidemics like Chikungunya, Malaria, Dengue A revolutionary new software developed

by Zyxware Technologies (India) is about to change the way information is collected and processed in tracking diseases like Chikungunya, Dengue, Malaria. The software, has been dedicated to the nation as Free Software under the GNU General Public License (GPL).

The software is web based and allows Hospitals to report cases of diseases as soon as the case is registered at the hospital. The

software seamlessly integrates with the existing manual process by allowing hospitals that don’t have any web access to send paper based reports to data entry operators who can enter them into the system or send soft copies of the reports that can be imported automatically.

Private angle to Govt’s low-cost healthcare for masses Private healthcare giants such as the Apollo Group and Wockhardt Hospitals are entering into partnerships with various state governments to provide healthcare services.

One such example Wockhardt, is looking at delivering primary and secondary healthcare, particularly through select bio-medical services, wherein they will offer back-end support through pathology labs and diagnostic facilities within a government hospital. It will leverage on high volumes to scale down costs.

The idea is to support government healthcare system from the back end. The private sector would offer services in areas like diagnostics, where they would operate and maintain medical equipment at government-owned hospitals.

This will be done without tinkering with the government’s healthcare budget and at the same time, improving the delivery of health services. The target will be low-and middle-income groups. The tab will be picked up by the state government.

The GIS interface uses Google maps to present the data on a real time basis on a map of the state, and presents reports that can be used by the Health Department to monitor the situation on a real time basis and take precautionary measures if required.

The software has been released as Free and Open Source Software to promote the fact that it is possible to develop state of the art software at very low costs.

SRIT forms a JV Company in Australia Sobha Renaissance Information Technology (SRIT) have announced its Joint Venture (JV) with Capital Technic Group (CTG), an Australian Management Consulting & Services firm.

The joint-venture capitalized at Australian $2.5m aims to produce $7.5m in annual revenues by the second year and ramp up to $65m by the fifth.

The joint-venture, Sobha CTG Solutions Australia Ptv. Ltd., will launch SRIT’s products and services in the Australasian markets, while SRIT will enhance the growth of CTG’s consulting services in the realm of ICT. Structured as a 50:50 JV, Sobha CTG Solutions Australia Pty Ltd. aims to enter the Australasian ICT markets in a cross section of areas including healthcare.

While the joint venture company has been registered as Sobha CTG Solutions Australia Pty Ltd, the trade name has been set as, ‘Sobha CTG Solutions’.

This JV would also create career opportunities for high-end ICT personnel from both, India and Australia. As an integral part of their commitment, CTG would identify knowledge and technology transfer opportunities to SRIT in the territory. CTG would also guide the JV Company on accessing Australian Federal Government R&D and other investment incentives. Induction of an Australian General Manager and other senior resources for the JV is already in process.

Fortis, Microsoft promise better healthcare through technology Fortis has entered into an agreement with Microsoft India to deploy solutions and services based on the Microsoft platform aimed at enhancing knowledge management and productivity.

Based on the 4P vision of healthcare - Prevention, Prediction, Personalization and Participation, Microsoft solutions will enable Fortis Healthcare collaborate on various processes online using best-in-class Office and Exchange applications. The focus will be towards making documents, workflows, projects and performance management available on a common SharePoint portal available to Fortis employees, doctors and nurses across all its centers. The deployment of the solutions will bring together diverse patient data from multiple sources and make it instantly available at the point of care, thereby enhancing productivity and most importantly, patient care.

Fortis claims that the Enterprise Agreement enables it to streamline their group-wide investment and leverage best collaborative solutions.

It also allows them to scale up without worrying about software management and focus more on healthcare technology.

November 2007

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IN CONVERSATION

India would have to look at interoperability and common repositories in order to share information Dr. Samuel Yeak MBBS, FRCS (Edin), FRCS (Glasg), FAMS (ORL) Chief Medical Informatics Officer, Tan Tock Seng Hospital, Singapore

What is the quantum of International patients that your hospital serves and from where do they mostly come?

Unfortunately I cannot give the exact percentage as it has been changing a lot since the last few years. But yes, we are growing international business by about 20% a year. We have just begun to market. Previously, being a public institution our main priority was to cater to the local residents. But because of the poor countries’ push towards Singapore medicine, we felt that it was important for us to get involved.

Our main clientèle are Indonesia and Malaysia. We are also beginning to see patients from India, Bangladesh, South East Asia, especially Vietnam and also China.

What about the market in the U.S. And Europe?

We have started to market to Canada and the U.S. We get most of UK clientèle through personal reference. Our marketing team has just been to the US to sign some MoUs with the big Insurers there. The Insurers need to accept a hospital as being accredited. We were the first ones to get JCI accreditation.

And we are the first to have CPOE widely implemented; something that is very important to Americans, because of the Assurance of Quality and patient safety.

What other service levels or certifications do you think hospitals require for servicing global clientèle?

Certification is one thing. Alternatively it is also the personal service, more than 20

certifications, that you can offer to the foreign clientèle.

We have an International Patient Liaison Centre. They provide all kinds of services, from the moment the patients step off the plane to the moment they get back onto the plane, everything is arranged in advance for them. We even work with the Air-Ambulance Service for ill patients who need to fly in.

And because time is very short, and doctors need to go there, we have facility for arranging appointments.

Do you face any difficulty due to absence of a National Health Information System in India – people coming from the U.S. must be having health cards- with all digital data recorded, which probably makes it very easy to start diagnosis and treatment?

Sure, it is definitely a bonus to be able to have more information before they come. In fact a lot of times before patients fly over to see us, they actually send information to get an idea of what we can possibly offer. And that is why we have this International Patient Liaison Centre to be able to handle such queries and to give them estimates of costs and so on. And sometimes if a patient sends in a query with very little information, it is actually impossible to give an idea of what you can offer and how much it will cost.

Regarding Patient Health Records, EMR and EHR, what is the Government’s strategy in Singapore?

What are the salient features of the

National Program in which you are managing the National Health Information System? And how can countries like us benefit from learning from these Plans?

Well we have the National Health Group and the Sing Health Group. Basically they are divided into two clusters by the Government; separated interestingly by the Central Expressway. It is just a physical demarcation, so everybody west of the Central Expressway belongs to the National Health Group; the rest belong to the Sing Health Group.

Both the programmes are run by the Government, but they are kind of restructured institutions - privatized, so that they are better managed, and there is more accountability. And also I suppose to generate some competition, rather than everybody looking to the Ministry of Health for direction.

So with IT that poses a challenge because, for years we have been developing IT as a separate cluster.

But the Ministry has recognized that it is important to be able to share information between the two clusters.

So they have formed this EMRX, for EMR Exchange. In the Committee we look at which common data fields we can share, and try to standardize that.

We know that it is a bit too late to turn back the clock and to develop common systems at a stretch, so it is better to make use of what we have and move forward from there. That’s what any country especially India would have to do- look at interoperability and common repositories etc. Only then can you share information. www.ehealthonline.org

In India we talk about EMR, EHR and Health Information Exchange, but the mind set among service providers is that if you share information, you lose your clientèle. What is the situation in Singapore?

Firstly, this sharing of information needs very high levels of adaptiveness.

For us effectively it came from the Government. In order to effect this, first there must be Government funding, otherwise there is very little impetus to do so. The main hindrance is really the cost involved.

It is futile to worry about losing patients to the other cluster. We do not mind the patients going across to seek a second opinion. If you are good, people will come to you and we should be open about sharing some information and demonstrate that we are putting the patient’s interest first, rather than our own interest. And mostly the patients come back, they also bring other patients.

Do you see India having one single Information Exchange, which can address both public as well as private service providers?

It is going to be extremely difficult. I mean, even in the U.S. it was actually with government funding that all these clusters were formed and now they get to share information. But even between these clusters, I do not think there is a sharing of information. Part of the problem is that there are too many players. It is not an easy task to have such a central repository, in a very advanced country like the U.S. So India, I would say, is probably even further away from there. You have to look to the U.S. for their model to work on first.

It is difficult for a small country like Singapore to comment on this because the task is relatively easy for us.

Do you think guidelines to follow standards should come from a central authority or the government, so that when the market as well as the government are ready, the public and private networks can seamlessly be integrated?

The standards need not necessarily be from government. There are lots of international groups, that are laying out standards like HL7 and DICOM. November 2007

These international standards have become widely accepted and need not be reinvented. So we should look at adopting rather than reinventing them.

There are also quality standards that are being introduced in the US now like the HIPAA group and CCHIP group. These are all standards that have already been developed and agreed upon. Soon they will spread to the rest of the world. We have also started looking at some of these.

In Singapore, does the Government have a directive in terms of pricing in the services of public or private hospitals?

Well, the private sector looks at the benchmarks that the government hospitals set. They actually do charge more than the public hospitals. But they do not go too far; otherwise they will not get any local clientèle. The standards in the government hospitals are very high. A lot of local citizens who can afford private care, would

90% subsidy. Subsidy does not depend on economic criteria. You could be a rich tycoon owning millions of dollars and if you choose to stay in C class, you will still get your 90% subsidy. It only means that you do not get the frills but you get the same level of medical care.

You do not get to choose the senior doctor or get the immediate private access to him. But you can be sure of the medical standard of care. You are in an open ward. If it is a C class, it would be a 10 bedder room; B2, will get you a 5-6 bedder; B1 gets you a 4 bedder.

Whereas, if you are an A class patient, you get a private room to yourself.

How has Singapore addressed the issue of ‘Doctors not being IT friendly’, and how different is your medical training in that respect, from countries like India?

IT exposure is not really provided in medical school. Although, nowadays most of the kids are wizards at using computers by secondary school. But,

We know that it is a bit too late to turn back the clock and to develop common systems at a stretch, so it is better to make use of what we have and move forward from there. That’s what any country especially India would have to do- look at interoperability and common repositories. Only then can you share information. rather seek treatment in government hospitals, knowing that they have a stricter audit system since the motive is less financially driven; and they are more assured of certain standards.

We actually have no dearth of so called ‘private patients’ in government hospitals as well. Occasionally the private sector may charge highly: say rich clientèle from the middle east, where the government is paying for them. Generally the prices are close to public sector prices. Incidentally in our hospital a foreign private patient pays exactly the same amount as a local private patient.

Then there are those patients that are subsidized by the government. For instance, we have three tiers of subsidyB1, which is effectively private, where patients get some subsidy for room rates; B2 where they get 60 to 70% subsidy; and a C class where there is

for the older generation, it is always a potential problem and that is why in our hospital, we believe clinicians should try to demonstrate that despite their own busy schedules, they can learn how to use computers. They must recognize that it helps improve their own workflow and saves time and also improves the quality of patient care and safety. In our hospital, the acceptance rate of these initiatives is very high, especially among the surgeons. Since I am a surgeon myself, they generally trust me. I think, it is ultimately a leadership issue. It is not that the system is not user-friendly, because in our design of systems we get huge amount of physician input, and we ourselves test and re-test them all the time.

So this is the strategy that we have been adopting. We get doctors who are interested, and can see the advantage of using IT to inspire others.

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POWER HOSPITAL This section features Hospitals & Healthcare Institutions providing top class healthcare services and infrastructure in their endeavour to provide International Standards in comprehensive patient care. To have your facilities featured, write to dolly@elets.in

Tan Tock Seng Hospital, Singapore

T

an Tock Seng Hospital (TTSH), established in 1844, is the second largest acute care general hospital in Singapore, with specialty centres in Rehabilitation Medicine and Communicable Diseases.

Named after its founder, Mr Tan Tock Seng, a Chinese entrepreneur and philanthropist, the hospital is a member of the National Healthcare Group and continues to provide high quality holistic health care services to the people of Singapore and International patients from around the world. After three major moves in its long and distinguished history, the hospital now provides most of its

services in one modern complex, comprising the Hospital Block, the TTSH Medical Centre and the Podium Block. The 1,200-bed hospital is equipped with state-of-the-art facilities and medical equipment, as well as the latest communication and information technology tools.

Tan Tock Seng Hospital champions the development of Geriatric Medicine, Infectious Disease Management, Rehabilitation Medicine, Respiratory Medicine, Rheumatology, Allergy & Immunology in Singapore.

It is also a major referral centre for Geriatric Medicine, General Surgery, Emergency Medicine, Diagnostic Radiology, Gastroenterology, Otorhinolaryngology (Ear, Nose & Throat) and Orthopaedic Surgery.

The hospital came into the international spotlight when it was designated by the

The Atrium, TTSH

Ministry of Health, as the sole treatment centre for the Severe Acute Respiratory Syndrome (SARS) epidemic which struck the country in 2003.

THE HOSPITAL COMPLEX

Completed in 1999, the complex is specially designed to provide comprehensive inpatient and outpatient services under one roof. Most services are provided in the modern complex, comprising the Hospital Block, the TTSH Medical Centre and the Podium Block. On average, specialist clinics receive 1,500 patients daily, while the 22

www.ehealthonline.org

Clinical Specialities

Allied Health Services

Specialties Centres

Anaesthesiology

Care and Counselling

Communicable Disease Centre

Cardiology

Clinical Immunology Laboratory

Day Surgery Centre

Clinical Epidemiology

Complementary Integrative Medicine

Dental Clinic

Diagnostic Radiology

Nutrition and Dietetics

Diabetes and Endocrine Centre

Emergency Medicine

Occupational Therapy

Endoscopy Centre

Endocrinology

Pathology and Laboratory Medicine

Foot Care and Limb Design Centre

Gastroenterology

Pharmacy - Outpatient and Retail Pharmacy

Health Enrichment Centre

General Medicine

Physiotherapy

Hyperbaric Medicine Centre

General Surgery

Podiatry

Institute of Plastic Surgery (Singapore)

Geriatric Medicine

Prosthetics and Orthotics

Johns Hopkins Singapore International Medical Centre

Infectious Disease

Travellers’ Health & Vaccination Centre

Oncology Services

Psychological Services Respiratory Function (Pulmonary) Laboratory

Ophthalmology

Speech Therapy

TTSH-NNI Trauma Training Centre

Orthopaedic Surgery

Vascular Surgical Services

Yew Tee Specialists Clinic

TTSH Rehabilitation Centre

Otorhinolaryngology (Ear, Nose and Throat) Psychological Medicine Radiotherapy Centre Rehabilitation Medicine Renal Medicine Respiratory Medicine Rheumatology, Allergy and Immunology Urology and Continence Clinic

Emergency Department attends to a daily 400, making it Singapore’s busiest emergency department.

COMMUNICABLE DISEASE CENTRE (CDC)

The Communicable Disease Centre is the national referral centre for the diagnosis and management of communicable diseases that include HIV and SARS. The CDC is made up of 2 campuses, equipped with inpatient and outpatient facilities to handle disease outbreak as well as laboratory facilities to conduct research for better disease management and patient care.

THE HERITAGE MUSEUM

The Tan Tock Seng Hospital Heritage Museum opened its doors on 25 July

NCICH - TTSH Signing of Memorandum of Understanding Ceremony

2001. Features a collection of items Accreditation from the mid-1800s.

In particular, hospital’s pioneering role in the treatment of tuberculosis • Computerized physician order entry (CPOE) (1940s) and its monumental leadership in the fight against SARS - are presented • Joint Commission International(JCI) through narrative displays, salvaged historical objects and a time capsule.

• Singapore Quality Class (SQC) • People Developer Standard (PDS) • ISO 9001:2000 TTSH AND SAF MEDICAL CORPS INKED • ISO 14001 MOU ON TRAUMATOLOGY • OHSAS 18001 • Green Mark Award SAF Medical Corps and Tan Tock • Sporting Singapore Inspiration Seng Hospital inked a Memorandum Awards-Gold Award of Understanding (MOU) at TTSH on • Work-Life Excellence Award 18 October 2007 to formalize their • Singapore Health Award partnership to further develop the • Certified On-The-Job Training field of Traumatology in the areas of Centre education, training and research.

THE ART OF HEALING PROGRAMME

The Heritage Museum

November 2007

Tan Tock Seng Hospital’s The Art of Healing programme, an initiative that aims to use the arts as a form of therapy to soothe patients’ mind and

body and help them on their path to recovery, was launched on 6 February 2006.

Under the arm of The Art of Healing programme, the hospital’s Healing Sky Garden & Orchid Botanica were launched in 2006 & 2007 respectively.

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NEWS REVIEW

WORLD

Nobel Prize for Medicine 2007 U.S. citizens Mario R. Capecchi and Oliver Smithies and Sir Martin J. Evans of Britain won the 2007 Nobel Prize in medicine. They were honored for a technique called gene targeting, which lets scientists inactivate or modify particular genes in mice. This in turn lets them study how those genes affect health and disease.

The widely used process has helped scientists use mice to study heart disease, diabetes, cancer, cystic

fibrosis and other diseases. To use this technique, researchers introduce a genetic change into mouse embryonic stem cells. These cells are then injected into mouse embryos. The mice born from these embryos are bred with others, to produce offspring with altered genes.

The citation said that gene targeting has pervaded all fields of biomedicine.

Its impact on the understanding of gene function and its benefits to mankind will continue to increase over many years to come.

IBM’s 3D Avatar to Help Doctors Visualize Patient Records and Improve Care IBM researchers have developed a prototype visualization software that allows doctors to interact with medical data the same way they interact with their patients, that is by looking at them. Created at IBM’s Zurich Research Lab, the technology uses an avatar - a 3D representation of the human body - to allow doctors to visualize patient medical records in an entirely new way.

Called the Anatomic and Symbolic Mapper Engine (ASME), this innovative visualization method allows a doctor to click with the computer mouse on a particular part of the avatar “body” to trigger a search of medical records to retrieve relevant information.

The ASME system will allow doctors to “click” on different parts of the 3-D avatar of the human body - for example, the spine - and instantly see all the available medical history and information related to that patient’s spine, including text entries, lab results and medical images such as radiographs or MRIs.

First Zero-Gravity Surgical Robot Demonstration SRI International, a nonprofit R&D organization, has developed a teleoperated surgical robot that can work in a zero-gravity environment.

The SRI robotic surgical system is designed to be stored in a very compact space for space travel, that astronauts can reassemble for use in the event of illness requiring surgical intervention.

The system was successfully tested underwater in the Aquarius undersea laboratory off the coast of Florida earlier this year. A Canadian surgeon successfully utilized the device to perform a vascular suturing operation from fifteen hundred miles away.

Now SRI researchers are testing the device in the extreme environment of zero gravity. The tests will be done over a period of four days aboard a NASA C-9 aircraft. The plane undergoes a series of parabolic flight maneuvers that simulates, for a brief period, the microgravity environment of space.

SRI-developed software is intended to help the robot compensate for errors in movement that can occur in moments of turbulence or transitions in gravitational field strength. The experiment will compare the same surgical tasks performed by a physician who is physically present on the plane with those performed remotely using the teleoperated robot.

Pfizer with largest online physician community of U.S. to Improve Patient Care Pfizer Inc and Sermo, the largest online physician community in the US, have announced a strategic collaboration designed to redefine the way physicians in the U.S. and the healthcare industry work together to improve patient care. Sermo is a Web-based community where physicians share observations from daily practice, discuss emerging trends and provide new insights into medications, devices and treatments.

Through this collaboration, Sermo’s community of physicians will have access to Pfizer’s clinical content in tangible ways that allow for the transparent and efficient exchange of knowledge. With access

to comprehensive and up-to-date information on Pfizer products, physicians will be able to find the data they need, when they need it, to make informed decisions.

Pfizer, working together with Sermo’s physician community and other Sermo partners, plans to pursue a number of key objectives through this collaboration, such as: discover, with physicians, how best to transform the way medical information is exchanged in the fast-moving social media environment and create an open and transparent discussion through the innovative channel offered by online exchange; and develop a productive exchange between pharmaceutical professionals and the Sermo community.

RFID to track dementia patients in Luxembourg A luxembourg hospital is now tagging patients suffering from dementia with RFID solutions from AeroScout to ensure they remain safe within hospital grounds and are in close range of nurses and caregivers.

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The hospital is using AeroScout’s T2 tags, which has about four years of battery life. These are worn by patients or even attached to hospital equipment. They emit a signal which is detected and accurately located by the hospital’s Cisco Unified Wireless Network.

Location and status data from these tags is then sent to AeroScout’s MobileView software and integrated with interactive maps and detailed information. This allows the hospital to search for and identify at-risk patients in real-time, over any web browser. The AeroScout system can also trigger automated alerts based on movement and location, immediately sending an email, page or voice message to staff when a patient leaves a designated area.

www.ehealthonline.org

European Consumers Seeking Health and Pharmaceutical Information

French MOD Selects Vizada For Telemedicine Program

According to a recent study by Manhattan Research, European consumers are more likely to have researched health information online than they are to have participated in online dating, online gaming or even online bill pay.

Furthermore, in the absence of direct-to-consumer advertising, or local product.com destinations for European consumers, consumers are actually going to the corporate sites of pharmaceutical companies for health and pharmaceutical information. In fact, an estimated 21 million consumers report visiting corporate sites in the past 12 months across the 10 countries surveyed in the research. Pfizer, Bayer and GSK are the top three corporate sites visited by consumers specifically for health and treatment information.

Consumers are also researching a wide range of diseases online.

Consumers are actively seeking information about depression and targeted topics such as cancer, which has a relatively low population of patients compared to the population seeking information online. Patient wellness can be dealt with in an easy and affordable solution.

The French Ministry of Defense has selected Vizada to provide mobile satellite communications to enable military surgeons to transmit images to medical staff in a different site or country.

Vizada, formerly France Telecom Mobile Satellite Communications, is using a solution based on Inmarsat’s Broadband Global Area Network (BGAN) system. The system uses simultaneous IP BGAN links, a 256 kilobit per second (kbps) streaming connection to perform the videoconferencing and relay images from the operating table to the medical staff and a background IP connection with speeds of up to 492 kbps to send medical files, analysis reports, X-rays, photos and scans. The IP traffic is relayed to Vizada’s ground station and leased line to the hospital.

Space Technology for TB Detection New research on detecting tuberculosis (TB) using space technology has underlined the relevance that space technologies can have for other areas such as, healthcare. The technology in question is a spectrometer developed for the European Space Agency’s Rosetta comet-chaser and the Beagle 2 mission to Mars.

TB is thought to kill two million people every year, mainly in developing countries, where resources are restricted, TB detection is usually carried out using a smear microscopy of sputum samples. This is not only a very labour-intensive process, but also has a low sensitivity.

Rosetta will be the first spacecraft to conduct scientific measurements

on the surface of a comet. The Ptolemy instrument on board will analyse small pieces of the comet’s nucleus in order to identify what it is made from.

A team of researchers have received funding to develop a portable mass spectrometer (an optical instrument used to measure the properties of light) for diagnosing TB. This team will now adapt the technology used on Rosetta to create a spectrometer capable of detecting TB in sputum with greater sensitivity and speed than a smear microscopy.

The process could also be automated, removing the need for skilled technicians and a specially equipped laboratory.

Quest Diagnostics joins e-prescribing initiative Quest Diagnostics announced recently that it has joined the National ePrescribing Patient Safety Initiative (NePSI), and will offer physicians access to its Care360 Physician Portal and results capabilities.

NePSI is a coalition of technology companies and healthcare organizations dedicated to improving patient safety by providing free access to simple, safe and secure electronic prescribing for every physician in America.

Quest Diagnostics will provide eRx NOW, a web-based NePSI electronic prescribing application from Chicago-based Allscripts, access to pending lab results and its Care360 Physician Portal. Physicians will be able to order lab tests and view, flow and graph laboratory results, as well as run analyses on patient populations.

Quest Diagnostics provides more than 115,000 physicians nationwide with its connectivity products. The company believes that its large customer base will help drive market penetration and physician utilization of electronic prescribing.

Physicians to Benefit from Medical Software Advice Website Software Advice recently launched its Medical Software Advice website: www.softwareadvice.com/ medical, a free resource designed to help prospective medical software buyers narrow down the right technology for their practices. An innovative service that seeks to help physician practices find the right software for EMRs, medical billing, patient scheduling and practice management.

It attempts to bring clarity to the market by matching physicians with the right systems for their practices, as also helping software vendors reach the customer segments they can serve best.

Software Advice’s proprietary matching algorithm recommends software products based on each practice’s medical specialty, size and functional requirements. This assures that rather than taking weeks to sort through search engine results, directory listings and trade magazines, buyers can now generate a highly relevant “short list” of software products in minutes. And all this is done free of charge.

Participating vendors serve a wide range of practice sizes, including solo practitioners, group practices and managed service organizations (MSOs), as well as medical specialties ranging from family practices to bariatric medicine. Participating vendors also cover the full range of application capabilities, including EMRs, medical billing, patient scheduling and complete practice management systems.

November 2007

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BUSINESS

NEWS REVIEW

Eli Lilly to expand India ops US drug major Eli Lilly & Co has decided to expand its business in India beyond R&D initiatives. The $15.7billion company is looking to reinforce its position in the Indian drug market with plans to expedite the launch of new drugs in line with their US commercialisation.

For starters, Eli Lilly plans to launch at least 5-6 new revolutionary drugs in India in the short term. These would be in areas like diabetes,

oncology, critical care and women’s healthcare. The company may also expand contract manufacturing out of India. It expects such strategic initiatives will more than double its Indian turnover of $40 million in five years.

Eli Lilly will cut down on the lead time for new drug launches in India.

The company’s latest anti-diabetes drug ‘exenatide’ was launched in India last week after nearly two years of its launch in the US.

Fortis plans USD 498.48 million investment and 40 hospitals by 2011 The Delhi-based INR 512 cr (USD 128m) company had already established a toehold in the western and southern parts of the country.

Fortis Healthcare Ltd, an INR 512 cr company plans to invest US$500 million (INR 1,970 cr) to achieve its target of 40 hospitals by 2010-11, focusing on improving its presence in the West and South to get a pan-India presence.

They will fund half of the money from internal resources, including proceeds from an initial public offering of shares, as well as debt. But they haven’t ruled out a second public offer or infusion of

additional funds through private equity.

The Delhi-based company had already established a toehold in the West and South—it acquired Hiranandani’s hospital project in Vashi, Navi Mumbai, for about INR 25 crore and Chennaibased Mallar hospital for a similar sum.

The second largest hospital chain in the country, behind Apollo Healthcare Enterprises Ltd, Fortis has a network of 13 hospitals with 2,200 beds.

Private hospitals generated $15.51 billion in revenues in 2006 and are expected to generate USD 36 billion by 2012, according to a study by Ernst&Young and industry body FICCI.

Quovadx Acquires Healthvision Quovadx(R) has announced the acquisition of Healthvision(R), a Health Information Exchange (HIE) industry leader with proven solutions that connect the healthcare communities of hospitals, labs, physicians, patients and consumers.

Quovadx and Healthvision have collaborated for many years to deliver an integrated solution with Cloverleaf(R) serving as the critical component of Healthvision’s ehealth interoperability platform. This close association also allows the smooth transition.

The new, expanded company will host 11 million patient records and serve over 2,000 hospitals, 250 extended healthcare communities, 23,000 clinicians, thousands of patients, and millions of consumers.

The company will retain its focus of providing healthcare software and solutions through Cloverleaf Integration Services and Healthvision’s Clinical and Consumer solutions.

Cryobanks plans INR 500 cr (US$ 125m) investment Cryobanks International India(CII), a JV between Cryobanks International Inc of US, and RJ Corp of India, is planning to invest INR 500 crore in the health care industry in the country over the next five years.

The stem cell banking company is looking at investing INR 150 cr in the first phase to set up cord-blood stem-cell banks. Around 10 to 15 such banks will come up, of which some

would be overseas. It aimed to start stem cell therapy units in the country as well.

Stem cells collected from cord blood can be used for treating more than 75 serious ailments. Given the potential of therapeutic uses, the company was looking for partner institutions, both private and public, to develop stem cell therapy units, besides setting up banks.

At present the country’s only stem-cell

bank is in Gurgaon with the facility to preserve around 150,000 units. Delhi will soon to have a cord blood transplant (CBT) unit as well with facilities for R&D. India has over 25 million births every year, and therefore the market in the country for collecting cord blood cells is huge. The company expects turnover to rise from Rs 8 crore last year to Rs 300 crore in the next five years.

Bharat Biotech sets its sight on EU, US market As pharma biggies like Ranbaxy and Dr Reddy’s Lab announce plans to tap the regulated biotech drug market, mid-sized players in the segment also seem to harbour such ambitions.

Hyderabad-based mid-sized biotech firm Bharat Biotech International is finalising plans to roll out drugs in Europe and US. Initially, the company will initiate European trials

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on three products which will be soon filed to the European Medicines Agency (EMEA) for regulatory approval. It is also in talks with a couple of US pharma companies to enter into a technology and marketing partnership.

As far as US plans go, Bharat Biotech will enter into a tie-up with a US bio-pharma company for joint drug development and marketing.

Bharat Biotech exports its products to Kenya, Zambia, Peru, Bolivia, Philippines, Bangladesh, Kenya, Vietnam, Malaysia and Columbia.

This apart, it has seven products in Phase II trials in areas like Japanese encephalitis, malaria vaccine, rotavirus vaccine and anti-infective.

Future projects are in areas like combination vaccines, bio-antibiotics, combination probiotics and chikungunya vaccine.

www.ehealthonline.org

GE Healthcare acquires Dynamic Imaging

Microsoft’s HealthVault: software and services platform for health information

The recent acquisition of Dynamic Imaging, announced recently, will result in GE Healthcare’s expansion of its information technology products and services across all segments of healthcare.

Dynamic Imaging, based in Allendale, New Jersy, provides Web-based image and information management with its IntegradWeb suite of products.

The financial terms of the deal were not disclosed.

The acquisition builds on GE Healthcare’s strategy to combine early diagnosis with information technology to enable a new “early health” model of care focused on earlier diagnosis, pre-symptomatic disease detection and disease prevention.

Microsoft Corp. recently launched Microsoft HealthVault, a software and services platform aimed at helping people better manage their health information. It aims to bring the health and technology industries together to create new applications, services and connected devices that help people manage and monitor their personal health information.

Microsoft also announced the availability of HealthVault Search, a powerful new vertical health search tool designed to work with the platform. Integrated with Live Search and accessible on the HealthVault Web site, this specialized health search engine intuitively organizes the most relevant online health content, allowing people to refine searches faster and with more accuracy, and eventually connect them with HealthVault-compatible solutions.

Created in cooperation with privacy advocates, security experts and dozens of the world’s leading healthcare organizations, it is designed and built to enhance privacy while providing people with the control they expect and require. It assures that the consumer’s personal health information will not be data-mined, because they alone control it. A broad range of more than 40 applications and devices will be available on the HealthVault platform soon.

Ranbaxy to make China a major sourcing hub Pharmaceuticals major Ranbaxy Laboratories plans to make China its major sourcing hub for Active Pharmaceutical Ingredient (API).

The company, already has a Chinese presence through a joint venture named Ranbaxy Guangzhou China Limited (RGCL), will explore new partnership options to facilitate raw material outsourcing.

RGCL will continue to focus on manufacturing medicines for exclusive supplies to the Chinese market. China’s low-cost raw material manufacturing ability is an opportunity for reducing manufacturing expenses for pharmaceutical companies.

Ranbaxy plans to create a lot of value by leveraging on the strength of its newly acquired biotech company, Zenotech Laboratories. Zenotech has two biotechnology-based cancer offerings in India and eight more are being developed. Its medicines are expected to be cleared for shipping to Europe by 2011.

Sources say that the company is also expecting to expand its bio-similar drugs (low cost biotechnology medicines) business in a big way, and may also enter speciality areas, such as oncology where there is less competition.

Private Equity investments in pharma touch $400 m Private Equity (PE) investments in the domestic healthcare and pharma industry have touched around $400 million during the first nine months of the year. This trend is set to accelerate as companies go for overseas acquisitions, hive off their R&D units, and Foreign Currency Convertible Bonds (FCCB) lose their sheen.

The PE investments include Apax Partners’ $104 million fund infusion in Apollo Hospitals, IFC’s $67 million in Max Healthcare, Trinity Capital’s $31.4 million in Fortis Healthcare, ChrysCapital’s $24 million in Mankind Pharma and Kotak’s $10 million in Intas Biopharmaceuticals.

Within the pharma sector, the companies which are into formulation and have strong R&D are likely to get the preference.

Wockhardt buys Morton Grove for $38 mn Indian drug maker Wockhardt recently acquired US-based speciality drugs company Morton Grove Pharmaceuticals, which has annual sales of $52 million. Though officially it has not been confirmed, Wockhardt has reportedly paid nearly $38 million for the Illinois-based company.

This ends a long wait for the Mumbai-based drug maker, which had been scouting for acquisition in the US market for over two years, and also brings it closer to its Indian rival Cipla, which had signed a supply agreement with Morton Grove in 2004.

November 2007

e4e offers software for health insurance sector e4e (headquartered in the US) plans to launch an ‘on-demand’ software solution targeted at small overseas commercial health insurance plans covering less than hundred thousand individuals. e4e,is a services-on-tap company that allows deployment, management and operation of business process across the enterprise.

The company aims to develop a software based on the ‘per member per month’ payment model. Since competitors like IBM, Accenture and Perot Systems have moved to higher plans, concentrating on insurance schemes with over hundred thousand members, e4e feels that the mid market segment, currently neglected, needs such solutions.

The solution will allow patients to choose health insurance plans, help hospitals evaluate and manage insurance claims without any manual intervention and follow up on payments. The project will be pilot-tested in about 6 months, after which e4e will evaluate it for commercial adoption.

It has also been pointed out that the company had about 5 per cent market share in the $120 million (INR 480 cr approx.) healthcare payer space. The company aims to have about 10 clients next year and 25 by 2009 for its new solution. To achieve this, e4e may complete an acquisition by the third quarter of next year.

The company on its path of expansion is also planning to double its workforce, in the healthcare services division to 2,000 by next year. It is also seeking to set up a centre in a tier-II city in Tamil Nadu. e4e is currently working with a large Indian hospital to develop a healthcare solution for the domestic market.

This is the company’s first endeavour to enter the Indian market.

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PRODUCT PROFILE: MEDICAL & HEALTHCARE DEVICES eHealth gives you an overview of the latest medical equipments in the global market. This service is brought to you absolutely FREE. To have your new products featured, send us the details at dolly@elets.in

SONOSITE MICROMAXX HAND-CARRIED ULTRASOUND

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High-resolution, all-digital System Chip Fusion™ Technology Broadband Multi frequency Transducers Light Wight Just 3.8-Kg (With Battery ) Integrated Fully Digital 10.4” TFT Colour Liquid Crystal Display.

Dynamic Range : Up To 165 db 2D grayscale, M-mode, Velocity Colour Mode, Colour Power Doppler Pulse wave Doppler, Continuous wave doppler Comprehensive, application-specific calculation packages Tissue Harmonic Imaging, Cine Review facility Alphanumeric QWERTY keyboard Linear Array, Curved Array, Phased Array, Multiplane TEE transducer capabilities SonoRES™ image enhancement capability

CRITIVENT INTENSIVE CARE VENTILATOR

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Microprocessor based and menu driven Patient data monitoring like expired tidal volume, minute volume, peak and mean airway pressure CMV, AV, SIMV, SPONT, BIPAP & APRY modes Facilities of CPAP and pressure Support Apnea backup ventilation Electronic FiO2 controller & inbuilt oxygen analyzer Keypad switches for parameter setting Inbuilt air compressor Standby and safety PIP limits Alarms: oxygen/air failure, patient disconnection and automatic switchover to 100 % oxygen in case of air failure or 21 % oxygen in case of oxygen failure One hour in-built Battery backup Electrical requirement : 200-220 V AC, 50 Hz

For Details Contact: Flat No. 101-C, Pal House, Behind NAFED Building, Hari Nagar Ashram, New Delhi – 110014, India Tel : 011-26349847, 26345764, 26345919 Fax : 26345921 E-mail: medisys@bol.net.in Web Site : www.medisysindia.net

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SonoMB™ real Time compound imaging Inbuilt image & cine Storage on Compact Flash card PC direct connectivity capability DICOM option available System operates via battery or AC power – Rechargeable lithium-ion battery.

Special transducer available for surgery i.e. Laparoscopic, Intraoperative.

System and most of the transducers drop tested from 1 meter.

For Details Contact: SonoSite, Inc. Unit 603, 6th Floor, Tower B Global Business Park, Gurgaon - 122002, India Tel: +91-124-2881100 Fax: +91-124-2881110 E-mail: parul.kaushal@sonosite.com Web site: www.sonosite.com

SIGNA HDE 1.5T MR SYSTEM

LEICA DMI4000 B MICROSCOPE

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Overall siting footprint 30% smaller than other 1.5T systems - compact footprint.

Ideal for new installations or replacements. It fits easily into all existing 1.0T sites and over 90% of 0.5T sites.

Low operating costs, easy to use, versatile and reliable Complete set of advanced HD applications: PROPELLER, TRICKS, LAVA and VIBRANT Reconstructions at more than 1,000 images p. s.

Backed by the GE-exclusive Signa Continuum, a clear and easy upgrade path for the system throughout its lifetime.

InSite remote diagnostics and repair, monitors, diagnoses and repairs the system remotely.

Perfect: as a primary scanner for a smaller hospital; as an additional system for larger hospitals with increased imaging demand/capacity; for a central hospital or a satellite center

For Details Contact: FF3, !st Floor, Palani Centre, 32, Venkatnarayana Road, T. Nagar, Chennai 600 017, India Tel: +91 44 434 0747 Fax: +91 44 432 3770 e-mail: supportdesk.india@ge.com

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Ergonomically designed tubes with an integrated “View-Chute” to get a glance to the sample on the stage with naked eyes Ergonomically designed stand in cooperation with the Fraunhofer Institute (IAO) Tremendous free working range with the new S28 condenser and ultra small stages Status display, all microscope settings at a glance Constant Color Intensity Control (CCIC) keeps the color temperature in TL axis constant at 3,200k Integrated Interpupilary Interface for a direct access to the back focal plane to adapt different contrasting techniques The internal filter wheel with motorized ExMan and FIM enables excitation of fluorochromes in less than 20 milliseconds The automated research microscope is also suitable for scanning cell and tissue cultures

For Details Contact: Plot No. 372, Udyog Vihar Phase II , Gurgaon - 122016, India Tel.: 0124-2843200 Fax.: 0124-2843299 www.leica-microsystems.com

www.ehealthonline.org

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PRODUCT PROFILE: SOFTWARE SOLUTIONS

AdvancedMD - Web-Based EMR & Practice Management OVERVIEW

SALIENT FEATURES

AdvancedMD is one of the most popular Medical Billing, Scheduling & EMR software solutions on the Web. AdvancedMD serves thousands of primary care physicians, specialty physicians and third-party medical billing services all over the U.S. With AdvancedMD’s Web-based technology one may never need to purchase expensive hardware, i nstall medical office software or perform manual data backups. Its security features exceed HIPAA requirements.

Additionally there is free live technical support and a 98% satisfaction rate.

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AdvancedMD drives rejected claims below 5%, guaranteed.

Anytime, anywhere access to data.

Amazing data security that exceeds HIPAA requirements.

Free unlimited live technical support available 24x7x365.

Superior ROI—no need to purchase expensive servers, updates or patches ever.

TARGET CUSTOMERS

Primary care physicians, specialty physicians and third-party medical billing services of any size. AdvancedMD is scaleable to any size medical practice or medical billing business.

Advanced MD - Tech Specs Client: Web Browser Server: 100% Web-Based Database(s): Microsoft SQL Server Code base / tools: Microsoft VisualBasic, C# & .NET Hosted: 100% Web-Based www.advancedmd.com

Source: www.softwareadvice.com

Modules Medical Billing

Electronic Medical Records Patient enrollment; Chief complaints (CC); History of present illness (HPI)

ICDM-9 coding; CPT/Dx coding; Householding

Constitutional exam; Past, family, and social history (PFSH); Review of symptoms (ROS)

Data validation; Patient messaging; Maximum visits/coverage

Automatic coding; CPT/Dx codes; ICDM-9 codes

Eligibility inquiry; Claim scrubbing; Narrative reports

Current medications; Previous encounters; SOAP notes

CMS-1500 form; EDI support; Clearinghouse submission

Lab orders & results; Referral letters; Ad hoc reporting

Direct-to-carrier submission; ERA support; support Re-bills / tracers

Voice recognition; Touch screen / stylus; Wireless support

Batch posting; ERA posting; Code-level posting

HIPAA compliant; HL7 support; SSL security

Claims reporting; Superbill; 3rd party printing Custom billing plans; Billing dashboard; Finance charges Dunning letters; Ad hoc reporting; Carrier database HIPAA compliance

November 2007

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PERSPECTIVE

Play on!

Virtual Reality Games for Smoking cessation The Virtual Reality Medical Center (VRMC) has created an Internet-based Virtual Reality (VR) game that helps adolescents cease smoking. This interactive program uses cue exposure therapy (CET) to treat addictive behaviors. Furthermore, VRMC’s teen smoking Cessation program educates adolescents on how to effectively avoid situations that cause cravings. In addition, repeated exposure to problematic triggers eventually leads to desensitization.

Dr. Brenda K. Wiederhold, Virtual Reality Medical Centre VIRTUAL ENVIRONMENT (VE) OVERVIEW

The VRMC Teen Smoking VE consists of two major regions: home and school. The home is comprised of two floors: The first floor is the garage, the one above has a bedroom, kitchen, living room and bathroom (refer to Figures 1a-b). The school environment includes the classroom, restroom, and cafeteria area (refer to Figures 1c-d).

At the start of the program, the user is placed in his/her bedroom where he/ she must select a quit date from the provided calendar before being able to participate in other activities. A smoking cessation tip is 1a - BEDROOM to remove all smoking paraphernalia from the environment if possible, which is what the player must do in the game to help decrease their craving level. In the first VE, smoking cues are placed around the teenager’s home.

In 1c - CLASSROOM these cases, users can choose to “smoke,” “ignore,” or “throw away” objects, such as a pack of cigarettes, which increases their cravings if not removed. In the second environment, at school, they deal with pressure from their peers to smoke. In those scenes, the user has the option of refusing, considering, or accepting the offer to smoke. When the user turns down cigarettes offered by peers, the user is faced with the challenge of suppressing the craving by playing a mini game. If he/she wins the randomly selected game, the user has successfully denied the craving. However, if the user loses, this translates to him/her giving into the craving and smoking, which also leads to the resetting of the smoke-free day counter.

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The presence of the “lungs” icon in the lower left corner of the screen represents the current lung condition of the user.

The more the user smokes, the darker the lungs become. The status bar directly below it indicates the user’s current “stamina” level. Each day, the bar starts off full and gradually decreases as the day goes on. Participating in activities, like exercising, also uses up stamina. Furthermore, the rate of stamina decrease is dependent on the lung condition. The healthier the lungs (brighter), the slower the stamina rate decreases. When the stamina falls too low, the user must either rest by taking a nap or refuel the body by making and eating a sandwich. On the lower right corner is the “craving” status bar 1b - KITCHEN which starts off empty.

It indicates the user’s current craving level to smoke. When a user approaches smoking cues like an ashtray, alcohol, or coffee, the craving bar goes up.

However, when users participate in an activity 1d - CAFETERIA in an effort to distract themselves from the desire to smoke, the result is a reduction in cravings. When the user’s craving level approaches the maximum, the user’s vision (the visuals on the screen) will begin to blur and flash red, acting as a warning sign. Under these circumstances, the user can either participate in an activity or take a smoke in order to alleviate the craving.

Ultimately, the goal of the program is for users to remain smoke free in both environments for as long as possible.

Rewards and other forms of encouragement are awarded after the user has maintained a smoke-free regimen following certain time periods. www.ehealthonline.org

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PLAY ON! VIRTUAL REALITY GAMES FOR SMOKING CESSATION

PERSPECTIVE

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FIGURE 2a

Before the game was played, 86.7% of participants agreed with the following statement: “It helps to keep busy when you have a hard time quitting smoking,” whereas after the game was played, 93.3% of participants agreed (refer to figures 2a and 2b).

Additionally, the option of selecting a quit date is offered to subjects. When asked whether setting a quit date would aid in actually quitting, 60% of subjects agreed that it would aid in quitting prior to playing the game, whereas 40% were neutral. After playing the game, however, 66.7% agreed that setting a quit date helps you to quit, whereas 6.7% disagreed, and 26.7% remained neutral. (refer to figures 3a and 3b)

FIGURE 4. On a 1 to 7 scale, the mean scores in response to the statements “How much did the auditory aspects of the environment involve you?” and “How much did the visual aspects of the environment involve you?” were 4.4 (SD=1.6) and 4.7 (SD=1.2), respectively. Those scores are both above the average score of 4.

FIGURE 2b

METHODOLOGY

A research study was conducted with 15 participants, for sessions of 15 minutes each, after all regulatory approvals (IRB) were received. The Teen Smoking Pre/Post Test Questionnaire was used to assess the adolescent’s knowledge related to the cessation of smoking.

Subjects who fully agreed with a question rated it with a 1, fully disagreeing led to a rating of 10, and ratings from 2-9 delineated a response either associated with somewhat agreeing or disagreeing.

Scores were summed, signifying each participant’s knowledge.

SUMMARY AND CONCLUSIONS

FIGURE 3a

FIGURE 3b

RESULTS

The data were reviewed and analyzed.

Overall, the data collected suggests the development of healthier habits following game play.

In the program, subjects can choose to do physical exercise or to smoke.

Before they played the game, 40% of the users disagreed with the statement that “physical exercise makes you want to smoke,” but after they played the game, 60% of them disagreed.

The environment also allowed subjects to choose whether they wanted to smoke or to do another activity (other than exercise) to occupy their time.

32

auditory and visual involvement and consistency of VR environment.

It was shown that the more auditory and visual involvement the subjects felt, and if the subjects felt that the VR environment was consistent with the natural environment, those subjects did better in the questionnaires, which was a measurement to detect the overall likelihood for subjects to quit smoking.

Positive trends were detected between auditory involvement and score differences, visual involvement and score differences, and consistency and score differences.

To test the degree of realism experienced by the participants in the VE, a Presence and Realism Questionnaire was also administered.

The higher the score, the more realistic the participant felt the VE was.

The following data were collected as self-rated scores on a scale from one to seven: auditory involvement, visual involvement, and consistency between the VR world and the natural environment. The score differences between the before and after training were treated as a new variable. Linear regression was applied to detect the trends between score differences and

VRMC has thus successfully created an Internet based virtual interactive environment in an effort to curb teen smoking. This teen smoking cessation program is Adobe Flash Player 9.0 based and can be easily accessed at www.vrphobia.com/teensmoking.

Furthermore, after participating in the program, subjects agreed that setting a quit date helps you to quit; and keeping busy and performing physical activities can aid with distraction from smoking.

Participants also agreed that the virtual setting provided an environment with realistic visual and auditory effects and no occurrence of side effects.

VRMC and its affiliate in Brussels, Virtual Reality Medical Institute (VRMI), have initiated conversations with European partners who are committed to help bring the Teen Smoking Cessation project to their countries. VRMC has also established an agreement to deliver the software via the Internet.

For the complete version of the article with references log on to www.ehealthonline.org Dr. Brenda K. Wiederhold Executive Director The Virtual Reality Medical Center (VRMC) cybertherapy@vrphobia.com

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10 Best Practices for Selecting EMR Software Don Fornes, Software Advice

T

he value of going digital with patient records has become increasingly clear to one and all.

Just as a practice management system optimized patient schedule and improved receivables, today’s EMRs promise to automate clinical workflows; they can reduce time spent charting, provide more efficient patient visits and help meet regulatory requirements.

3. GET THE RIGHT EMR FOR YOUR SPECIALTY Though it seems like an overwhelmingly ‘techie’ task, the good news is that selecting an EMR doesn’t require in-depth Most EMR products are designed to serve a wide technical knowledge. One simply needs to run a disciplined range of medical practices while others are designed for specialties. selection process.

The narrow focus of a specialty EMR While there are hundreds of software packages vendor allows them to design their on the market, you can fairly quickly narrow Choose your EMR right systems around the unique needs of them down using some easy processes and physicians within their target market. criteria. Here we present ten best practices 1. Take ownership of the decision For example, an OB/GYN EMR would for selecting an EMR system.

2. Determine your own requirements have special screens designed for 3. Get the right EMR for your specialty ante partum visits. This results in 1. TAKE OWNERSHIP OF THE DECISION 4. Integrate practice management a more familiar workflow for the 5. Focus on ease-of-use specialist and less customization Your EMR software will impact how 6. Assess support and upgrades of the software. At the same you practice medicine, so this is 7. Consider vendor viability time, specialty vendors may be not a process that should be left to 8. Be smart about your budget challenged to generate enough back-office staff or the local “computer 9. Consider your deployment strategy revenue to support the wide range guy.”

10. Don’t forget the technology of ongoing development required by While your staff should play client demand, government mandates a key role in selection, this process and device integration. Large, broadlydemands medical expertise and leadership focused vendors may have more resources and that only the physician can provide. The computer broader reach, but may not offer specialty features guy may fail to recognize that a system of his choice forces and workflows. Ask the larger, more generic vendors how they you into rigid workflows that change how you interact with will meet your unique requirements and request references your patients. from customers within your specialty.

2. DETERMINE YOUR OWN REQUIREMENTS

4. INTEGRATE PRACTICE MANAGEMENT

Only you know how you should practice medicine.

Therefore, it’s critical to map out your ideal workflow and how you interact with office staff to complete a patient visit.

At the same time, realize that your interactions with software vendors are good opportunities to learn new best practices and workflows that could improve the way you work. Based on your initial requirements and those that arise during the selection process, build a comprehensive list of features and then prioritize them based on what will provide the most value to your practice. Realize that you can phase in new modules over time.

In addition to EMR functionality, consider how you want your system to support medical billing, patient scheduling and practice management.

Do you want all of these functions in one complete suite, or should your EMR interface with existing systems? There are advantages to managing clinical and practice management functions in a single system. For example, an integrated coding engine can help physicians to develop more accurate claims during the encounter. Meanwhile, health alerts made available during scheduling ensure a higher quality of care and patient compliance. On the other hand, many practices have already made significant investments in their existing

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10 BEST PRACTICES FOR SELECTING EMR SOFTWARE

practice management systems or third party billing services.

Simple integration may suffice just as well.

that soon thereafter “sunsets” their product? All of these situations could have big implications for you.

5. FOCUS ON EASE-OF-USE

8. BE SMART ABOUT YOUR BUDGET

It’s critical to find a system that makes work easier, not harder. The simplest way to evaluate ease-of-use is to use a demo copy yourself. Try to manage a common process such as documenting a frequent diagnosis. The right software should make it easy. Features that can augment ease-of use include on-line help functions, tablet or stylus interfaces and voice recognition. Ease-of-use will be especially important when staff turns over and you need a new employee up-tospeed quickly.

With EMR prices ranging from USD 1,000 to 100,000 (approx.INR 40,000 - 4,000,000), you can quickly narrow down your software search based on price. However, this approach will more than likely limit your ability to find the right system. You must consider the value of the system (as measured by return on investment), rather than thinking in absolute dollars. More expensive systems typically meet the latest standards (e.g. CCHIT), offer more sophisticated features and integrate with third party devices such as heart monitors and imaging systems. They may also include very sophisticated decision support protocols to standardize care across large groups or delivery networks.

9. CONSIDER YOUR DEPLOYMENT STRATEGY

6. ASSESS SUPPORT AND UPGRADES

You’ll need them. Leading vendors provide support 24 hours a day / 7 days a week. You’ll most certainly want weekend support if you work like most physicians, and you might want night-time support too. And remember, when it comes to software, support isn’t just technical assistance; support often includes access to new features, bug fixes and major upgrades. Assess the vendor’s track record in delivering consistently high quality new releases of their software. After all, you’ll likely be paying for them annually.

7. CONSIDER VENDOR VIABILITY

Often an EMR isn’t all you’re buying. You’re also entering into a long-term software vendor relationship. It’s critical to assess the software company’s viability - not just if they survive, but how… Sure, healthy margins in the software business keep most established vendors afloat, but what about the vendor’s “strategic viability” in a market that is poised for dramatic consolidation? Can and will they invest in new development?

Will they continue to meet regulatory requirements and support new standards? Will they sell out to a larger company 36

With faster Internet connections and new technologies, it’s now possible to access your medical records entirely over the web. Application Service Provider (ASP) options lower up-front costs, simplify maintenance and provide the ease-ofuse of a web application. Software as a Service (SaaS) vendors have invested heavily in security, HIPPA compliance and data redundancy to provide a highly secure EMR platform.

At the same time, a SaaS system requires a consistent, highspeed Internet connection. If the connection is slow, the practice will be less efficient. If the connection goes down, so too will the ability to access patient records. Think hard about the tradeoffs between a SaaS solutions and the more traditional path of installing and maintaining your own IT infrastructure.

10. DON’T FORGET THE TECHNOLOGY

Development languages and databases should not drive a software selection process in health care or any other industry. Instead, you must assess underlying technology from a defensive standpoint. For example, reimbursement procedures and regulatory requirements change often. So a system must be built on technology that is flexible and enables the vendor to release frequent, quality updates. It is also important to assess the support requirements of systems with questionable “architecture.” Avoid purchasing an EMR with exceedingly rigid or soon-to-be-obsolete technology.

Best practices are critical for selecting the right software for your practice. While one could suggest many more criteria for this process, managing to use these ten best practices will quite do to find the right system. Good luck!

Don Fornes Founder and chief executive officer of Software Advice don@softwareadvice.com

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