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SEPTEMBER 2019, VOLUME 3 ISSUE 9 `200 INDIA MED TODAY

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TACKLE

HEART FAILURE

HEAD-ON WITH NEUROMODULATION THERAPY Innovations in Heart Failure Management

APPROACH

NAVIGATING HOSPITALS

INTERVIEW

SOMERSET INDUS CAPITAL PARTNERS INVESTS IN TWO HEALTHCARE FIRMS, DEPLOYS II FUND SEPTEMBER 2019

IMPACT

MICROSOFT APOLLO PARTNERSHIP FOR COMBATING CVD


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Heart failure, shadowy monster HEART FAILURE is creeping on us like a shadowy monster in a horror movie. It is there but we cannot see it. Heart failure affects about 0.9 per cent of the total population in India. In fact, the lifetime risk of developing coronary heart disease is 1 in 2 for men and 1 in 3 for women, by the age of 40, men and women have equal lifetime risks of developing HF. What’s more, now patients as young as 25-yrs are also developing heart failure. Due to various advances in medicine the outcomes of patients with heart failure has improved drastically over the last two decades. Availability of drugs such as beta-blockers , ACE inhibitors , ARBs and Aldosterone anatagonistsetc. helps heart failure patients survive longer and lead more comfortable lives . Besides this, change in lifestyle and proper diet with management of salt and fluid intake is improved the quality of life of patients. Newer devices such as Implantable Cardioverter Defibrillator (ICD) and CardiacResynchronisation Therapy (CRT )significantly improves outcomes for some patients. Patients who do not benefit from ICD require heart transplantation. However, a new set of device called ventricular assist device (VAD) — also known as a mechanical circulatory support device acts as a bridge between heart transplants.

Heart failure affects about 0.9 per cent of the total population in India. In fact, the lifetime risk of developing coronary heart disease is 1 in 2 for men and 1 in 3 for women, by the age of 40, men and women have equal lifetime risks of developing HF But can there be a better management for heart failure patients? Apparently, a new pacemaker like device is trying to do just that. Our current cover story focuses on this new technology. Modulation of the autonomic nervous system has been of much interest to researchers as a possible therapy for heart failure. Second-generation minimally invasive implantable system is approved for use in heart failure in over 30 countries. Read more about this therapy in our cover story this issue. Do send feedbacks on editorial@indiamedtoday.com

advice or delay in seeking it because of something you have read on IndiaMedToday. No part of this publication or any part of the contents thereof may be reproduced, stored in a retrieval system or transmitted in any form without the permission of the publishers in writing. Printed and published by M Neelam Kachhap, 301, Grazia, 1st main, 2nd Cross, Lingrajpuram, Bangalore 560084 on behalf of Neelam Publishing (OPC) Private Limited, Printed at Supriya Print Art 143, Pragati Industrial Estate, N M Joshi Marg, Lower Parel West, Mumbai - 400011. and published at 301, Grazia, 1st main, 2nd Cross, Lingrajpuram, Bangalore 560084.

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CONTENTS APPROACH

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UPFRONT

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Navigating at Hospitals

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COVER STORY

New hope for Heart Failure: Neuromodulation Therapy Innovations in Heart Failure Management

IMPACT

Microsoft Apollo Partnership for Combating CVD

Advantages of implementing wayfinding technology in hospitals and medical centers. Simone Health Development Companies, USA

DEVICE TRAIL

Enlightened Diagnostics with FIA

04 Editorial 06 Letters 08 News roundup 42 Event Listings FEATURE

Hybrid OT: boon for Neurosurgery

34 Exercise and Cardiovascular Fitness

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30

An effective and efficient device is changing the way Fluorescence Immunoassay Analyzers are used in India

OPINION

NMC VERSUS MCI

36

INTERVIEW

Somerset Indus Capital Partners invests in two healthcare firms, deploys II fund

40

The investments went to Genworks and Apex Hospital

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LETTERS Organ Transplants drastically improves the quality of life of patients suffering from irreversible organ failure and gives them another chance to live. One organ donor can save up to nine lives. The deceased donor donation rate in India stands at around 0.34 per million, which is abysmally low when compared to the organ donation rate prevalent in other developed countries. In the Indian scenario, there is a great mismatch between the number of potential donors and actual cadaveric donors. Even in the case of individuals who have given consent for donation after death, the influences of the familial members might change the actual decision.

ORGAN DONATION DAY

I

ndia is struggling with acute shortage of organs for transplantation and there is dire need to increase awareness on organ donation. According to a report, more than 500,000 people are waiting fAor organ

transplant in the country and only handful of 3,500 transplants are performed annually. Despite India being the world’s second-most populous country, it has a poor deceased organ donation rate of just 0.26 per million population compared to 26 in the US. Undoubtedly, the

Dr Vigil Rahulan, HOD & Senior Consultant - Pulmonary

demand far outstrips the availability of organs. Due to the

Medicine (Lung Transplantation) & Critical Care Medicine,

prevalence of myths and superstitions, many do not think

BGS Gleneagles Global Hospital

about donating their organs even after death. Awareness on organ donation is therefore the only way out of this

We have been always extending our sincere support to the organdonation initiative. We recognize that this wonderful and noble accomplishment would not have been possible without the selfless act of the patient’s family. We extend sincere thanks to the family members of the deceased. We are also thankful to the Government of West Bengal for putting so much focus on organdonation that has led to an environment of awareness around us. Dr. Alok Roy, Chairman, Medica Group of Hospitals

depressing scenario. Unfortunately, very people in India have any idea about organ donation, or how they could potentially help after their deaths. Awareness sessions have to be held at offices, colleges, schools, and even homes to change this scenario. Most organ and tissue donations occur after the donor has died. But some organs and tissues can be donated while the donor is alive. However, the hope is the more potential donors there are, the more the likelihood

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NEWS ROUNDUP CLINICAL ROBOTIC SURGERY ASSOCIATION (CRSA) LAUNCHED IN INDIA Clinical Robotic Surgery Association (CRSA) is the leading body of experts in the field of Robotic Surgery across the world, based out of Chicago, USA. It has started the first international chapter in India. The inaugural meeting of the chapter was held in New Delhi on August 24-25, 2019 at Hotel Le Meridien. This is the first Indian robotic surgery society. The inaugural meeting of CRSA India saw leading surgeons from all over the country and abroad come together and share their knowledge and wisdom in the field of robotic surgery. CRSA India would also provide training opportunities to young surgeons who want to train themselves in the field of Robotic Surgery. It would help surgeons learn from the best experts with the help of a peer reviewed journal and online video library. The members can access the surgical techniques of experts, and visit them for further training.

PHILIPS’ 2019 FUTURE HEALTH INDEX REPORT: DIGITAL HEALTH TECHNOLOGY UPS THE GAME Royal Philips, a global leader in health technology, recently unveiled the India findings of its 15-country Future Health Index (FHI) 2019 report: ‘Transforming healthcare experiences: Exploring the impact of digital health technology on healthcare professionals and patients’. The study reveals that India is a forerunner in the adoption of digital health technology with 76% of healthcare professionals in the country already using digital health records (DHRs) in their practice. Interestingly, India meets the 15-country average when it comes to the usage of AI within healthcare at 46%. Commenting on the launch, Rohit Sathe, President – Philips Healthcare, Indian Subcontinent said, “Philips’ Future Health

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September 2019

Index 2019 report confirms that digital health technology is a pivotal pillar in delivering value-based care across the healthcare continuum in India. Tools including telehealth and adaptive intelligence (AI) solutions can help lower the barriers between hospitals and patients, thereby improving access to care and enhancing overall patient satisfaction, particularity in tier II & III cities in India. We hope that the insights from this report will assist key stakeholders in designing and implementing robust and sustainable health systems in the country.”

ASTER TO SET-UP AN INNOVATION AND RESEARCH HUB IN BANGALORE, INDIA AND GCC To improve the ultimate health outcomes for patients and enhance their overall experience

at all its facilities, Aster DM Healthcare is setting up Aster Innovation and Research Centre in Bangalore, India and GCC. Over the next three years, the Centre will aim to achieve key milestones like introduction of innovative solutions for home healthcare with focus on digital primary care, establishing a rich eco-system of digital health partners from start-ups to academia and starting digital health/ informatics/ medicine as a stream for future healthcare workers. Joining as the Chief of Innovation, Dr. Satish Prasad Rath, MD would be spearheading the innovation projects, that will be aim to leverage the advances in digital health research like AI, cognitive psychology, blockchain, IOT, behavioral economics etc. and on-board start-ups which can drive innovation. The Centre will also work in a collaborative manner focusing on applied research with academia, startups and industry partners. Aster DM Healthcare has the unique


positioning of providing an integrated service offering that ranges from primary care (aster clinics and pharmacy) to quaternary care, along with an in-house research center as MIMS Research Foundation and a medical college as DM Wayanad Institute of Medical Sciences (DMWIMS). The new center will accelerate various ongoing innovation projects being led by different units, like the diabetes, sepsis and dialysis projects; and will be working to introduce an interdisciplinary subject on digital health/medicine at DMWIMS.

Mathur, Chief Operating Officer, Godrej Interio along with medical experts like Dr Vivek Desai, Director, HOSMAC, Dr Vispy Jokhi, CEO, Masina, and Gautam Khanna, CEO, Hinduja. On this occasion, Godrej Interio also released insights from its first survey on the healthcare industry, ‘Elevating Experiences, Enriching Lives’. The survey highlights prevalent challenges faced by the nursing staff while delivering healthcare services in India. The study revealed more than 90 per cent of nurses complain of some musculoskeletal disorder. Nursing as a profession requires

GODREJ INTERIO LAUNCHES HEALTHCARE EXPERIENCE CENTRE IN MUMBAI

nurses to work in a standing posture. The study highlighted 88 per cent of nurses work for 8-10 hours a day along with doing overtime at least twice or thrice a month (35 per cent do over time more than three times a month). 74 per cent of the nurses stand for more than 4-6 hours a day at a stretch which could cause stress on their lower limbs. These long working hours, overtime and work overload contribute to impact their physical and psychological well-being. Experts have cautioned that a tired workforce is one of the chief contributors to medical errors.

Godrej Interio, recently launched ‘Godrej Interio healthcare Experience Centre’. It is a hub wherein one can experience the products and services by Godrej Interio for the healthcare industry. The healthcare experience centre was launched in the presence of Jamshyd Godrej, Chairman of the Board, Godrej and Boyce, Anil

BD INAUGURATES CENTRE OF EXCELLENCE IN CLINICAL FLOW CYTOMETRY AT AIMS, KOCHI

Becton, Dickinson and Company (BD), in collaboration with Amrita Institute of Medical Sciences (AIMS) launched the AIMS-BD Centre of Excellence (CoE) in Clinical Flow Cytometry, a critical technique that has many clinical applications. The state-of-the-art CoE was launched in Kochi that will provide training to researchers and clinicians to enhance their expertise in flow cytometry and focus on frontier areas in Biological Sciences. The CoE is well equipped with a comprehensive range of flow cytometer instruments like BD FACSAria™ II cell sorter and BD FACSCanto™ II Clinical Cell Analyser that will address both current and future needs for research and clinical applications. Dr Ullas Mony, Head-Advance Immunohematology and Flow Cytometry Lab, Amrita institute of Medical Sciences and Research Center, Kochi said, “This facility

BD inaugurates Centre of Excellence in Clinical Flow Cytometry at AIMS

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NEWS ROUNDUP helps in providing the diagnostic needs of our hospital as well as other hospitals in and around Kochi and also in Kerala. This centre aims to organize CMEs and workshops in clinical Flow Cytometry and also plans to conduct good quality research and thereby standardise novel clinical flow cytometric assays for better patient care. CoE will strengthen our relationship with BD India and I sincerely hope that this centre can serve as a nodal platform for building consensus and developing quality assurance in clinical flow cytometry.”

FIINOVATION & HFCL PARTNER FOR MOBILE MEDICAL UNITS PROJECT Innovative Financial Advisors Pvt. Ltd (Fiinovation) recently partnered with Himachal Futuristic Communications Pvt. Ltd (HFCL) for evaluation of HFCL’s Mobile Medical Units (MMU) projects running in Goa, Solan – Himachal Pradesh, Ghazipur – Uttar Pradesh and Sardarshahar – Rajasthan. The projects are categorically designed to reach out to the poor and to those who have limited or no access to basic healthcare facilities in the targeted areas. The MMUs consist of dedicated teams

Fiinovation Dr. Soumitro Chakraborty

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including, medical consultants, pharmacists, social workers and lab technicians. Medical consultations, medicines and diagnostics are provided free of cost under the project. Each MMU is equipped with an ENT & Eye diagnostic set, an ECG machine, minor surgical and dressing set. More than 1.5 lakh beneficiaries from the marginalized community have benefitted since the inception of the project. As part of the alliance, Fiinovation has reviewed the status of the project based on accurate data collected from the ground to understand the positive aspects and to suggest counter mechanisms for mitigating the challenges if any facing the project. The partnership will also benefit in evaluating the design and planning structures of the project, status of on-ground implementation and assessment of the sustainability of the program. Increased access to mobile health units and qualified medical professionals has benefitted all, especially the elderly as it reduces the time sought to reach health facilities. Awareness campaigns designed around the importance of good hygiene practices have resulted in overall improvement of the health of the community members.

PIROJSHAW SARKARI (PHIL) APPOINTED AS THE CEO OF MAHINDRA HEALTH CARE BUSINESS

Mahindra Health Care, a newly formed business under Mahindra Partners, has announced the appointment of Mr. Pirojshaw Sarkari (Phil) as its Chief Executive Officer effective October 1st 2019. Mr. Sarkari joins from Mahindra Logistics Limited (MLL) where he was instrumental in growing the company into a position of industry leadership. From the early days of setting up of MLL, he successfully steered the company to a stellar IPO, which was oversubscribed eight times on opening. Today, MLL is a Rs. 4000 crore company, which he, along with his team, has built into one of the largest and best 3PL companies in India. In his role as CEO of the Mahindra Health Care Business, Mr. Sarkari will support the

Pirojshaw Sarkari

existing business in its growth trajectory and focus on building new partnerships. He will also look at opportunities to incubate new healthcare businesses, within the company. Prior to joining Mahindra Group, Mr. Sarkari was the Managing Director & Country Head for United Parcel Service (UPS) India. During his stint with UPS India, he was part of the start-up operations where he played a key role in setting up systems and processes and establishing various global best practices. Mr. Sarkari established UPS in India from a very low presence of 16 offices to building a network which covers the entire country. He also had a stint as the Managing Director of UPS Philippines. Sarkari is a Chartered Accountant and a Bachelor of Commerce from the Mumbai University. Mahindra Partners is the 1 billion USD Incubation, Private Equity & Venture Capital division of the Mahindra Group. Its mission is to accelerate value creation through a diversified global portfolio of emergent businesses. The portfolio spans across multiple industries like logistics, steel processing, renewable energy, health care, conveyor systems, retail, infrastructure consulting and skill building, luxury boat manufacturing and media. It has recently expanded operations in U.S. by


investing in the IoT and shared mobility space.

WORLD’S SMALLEST HEARTWARE VENTRICULAR DEVICE IMPLANTED AT FORTIS MALAR Doctors at Fortis Malar Hospital successfully implanted world’s smallest pump – Heartware Ventricular Device (HVAD) on a 14-year girl from Pakistan. This challenging and complex procedure was conducted by a team of expert doctors led by by Dr. K R Balakrishnan, Director, Cardiac Sciences, Fortis Malar Hospital and Dr. Suresh Rao KG, Head of Department, Critical Care & Cardiac Anaesthesia, Fortis Malar Hospital. Ayesha was admitted to the hospital with complaints of breathlessness and vomiting along with hypotension. She was diagnosed with dilated cardiomyopathy and was waitlisted for heart transplant. During the waiting period, Ayesha suffered a sudden cardiac arrest and doctors performed temporary LVAD (centrimag) surgery. Post the operation, she was recuperating well with her vital parameters being stable. Due to dearth and uncertainty of an available heart anytime soon, doctors as well as the family discussed her condition and decided to do a long duration

HVAD instead of a heart transplant surgery. Speaking about the case, Dr. K R Balakrishnan said, “A left ventricular assist device, or LVAD, is a mechanical pump that is implanted inside a person’s chest to help a weakened heart pump blood. Unlike a total artificial heart, the LVAD doesn’t replace the heart. It just helps it do its job. In rare cases, LVAD lets the heart recover its normal ability by giving it a chance to rest. It maintains or improves other organs, helps with doing exercise, and lets the person go through cardiac rehabilitation.”

PRACTO AND RBL BANK LAUNCH INDIA’S FIRST HEALTH-FOCUSED CREDIT CARD

RBL Bank, one of India’s fastest growing private sector banks and Practo, India’s leading digital healthcare platform, have partnered to launch a co-branded credit card, powered by Mastercard. This industry-first credit card is available now, on both Practo and RBL mobile apps and websites. In a world where people are increasingly busy to pay attention to their day-to-day health needs, this is an innovative step to encourage users to think health-first on a daily basis. The card is designed to cater to customers in both metros and nonmetro cities, through Practo and RBL Bank’s

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NEWS ROUNDUP extensive customer base that spans across the country. With benefits like unlimited online consultations with doctors 24*7, users are guaranteed that there is an experienced qualified doctor available to them whenever there is a need – instead of relying on selfdiagnosis or advice from friends and relatives.

WORLD’S FIRST INNOVATION FOR THE CRITICAL CARE UNIT AIMS TO BRING DOWN MORTALITY RATE OF PNEUMONIA AFFECTED ICU PATIENTS InnAccel, India’s first product innovation platform with a diverse portfolio of globally patented medical technologies has launched VAPCARE, the world’s first automated, and intelligent secretion clearance and oral hygiene management system for ventilated patients. VAPCare has been developed by Coeo Labs, the critical care division of InnAccel Technologies. Speaking on the first-of-itskind product, Nitesh Jangir, Lead Engineer, Coeo Labs, said, “People admitted to ICUs often contract VAP, an infection caused by the bacteria that collect in the lungs of a patient who has been on a ventilator for more than 48 hours. VAPCare addresses this issue by completely automating oral hygiene management. Through its patented technology platform, VAPCare intelligently clears secretions from 3 areas, and allows the doctor to customise the protocol depending on each patient’s clinical needs.”

HEALTHTECH STARTUP DOXPER RAISES US$4 MILLION IN SERIES A FUNDING FROM ALKEMI VENTURE InformDS Technologies Pvt. Ltd., the company behind Doxper, has raised US$4 million in the first close of its Series A round led by

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Doxper Founders

healthcare focused fund Alkemi Venture Partners. Also participating in this round are Rainforest Venture Network, existing investor growX Ventures and some marquee angel investors. Doxper, founded by three IIT alumni,Shailesh Prithani, Pawan Jain and Randeep Singh; is an ML/AI powered data capture solution that allows doctors to instantly digitise their case sheets using a digital pen and encoded paper. The solution can be fully integrated with any existing EMR systems. In more than 100 countries with a poor doctor-patient ratio, prescriptions and case histories are still “analog”, unlike data output from imaging, pathology, genomics etc which have long gone digital. Handwritten notes on paper pose the most serious impediment to the promise of ‘Digital Health’. Doxper today is serving nearly 1600 independent clinics and 20 of the country’s top corporate hospitals, including 3 chains. The company is processing close to 500K case sheets every month and has so far, through its platform, digitized case sheets of over 3.25 million unique patients, with a total of nearly

5 million records. The company plans to use the funds to double down on its growth in India expanding geographically across the country. Further investments in technology and R&D are planned to improve the accuracy of the ML/AI powered handwriting recognition engine and to develop products in business and clinical analytics.

BREAKTHROUGH DNA TEST TO IDENTIFY ALL DRUG RESISTANCE MUTATIONS IN TUBERCULOSIS MedGenome Labs– leader in clinical data driven genetic diagnostics and drug discovery research in India, has developed ‘SPIT SEQ’, the first Whole Genome Sequencing based test that can provide a detailed analysis of every single mutation present in any tuberculosis bacteria causing drug resistance-directly from the sputum. This break-through will enable a doctor to quickly and accurately prescribe the


most effective drug to a tuberculosis patient without a trial and error process, followed currently that takes a month. This test has been validated with over 100 samples where it recorded with 100% sensitivity and 98.04 % specificity when compared with Line Probe Assay (LPA). 50 out of those samples were in association with P.D. Hinduja Hospital and Medical Research Centre, Mumbai. A manuscript is under review for publication. Typically, the process of analyzing the drug resistance is very long which delays treatment for MDR-TB patient. Here as well, the current expertise allows testing resistance only on 4 drugs hence the patient had to wait until testing on all possible drug concluded. In such a situation, where long turn-around diagnosis time, repeated testing led to multiple changes in the course of treatment along the way. “Direct Whole Genome Sequencing reveals information on drug resistance mutations for all anti TB drugs in a matter of 10 days. Soon, this technology will help in optimizing the precise management of an MDR-TB patient”, says Dr Camilla Rodrigues, P D Hinduja Hospital and Medical Research Centre, Mumbai.

with 100% success rate, out of which 150 were only from Northern Maharashtra. By understanding the importance of patients receiving from other parts of Maharashtra, Wadia management has taken the noble step to come up with Outreach OPD centres. Heart specialists from Bai Jerbai Wadia Hospital for Children would conduct OPD’s on alternate Sundays, twice a month. This will make life easier for those children as most procedures and follow-ups can be done at their doorstep in Nashik itself.”

MICHAEL NEEB JOINS MAX HEALTHCARE INSTITUTE LIMITED AS INDEPENDENT DIRECTOR

Michael Thomas Neeb (57yrs), HCA UK’s Former President and CEO, has been appointed as an independent director at Max Healthcare Institute Limited for five years starting July 15, 2019. Neeb retired from HCA UK earlier this year after 19 years of service. Under his leadership, HCA UK had grown from four hospitals into the largest provider of privately funded healthcare in the UK, with a

WADIA HOSPITAL OPENED ITS FIRST OUTREACH OPD IN NASHIK

Wadia Hospitals are heritage legendary leading institutions of our country, treating patients from all over India, and abroad. By catering to the needs of paediatric patients in Nasik and North Maharashtra, the hospital has joined hands with Vijan Hospital & Research Centre (VHRC), to introduce Outreach OPDs. It is a firstof-its-kind initiative by the hospital, to provide high-end clinical diagnosis and consultation by heart specialists for paediatric patients. Dr Minnie Bodhanwala, CEO, Wadia Hospitals, Parel, said, “Since the inception of cardiac Department in Wadia Hospitals, in 2017, with state-of-the-art Cath lab and dedicated Cardiac Operation theatre and ICU, more than 1500 cases have been treated

Michael Thomas Neeb

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NEWS ROUNDUP network of hospitals and clinics in London and Manchester, and partnerships with leading NHS trusts. Recently, Radiant Life Care Private Limited backed by KKR, acquired 49.7% stake in Max Healthcare Institute Limited from South Africa-based hospital operator Life Healthcare. Radiant’s stake acquisition is one of several steps that will eventually result in Soi and KKR together acquiring a controlling stake in Max Healthcare by combining the health care assets of Max Healthcare, Max India Limited, and Radiant to create the largest hospital network in North India. As part of the transaction, Max India’s promoters have received an advance of INR 361 crore (US $52.2 million) from KKR in exchange for a 4.99% stake in the merged entity. Max India’s promoters have used the funds for deleveraging purposes. Radiant is promoted by Abhay Soi and is in the business of developing/redeveloping hospitals to provide high end quaternary care. Presently, Radiant has two iconic facilities in its portfolio namely: BLK Super Specialty Hospital, Delhi and Nanavati Super Specialty Hospital, Mumbai. Abhay Soi Chairman and Managing Director of Radiant has been appointed as the Chairman of Max Healthcare Institute Limited Board and

Sustainable Manufacturing

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Executive Council. The process of combining Radiant Life Care and Max Healthcare and the eventual listing of Max Healthcare is underway, and is likely to be completed in 6 to 8 months, subject to receipt of the requisite approvals. Neeb is a Non-Executive Director of Max Healthcare Institute Limited. He did bachelor’s degree in accounting from Baylor University in 1984 and a master’s degree in business administration from the University of Dallas in 1998. Neeb joined HCA in 1991, moved to the UK in 2000 as CFO for its international division, and became president and CEO in 2007.

SUSTAINABLE MANUFACTURING PRACTICES NEEDED TO COMBAT GROWING ANTIMICROBIAL RESISTANCE Centrient Pharmaceuticals, a global leader in sustainable antibiotics manufacturing, in partnership with Indian Institute of Technology – Delhi, organized a workshop on ‘Sustainability Through Excellence in Manufacturing’ (STEM) in Seoul. The workshop

imparted training and education on advanced clean and sustainable manufacturing techniques for pharmaceuticals. The session was attended by nearly 50 participants from Manufacturing, R&D, Regulatory Affairs, Quality Control/Assurance and Purchasing departments of leading pharmaceutical companies in Korea. The World Health Organization (WHO) recognizes Antimicrobial Resistance (AMR) as one of the top ten threats to public health worldwide. According to the AMR Review (2014), nearly 700,000 people die each year due to AMR, and by 2050, this number is projected to reach 10 million per year unless strong actions against the drivers of AMR are taken. Next to misuse and overuse of antibiotics, environmental factors like release of inadequately treated antibiotic manufacturing effluent into the environment play an important role in development of drug resistant ‘superbugs’.

TGI HOSTS INDIA’S FIRST RAPID EVIDENCE SYNTHESIS UNIT IN COLLABORATION WITH WHO AND NHSRC


Erba Hematology range of analyzers

The George Institute for Global Health, India (TGI) in collaboration with the National Health Systems Resource Centre (NHSRC), and with support from WHO Alliance for Health Policy and Systems Research has established India’s first rapid evidence synthesis unit. The goal is to provide rapid evidence synthesis products that are rigorous, unbiased, and developed ondemand through continuous engagement with stakeholders, end-users and decision-makers. Rapid evidence synthesis is a pragmatic and efficient approach that provides a summary of the best available research evidence, contextualized to suit the requirements of decision making. This is done by methodological tailoring as per the actual requirements for decision making in a time-sensitive and cost-effective manner. RES outputs are rapid reviews, which can be done in four to 12 weeks, and rapid policy briefs, which can be produced in two to four weeks. “There is a need for policymakers and researchers to develop evidence-informed health policies, which would involve collaboration between evidence synthesis units such as the TGI-RES and the National and State health system resource centers,” said Dr. Rajani Ved, Executive Director, and National Health Systems Resource Centre.

TRANSASIA - ERBA GROUP SETS A NEW BENCHMARK IN THE INDIAN IN-VITRO DIAGNOSTIC INDUSTRY Transasia Bio-Medicals Ltd. announced that it has successfully sold over 1,000 units of the recently launched Erba hematology range of analyzers in India, thereby retaining its No. 1 position in the Indian hematology market. Transasia is India’s leading In-vitro Diagnostic Industry and a part of the global TransasiaErba group. A result of in-depth research and development at the group’s European centre, the Erba hematology range was launched in India just four and half months ago to mark Transasia’s 40th anniversary. The 3-Part (H 360) and 5- Part (H 560 and ELite 580) fully automated hematology analyzers, reagents and controls include a number of features to help institutions, clinicians and laboratory technologists offer accurate diagnosis. When asked what he felt about this remarkable feat, Mr. Suresh Vazirani, Chairman & Managing Director said, “All along the 40 years of our journey, we have been committed

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NEWS ROUNDUP to offering the highest level of quality and service to Doctors and their patients. India’s greatest need is the easy access to affordable healthcare. And that is the lacunae that we have been striving to fill by pooling in our best technologies from our global subsidiaries and making them available at affordable prices for Indian hospitals and labs.” “Our Erba range of hematology analyzers is comparable to the best in the world and is widely used in the European market. I am grateful to our customers for their overwhelming response and our success is an outcome of the trust they bestow in us”, he further added. Erba H 360 is a 3-Part Differential Hematology analyzer and is suitable for obtaining a complete blood count (CBC) with a three part differential white blood cell (WBC) count. On the other hand, the 5-Part Differential analyzers, H 560 and Elite 580 measure cell morphology and detect small cell populations to diagnose rare blood conditions. All the three instruments are designed to be user-friendly and convenient. They aid in

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the screening of hemoglobinopathies like Thalassemia, sickle cell anemia and other hemoglobinopathies that are prevalent in India. With more than 65,000 installations and the largest sales and service team in the Indian IVD Industry, Transasia has been living upto its aim of quality, accessible and affordable diagnostic solutions. Globally, the TransasiaErba group with 14 subsidiaries across USA and Europe, is serving more than millions in over 100 countries and is dedicated to offering affordable solutions for the emerging markets.

LYNX – LAWRENCE AND MAYO PARTNERS WITH IDEAFORGE TO PROVIDE HIGHLY SPECIALISED UAVS (DRONES) FOR THE INDIAN MARKET Lynx – Lawrence & Mayo, one of India’s leading Engineering equipment providers, recently

announced the expansion of their portfolio to include specialised drones, through its partnership with the ideaForge, India`s largest UAV manufacturer. As part of the agreement, ideaForge’s range of award winning drones equipped with over a decade of UAV design expertise, will be accessible to Lynx – Lawrence and Mayo for applications across urban development, weather monitoring and testing, agro-technology and other sectors. Developed by a team of IIT Bombay graduates, ideaForge has been celebrated for their unique innovations in the Unmanned Aerial Vehicles (UAVs) domain, having built the then world’s smallest and lightest autopilot in 2009 and India’s first autonomous quadcopter UAV. Their designs have been internationally acclaimed and they have led the development of world class, indigenous UAVs for security & surveillance, reconnaissance, mapping, photogrammetry and other industrial applications. Now, their UAVs even come with the capability to meet the DGCA regulations, to ensure NPNT compliance.


DETAIL NEWS

Machine Learning to Predict Cardiac Risk IMT TEAM

MEDIAL EARLYSIGN, a leader in machine-learning based solutions to aid in early detection and prevention of high-burden diseases, recently announced the results of new research with Mayo Clinic assessing the effectiveness of machine learning for predicting cardiac patients’ future risk trajectories following hospital discharge. The peer-reviewed retrospective data study, Leveraging Machine Learning Techniques to Forecast Patient Prognosis After Percutaneous Coronary Intervention, published in JACC: Cardiovascular Interventions, evaluated the ability of machine learning models to assess risk for patients who underwent percutaneous coronary intervention (PCI) inside the hospital

and following their discharge. The analyzed algorithm was developed by Medial EarlySign data scientists to identify patients at highest risk of complications and hospital readmission after undergoing PCI, one of the most frequently performed procedures in U.S. hospitals. “Contemporary risk models have traditionally had little success in identifying patients’ post-PCI risks for complications, inpatient mortality, and hospital readmission. This study shows that machine learning tools may enable cardiology care teams to identify patients who may be on high-risk trajectories,” said Rajiv Gulati, MD, Ph.D., Interventional Cardiologist at Mayo Clinic. The analysis was based on electronic health records (EHR), demographics, and social data collected from a cohort of 11,709 unique Mayo Clinic patients who underwent 14,349 PCIs during 14,024 hospital admissions. The patients’ mean age was 66.9, most were male (71.5%), 45.9% were obese, and 59.8% had a history of heart attacks. The study revealed that Medial EarlySign’s algorithm had an excellent discriminatory ability using only data points available at time of admission or at discharge. Compared with standard regression methods, it was more predictive and discriminative at identifying inpatient sub-groups at high risk for 180-day postPCI mortality and 30-day rehospitalization for congestive heart failure.

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DETAIL NEWS The algorithm also proved effective at identifying patient subgroups at high risk of post-procedure complications and readmission, supporting the potential role for integrating machine learning into clinical practice. “Machine learning models can help clinicians assess patient risk at different points on their clinical pathways, including hospital admission, discharge and future re-admission,” said YaronKinar, Ph.D., Medial EarlySign’s Chief Data Scientist. “Collaborating with Mayo Clinic clinicians for this retroactive study provided the added benefit of assessing how social and demographic information, together with routine lab and existing EHR data, can provide further insights to stratify patient risk.” Founded in 2013, Medial EarlySign is headquartered in Tel Aviv, Israel with US headquarters in Boston, MA. Their suite of outcome-focused software solutions (AlgoMarkers™) find subtle, early signs of high-

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Mayo Clinic patients who underwent 14,349 PCIs during 14,024 hospital admissions. The patients’ mean age was 66.9, most were male (71.5%), 45.9% were obese, and 59.8% had a history of heart attacks risk patient trajectories in existing lab results and ordinary EHR data already collected in the course of routine care. EarlySign’sAlgoMarkers are currently helping clients identify patients at high risk for conditions such as lower GI disorders, prediabetic progression to diabetes, downstream diabetic complications, first coronary artery disease (CAD) and equivalent events, and chronic kidney disease (CKD).


COVER STORY

NEW HOPE FOR

HEART FAILURE:

NEUROMODULATION THERAPY Innovations in Heart Failure Management

M NEELAM KACHHAP

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September 2019

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COVER STORY

T

his August, a new pacemaker-like device got FDA market clearance for heart failure treatment. The neuromodulation device is said to improve symptoms and quality of life (QoL) in patients with advanced heart failure. With this device the patient can perform normal daily activities, and there are improvements in levels of a biomarker that measures heart failure. Needless to say this innovation marks the beginning of a new chapter in heart failure management. Today, heart failure is one of the biggest clinical challenges in the cardiovascular sphere and the largest untreated clinical need with increasingly high cost of treatment.

TWENTY MILLION PEOPLE WORLDWIDE SUFFER FROM HEART FAILURE, OUT OF WHICH INDIA WITNESSES TWO MILLION NEW CASES EVERY YEAR WITH AT LEAST A THIRD OF THEM REQUIRING ADVANCED THERAPY TO SURVIVE

Heart Failure When the ability of the heart to pump blood reduces it is called heart failure. It does not mean that the heart has stopped working. Heart failure simply means that the heart is not working as well as it should because of structural or functional damage. Heart Failure is a major health concern worldwide including in India. Twenty million people world-wide suffer from heart failure, out of which India witnesses two million new cases every year with at least a third of them requiring advanced therapy to survive. It is also important to note that, the mortality in heart failure patients is as high as 30-40 per cent, within a year of diagnosis. In India, the treatment for heart failure is restricted to medical therapy, revascularization therapy restoration/augmentation of blood supply to the Pic Courtesy: CVRx

Baroreflex

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heart), valvular surgeries and cardiac resynchronization (heart pacing) therapy. The goals of these therapies are to improve the symptoms, slow disease progression, and enhance survival. However, not all patients are able to benefit from these therapies as their conditions and underlying disease etiology is not the same. Emerging Therapies Much progress has been made in the management of heart failure and yet patients with heart failure are faced with poor quality of life. In addition to being expensive the treatment for heart failure is difficult as options keep reducing. Moreover, for some patients with severely reduced heart function there are very limited treatment options. In addition, these patients have an increased risk of ventricular arrhythmias - abnormal rapid heart rhythms. In fact, autonomic nervous system plays a predominant role in heart failure as it controls organ function. It is no surprise then that the modulation of the autonomic nervous system has been of much interest to researchers as a possible therapy for heart failure. Emerging therapies such as device based approach to neuromodulation of autonomic control of the heart are gaining momentum as alternative approach to heart failure management. Neuromodulation therapies for Heart Failure The CardioFit device from Biocontrol Medical Ltd., Yehud, Israel is an implantable electrical stimulation device designed to improve heart function and the first medical device to treat chronic heart failure using neurostimulation. The device can deliver low current adjustable electrical pulses to stimulate the vagal nerve. CardioFit addresses an imbalance in the autonomic nervous system’s sympathetic and parasympathetic branches, which regulate heart muscle activity. Although initial studies showed the efficacy and safety of chronic vagal nerve stimulation with improved quality of life and LV function at 1 year; recent studies like the INOVATE-HF did not meet its set endpoint. The INOVATE-HF (Increase of vagal tone in chronic heart failure) trial was the first large, randomised trial of device-based autonomic modulation in heart failure. The primary results of this study show that vagus nerve stimulation was not effective for reducing the rate of

MODULATION OF THE AUTONOMIC NERVOUS SYSTEM HAS BEEN OF MUCH INTEREST TO RESEARCHERS AS A POSSIBLE THERAPY FOR HEART FAILURE

death from any cause or heart failure events. However, Quality of life, New York Heart Association Class and sixminute walking distance were favorably affected by vagus nerve stimulation. Another Israeli company, Caesarea based Enopace Biomedical Ltd, introduced the Harmony Aortic Stimulation System four years back. It is a minimally invasive implantable neurostimulator system capable of delivering stimulation to the aortic wall. ENDO-HF study to determine the safety and performance of the Harmony System for the treatment of heart failure is still on and is said to be completed by 2020. Meanwhile, Minneapolis, Minnesota based CVRx, has developed the second-generation Barostim Neo, a minimally invasive implantable system approved for use

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COVER STORY

in heart failure in over 30 countries and approved for use in resistant hypertension in the European Economic Area, Colombia and New Zealand. The device became the first-of-its-kind to receive FDA clearance for sale in the US. The device received a breakthrough device designation because it treats a life-threatening disease, heart failure, and addresses an unmet medical need in patients who fail to get adequate benefits from standard treatments and have no alternative treatment options. “After many decades of research in the field of neuromodulation, the BAROSTIM NEO is the first device approved in the United States that uses the power of the brain and nervous system to target cardiovascular disease,” said NadimYared, President and CEO of CVRx. “We are thrilled to transition to the next stage of our company’s growth, shifting our focus to the successful adoption of BAROSTIM NEO in the United States and bringing an innovative solution to chronic heart failure patients.” The Barostim Neo The Baroreflex Activation Therapy for Heart Failure Pivotal Trial (BeAT-HF) phase III randomised clinical trial confirmed the safety of Barostim Neo and its effectiveness in improving symptoms in patients suffering from chronic heart failure. The trial analysis included results from 264 patients randomized to two arms: 130 subjects randomized to receive a Barostim Neo were compared to 134 subjects randomized to stay on guideline-directed medical therapy. The positive safety and effectiveness results were presented in Late Breaking Clinical Trial sessions at the Heart Rhythm Society and the European Society of Cardiology Heart Failure conferences in May 2019. “With the FDA’s approval of the Barostim Neo, we finally have an effective neuromodulation therapy for advanced heart failure patients who are not indicated for Cardiac Resynchronization Therapy (CRT),” said Michael Zile, M.D., Professor of Medicine at the Medical University of South Carolina and Chairperson of the BeAT-HF Executive Steering Committee. “The Barostim Neo improves the quality of life and the exercise capacity of heart failure patients who previously did not have access to a device-based therapy.” The Barostim Neo System includes an implantable pulse generator (IPG) that is placed under the patient’s

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BAROSTIM NEO ADDRESSES AN UNMET MEDICAL NEED IN PATIE NTS WHO FAIL TO GET ADEQUATE BENEFITS FROM STANDARD TREATMENTS AND HAVE NO ALTERNATIVE TREATMENT OPTIONS

skin, below the left or right collarbone and a carotid sinus lead placed on the patient’s left or right carotid sinus. The IPG is then connected to the carotid sinus lead. The doctor programs the IPG based on the patient’s individual requirements. The IPG delivers electrical impulses to the baroreceptors on one of the carotid arteries. The brain, in turn, sends signals to the heart and blood vessels that relax the blood vessels and inhibit the production of stress-related hormones to reduce heart failure symptoms. Barostim Neo is intended to be used in patients who have advanced symptoms of heart failure and are not responding to medical therapy or who are not suited for treatment with other heart failure devices such as cardiac resynchronization therapy. The system was evaluated in a clinical study that compared patients who received the device and standard medical therapy with patients who received only standard medical therapy. The study results demonstrated that the device may improve an individual’s ability to perform Pic Courtesy: CVRx

Carotid Sinus Lead


normal daily activities, distance walked, quality of life, and lower levels of a biomarker that measures heart failure. This system is contraindicated in patients, who have anatomy that would impair implantation of the device; certain nervous system disorders, uncontrolled or irregular heart rate, atherosclerosis or blood vessel irregularities near the implant location, and patients with known allergy to silicone or titanium. Road Ahead In the last couple of years the race to solve the heart failure

SECONDGENERATION MINIMALLY INVASIVE IMPLANTABLE SYSTEM IS APPROVED FOR USE IN HEART FAILURE IN OVER 30 COUNTRIES

riddle has intensified. A number of new interventions, targeting different pathophysiologic approaches are being developed. Some of these have shown promising preliminary results with enhanced symptomatic relief, heart function, QoL and haemodynamic performance. Most of the emerging therapeutic innovations are working towards making life better for heart failure patients, with smaller devices, better software and connectivity for better personalization. However, only time will tell, how these devices fare and if they can ultimately alter the course of life for heart failure patients.

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IMPACT

Microsoft Apollo Partnership for Combating CVD MICROSOFT’S INCREASING presence in the healthcare space is augmenting provider’s efforts to impact healthcare delivery by helping navigate through complex technologies. Last year, the technology mogul, took a giant leap towards healthcare innovation by expanding its AI network for health to create an AI-focused network in cardiology. For this, the platform and productivity company partnered with Apollo Hospitals in India. The idea was to develop and deploy new machine learning models to predict patient risk for heart diseases and assist doctors on treatment plans. It was an instinctive step to use AI to improve detection of cardiac illnesses as it affects a large percentage of the Indian population. CVD risk assessment According to the recent National Family Health survey, one in every eight Indians suffers from

high blood pressure. In fact, cardiovascular diseases (CVDs) are the largest cause of mortality in India with nearly 25 percent of mortalities – amongst the age group of 25 to 69 years. The condition also seems to affect Indians at least a decade earlier as compared to Europeans. Despite the enormous number of cases, doctors in India are unable to identify the probability of CVDs and there is a reason for that. While there are various CVD risk models available worldwide, these do not cater specifically for the Indian population. Like everything else, Indian doctors were using prediction models for CVD based on Caucasian studies conducted in North America and Europe. This has made identifying risk for CVD difficult among Indian patients, as available literature and studies do not apply well to Indian population. For example, high LDL cholesterol, which is a significant cause

“We have brought some of the best cardiologists from renowned hospitals like AIIMS and KGMU together to be a part of this committee. The NCCC will help us immensely in our fight against the rising tsunami of NonCommunicable Diseases (NCDs). We are also extending the scope of our partnership with Microsoft to meet the growing healthcare demands of people across the country and contribute more towards saving precious lives” Sangita Reddy, Joint Managing Director, Apollo Hospitals Group

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“Our approach is to combine the rich data and deep expertise that Apollo offers with Microsoft’s powerful cloud and AI capabilities to develop a scoring system to identify patients in India who are at high risk for suffering a heart attack” Jean-Philippe Courtois, EVP and President, Microsoft Global Sales, Marketing & Operations

of heart attacks in western countries, is less common in India.Something had to be done to stop the mortality and morbidity caused by rampant CVD. AI Powered Healthcare By the end of April 2018, the team had already started working on an AI-powered cardio API (application program interface) platform. Within the next four months, the partnership was moving towards the next stage. In August

2018, Microsoft India and Apollo Hospitals announced the launch of the first ever AIpowered cardiovascular disease risk score API (application program interface), designed specifically to predict the risk of CVD in the Indian population. Doctors across the Apollo network of hospitals were able to leverage this AI-powered API to predict risk of CVD and drive preventive cardiac care across the country. Built on Microsoft Azure, this API aimed to determine a more accurate CVD risk score

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IMPACT “The NCCC is a great step forward as part of our partnership with Apollo. We are also engaging global consortium partners to scale the AI-powered API. We have already received approval for a pilot study and we hope that the findings will enable physicians to better understand the causes of CVDs in Indian population” Anil Bhansali, Corporate Vice President, Cloud & Enterprise, Microsoft

for the Indian population. It was developed using a combination of applied AI and clinical expertise on a large sample of retrospective data on health checks and coronary events. The scoring considered risk contributors including lifestyle attributes such as diet, tobacco and smoking preferences and physical activity as well as psychological stress and anxiety as reflected via rate of respiration, hypertension and systolic and diastolic blood pressure.

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The score categorises risk into high, moderate and minimal and also provides insights on the top modifiable risk contributors, thereby assisting physicians to consult patients in a more holistic way, while providing insights to patients for lifestyle modification and timely interventions. “Our approach is to combine the rich data and deep expertise that Apollo offers with Microsoft’s powerful cloud and AI capabilities to develop a scoring system to identify patients in India who are at high risk for suffering a heart attack,” explained Jean-Philippe Courtois - EVP and President, Microsoft Global Sales, Marketing & Operations, in a blog. He further explained how this was achieved. “To do this, a team of Apollo clinicians and data scientist started by reviewing more than 400,000 patient records from its hospitals around the country and found that nearly 60,000 patients had suffered a cardiac event after a health checkup. The challenge was to uncover the risk factors in the data that existing models had overlooked. To do this, they uploaded all the data they had collected to the cloud using Microsoft Azure and then worked with Microsoft Azure Machine Learning services to search for hidden correlations,” Courtois said. The team started with 100 potential risk factors and 200 lab data points. Using the massive computing power of the cloud, they trained machine learning algorithms to find


the statistical significance of each factor in the occurrence of future heart attacks. This enabled them to create a model that identified 21 risk factors in Indian populations. Dr K Shiv Kumar, HOD Cardiology, Apollo Hospitals said that the resulting model is twice as accurate at predicting the probability of future coronary disease as previous models. Till date, over 200,000 people have already been screened using the AI-powered API across Apollo Hospitals and in many cases, physicians have been able to predict the risk score of patients five to seven years in advance. Not only is this transforming how physician’s conduct preventive health checkups, but they are now developing an AI-powered app that would allow anyone to find their heart risk score without visiting a doctor for a detailed health checkup. Next Logical Step In august, 2019, Microsoft India and Apollo Hospitals Group set up a National Clinical Coordination Committee (NCCC) for the AIpowered Cardiovascular Disease Risk Score API. The committee consists of leading doctors from Apollo Hospitals; All India Institute of Medical Sciences, New Delhi; and King George’s Medical University, Lucknow. This initiative will extend the Microsoft Apollo effort and compliment it by providing rich data and insights. Speaking about the National Clinical Coordination Committee, Sangita Reddy, Joint Managing Director, Apollo Hospitals Group, said, “We have brought some of the best cardiologists from renowned hospitals like AIIMS and KGMU together to be a part of this committee. The NCCC will help us immensely in our fight against the rising tsunami of Non-Communicable Diseases (NCDs). We are also extending the scope of our partnership with Microsoft to meet the growing healthcare demands of people across the country and contribute more towards saving precious lives.” The NCCC will be assisting the core team at Apollo Hospitals and Microsoft by

providing guidance on all cardiology- and cardiovascular-related AI projects; clinical insights on developing clinical algorithm and treatment guidelines based on the inferences of national, multi centre prospective study. “The NCCC is a great step forward as part of our partnership with Apollo. We are also engaging global consortium partners to scale the AI-powered API. We have already received approval for a pilot study and we hope that the findings will enable physicians to better understand the causes of CVDs in Indian population,” said Anil Bhansali, Corporate Vice President, Cloud & Enterprise, Microsoft. Apollo Hospitals and Microsoft India are already in discussions with renowned health systems across the world to scale the API and contribute towards World Health Organization’s goal of reducing the risk of premature mortality (30 to 69 years of age) from NCDs, including CVDs, by 25 percent by 2025.

“Providing cloud- and AIpowered tools will unlock the vast potential at these points of convergence. It’s why our focus is threefold: developing foundations for precision health care, enabling the health industry’s move to the cloud, and empowering the people that make healthcare work”

Road Ahead Peter Lee - Corporate Vice President, Microsoft Healthcare wrote ‘several themes emerge at the convergence of healthcare and technology.’ The explosion of data, incredible advances in computational biology; genomics and medical imaging have created vast amounts of data well beyond the ability of humans to comprehend. Talking about Microsoft’s focus on transforming healthcare Lee says that, clinicians and care teams are yearning to swivel their chairs from the computer and Peter Leet, pay more attention to the patient, yet still they Corporate Vice President, spend two-thirds of their time interacting Microsoft Healthcare with burdensome IT systems. And healthcare organizations everywhere still struggle with the lack of operational and regulatory clarity in managing and analyzing the datasets that they are generating every day. “Providing cloud- and AI-powered tools will unlock the vast potential at these points of convergence. It’s why our focus is threefold: developing foundations for precision health care, enabling the health industry’s move to the cloud, and empowering the people that make healthcare work,” he concludes.

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APPROACH

Navigating at Hospitals Advantages of implementing wayfinding technology in hospitals and medical centers. Simone Health Development Companies, USA

Image Credit: Gozio Health

NAVIGATING UNFAMILIAR territory can always be a little stressful, but this feeling is only amplified when in a healthcare setting. Daunting medical campuses and confusing healthcare buildings can puzzle visitors and patients alike as they find their way around. Now, imagine your hospital’s patients and visitors were provided with a personalized navigation system specially tailored to your building layout, confidently finding their way to family and friends’ inpatient rooms with ease; this is the kind of future that wayfinding technology can bring to a hospital setting. Let us look at the advantages that come with implementing wayfinding technology in hospitals and medical centers.

Finding the Way Hospital visitors can easily get lost, even when using architectural clues such as colors, physical signage, and paintings or murals to remember where in the hospital they are. Having the ability to pinpoint their location, visualize the pathway, and be guided by other technological checkpoints reduces the need to remember confusing navigation points. Wayfinding tools can aid any visitors who may have lost their way, providing a comprehensive directional guide to navigating the medical center. Overcoming Stress Distraught or distracted visitors can quickly forget directions given to them by hospital personnel, causing frustration and less time they can spend visiting loved ones. A hospital setting has lots of potential for stressful or dire situations, so it’s best for both the busy medical staff and hospital visitors to have various reference points throughout the building for urgent navigation in times of need. Technological Advantage The technology is available. Recent wayfinding trends in healthcare environments include implementing mobile apps, digital adaptive signage, and interactive kiosks equipped with touchscreens. All of these developments incorporate smart wayfinding technology in a professional medical setting with ease and accessibility. It’s not up and coming technology with expensive, unrealistic applications; the software and hardware have both; been heavily tested, developed, and utilized in many other industries, and healthcare navigation is the next step forward. Peace of Mind Provide peace of mind to visitors by utilizing

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these forms of technology. Being able to easily find their way using these wayfinding systems very well may ease visitors’ anxiety by allowing them to focus on the patient they came to see rather than worrying about navigating unfamiliar territory. Plus, having visitors and patients alike being able to easily find their way around increases their satisfaction with hospital service and their medical experience in the end. Wayfinding technology has many clear advantages for visitors navigating a hospital, but it truly benefits the healthcare building in the end as well, increasing customer satisfaction and ease of operations without lost patients and visitors wandering about or becoming distressed when they cannot find their way. Giving your medical center’s visitors the technological tools to successfully navigate your space not only empowers and eases the

NOVEMBER 2018, VOLUME 2 ISSUE 11 `200 INDIA MED TODAY

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SPECIAL FEATURE AMERICAN ACADEMY OF EMERGENCY MEDICINE CEO’S PERSPECTIVE DR. HARISH PILLAI, CEO – ASTER HOSPITALS & CLINICS INNOVATE PROTEMBO CEREBRAL PROTECTION SYSTEM

What Ails

EMERGENCY MEDICINE in India

Lack of standardisation, fragmented training landscape and distrust relation among doctors NOVEMBER 2018

M Neelam Kachhap

mind of those finding their way around, but also brings your healthcare building one step closer to the 21st-century smart hospital.

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DEVICE TRAIL

Enlightened Diagnostics with FIA An effective and efficient device is changing the way Fluorescence Immunoassay Analyzers are used in India

RECENTLY, A revolutionary and innovative immunoassay analyser was launched in India. The iQuant as it is known, is a unique product by J Mitra& Co and Healthcare Technology Innovation Centre (HTIC), a multi-disciplinary R&D centre initiated jointly by Indian Institute of Technology Madras (IIT-M) and Department of Biotechnology (DBT), Government of India. The device is based on the fluorescence technology, bridging the divide while converging digital and medical technologies for the detection and diagnosis of various ailments and diseases. It is a unique offering in the diagnostic space that addresses the shortage of low-cost medical test infrastructure in local diagnostic centres, while being a small-footprint, cost-effective and mobile solutions. M Neelam Kachhap talks to JatinMahajan, managing director of J Mitra& Co during a free-wheeling interview on the healthcare Industry and the development of such technologies. Tell us about the history of immunoassay analyzers? When was the first immunoassay analyser invented? Immunoassay Analysers were developed around 1955, but were quite complex and cost intensive at the time. Over the last 50 years, with extensive research and technology developments, the use of immunoassay analyzers has increased and become more potent, efficient, and cost-effective.

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What are the benefit of Fluorescence Immunoassay Analyzers, especially iQuant? The immunofluorescence assay reader follow the principle of detecting emission from fluorescent immunoassays. These are simply a different type of immunoassay, where the key variable is the biochemical technique used for detecting the binding of the “detection” antibody and the analyte molecule. The advantages of these test processes lie in higher sensitivity detection of the analyte, simplified reagents and simpler assay designs. Recent technical improvements, including narrow wavelength low-cost light sources, newer and more stable fluorophores with wide stokes shifts, stable solid-state light detectors and microprocessors that process and analyze the data from each test, have enabled the implementation of a high sensitivity immunoassay system easily. In case of iQuant, the advantage of the design lies in its portable, lightweight form factor. It weighs about two kilograms and has a 1-hour battery back-up in case of power failure. It’s inbuilt memory stores up to 1-lac patients’ data. A processor unit enables quick report generation. The results can be viewed over a 10-inched intuitive touchscreen display. Moreover, the data can be transferred to a proprietary cloud facility (iQCloud) or can be printed wirelessly using a Bluetooth printer.


What is the market overview for Fluorescence Immunoassay Analyzer’s (FIA) in India? From a user or customer perspective, the target group for FIA’s are large laboratories and diagnostic centres, and thus more for metros, and category A cities. iQuant, due to its design and small footprint is further targeted at healthcare specialists, medical practitioners and diagnostics solution provider, especially in rural areas, remote locations and settings with limited resources. The product is scaled for small and medium labs, keeping in mind its compact desktop form factor. It allows doctors to quickly diagnose suspected ailments, and as a result, catalysing quicker treatment and recovery. From an end-beneficiary perspective, it is about reaching out to all those patients and diagnostics-seekers who would find it extremely difficult and prohibiting to receive quality diagnostics solutions in their nearby vicinity. The

iQuantanalyzer uses test kits created specifically for Indian conditions. Given the ground reality that India has a majority of the people living in rural and semi-urban areas, the potential for usage and growth is humongous. While thinking of buying a Fluorescence Immunoassay Analyzer, what are the things a customer should look out for? The Fluorescence Immunoassay Analyzers are largely bought by diagnostic and pathological laboratories and blood banks. Given the cost of the Fluorescence Immunoassay Analyser, most independent doctors are unlikely to procure the device unless they have enough patients for diagnostics test. Factors that affect the purchase decisions are  Cost of device procurement  Space requirement  Specialist technician requirement  Daily cost of usage and break-even revenue point

The device is based on the fluorescence technology, bridging the divide while converging digital and medical technologies for the detection and diagnosis of various ailments and diseases

Pic Courtesy: iQuant

iQuant immunoassay system

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DEVICE TRAIL iQuant, due to its design and small footprint is further targeted at healthcare specialists, medical practitioners and diagnostics solution provider, especially in rural areas, remote locations and settings with limited resources

How many diagnostics tests need to be performed in a day / month to make the acquisition a fruitful initiative  Ease of use in limited resources settings, like electricity, air-conditioning etc  Portability  Service availability and upgradability Devices like iQuant are changing this landscape by being very affordable, simple to use, without the need for specialised trained manpower. They require very limited space and have no challenge in operating in limited resources settings, which make them a very effective and efficient device, especially for rural and semi-urban areas. 

What is the future of this technology? This is a growing technology with vast scope. The world is moving from reactive healthcare to proactive healthcare and health management which has not only necessitated, but also spurred the growth of the diagnostics segment throughout the world. Cost reductions, ease of use and widespread acceptance as the technology of choice is going to fuel and maintain the demand for the technology. Having said that, biotechnology is a very dynamic and fluidic industry segment. We might have more advancements and developments that may critically change the dynamics, in favour or against the use of immunoassay analysers, but the implementation of these technologies on a large scale takes a lot of time – in fact decades. It

would be safe to therefore say that the technology is here to stay for a long time, only to be bettered at some point in time with a more effective and potent biotechnological breakthrough. What were the challenges that you faced? Building a single system to analyze different kinds of test kits that too in an ergonomic and economical form was not an easy task. When we initially came up with the thought, looking at the number of parameters that we were trying to handle – cost of equipment, cost of test results, size of equipment, portability, ease of handling, scalability, number of tests it could handle etc. - made ourselves sceptical about our ambition. But we already had a very potent ally in HTIC (IIT Madras). Both of us had collaborated several times earlier, and we hit the ground running from day one. There were no teething problems, and between our R&D team and the HTIC team, we were able to achieve good and speedy results. The beta launch phase allowed them to further crease out the minor flaws and limitations, enabling them to optimise the solution. The manufacturing of iQuant is being carried out under guidance of HTIC. We face operational challenges due to components which are sourced globally, as there is no ecosystem presently in India. They also pay attention to quality stringency with a zero-error tolerance policy. They meet quality requirements through certifications like ISO 9001:2015, EN ISO 13485:2016, WHO-GMP and CE. What are your plans for expanding the market? J Mitra is currently serving iQuant to the Indian market only. Demands are far exceeding the production currently. So, we will focus on international markets only after we have majorly fulfilled the demands in this country. J Mitra already has exports channels to over 45 countries across Europe, Latin America, MiddleEast, Africa, SAARC, South-East Asia including the USA and UK, which will eventually help them to get the iQuant Analyser to customers abroad.

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FEATURE

Hybrid OT: boon for Neurosurgery Dr NK Venkataramana, Founder Chairman & Chief Neurosurgeon, Brains Neuro Spine Hospital, Bangalore THE RECENT advances in neurosciences have brought about a sea change in the way neurosurgery is being conducted. The introductions of minimally invasive and keyhole surgeries have paved the way for better outcomes with minimal tissue injury. However, there are certain complex neurosurgical conditions in which quick and combined interventions are required to produce successful results. In such complex situations the new Hybrid operating rooms at the hospital will be extremely helpful. The hybrid operating room at Brains Neuro Spine Hospital, Bangalore, is the first of its kind installation in India. This has a miniaturised angiography suite compactly accommodated in the regular neurosurgical operating room compatible for a dual purpose. Essentially this becomes a two-in one operating room that has the most sophisticated operating facility in addition to ability to perform cerebral angiography with all possible interventions simultaneously. As the brain operation is in progress a neuro vascular team can perform angiography without moving the patient to any another location. This technique is useful in studying the dynamics of blood flow to the brain, identifying the abnormalities, embolization of highly vascular tumors, retrieval of intravascular clots, balloon occlusion to control

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bleeding as well as to test the cerebral tolerance, to deploy a stent and to help the surgeons to identify and preserve the specified blood vesselsas well asto control bleeding during surgery. Such preservation of blood vessels will ensure the normal circulation to the brain with a faster recovery and better outcomes. Here two operating teams can work together – one team can perform micro-surgery and simultaneously other team can help assist, compliment and treat through endovascular techniques. The Zeihm technology from Germany will provide a larger arch for imaging with all the nuances that a large cath-lab can offer. The clinical images are based on 65,536 shades of gray. Adding color allows details to be seen that were not previously recognizable. Structures can be differentiated more easily, which could help in future diagnostics. The artificial images of complex and unique cases, to which the device adds a level of information by using color, seem like a kind of homage to the future. In addition, the Hybrid Operating Room has many other advantages such as effective utilization of space, ability for both the teams to work and complement each other, especially in complex surgeries like highly VascularBrain Tumors, Brain Haemorrhage, Stroke, Aneurysms and Arteriovenous malformations. One need not move the patient to the cath-lab for such Vascular studies anymore. Added to this, this technology is capable of creating 3 Dimensional images of the brain and spine for a better orientation and to plan the trajectory with precision during surgery is a great boon to Neurosurgeons.

Pic Courtesy : Ziehm Imaging

Lumbar Spine Many screws are used in the derotation spondylodesis technique for stabilizing a spine that is distorted due to scoliosis. Coloration makes it easier to recognize the vertebral bodies.


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OPINION

NMC VERSUS MCI

Dr Ashish Banerji, MBBS, MS, FAIS, PGDHHM, PGDMLS, PGDQMHHO

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THE LAST few weeks have witnessed parliamentary debates and strikes of MBBS doctors all over the country, regarding the contentious issue of replacing the old Indian Medical Council Act, with the new National Medical Commission. This article aims to review what has been written and debated, and offers some insights from the perspective of a veteran doctor and medical administrator. To get a sense of context, we must appreciate that there were some strong reasons to replace the IMC Act, mainly because of the proved and perceived large-scale corruption among its erstwhile members, and also because of the chronic shortage of MBBS doctors (who practice Allopathy), which no Government has been able to address in a comprehensive manner. India has a total of 479 medical colleges, out of which there are 252 private medical colleges, and 227 Govt medical colleges. The total number of students who graduate with MBBS from these colleges is 67,352. The number of seats for postgraduate courses in the various branches of medicine and surgery are 31,415. This high number (close to 50 percent of total MBBS seats) is accounted for by the fact that many private hospitals, which are not medical colleges, offer PG degrees like DNB (Diplomate of the National Board) and FCPS (fellow of the College of Physicians and Surgeons). Govt medical colleges have extremely low fees and the teaching staff earns less than salaries paid in private medical colleges, but are perceived to be “full timers” and are available at the campus, and do not indulge in private practice (by and large). A plethora of patients, who are usually from the lower socio-economic strata go to these medical colleges for treatment. This means a wealth of clinical material, excellent teaching, and plenty

of opportunities to practice surgery as a PG student. Hence students prefer such colleges. In contrast, private medical colleges tend to be extremely expensive, with fees which can range from INR 50 lakhs to even 1 Crore (exact figures are not available). Private (Corporate) hospitals which offer DNB or FCPS seats invariably have some “private” patients admitted under their high-profile consultants, and PG students are not allowed to touch these patients. The consultants themselves are allotted PG students, but how much time is spent on actual teaching is hugely debatable. The doctor patient ratio in India is estimated to be 1: 1436, whereas the WHO recommends 1: 1000.To make matters worse, the urban: rural divide is 3.8: 1, which means that almost 4 out of every 5 doctor practices in urban areas. To address the huge shortage of MBBS doctors combined with their reluctance to serve in rural areas, the Govt is proposing to institutionalise the concept of CHPs (Community Health Providers). This cadre of health care workers has been making very significant contributions to the health of developed countries like USA and UK (in the form of Nurse Practitioners and Physician Assistants), but also in developing nations like Brazil, China, and dozens of countries in Africa. The precise details of who will be eligible to become a CHP, what training would be imparted, and exactly what kind of treatment can be offered by them, has been left to the members of the NMC Committees. But the concept itself has drawn a lot of flak from the medical community of MBBS doctors. The concept of “Bridge Course” has also drawn criticism from all quarters. While MBBS doctors claim that this will create a new breed of half trained “quacks” who know something, but not enough, the AYUSH doctors feel that their indigenous schools of medicine will


get adversely impacted. We know that Nurse Practitioners and Physician Assistants do go through years of training, and many American Universities have health centers manned only with such people, when there are no MD doctors available (equivalent of our MBBS). In developing countries, the CHPs have done pioneering and praise worthy work in reducing the burden of communicable diseases, promoting Immunization programs, and spreading awareness about healthy practices like breast feeding, antenatal visits to PHCs, delivery in hospitals, etc. Perhaps the most alarming statistic is revealed by recent surveys which show that 57.3 per cent doctors practicing allopathy do not have an MBBS degree!! One can only speculate about what training they have, if they have any training at all!! The NMC has addressed some of these issues, and the Govt of India has opened many replicas of the world famous AIIMS New Delhi in several parts of the country.These institutes will churn out more MBBS doctors and PG qualified doctors in the years to come. New

private medical colleges are also opening, and this brings us to the controversial issue of fees to be charged to students. If these colleges are allowed to charge fees without any restriction whatsoever, all agree that fees will become more exorbitant than they already are. If the reverse is enforced, and fees for all seats (100% seats) are regulated by State or Central Govt, the perception is that entrepreneurs and educationists would not be able to start new colleges, or maintain the established ones, due to the high costs of infrastructure and salaries. Hence the NMC says that 50 per cent of seats in private medical colleges would have fees regulated by Govt agencies. Making this 75 per cent (as recommended by some Parliamentarians) may make Private medical colleges not feasible. Another controversial issue is regarding NEXT (National Exit Test) for MBBS students when they complete their MBS education. This exam, which will be common for all MBBS students all over India, will have a set of MCQs (Multiple Choice Questions). The current system has a multi-tiered system, details as below:

India has a total of 479 medical colleges, out of which there are 252 private medical colleges, and 227 Govt medical colleges. The total number of students who graduate with MBBS from these colleges is 67,352.

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OPINION A) Each Medical College conducts its own Final MBBS exam, consisting of theory papers and clinical cases (known as the viva). This exam is necessary to leave the medical college, and start the one-year internship, and become a qualified doctor. B) There is a separate NEET (National Entrance cum Eligibility Test) for getting a PG seat, which doctors can take, after completion of the one-year internship. C) There is yet another exam which is meant for medical graduates who have done their medical education from institutions outside India (Russia and China are popular destinations). They have to sit for an exam which makes them eligible to practice medicine in India. The NMC aims to combine all these three exams into one NEXT exam. One major advantage would be that medical students can focus on acquiring practical skills in patient management during Internship, rather than studying for PG entrance exams,

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and thus neglecting the internship curriculum. Even after Internship, many young Doctors do not get a seat for PG (due to paucity of seats), and this creates a situation where they get into a cycle of seeking jobs, studying for PG seats, resigning or carrying on with their jobs, till they get a PG seat. This cycle of getting a job, studying during working hours, and sitting for PG exams again and again, simply continues till they qualify or give up. All stake holders suffer; students face huge tension trying to work and study at the same time, hospitals suffer the consequences of young doctors not working sincerely, and parents/guardians have to support their children/wards till they get a PG seat. The MCQ format of the NEXT exam has been criticized, as there is no viva voce component, and thus clinical skills and acumen are not being tested. While this is a valid criticism, it must be stated that an earlier exam called ECFMG was used for admission to hospitals in USA, it was a pure MCQ exam. In fact, arranging an MBBS like exam with written papers, tables with various drugs, and clinical cases (patients); poses virtually insurmountable problems of replicabilityand uniformity all over the country. Exams tend to be very subjective, and the individual whims and fancies of internal and external examiners play a huge part in results. The NEXT exam aims to do away with all these vagaries and uncertainties and achieve country wide uniformity, with unparalleled objectivity and elimination of partiality, killing three birds with one stone!! And yet there are a few issues that the NMC does not address. Post-graduate medical education, and laying down uniform standards for the same, as is done in UK is missing. There are no innovative ideas for imparting of medical education, and it is still being taught the way it has been decades. There is no mention of the healthcare infrastructure (new hospitals). MBBS doctors will keep practicing in urban areas, as no new schemes have been launched to curb this trend. Last but not least, there are no guarantees that the system would be free from corruption.


Exercise and Cardiovascular Fitness

Dr. Kishore K.S, Consultant Cardiologist, Sagar Hospital

PHYSICAL ACTIVITY is considered as one of the credible ways to prevent most of the chronic illnesses including cardiovascular diseases. In today’s fast paced life, physical activity has become a neglected entity and no wonder there is higher incidence of chronic illnesses these days. This is not only a financial burden but also can impact on one’s productivity as well. Most of the chronic illnesses are our own making, owing to poor life style and is preventable. ‘Prevention is better than cure’ is a commonly heard slogan but poorly followed. Few decades back most of the deaths in our country was caused by infectious diseases, which is not the case anymore. With improvement in our economy and better sanitation, incidence of infectious disease leading to death has reduced considerably in our country, and unfortunately chronic illness like diabetes, hypertension and cardiovascular diseases have been on rise in recent years. Cardiovascular diseases have replaced the infectious diseases as the leading cause for deaths in our country. It’s an alarming trend to see more and more patients at a younger age developing heart diseases. Preventive measures like exercise are cheaper than the prohibitive cost of cardiac procedures. Regular exercise offers a simple and fool proof way of preventing heart diseases. Endurance exercises like walking briskly running, jogging, dancing, swimming, cycling, climbing stairs at

work, sports such as tennis, basketball and soccer are likely to boost your heart health. Exercise not only benefits your heart, but also does offer other collateral benefits like weight reduction, better control of hypertension, diabetes mellitus and lowering of bad cholesterol levels. Exercise increases your tolerance to anxiety, stress and depression. Regular exercise improves overall fitness by strengthening bones and joints. How much exercise does an individual need? To get started, for the beginners its worthwhile to Start out with 10-15 minutes of moderate to high intensity exerciseat a time and then gradually build up. American heart association recommends 150 minutes of moderate to high intensity exercise per week. It effectively boils down to thirty minutes a day five days a week is an easy goal to achieve.It’s important to set realistic goals for your exercise based on your own health and stamina. Over a period of time, with regular exercise, you can build on your routine by adding new physical activities; increasing the distance, time, or your favourite activity; or do your activities more often. You could first build up the amount of time you spend doing endurance activities, then build up the difficulty of your activities. For example, gradually increase your time to 30 minutes over several days to weeks by walking longer distances. Then walk more briskly or up-hill. Those with previous history ofheart attack must consult your doctor before starting any exercise to be sure thatyou follow a safe and effective physical activity program. Investing your time in regular physical exercise will keep you and your heart fit.

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INTERVIEW

Somerset Indus Capital Partners invests in two healthcare firms, deploys II fund The investments went to Genworks and Apex Hospital SOMERSET INDUS Capital Partners has invested in two healthcare companies Genworks and Apex Hospitals. Genworks is a medical device solution firm based at Bangalore and Jaipur based Apex Hospitals runs three multispeciality hospitals in Rajasthan. This is Somerset’s 6thinvestment in healthcare so far. The fund will make a total investment of around Rs20 crore in the two companies, marking this the 9th investment for the firm set up by Carlyle principal Avinash Kenkare and life sciences industry executive Mayur Sirdesai along with Ramesh Kannan and Sharad Ladha. The PE firm, which has been making investments from its $40 million Somerset Indus Healthcare Fund – 1, and $25,000,000 Somerset Indus Healthcare Fund - 2 backed by Overseas Private Investment Corporation (OPIC); has struck the deal after a hiatus of two years. The fund, which is registered in Mauritius and has offices in Mumbai and Bangalore, aims to invest in a few more companies in the coming months. M Neelam Kachhap caught up with MayurSirdesai to find out more about Somerset’s investment. What is your opinion of the current healthcare delivery market in India? We feel that the healthcare market has good potential especially in tier two markets. Also with Ayushman Bharat coming of age – healthcare delivery in lower tier markets will get a boost. The metro, Tier 1 markets are seeing consolidation in the healthcare delivery space.

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What challenges do investors see in the current healthcare market scenario in India? The healthcare market in India is divided into two markets – Metro/ Tier I and then lower tier markets. The business models and metrics of doing business in these markets are very different. What works for Tier I may not work for Tier II and the dynamics of doing business in these markets is completely different. Healthcare is a self-pay market, paying mechanisms are largely out-of-pocket as insurance penetration is low. So the main market for healthcare was in Tier 1 cities because of the affordability factor. But now these markets are saturating and the growth is sluggish. Large players are consolidating and the lower tier market is now opening up. This is a new and emerging area.

GenWorks provides comprehensive medical device solutions for healthcare providers. Apex Hospitalsruns three multispecialty ओओhospitals in Rajasthan

Health tech and diagnostic service have much lower penetration in terms of geography and scale. Affordability playes a bigger role in this market and so players looking to dive in here have to build a low cost model. These models can ride on large numbers for example from govt schemes like Ayushman Bharat. Healthcare is more of a regional play. Geographically, healthcare as a whole is more mature and developed in south and west India. North and East provide much more opportunity to build and gain more footprint. These markets are under-developed and there is an open landscape for the companies to gain market share. Healthcare needs to be built in a very calibrated manner, you can’t just keep building assets due to long gestation period. Healthcare is not a positive need so the business has its own life-cycle. Specially, healthcare delivery needs to grow in a much calibrated manner. What differentiates Somerset Indus Investment Partners from other healthcare investors? Somerset team members have a combination of experience in investing and operations and that too across the healthcare spectrum. This helps us work in tandem with our portfolio companies not only after investing in them but also pre -investment wherein we showcase what we can do with these companies and gain confidence of the promoters. We spend 6-12 months at least before making an investment and I think that process helps build the connect with the potential investees.


How do you identify good assets? The deal flow is predominantly proprietary through our networks and some through specific investment bankers who know our requirements. Out of nine investments till date – five are proprietary in nature. We see potential investments across typically five areas:  Pharma and Lifesciences  Med Tech – Equipment, Devices and Consumables  Diagnostic products and services  Healthcare Delivery – Hospitals, specialty clinics  Preventive/ Primary care, Nutrition, Wellness and Insurance

Mayur Sirdesai, Somerset Indus Capital Partners

Often stereotyped as targets more suitable for venture capital than for PE, healthcare tech sees relatively few deals. Health Tech is more of an enabler and that too it supports primary care/ preventive care than in curative care. This part of healthcare will emerge with the expansion of Insurance and the focus shifting from curative to preventive care. Currently, it is more focused on innovation and technology which is more of a VC space than a PE space which will happen once the insurance space expands and scale ups into this part of the market. Pls tell us about your current investment in Genworks and Apex Hospitals? Genworks health is a flagship venture by Wipro GE Healthcare and plays the role of distribution and access toTier-2 and -3 towns with medtech products. We have acquired 30 per cent stake in GenWorks for USD 10 mil (65 cr). Apex Hospital is multi-specialty, 150 bed, state-of-art medical center, in Jaipur where we acquired 30 percent equity for USD 5mil. We plan to invest another USD 3-5 mil in the next few years. Both these companies have immense potential for growth and we will fast-track their efforts. What is the plan ahead? These investments were based on the companies fitting our investment thesis – both in terms of sub sectors and also Promoter capabil-

ity. Both these companies are focused on providing access to affordable quality healthcare – Genworks in Med Tech and Apex in terms of Tertiary care including ICU, Onco, Cardiac and E-ICU. The intent is to grow these companies to another scale in terms of revenues, EBITDA and also organizational structure. What is happening with your earlier investments? Our investments from Fund 1 are doing well – we made seven investments from Fund 1 – we have exited our first two investments at good returns and have visibility to an exit path for most of our investments. We believe that we could get a 3x multiple of the fund when we exit all our investments and that too within the fund life period.

From the 2nd fund are there more commitments that we will see in the coming months? Our second fund is about USD 100 milwith a fund term 10 years. We are looking at another investment towards the end of the year when we will do the final close for the fund. We have a strong pipeline for the fund and are tracking 4-5 potential investments in detail. These are in the medtech and pharma space. Are you looking at raising a third fund? What will be its focus? Yes we will raise a third fund once we are nearing completion of our investment from Fund 2. We expect this to be in the next 3-4 years. The focus will be healthcare but it could potentially cover a larger geography and the fund size could be in the range of USD 150-200 million.

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EVENTS CAHOTECH 2019 Date: 27-28Sep, 2019 Location: IIT Madras, Research Park City: Chennai Organizer: Consortium of Accredited

healthcare Organizations (CAHO) Click: http://cahotech.com Contact: Organizing Secretary, J Adel, 99444 37572 AHOTECH is one of the most primed events that brings together all stakeholders – hospitals, healthcare and technology startups. Cahotech 2019 -4th International Annual Healthcare Technology Event, promises to

C

SCIENCEFORA -ICMEP Date: 23 June, 2019 Venue: Hotel Raj Palace City: Chennai Organiser: Sciencefora Contact:info.sciencefora@gmail.com

September 2019

and organise a visit for the delegates to the Army Research and Referral Hospital.

ADVANTAGE HEALTHCARE-INDIA 2018 Date: Nov 13-15, 2019 Venue: India Expo Centre and Mart, Greater

Noida(NCR) India The medical value travel industry has emerged as one of the fastest growing segment of tourism industry despite the global economic downturn. According to the FICCI – IMS Report, India is one of the key MVT destinations in Asia with over 500,000 foreign patients seeking treatment. MVT can be a 9 billion USD opportunity by 2020 through adequate focus and effective execution. The objective of this summit is to promote India as a Premier Global Healthcare Destination and to enable streamlined medical services exports from India. This underlying objective is a unique conglomeration of the ‘5 – Ts’ - talent, tradition, technology, tourism and trade. The event will host three days exhibition with B2B meetings and hospital inspection. Along with Proposed Health Minister’s round table meeting followed by Networking Dinner hosted by Hon’ble Health Minister. There will also a proposed Tourism Minister’s round table meeting followed by Networking Dinner hosted by Hon’ble Tourism Minister along with

INDIA HEALS, KERELA ( AHCI) Date: Jan31- Feb 1, 2020 Organiser: Services Export Promotion

Council City: Kochi, Kerala Contact: MdIlias, 91-9940553791 Click: indiaheals.sepc@gmail.com SSEPC supported by Ministry of Commerce and Industry organizes IndiaHeals. India Heals will enable B2B meetings with over 100 foreign buyers from Afghanistan, Bangladesh, Bhutan, China, Indonesia, Kenya, Malawi, Mauritius, Myanmar, Nigeria, Oman, Rwanda, Tanzania, Sri Lanka, Uganda, Uzbekistan - our main export markets. They will meet with reliable NABH/JCI accredited hospitals, dental clinics, wellness centers and AYUSH centers. Foreign Buyers will also visit these establishments to experience first-hand the prowess of the Indian healthcare sector. Mainstreaming traditional medicine in healthcare is the vision of India Heals. Ethical healthcare practices the world yearns for, will be strengthened through India Heals.

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bring some of the best incubation centers like IITM Research Park, HTIC, SINE (IIT Mumbai), Health Pod, Start-up Podium, The Chennai Angels, TiE Global etc and their startups, the most respected healthcare leaders and the industry’s most sought after investors on board. It is primed to be event of the year with discussions on disruptive and adaptable technologies in healthcare. The event boasts of stalwart speakers, contemporary topics and provides an opportunity for professional upgradation, paper presentation, master classes, liaison and networking.

INDIA MED TODAY

An elegant and rich premier global platform for the International Conference on Medical Ethics and Professionalism (ICMEP) that uniquely describes the Academic research and development acros 1st conference of Military Medicine for SCO Member States Date: Sep 12-13, 2019 Organiser: Indian Armed Forces Venue: New Delhi The first conference of Military Medicine for Shanghai Co-operation Organisation (SCO) Member States will be held here on 12 – 13 September, 2019. The conference will be the first Military co-operation event hosted by India,under the SCO Defence Co-operation Plan 2019-2020, after it became a SCO Member State in 2017. The conference will be conducted by the Indian Armed Forces under the aegis of Headquarters Integrated Defence Staff (HQ IDS), with the aim to share best practices in the field of military medicine, build capacities and overcome common challenges.During the conference, the Indian Armed Forces will also demonstrate the Rapid Action Medical Team

networking dinner on last day hosted by FICCI.

atness Poised for Gre

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