IndiaMedToday Jan 2019

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DECODING

BIJU SWASTHYA KALYAN YOJANA Towards Affordable Healthcare with PPP

THE ENDEARING ENTREPRENEUR: DHIRAJLAL KOTADIA PLEXUX HEART CENTRE JANUARY 2019

COMMON CYBERSECURITY THREATS

“Curing Hearts across the Country”

Extraordinary Heart care closer to your home at affordable cost

Plexus Hospital is a Healthcare group committed to providing world class services, state-of-the-art technology and expert and experienced manpower in every tier of India and all under-served regions of the world.

Plexus Heart Center is a chain of cardiac units based across the length and breadth of the country with the vision to establish ‘Excellence in Cardiovascular Intervention’. It provides a standard model of operations with state-of-the-art technology run by a highly trained and experienced team of doctors, nurses and technicians.

Plexus Consultancy is a hub for Infrastructure and Clinical expertise for setting up Hospitals ranging from 50 to 1000 beds.

Plexus is a home for a large clinical team which enjoys to serve at different locations across the globe.

Plexus Training Academy is an important link to implement the company’s philosophy of creating Cardiac excellence. In order to successfully operate centers with evolving technology, there is a continuous need to create a pool of skilled and experienced manpower across emerging countries. We provide the best in class curriculum with a true hand on experience and 100% merit based placement assurance for anyone willing to grow and excel with the growing Plexus network. We are driven to maximize access and affordability to quality healthcare for all patients. At Plexus we cherish the sound of a healthy heartbeat & a hearty laugh !

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Dibrugarh | Kanpur | Jaipur | Gorakhpur | Bangalore | Abu Road | Kathmandu No.19. First Floor, JMD Regent Arcade, Opposite Metro Pillar No.79, MG Road, Gurugram -122002 contact@plexushospitals.com www.plexushospitals.com

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JANUARY 2019 EDITORIAL

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What Will 2019 Bring?

A NEW YEAR is a fresh start. Regardless of how the previous year ended the dawn of a new year brings a lot of encouragement to start over and try new things. The healthcare delivery market is entering new uncharted territories.

Putting previous year’s policy bottlenecks, demonetizing and GST behind, in 2019 industry will come back with all its might.

Leading this will be a number of mergers and acquisitions’ that are already in talks. Large players will consolidate their place and move into underserved areas to further enhance their market share. New players will enter the market through the FDI route and we hope that the healthcare delivery will see a culture change among other things.

New opportunities for delivery model innovators awaits as different stakeholders recognize the importance of working together. Amazing new partnerships between either between providers and Information systems or researchers and innovators is on the cards.

The market will become highly competitive owing to higher insurance penetration and there will be more public – private partnership in this space.

Putting previous year’s policy bottlenecks, demonetizing, and GST behind, in 2019 industry will come back with all its might 2019 is a very important year not only for Indian politics but also for healthcare. A slew of pre-pole policy measures are in the pipeline.

As always, IndiaMedToday has a full lineup of topics for 2019 to help wade through different challenges in the forthcoming year.We will be your voice, and raise your concerns to the authorities.

We will bring you inspiring stories and innovative tech as well as see you at the most acclaimed events.

However, I am most excited about a series of new content on video featuring the most deserving stories that need to be told. This series will feature your fellow doctors, administrators as well as industry leaders. Our goal in each episode will be to find and celebrate the people who make Indian Healthcare delivery great. Hopefully these stories will not only be entertaining, but also educational.

For each of these new additions, please reach out to us for collaborations!

Please contact editorial@indiamedtoday.com/ mneelam.kachhap@indiamedtoday.com

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.

Happy New Year

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CONNECT WITH US Join the conversation with IndiaMedToday through our social media pages Twitter

CONTENTS

20

Facebook Linkedin

UPFRONT 03 Editorial 05 Letters 06 News roundup

DRIVE

16

The Endearing Entrepreneur: Dhirajlal Kotadia Driven by passion and entrepreneurial spirit this humble leader created a world class medical device company

OPINION

COVER STORY

Decoding Biju Swasthya Kalyan Yojana Towards Affordable Healthcare with PPP

28

Fighting Cancer Digitally

Plexus Heart Centre (Plexus Hospitals), committed to providing world class services, state-of-the-arttechnology and expertise to the underserved Indians

41 Q&A

32 Fear the Five HEALTH-IT

Common cyber security threats to be weary of in 2019

Personal Health Record and Data protection Revisiting DISHA (Digital Information Security in Healthcare Act) in light of the Personal Data Protection Bill, 2018

36

Why the virtual world could hold the key to beating breast cancer

EVENT REVIEW

PULSE

Accessible Affordable Cardiac Care

40 Events listing

NetHealth 2019

30

39

APPROACH

Human Approach towards Patient

25 4

January 2019

Patients’ sentiments and expectations are overshadowed by treatments and procedures. How to balance present day’s healthcare challenges

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LETTERS

2

018 has been a remarkable year for healthcare in India. This year, the government has taken significant steps towards a universal health coverage model for our citizens. The innovative ‘Ayushman Bharat’ Scheme will help bring financial inclusiveness and access to health services for the masses. We support the Government as it implements one of the world’s largest public health schemes.

The launch of the Ayushman Bharat Yojana at the beginning of this financial year has been a welcome move which will increase access to secondary and tertiary healthcare for the masses. While this increases access to quality hospital care, there is yet a lack of awareness among people on the importance of pre-hospital care.

Citizens should be educated about the importance of emergency healthcare which if administered within the Golden Hour can increase the chances of survival significantly.

With the increase in use of healthcare facilities, there will be a spur in the use of ambulances to access hospitals as well. The Government should consider including ambulance services in the scheme to ensure timely treatment. This would require adding fleet of ambulances to the 108 service to widen reach. Due to the Government’s consistent efforts, the patient to ambulance ratio has reduced from 1:1,00,000 to 1:60,000. In the coming year, we expect that the ratio to be further reduced to meet global standards. While the Ayushman Bharat Scheme is a great scheme on paper, to implement the yojana effectively, we expect the right allocation of budgets and resources. 2019 is a year where a lot has to be implemented on ground in the healthcare segment and private-public partnerships can go a long way to help achieve this.

The use of state-of-the-art technology is an excellent way to reassure the masses by ensuring access and timely response for people looking to avail the scheme. Overall, it is a big paradigm shift for the healthcare industry in India.

Also, we welcome the Prime Minister’s move to increase India’s health spending to 2.5% of GDP by 2025 from 1.15% currently.

An area of concern that remains is the rapid rise in Non Communicable Diseases. An estimated 17 million people die of cardiovascular diseases worldwide every year, with India recording a significant increase over the years. The cost burden of Non-communicable diseases (NCD) as per a World Economic Forum (WEF) report by 2030 for India alone, will be ₹4.8 trillion, which will be 50 per cent of the nation’s Gross Domestic Product (GDP). We all must do much more in the coming year to meaningfully tackle and stem the rise of this health crisis.

Manish Sacheti, CFO, Ziqitza Heathcare Ltd

What is also undeniable is that as 2018 comes to an end, we still remain underinvested in health infrastructure, we have a scarcity of doctors and nurses and are vastly under-insured as a nation. Other challenges that remain are access to primary & quality healthcare, changing disease patterns, GST and price regulations on treatments and medical devices - which remain areas of debate and consensus building.

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Innovation in Healthcare

SPECIAL FEATURE AMERICAN ACADEMY OF EMERGENCY MEDICINE

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CEO’S PERSPECTIVE DR. HARISH PILLAI, CEO – ASTER HOSPITALS & CLINICS INNOVATE PROTEMBO CEREBRAL PROTECTION SYSTEM

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EMERGENCY MEDICINE

SPECIAL FEATURE

HOW TO DISRUPT STATUS QUO RAMESH KANNAN, PARTNER, SOMERSET INDUS HEALTHCARE FUND

CAN QUALITY

TOOLKIT

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HEALTHCARE INNOVATION: WHERE IS IT GOING SUNIL THAKUR, MANAGING DIRECTOR, QUADRIA CAPITAL ADVISORS

in India

IMPROVE CARE

A simple quality toolkit can improve the quality of care in Acute Coronary Syndrome management

IMPACT

APRIL 2018

WILL THE NEW PMA POLICY NEGATIVELY IMPACT INDIAN DEVICE MANUFACTURERS?

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

CAHOCON

2018

15 INNOVATIONS CHANGING THE MANAGEMENT OF CARDIOVASCULAR DISEASES

NOVEMBER 2018

OCTOBER 2018

HOW SWITZERLAND IS LEADING INNOVATION GOING FORWARD

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HOW A SMALL HOSPITAL IN RAIPUR MADE HUGE GAINS IN CHD

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NEWS ROUNDUP METROPOLIS HEALTHCARE LAUNCHES METROPOLIS HISTOXPERT TO ADVANCE TISSUE DIAGNOSTICS Metropolis Histoxpert Digital Services Private Limited, a subsidiaryof Metropolis Healthcare Ltd, is introducing Metropolis HistoXpert Digital Diagnostic solution to its customers for undertaking advance tissue investigation in India.

Under HistoXpert, Metropolis offers the convenience of Digital Pathology, HistoXpert is based on the concept of reflex testing, saving the hassle of having to order more tests to reach a final diagnosis. This is made possible by a skilled team and a panel of subspecialty experts.

The technology implemented by Metropolis Healthcare comprises of a pathology slide scanner, an image management system and a display. This solution is complemented by software tools to manage the scanning, storage, presentation, reviewing, and sharing

Metropolis Histoxpert

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January 2019

of information thereby enabling digital workflows.

Dr. SushilKanubhai Shah, Chairman and Executive Director, Metropolis Healthcare said, “A complete and accurate pathology report is crucial for getting a precise diagnosis and deciding on the best treatment plan for the patient. Introduction of digital pathology marks a major milestone for innovation in pathology and aims to increase accuracy and enhance patient care.”

Speaking on the launch, Sanjeev Nair, CEO, Metropolis HistoXpert, said, “At Metropolis, we understand that in running an in-house histopathology set up is not be a viable option for hospitals with less than 500-600 samples a month. Therefore, Metropolis HistoXpert is our end to end automated processing and digitization solutions to all hospitals.”

PORTEA LAUNCHES INTENSIVE & SPECIALIZED CARE Bangalore based home healthcare provider Portea,has expanded its services to include

a high-quality and comprehensive range of specialized home care. Called Portea Intensive & Specialized Care, the offerings include critical care at home, respiratory services (home ventilation), sleep apnea care, palliative care, cancer support services, posttrauma/accident care, and specialized rehab services (including pulmonary, neuro, and cardiac rehabilitation; speech therapy). The suite of services also includes end of life care for terminally ill patients.

Speaking about this, Meena Ganesh, MD and CEO, Portea Medical, said, “Over the last five years, while serving our nursing care patients, we have received many requests from families for additional services.

These included round-the-clock condition monitoring, provision of medical devices, and medical supervision. The foray into critical care and specialized services, therefore, was an obvious next step for us to address all this rising demand with a robust offering. We are also proud to have on board Dr Vishal Sehgal, who has done some pioneering work in the field of critical and specialty home care. With an experienced team in place, we’re all set to

Dr. Shanaz Khodaiji addressing the gathering at Transasia Scientific Seminar at Nanded

cater to the growing demand for advanced patient care at home. ”

TRANSASIA HIGHLIGHTS THE IMPORTANCE OF AUTOMATION IN CLINICAL DIAGNOSTICS

Transasia Bio-Medicals Ltd., India’s leading In-vitro Diagnostic Company recently organized a scientific seminar on the latest advancements in clinical diagnostics. Titled Transasia Scientific Seminar (TSS) Ace, this pioneering academic initiative aims at bringing together doctors in Tier II & Tier III cities, thereby encouraging the exchange of technical know-how. This is the first time, that TSS Ace was conducted in Nanded – the city of Gurudwaras. The seminar highlighted biochemistry and hematology-the two most critical areas for in-vitro diagnostics.

The session on ‘Journey from semiautomated to fully automated biochemistry analyzers’ by Dr. MilindBhide, Managing

Director-Bhide Laboratory, Mumbai; focused on the role of automation in increasing lab efficiency and decreasing manual intervention, leading to greater precision.

This was followed by a discussion on ‘Shaping Hematology with 6 PDA automation’ led

by Dr. ShanazKhodaiji, Consultant – Dept. of Hematology and Transfusion Medicine, Hinduja Hospital, Mumbai. She emphasized on how the latest technologies assist in precise enumeration of the different parameters, thereby giving an in-depth analysis. Both the sessions were moderated

by Chairperson, Dr RajendraMundra , a senior pathologist Practicing in Nanded past 40 years and also the head of Pahologist association of Nanded.

The seminar received an overwhelming response with full-house participation. In fact, the over 48 attendees also comprised pathologists and clinicians from nearby towns such as Latur , Aurangabad , Beed , &usmanabad.The attending Doctors highly appreciated the efforts and demanded more

such seminars to be held in the future as well.

Speaking on the occasion Y.S. Prabhakar, CEO, Transasia Bio-Medicals Ltd. said, “There is an alarming burden on the society from both communicable and non communicable diseases in India. 70% of the treatment decisions are based on lab results. Yet, less than 30% of the Indian population has ever got their blood test done. The major chunk of the 70% population is in the smaller towns.

At Transasia, we are committed to reaching out to the pathologists and clinicians in every nook and corner of the country, so that they are well equipped to cater to this population.

TSS Ace is a unique platform that empowers the pathologists with the technological advances and encourages exchange of scientific updates, backed by expertise and experience. ” Over the years, TSS Ace has grown in popularity and has become Transasia’s identity. It has been well accepted as a successful forum and benefits more than 800 pathologists and clinicians annually.

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NEWS ROUNDUP LYBRATE LAUNCHES GOODMD, AN EXCLUSIVE SOCIAL NETWORKING PLATFORM FOR DOCTORS Lybrate, India’s first and largest online doctor consultation platform, has launched GoodMD, an exclusive social networking platform for doctors, where they can de-stress themselves in the midst of their busy and tiresome lives, as also voice their opinions on multitude of issues related to healthcare, including regulatory and administrative, without the inhibition of being judged.

GoodMD, which is a lot more than just a community of doctors, was launched realizing the lack of a relevant online space for healthcare practitioners where they can exchange opinions with fellow doctors and bust their stress.

Given the burnout level of doctors getting high, GoodMD is a gateway for them to relax and express themselves freely. The platform provides an outlet to their pent-up thoughts, find solidarity from peers to what and how they feel, share their clinical expertise with fellow colleagues, check out what their peer group has posted and stay updated on pharma, patient care, business-related and other developments in the healthcare industry via Medshorts, which keeps them posted about healthcare-related news in just 360 characters.

Good MD is a first-of-its-kind professionalcum-personal social networking platform for doctors which is only meant for them.

Guided by the approach of inclusiveness, the platform aims to bring together doctors from across specialties, including AYUSH, and multiple backgrounds to help them forge a healthy professional bond.

APOMORPHINE, NEW MED FOR PARKINSON’S DISEASE LAUNCHED IN INDIA

In a boon to patients in the middle stages of Parkinson’s Disease, Vikram Hospital Bengaluru, in association with the UK-based

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January 2019

Apomorphine Launch

specialty pharmaceutical company Britannia Pharmaceuticals, has launched Apomorphine for the first time in India. This powerful new drug stimulates the production of dopamine by nerve cells in the brain, providing quick and effective relief to patients and improving their quality of life. Apomorphine, available both as injections and infusion pumps, has been popular in the West for over 15 years in the management of Parkinson’s, but Indian patients could not benefit from it until now.

Dr. Prashanth LK, Parkinson’s Disease & Movement Disorders Specialist, Vikram Hospitals, Bengaluru said, “Currently in India, patients of Parkinson’s have only two options: either oral treatment for the early stages of the disease, or very expensive Deep Brain Stimulation (DBS) surgery for advanced stages. There was no treatment for the middle stages of the disease. Most patients in India cannot afford DBS. This procedure is also not a choice for all ages or stages of Parkinson’s Disease. Apomorphine is recommended for patients who have started to have motor fluctuations – that is, the effect of oral medications is not lasting long enough for them. It is an effective alternative for patients

who are not the right candidates for DBS, or those who do not want to undergo surgery yet. Introduction of apomorphine in India has given an important medical option to doctors in the middle stages of the management of Parkinson’s Disease and improve the quality of life of patients.”

Talking about the availability of Apomorphine in India, Dr. Somesh Mittal, CEO, Vikram Hospital, Bengaluru, said, “Apomorphine, a highly selective dopamine receptor stimulator, is a long-awaited boon for patients of Parkinson’s Disease. It is not an OTC medication but has to be taken under the supervision of a Movement Disorder Specialist at specialized centres.

Since the drug has just been launched in India, it will initially be distributed through select centers where well-trained movement disorders specialists are available. In due course, we aim to increase the distribution footprint to cover almost all movement disorder centers and neurology clinics across the country. Vikram Hospital Bengaluru will remain the major center for the availability and distribution of Apomorphine for the foreseeable future.”

CANCER INSTITUTE (WIA) LAUNCHES INDIA’S FIRST MOLECULAR LAB FOR CERVICAL CANCER SCREENING Roche Diagnostics India, the country’s leading provider of cutting-edge in-vitro diagnostics solutions, announced the launch of its HPV (Human Papilloma Virus) DNA screening solution at ‘Cancer Institute (WIA)’ making it India’s first Molecular Laboratory for Cervical Cancer Screening.

Persistent infection with high-risk HPV has been established to be the principal cause of cervical cancer in women, with HPV implicated in greater than 99 percent of cervical cancers worldwide[i]. It can take 10 to 15 years or longer for cervical cancer to develop,[ii] so regular screening to know a woman’s individual risk and finding disease early, before cancer develops, is an important prevention strategy.* The molecular lab launch event which discussed at length the need for screening of cervical cancer saw the presence of dignitaries namely Dr. J Radhakrishnan, Principal Secretary (Health and Family Welfare), Government of Tamil Nadu, Dr. V Shanta, Chairperson, Cancer Institute (WIA), Mr. S N Pandey, Managing Director, Chennai

Petroleum Corporation Limited and Dr. ShravanSubramanyam, Managing Director, Roche Diagnostics India.

Dr. V Shantha said, “Cervical cancer is preventable, hence, adopting a comprehensive approach that includes vaccination, effective screening, early diagnosis and treatment has the potential to reduce the existing mortality relating to this cancer. In India, the absence of organised screening programs have contributed to this situation. We in Tamil Nadu, however, have implemented a Statewide cancer registry and the Government of TN has been running a state-wide screening program.”

Speaking at the event, Dr ShravanSubramanyam, Managing Director – Roche Diagnostics India said, “Roche Diagnostics with its molecular HPV DNA testing has been globally partnering with prestigious Government and private health institutions to enable prevention and early diagnosis of cervical cancer. In India and especially in Tamil Nadu, where the incidence of this completely preventable cancer is high, with the Cancer Institute’s progressive molecular testing lab, we can start making a difference to women’s lives. That this facility is going to be available to women across the State, especially for women in vulnerable communities makes it fulfilling. I

am confident that our discussions with the forward-thinking TN State Government will help us implement HPV DNA-based cervical cancer screening across the State to help prevent cervical cancer and save valuable lives.”

USA, UK, IRELAND SCIENTISTS PARTNER WITH ANDHRA PRADESH MEDTECH ZONE

The Kalam Institute of Health Technology (KIHT), at the AP MedTech Zone, Visakhapatnam hosted a day long Annual review meeting of the Translational Center of Excellence in Biomaterials for Orthopedic and Dental Applications on December 22nd.

This also earmarked the second meeting of the Bio-Medical Implants & Materials Mission (BIM2) Mission. Supported by the Department of Biotechnology, Govt. of India, KIHT, IISc Centre of Excellence and the Ceramic and Glass Industry Foundation, this event showcased inventions in health technology across the country which are ready for industrial uptake.

The meeting discussed healthcare innovations in Orthopedic and Dental Applications, their research, manufacturing and clinical applicability in the Indian

USA, UK, Ireland Scientists Partner with Andhra Pradesh MedTech Zone

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NEWS ROUNDUP healthcare context. Aspects of detailed intense knowledge on designs, applicability, compatibility with living systems, noncontamination attribute, antimicrobial sterilization needs etc. were also put into perspective. Annual meeting of the “Translational Centre of Excellence & Bio Implants mission” at Kalam Convention Centre – AMTZ, the Med Tech Capital of India.

Curam Centre-Ireland; Georgia Tech- USA; Made Centre- South Carolina; Wyss InstituteHarvard; Tata Steel new material center; IIT Roorkee; PSG institute – Coimbatore; SreeChitra – Trivandrum; IISc – Bangalore; CIPET- Chennai; CGCRI-Kolkata along with several industrial partners participated. To innovate biomaterials & Implants through knowledge convergence.

Stakeholders from various reputed institutions like IITs, NITs, IISc, VIT, National labs, MSME manufacturers, large scale manufacturers like Tata Steel New Materials Business, Smith & Nephew and Stryker participated in the meeting hosted at AMTZ. A host of key Medical Implant manufacturing entities also joined the event to finalize the ecosystem for academia and industry collaboration.

In his opening remarks and welcome address, Dr. Jitendar Sharma, MD and CEO, AMTZ shared the role of AMTZ and KIHT in bringing the Bio-materials community together and how the entire ecosystem can promote indigenous products researched at Indian institutions of merit.

Further, speaking on the occasion Prof.

BikramjitBasu, Professor of the Materials Research Centre, Indian Institute of Science and Principal Investigator of the Translational Centre of Excellence explained the urgent need of the hour in this discipline of science.

Prof Basu is instrumental in leading the Academic Consortium of the BIM2 on a mission mode. Several Center of Excellence Mentoring Committee Members and Coinvestigators presented their research and experience in the field of biomedical materials research. Industry representatives presented and participated in the discussion.

The meeting concluded with a session for

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January 2019

internal discussion and recommendations by the Mentoring Committee, which is a global committee with distinguished researchers from Ireland, USA and UK.

ALZHEIMER’S ASSOCIATION INTERNATIONAL CONFERENCE® (AAIC®) SATELLITE SYMPOSIUM ORGANIZED AT BANGALORE Researchers from around the world met recently in Bengaluru to discuss one of the most challenging medical mysteries of our time – finding effective preventions, treatments and cures for Alzheimer’s disease and other dementias. The goal is to facilitate connections among researchers for scientific collaboration and data sharing that can move the field closer to breakthroughs in Alzheimer’s science.

“The Alzheimer’s Association recognizes that Alzheimer’s disease and other dementias are a growing global problem,” said Maria C. Carrillo, Ph.D., chief science officer, Alzheimer’s Association. “There is excellent dementia research underway in India and across Asia and neighboring countries. We want to bring these researchers together for collaborations with scientists in other parts of the world to advance our shared goals of developing better diagnosis, treatments and preventions for Alzheimer’s.”

“The maximum number of new cases of dementia will come from India and China,” said VijayalakshmiRavindranath, Ph.D., director, Centre for Brain Research. “The number of elderly in India will increase from 143 million to 300 million in 2050. Therefore, it is imperative for us in India to invest in research and identify risk and protective factors that contribute to diseases of the aging brain. We can then translate our knowledge to public health policies to decrease the burden of dementia.”

This is the fourth AAIC Satellite Symposium hosted by the Alzheimer’s

Association. Previous symposia were held in Mexico City, Mexico; Varna, Bulgaria and Buenos Aires, Argentina. In 2019, the Alzheimer’s Association will convene a Satellite Symposium in Brazil. The Alzheimer’s Association is the world’s leading nonprofit funder of Alzheimer’s and dementia research.

It is currently investing over $160 million in more than 450 projects in 25 countries.

AIMED APPOINTED ON BOARD OF NATIONAL MEDICAL DEVICES PROMOTION COUNCIL BY DIPP The Indian Medical Devices industry received a major boost with the establishment of National Medical Devices Promotion Council. The Association of Indian Medical Device Industry (AiMeD) has been appointed as a member of the Council under the aegis of Department of Industrial Policy and Promotion (DIPP) The elated Mr. Rajiv Nath, Forum Coordinator, Association of Indian Medical Device Industry (AiMeD) said “We are delighted and in high spirits to be a part of the newly established National Medical Devices Promotion Council. AIMED had been seeking a council for the development of Indian medical devices for quite some time. We look forward to new opportunities to contribute in Nation building by building a strong Indian medical device industry which is of utmost importance to address our National Healthcare Security Concerns & Economy.

BIOMARKER FOR MULTIPLE SCLEROSIS COULD BE AN EARLY WARNING

A biomarker for multiple sclerosis that could be an early warning for the disease has shown promise in both human and animal testing.

Researchers at Purdue University and the Indiana University School of Medicine found that acrolein, a molecule previously suspected

Androlife Launch

as a metabolic waste product that accumulates in people with certain neurological disorders such as multiple sclerosis and Parkinson’s disease, could possibly be used to help diagnose MS. Multiple sclerosis affects an estimated 2.3 million people worldwide, according to the National Multiple Sclerosis Society, and an estimated 1 million people in the United States have MS. The disease usually is diagnosed between the ages of 20 and 50, and affects twice as many women as men.

Although there is no cure for MS, recent years have seen a flurry of activity around possible biomarkers and possible treatments.

Dr. David Mattson, professor of neurology and the director of the Indiana University Multiple Sclerosis Center, says that if the results are validated, acrolein could also allow medical professionals to monitor the effectiveness of treatments.

“We are in the process of trying to correlate acrolein levels with MS disease activity, which potentially would help us monitor disease activity with a blood test,” he says.

“If this is validated, it would help us decide how aggressive to be with immunotherapy,

or whether a therapy is working or there is a need to switch to a different therapy.”

ANDROLIFE, INDIA’S 1ST EXCLUSIVE MALE FERTILITY CLINIC LAUNCHED AT OASIS, HYDERABAD Oasis Centre for Reproductive Medicine, a unit of the Sadguru Healthcare Services Pvt. Ltd., launched an exclusive Male Fertility Clinic – Androlife at its secunderabad facility. This exclusive facility was launched by Dr. Durga G Rao, Co-Founder and Medical Diretor of Oasis Centre for Reproductive Medicine along with Dr Krishna Chaitanya, Scientific Head and Clinical Embryologist of Oasis Centre for Reproductive Medicine and other doctors, staff members. This would be first such male specific reproductive facility in twin cities of Hyderabad and Secunderabad.

On this occasion, talking about the objective of launching the exclusive Male fertility clinics Dr Durga G Rao, Co- Founder and Medical Director of Oasis Centre for

Reproductive Medicine stated that “Being in fertility treatment space for last 10 years we realized how important it is to focus on the male fertility issue. We have have seen multifold increase in the fertility issues due to male factor, where in Androlife is going to be one stop solution for all male fertility issues and we take a lot of pride in announcing that this is going to be the first exclusive male fertility clinics in the twin states, We will be operating Androlife clinic in each of our Centers in Hyderabad, Secunderabad, Warangal, Vijayawada, Vizag and Chennai with Tailor made treatments & Advanced state of art Andrology lab.”

Talking on the occasion, Dr Krishna Chaitanya – Scientific Head and Clinical Embryologist of Oasis Centre for Reproductive Medicine said that “We, at Oasis does the Advanced sperm functional tests, which help us obtain a deeper picture of sperms fertilising ability (Sperm survival assays, Sperm DNA fragmentation index), Advanced treatments for couples with previous failed IUI and IVF cycles and with the advent of advanced surgical techniques like testicular aspiration and micro-testicular sperm extraction its now

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NEWS ROUNDUP possible for men with zero sperm counts to have their own genetic child without usage of donor sperms. We pride ourselves at the impeccable standards we maintain highly in our IVF advanced lab. Our lab is one of the very few labs in India that has proper Total Quality Management in place which optimizes the results of the Assisted Reproductive Techniques. We are first in India to offer fertility preservation for MenThrough this initiative we can freeze sperms of men who are at a risk of becoming zero sperm count in the future, We are also the first in AP to provide advanced services like PGS/ PGD /IVM/ mTESE/ Vitrification/ Fertility preservation” Speaking on the occasion Dr ParinaazParhar, Clincal Head – Oasis Centre for Reproductive Medicine at Secunderabad stated that “Through Androlife clinics we would like to bring in the focused approach to male fertility issues, the clinic offers comprehensive treatments pertaining to all male infertility and male sexual dysfunction as well. We are now operating Sexual dysfunction clinics, psycho-Sexual counselling, vibratory therapy as well.”

“Today we would also like to take this opportunity to announce the launch of Androlife website, which is a dedicated portal for Men’s fertility. One can find a 24×7 chat support as we understand that men with fertility issues would rather be discreet in their approach, so we would be having support group forums on our website where they can voice out their concerns and our counsellor will be happy to help them,” said SudhakerJadhav – Chief Operating Officer, Oasis- Centre for Reproductive Medicine.

rd Annual Conference of Indian Orthopaedic Association (IOACON 2018) at Coimbatore.

Carestreamrepresentatives showcased the unique benefits of the CARESTREAM OnSight 3D Extremity System that equips hospitals, orthopaedic practices and other imaging services providers with high-resolution 3D images,that offer advanced anatomical detail to help orthopaedic specialists make more accurate diagnostic and treatment decisions.

The OnSight system captures high-quality, weight-bearing imaging studies for patients with a wide range of injuries and conditions of the knee, foot, ankle and other extremities.

Unlike traditional CT technology, Carestream’s system has a large detector that easily captures a 3D image of the extremity in a single rotation. A patient simply places the injured extremity into a donut-shaped bore in the system. Since the patient’s head and body are not confined, patients do not experience the claustrophobia that often occurs with CT systems.

“Orthopaedic specialists around the world are adopting the OnSight 3D Extremity System because it offers high-quality, lower-dose 3D imaging and delivers greater convenience for

physicians and their patients,” said Sushant Kinra, MD, Carestream Health India Pvt. Ltd.

Other products showcased at the conference were the Carestream Vita Flex CR System, Carestream DRX Core wireless Detector and the DryView 5700 Laser Imager Carestream focuses on delivering innovation that is lifechanging—for patients, customers, employees, communities and other stakeholders—while enhancing operations for a broad range of healthcare facilities and helping medical professionals provide quality care.

SRCC CHILDREN’S HOSPITAL LAUNCHES BONE MARROW TRANSPLANT SERVICES

SRCC Children’s Hospital, a super speciality tertiary care paediatric facility managed by Narayana Health, launched bone marrow transplant (BMT) services at the dedicated children’s hospital in Haji Ali. With the launch of BMT service, SRCC Children’s Hospital, can offer the most critical treatment to children suffering from leukaemia and many other cancers.

CARESTREAM SPOTLIGHTS MEDICAL IMAGING TECHNOLOGY AT INDIA’S LARGEST ORTHOPAEDIC CONFERENCE Carestream Health demonstrated its expanding portfolio of medical imaging systems at the 63

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CARESTREAM OnSight 3D Extremity System

The bone marrow transplant team comprises of Dr PurnaKukure, chairman oncology collegium and head- division of paediatrichaemato oncology and bone marrow transplant services at SRCC Children’s Hospital Managed by Narayana Health. Dr Sunil Bhat, director & clinical lead - paediatric bone marrow transplant services, Narayana Health. Dr RuchiraMisra, consultant- paediatrichaemato oncology and bone marrow transplant services at SRCC Children’s Hospital, Dr SujataMushrif, consultant- paediatrichaemato oncology and bone marrow transplant services at SRCC Children’s Hospital.

“We are delighted to offer BMT for children.

Narayana Health has always believed in offering quality healthcare services that are affordable to all. In a short span, the hospital has emerged as a preferred provider for quality, tertiary paediatric healthcare not just in Mumbai, but also for the region, stated Dr SoonuUdani, medical director and head – paediatric critical care and emergency services at SRCC Children’s Hospital.

“Bone marrow transplant has evolved over a period of time and has become safer and more acceptable. List of conditions cured with BMT is expanding. More patients are able to find unrelated donors through donor registries and those who don’t have fully matched donors can undergo half-matched transplants from family members, with technological advances. This has given a new hope for lot of these children affected with life threatening disorders,” said Dr Kukure

TEXILA AMERICAN UNIVERSITY & YASHODA HOSPITAL TIE-UP Texila American University (TAU), an overseas provider of medical education, ties-up with Yashoda Hospital & Research Centre, Ghaziabad to launch a fellowship program in non- invasive cardiology in India. Non-invasive cardiology focuses on the detection and treatment of heart disease, using external tests—rather than instruments inserted into the body—to evaluate and diagnose cardiac disorders.

Speaking about the strategic tie-up, Founder

& President of TAU, SajuBhaskar said, “We are happy to associate with Yashoda hospital to introduce our fellowship program in noninvasive cardiology. We feel that there is a need to create more specialists in non-invasive cardiology. Common people today have become more conscious and watchful about their health, especially their heart which is vulnerable diseases owing to sedentary life- style, hectic work hours etc. According to recent statistics, on an average a non-invasive cardiologist receives about 25-30 patients per day. ” Non- invasive cardiology is a much in demand specialization across the globe as heart related ailment have increased many- folds.

“We have been receiving a lot of requests from doctors to introduce fellowship programs, especially in non- invasive cardiology. This is the reason we thought to support the fellowship program. This is a two-year program where students after their successful completion and evaluation will receive a fellowship from TAU,” said Dr Gurjit Singh Gill, Associate Consultant (Cardiology) at Yashoda Hospital & Research Centre, Ghaziabad.

JASLOKHOSPITAL INSTALLS ASIA’S FIRST CRYOGATT SYSTEM FOR IVF Jaslok Hospital and Research Centre takes first of its kind initiative by installing Asia’s first Cryogatt System for IVF (In-Vitro Fertilization). Cryogatt has developed Globally-Unique patented RFID systems which operate at accepted safe levels for delicate biomedical samples. During IVF, there is usually a surplus of embryos and this technique will help in storing and tracking the embryos.

Couples who are not able to conceive a baby, need not worry as IVF treatment along with RFSN (Radio Frequency Safety Net) system will help them have a family of their own. IVF mainly works where other infertility treatments fail. With the help of the Cryogatt System in terms of Safety measures; Radio Frequency Safety Net help detect the embryos, Sperm and eggs. Fertility clinics can now safely, quickly and accurately identify and audit.

Dr Firuza Parikh, IVF Specialist at Jaslok Hospital and Research Centrewas quoted saying, “We are thrilled to have always been amongst the first centres in the world to harness new technology to provide the highest quality care for our patients. For the people who have a blocked tube, IVF provides the best opportunity of having a child using their own eggs. Couples with male infertility problem might have a much higher chance of conceiving with IVF than conceiving naturally. People who suffer from PCOS (Polycystic Ovary Syndrome), where there is a hormone imbalance leading to irregular menstrual cycles. IVF has been proven very successful in patients with PCOS, who will not conceive with ovulation induction. Many other problems like these can be taken care of with the help of IVF and it can help people have a family of their own.”

George Alex Chief Marketing Officer and Chief Operational Officerat Jaslok Hospital and Research Centre said, “IVF helps patients who are unable to conceive. Medicines and procedures required for IVF rarely are associated with problems or complications.While many couples who are unable to bear children opt for IVF, doctors, nurses, technicians and staff of Jaslok Hospital will be there with you every step of the way, providing you with the comfort, support and expertise you need.

Dr Firuza Parikh, further added saying, “Embryos, sperm and ova can be indefinitely stored at -196 degrees Centigrade. The samples are traditionally placed in vials that are either bar coded or labelled manually. One has to be very careful that there is no mix up of biological samples. Sometimes the labels can become unstuck on defreezing. Also the correctly labelled straw has to be identified and removed from the other samples in less than 15 seconds.

Any longer exposure can damage the biological material.”

IVF also helps patients to avoid passing on certain genetic conditions, and allows hopeful parents to plan having children after establishing a career or achieving other milestones. The launch resulted in safeguarding the samples using fast, faultless RFID solutions.

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DETAIL NEWS

Karnataka And The Netherlands Partner For Living Lab On Healthcare LIFE SCIENCES and Healthcare is a priority sector under bilateral collaboration between India and the Netherlands. The Healthcare sector in India is growing at a fast pace because of increase in insurance penetration, growth in services and increasing expenditure by public as well as private players. Growing market opportunities in India, combined with the Netherlands’ strengths in areas such as Therapeutics & Vaccines, Diagnostics, Medtech and E-Health create excellent opportunities for partnerships that address shared societal challenges with smart solutions. Making India, a valuable partner for the Dutch Life Sciences & Healthcare Sector.

The affordability and accessibility of healthacre remains at the core of of partnerships between Indian and the Dutch stakeholders.

In 2016, The Netherlands Organisation for Scientific Research (NWO)/The Netherlands Organisation for Health Research & Development (ZonMW) and Department of Biotechnology (DBT), Government of India launch a joint call for proposals on the theme ‘Technology for a Sustainable Healthcare: Minimally invasive techniques’. The joint call has resulted in funding of three Indo-Dutch projectsthat are dedicated to developing sustainable healthcare systems. Two of these projects are from consortium partners in Bangalore, who are also involved in another

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Shri Raj Kumar Srivastava, Advisor for Govt. of Karnataka & IT, BT & ST; Michel Rademaker, Department Director, Hague Centre for Strategic Studies; Marten Van Den Berg, Ambassador of Netherland to India; GertHeijkoop, Consul General of Netherland Bengaluru; Niels Van Leeuwen, Netherlands Enterprise Agency (Ministry of Economic Affairs)

initiative between the Government of Karnataka, the Netherlands Enterprise Agency (RVO) & Taskforce for Applied Research (SIA) called Living Lab.

Living Lab RVO, SIA and Govt. of Karnataka signed a Letter of Intent (LoI) during the visit of Dutch Minister for Foreign Trade, Sigrid Kaag and Dutch Minister for Medical Care, Bruno Bruins

to Bangalore in May 2018 to set up Living Lab in Bangalore with the objective to ‘improve access to affordable healthcare via means of eHealth& medical devices’. Living Lab is a growing ecosystem that connects government, industry and academia to co-create innovative solutions for shared societal challenges.

In the upcoming Bengaluru Tech Summit (BTS) from 29th Nov to 1st Dec, the Netherlands is partnering with the Govt. of Karnataka as a ‘Technology Partner’ bringing in Dutch experts from a number of fields such as Healthcare, IT and cyber security. After the LoI was signed in May 2018, three pilot projects were jointly selected for co-funding opportunities.

Joint Projects: The following three projects will be pitched to stakeholders from academic institutes, hospitals, IT, med-tech companies, start-ups etc. for partnership in the Netherlands’ Health-tech session organized during BTS on 30th Nov: 1. Development of Generic tool box to create Health Literacy application for the use in India and the Netherlands (Current partners: Manipal University in collaboration with Maastricht University Medical Centre, MUMC) 2. Point of Care tool for fast diagnosis of e.g.

Urinary Tract Infection (Current partners: MUMC in collaboration with Brightlands, Manipal University, TCS & EHE Innovations) 3. A framework for identification of biomarkers for mass screening of population at risk of development of neurodegenerative disorders (Current partners: M.S. Ramaiah Institute of Technology in collaboration with MUMC and potential partners include TU Delft & Bosch) In the coming months, the two sides will also explore opportunities for student exchange under the three joint projects to begin research work. Centre for Human Genetics (CHG), which is the anchor institute for Living Lab in Bengaluru will assist the process, together with Nuffic Netherlands Education Support Office (NESO) in Bangalore and Taskforce for Applied Research (SIA) in the Netherlands. “In India and the Netherlands alike there is a need for more research and innovation to serve society in a more direct manner. The Dutch Universities of

Growing market opportunities in India, combined with the Netherlands’ strengths in areas such as Therapeutics & Vaccines, Diagnostics, Medtech and E-Health create excellent opportunities for partnerships that address shared societal challenges with smart solutions Applied Sciences do that by involving education and regional partners from the very beginning.

Our students and regional partners can benefit greatly from working with Indian eHealth and ICT solutions. It is exciting to see the Living Lab provide a platform for knowledge exchange between students, researchers and regional partners from India and the Netherlands,” said Mr. Eras Draaijers, Programme Manager, Taskforce for Applied Research (SIA).

Speaking on the occasion, Mr. GertHeijkoop, Consul-General of the kingdom of the Netherlands in Bangalore said “The state of Karnataka is a valuable partner for the Netherlands, especially in innovation ecosystems. After the MoU was signed between The Hague and the state of Karnataka in 2016, the two sides have worked diligently over the last few years in building partnerships for societal impact. Living Lab is one such example, which we believe will result in creating affordable solutions for sustainable healthcare in both India as well as the Netherlands”.

Mr. Gaurav Gupta, Principal Secretary, Department of IT & BT welcomed the Dutch delegation and said that, “In 2017, the size of the Indian health-care sector was estimated at $160 billion, and is projected to grow to $372 billion by 2023. As the sector grows, it becomes imperative to encourage innovation and R&D in healthcare, while also ensuring that challenges of efficient distribution and delivery of healthcare services are mitigated. Digital transformation of the sector using new and emerging technologies such as IoT, cloud services and wearable devices, would play a key role in addressing these challenges. Government of Karnataka is delighted to participate in “Living Lab” programme between India and The Netherlands as this type of international collaboration is a

much required step for transformation of the healthcare sector.”

“The affordability and accessibility of healthcare is a theme where our countries have excellent opportunities for innovation partnerships. Public private partnerships focused on research, innovation and implementation are key to unlock affordable solutions to healthcare challenges the world faces today. India is an important partner for the Netherlands in this respect”, says Mr. Niels van Leeuwen, Senior Advisor International R&D Cooperation, Life Sciences & Health, Netherlands Enterprise Agency.

The representative from Manipal University, Dr. Sanjay Pattanshetty, Associate Professor, Prasanna School of Public Health, shared his excitement saying, “We, at Manipal Academy of Higher Education, are excited about our participation in this unique challenge(s) driven initiative that aims at bridging existing gaps in the healthcare industry. We have not only been able to expand our network through this initiative but have conceptualised some interesting projects that we are looking forward to initiate”.

Maastricht University Medical Centre+ (Maastricht UMC+) from the Netherlands is another committed partner in Bangalore and specifically in the Living Lab initiative. “During the last 10 years Maastricht UMC+ has developed an extensive network for research collaborations with institutes in the Bangalore area. With our Indian partners we have performed many interesting studies. We believe that the Living Lab will allow us to take these collaborations to a next level”, said Dr. DorineCollijn, Senior Policy Advisor in the Research Office of Maastricht UMC.

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DRIVE

The Endearing Entrepreneur: Dhirajlal Kotadia Driven by passion and entrepreneurial spirit this humble leader created a world class medical device company M Neelam Kachhap “THERE IS no greater gift than the gift of life,” says Dhirajlal Kotadia, Founder and Chairman, Sahajan and Medical Technologies (SMT), “And no award can match the sense of pride and feeling that you had some impact on the world, for the better,” he adds.

I’m in Surat to visit the most enterprising man in medical device manufacturing in India.

He is India’s largest manufacturer of cardiovascular stents that proudly stand amidst globally accepted stents with better quality and outcome. Moreover, SMT stents are affordable and easily available as compared to the imported ones. SMT has made it possible for Indians to get quality stents and other cardiac devices at an affordable cost even before the Indian government came out with price capping.

Kotadia holds the distinction of creating a world class medical device manufacturing facility that not only epitomizes the call for makein-India but also resonates with Gandhiji’s belief in Indian talent, manufacturing. SMT is an apt symbol of the Indian entrepreneurial spirit and Dhirajlal’s passion for success. Kotadia is perhaps most celebrated as the man responsible for putting India on the global medical device map.

Recently, a global study called TALENT (Thin strut sirolimus-eluting stent in all-com-

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ers population vseverolimus eluting stent) has found that the SMT stents are at par with globally manufactured stents in for DOCE (deviceoriented end points). Now the company has the right tools to fight for larger market share in foreign markets and soon it will become the number one player in this business. “When I started SMT, I wrote in its vision statement that it would be a billion dollar company and very soon this will happen,” says Kotadia proudly.

Kotadia, 59, is one of the most humble down-to-earth persons I have met. As we settle down at his Surat office to talk about his life, I cannot help but wonder how a person from modest background with no formal knowledge of medicine created an exceptional business in medical device manufacturing.

The Quest for Knowledge Kotadia was born in 1959 in a small village called Bhalgam in Gujarat to a family of farmers. His father was a farmer and young Kotadia experienced the perils of farming early in life. “At that time Saurashtra was known for its deadly droughts. Farmers were at the mercy of moneylenders and poverty was the way of life.”

For Kotadia, reading was a way to deal with it.

An avid reader and lifetime learner he knew early in life that only hard work and knowledge

would help him break out of the rut of poverty.

“Our village was part of the erstwhile Gaekwad kingdom, which was known for its progressive policies and social reforms. In the pre-independence era we had big cupboards full of books in each village, functioning as a library. By the time I was in 7thgrade, I had read almost 2000 books ranging from Chandamama to the Guajarati masterpiece Saraswatichandra written by Govardhanram Madhavaram Tripathi,” shares Kotadia.

Young Kotadia was so fond of reading that he would carry books to the most unlikely places, like when he used to take the animals grazing or when he went to the bahirbhumi (designated place for toilet outside the village).

He even read at night using two lanterns alter-

nately so as to not disturb his flow.

“Whatever I am today is because of that early habit of reading and books as they opened a world of ideas,” he says. Kotadia was a good student and did well in his studies. By the time he reached adolescence he knew he had to move out of his village to a better educational environment like the ones at bigger cities to fulfill his dreams of a better life.

Kotadia moved to Rajkot for further studies at ShriSwaminarayanGurukul - an Ashram school and went to A V Parekh Technical Institute to earn engineering degree. “Actually, there were no IIMs at that time nor had I heard of IITs. If I knew of such institutions I would have definitely studied further,” laments Kotadia.

By the time I was in 7th grade, I had read almost 2000 books

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DRIVE I have always believed that you must do the right thing and the returns will follow. The more you give, the more you get in terms of either money or satisfaction Life the Teacher After finishing his studies, a young and ambitious Kotadia moved to Ahmedabad to look for a job. His knowledge led him to a projector shop where he repaired the broken ones quite well. This paved way for another job in the city of dreams Mumbai. For a salary of Rs 270 a month, he got a job at Film City to repair projectors, but fate had different plans for him.

“I met a man who used to sell pens to children at different schools. He exposed me to the way of business and taught me to sell,” shares Kotadia. It was here that Kotadia learned the art of marketing and sales.

They say life is a good teacher and indeed life taught the most valuable lessons to Kotadia. In the 1980s he travelled from Mumbai to Kerala selling stationary and getting exposed to different languages culture, societies and of course people. Needless to say, he earned immense experience through his hardships and work but the most prized possessions he counts are the numerous associations he was able to garner with the many people throughout his journey. It was these relationships and human connect and the brilliant business acumen that led him to set-up shop in Madras, selling electronic goods 2000 km away from his home.

“Through my travel experience, I had figured out that it was easier to set-up shop in Madras than in Gujarat as the rents were lower, but the market potential was larger,” explains Kotadia.

Dhiraj Agency opened with Kotadia’s savings of Rs 5000; whole-selling gas lighters and in the next couple of years grew to include home appliance and commercial kitchen equipment.

The shop did very well and instilled confidence in Kotadia to broaden his horizon and instead of selling think about manufacturing.

“I gifted that shop to one of my employees and moved back to Surat in 1987,” shares Kota-

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dia. Having travelled through Japan and Korea, witnessing their manufacturing and entrepreneurial zeal a now matured Kotadia took a risky decision. “I was sure, I wanted to get into a different business territory and Surat seemed like a good option to set-up a base,” explains Kotadia.

The Making of a Legacy When Kotadia moved to Surat it was the center of diamond trade, but the industry was changing. “Moving back to Surat, I got interested in doing something related to my field of study engineering. I looked at technologies that would help the diamond industry in its growth and landed on the idea of manufacturing laser machines. Thus Sahajanand Technology was born,” shares Kotadia.

Today, Sahajanand Technology is a market and technology leader in laser cutting and engraving machines dedicated to manufacturing industries.

Sometime in 1997,Kotadia came across a detailed article in a local newspaper about interventional cardiology. It was though this article that he came to know about stents and it got him hooked. It was his entrepreneurial spirit that identified an opportunity in the laser cutting machines he was developing for the diamond industry could also be used in the manufacture of coronary stents. After some teething problems,Kotadia managed to get the stent manufacturing in place and in 2001, SMT was born. Since then, there has been no looking back.

Recently, SMT successfully raised equity to the tune of Rs. 230 crore in a funding round led

by Samara Capital &Morgan Stanley Private Equity Asia and is now on the path to becoming the globalleader in cardiovascular devices.

One thing you should know about Kotadia is that he is a pathfinder and he never gives up.

He has been testing and concurring uncharted waters his whole life. And so it was with stent manufacturing. Today SMT is known for its wide range of products, including coronary stents (drug-eluting and bare-metal), renal stents, PTCA balloon catheters and other cardiac accessories in India and across 60 countries globally.

SMT has a manufacturing facility in the special economic zone in Surat in Gujarat and a R&D center in Dublin, Ireland. SMT is ISO 9001, ISO 13485, ANVISA and WHO-GMP certified.

The Family Man Kotadia is a complete family man. He marriedSharada in 1982 and had three children, daughters Urmi and Priyanka and son Bhargav. He is deeply rooted in spirituality and is a contented man.“I’m content with my life. This is the reason why I am at peace and have not faltered in life. Be it a financial challenge or family or even health,” Kotadia says.

He further says that his wife has been a true pillar of support and is very much part of his success.

“She always believed in me and supported all my decisions,” he adds.

His son Bhargav Kotadia, is the Managing director, Sahajan and Group of Companies and a Prude University alumnus. Both his daughters are settled and doing well.

Kotadia believes that a person really needs to understand the difference between need and greed. “Ambition is a good thing and I tell my children to reach to the sky, but remain rooted in the reality,” he says. He strongly believes in giving back to the society and has inculcated it as a habit. “I have always believed that you must do the right thing and the returns will follow.

The more you give, the more you get in terms of either money or satisfaction,” he says.

His mother has also had a big influence in his life. Talking about his mother he gets emotional remembering how at a tender age of five, he promised that he would make money rain.

“She was a pillar of strength and always inspired me to do more not only for my family but also for the society,” he says.

He has won several awards for his pioneering work but his biggest award he says is the gratitude and well wishes of the people whose lives he has touched through SMT. “It is an overwhelming feeling to know that the products we make are lifesaving. I often get calls from people requesting for help. It could be that a person cannot afford the procedure or the device, I try to help all,” Kotadia says. “When they come back and recount their stories and I learn that someone is well and will live for another 20-30 years; I feel a sense of fulfillment that no award and prize can give you,” he adds.

Talking about future Kotadia says he is looking forward to disrupt the cancer care market with a new device that will be launched soon. Surely, it won’t be far when the saga of his dedication, commitment and vision will spell another golden era for SMT. Kotadia family

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COVERSTORY STORY COVER

DECODING

BIJU SWASTHYA KALYAN YOJANA Towards Affordable Healthcare with PPP

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L

ast year, when Prime Minister Narendra Modi introduced Ayushman Bharat-National Health Protection Mission with much fanfare, a similar healthcare package was being rolled out in the state of Odisha. Biju Swasthya Kalyan Yojana (BSKY) did not receive as much attention as the central government’s health insurance scheme however, some experts claim it to be a better deal as compared to the ABNHPM, since it includes both APL and BPL people.

If you look closely, both the schemes aim to provide an annual cover of Rs 5 lakhs per family for secondary and tertiary care. Yet, the number of eligible beneficiaries is higher. According to some reports, under the ABNHPM the number of eligible beneficiaries in the state would be 61 lakhs, while under BSKY, the state intends to extend the cover to 70 lakh people. Besides, Odisha intends to adopt a trust model to manage the scheme, unlike the insurance model of ABNHPM. We spoke to Ayanabh Debgupta, Co-founder, Medica Synergie & Director, Medica Superspeciality Hospitals & CEO, Medica Healthcare Consulting to know more about the project.

What is the difference between Ayushman Bharat-National Health Protection Mission, and Odisha’s Biju Swasthya Kalyan Yojana?

The fundamental difference between both the schemes is that, while Centre’s Ayushman Bharat - National Health Protection Mission (AB-NHPM) scheme is insurance-based, Odisha’s Biju Swashtya Kalyan Yojana (BSKY) is a health assurance scheme.

Odisha has adopted a speedy modality wherein it has formed a trust to implement the scheme. Under this scheme, the Government will reimburse the hospitalisation cost and will not pay premiums to insurance companies, beneficiaries of the state scheme will receive reimbursement directly from the government.

In BSKY scheme,a combination of several financing mechanisms shall be routed through a single-payer system to mitigate hassles of multiple window approach. While BSKY scheme shall provide cashless health coverage of Rs 5 lakh per family and 7 lakh for women, the AB- NHM scheme ensures Rs 5 lakh coverage each for family and women.

Another interesting approach of the BSKY is that the existing schemes of BKKY (Biju Krushak Kalyan Yojana, OSTF (Odisha State Treatment Fund),RSBY (Rashtriya Swashtya Bima Yojana)

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COVER STORY will be automatically assimilated under the new program including the BPL and Anatodaya Anna Yojana (AAY) card holders, hence 70 lakh families shall be directly benefited.

BSKY shall encompass two other schemes i.e. Drop back assistance where ailing mothers and babies visiting public healthcare facility shall be provided Rs 500 assistance and Universal health coverage where other than free primary and secondary care the state government will also give allowance to carry forward the treatment of those patients who require to proceed for treatment at the public healthcare institutes outside state. State government has undertaken empanelment with 4 hospitals in Vishakhapatnam and intends to collaborate with CMC Vellore and AIIMS, New Delhi for that purpose. These patients will also get commutation assistance of a minimum of Rs 2000.

What are the initial challenges with Biju Swasthya Kalyan Yojana?

Considering the broad scope and large number of beneficiaries that the scheme envisages to serveaccess to quality healthcare infrastructure in the state would be a huge challenge. The state government will also have to address shortages of healthcare infrastructure and human resources, especially when it comes to the requirement of specialists.To address the increasing demand of services envisioned in the BSKY scheme, with the existing supply of services will be quite an arduous task. A fair balance of government and private Healthcare infrastructure providing a mix of primary to tertiary healthcare services in Odisha is usually concentrated in the three prime districts of Cuttack, Khorda and Sundergarh having a reasonable cosmopolitan population and amenities, whereas other districts primarily depend upon government healthcare instutions. Similarly, in terms of hospital bed gap it currently has 0.8 beds per 1000 population in comparison to the WHO average of 3.5 beds /’000 people for lowmid income countries, i.e. a gap of 120,000 beds.

Under the Biju Swasthya Kalyan Yojana how will the private healthcare delivery provider work with the government?

Health Care Providers having adequate facilities and offering services have been empanelled after being inspected by qualified technical team of the BSKY. Minimum quality criteria under availability of services and facilities have been inspected for the same. These healthcare providers will have to provide services as government fixed tariff list for secondary and tertiary healthcare

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services followed which they will receive reimbursement directly from the government. To ensure quality healthcare delivery, the private healthcare providers will however be required to maintain the empanelment criteria’s which shall be monitored on a periodic basis by the technical team of BSKY. Pls tell us about the PPP project of setting up hospitals in Odisha Realising the large headroom for growth of the private health sector in the state Government of Odisha, Health & Family Welfare Department resolved to enhance the equitable access to quality and affordable healthcare services to people within Odisha in partnership with the private sector. This project has been named as Affordable Healthcare Project (AHP).

To achieve the objective of the project, the department proposes to develop hospitals at 25 locations across Odisha on design, build, finance, operate and transfer basis through Public Private Partnership (PPP) mode. All the hospitals under AHP shall be green field projects offering secondary and select tertiary care services under broad specialities of Cardiology, Neurology and Nephrology. Support from the GoO side to the private partners would be in the form of land, applicable legal permits and viable grant funding (VGF) and procurement of utilities like water, electricity and sewerage system at site.

MedicaSynergiein its capacity of an integrated healthcare organization has a work experience of past 10 years in Odisha and has been intuitional in the execution of projects in diverse thematic areas like Infrastructure Planning & upgradation, Research & Evaluation, Healthcare Quality Management, Design, Monitoring & evaluation of health programs, Designing health communication programs, Training &capacity building and advocacy to name a few across 500 healthcare facilities. Some of the prestigious projects include Preparation of Master Plan for Three Medical Colleges and a Capital Hospital in Odisha, Assessing inaccessibility in terms of health care facilities across 360 public health facilities of Odisha, Technical support for Quality improvement and ISO 9001:2008 in the District Headquarter hospitals of Puri, Angul and Keonjhar a pilot project of quality improvement initiatives under NHSRC in India.

Currently MedicaSynergieis supportingGovernment of Odisha through IFC, World Bank as technical advisorfor structuring and implementing the rollout of affordable hospitals offering quality care across the state in a PPP model. In this role, Medica Synergie has undertaken a detailed due diligence study across the 30 districts in which the health infrastructure & services status of

all the 30 districts in the state were studiedto assess the demand and supply gap and determine feasibility of the PPP prospects followed with development of transaction structure model and identification and selection of suitable land parcels across the state, technical assistance in developing bid documents and facilitating the pre-bid conferences. In its further role Medica Synergie would render support for evaluation of bids, negotiation and finalisation with concessionaire and signing of the agreements.

How is this a landmark project?

The Affordable healthcare project of Odisha will be a pioneer in the PPP project in India, since it is the first of its kind project in India that shall be implemented on a large scale across 25 districts of the state in tier 3 cities and smaller towns where 25 (100- 200 bedded) hospitals, ensuring provision of both secondary and select tertiary care services shall be established.

The project is an integrated health care model where synergies and risk assessment of all the stakeholders have been adequately addressed. The Project design philosophy is based on Policy Modularity, Convergence, Optimized and Fair distribution of risks.

Project leverages existing programs for Institutional Capacity and Fiscal Sustainability and is deeply convergent with the Biju Swasthya Kalyan Yojana (BSKY). To ensure financial viability, the Govt. of Odisha will provide grant funding in the form of Viability Gap Funding (VGF) during the construction period, ranging between INR 140 million to INR 510 million, depending on the size and location of the project. Additional VGF is also offered to the private partner during the bid process. This is a first of its kind in the country. Further government support through land availability, applicable legal permits, procurement of utilities at shall be provided to the private partner.

To ensure equity and affordability, the state has backed the project with a social health insurance program that is planned to provide cover of up to INR 700,000 per family per year and covers nearly 70% of the state’s 42 million population. Any Select patient who are enrolled in the social insurance/assurance programs will be treated at the rates under the program given no additional priority of separate physical capacity reservation. The private partner is free to take private patients as well through market rates decided by itself.

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COVER STORY Strong Institutional mechanism for monitoring clinical and service quality shall be executed where all the hospitals would be required to ensure entry level NABH(National Accreditation Board for Hospitals and Healthcare providers) accreditation within first 2 years and final accreditation with 4 years of operation. This will synergize well with the NHPS as quality services will be developed across the states. A monitoring agency and independent engineer shall be selected to monitor timely completion of activities at each stage of on ground project implementation and ensure quality parameters are adequately met. To ensure risk reduction and better control over implementation and monitoring the entire project shall be rolled out in 3 phases with development of 6-8 hospital in each phase.

Other Impacts of the project  Covers 55% of the population and districts with 56% of bed gap  A total addition of around 3000 beds shall be implemented in this project.  Covers all 7 optimum location districts maximizing access and minimize travel time to higher centres: Angul, Mayurbhanj, Koraput, Kalahandi, Bolangir, Kandhamal, Keonjhar  A good mix of high viability and low viability regions  The project shall generate over 10000 employment opportunities to skilled personnel that include approx. 1500 clinicians, 3500 nurses, 2000 paramedics and around 3000 support staff. In addition to this during construction project will generate over 2000 employments for construction workers for a period of 4-5 years Who are the stakeholders in this project?

The key stakeholders of the project are Government of Odisha and the Private healthcare partners (Concessionaire)who would partner in to operate the healthcare facilities. Apart from them, other stakeholders primarily would be the builders, financial institutions, health insurance providers and medical equipment manufacturers.

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What is the timeline of completion of this project?

GoO has planned to roll-out the project in 3 phases. In the First phase 8 districts have been selected. The GoO Phase 1 of the project is expected to be bid out in the next 2-3 months.

What will be the total spend on this project and how is this project funded?

The Government funding for the project will be over 2000 Crore in form of fixed and variable gap funding.

What has been the progress so far?

Under Phase 1 of the project Medica Synergie undertook a detailed Due diligence& feasibility study across all the 30 districts of Odisha to understand the demand and supply gap of healthcare infrastructure and services followed with development of due diligence reports for each district and overall state.

Under Phase 2 Detailed transaction structure including business modelling, identification of land parcels for the project, project cost estimations and PPP modelling was worked out.

Under Phase 3, the Public announcementof the project details was expressed in public portals in September followed by Pre-bid meeting at Bhubaneswar. In view of promotional activities of the project, road shows were conducted at Bhubaneswar, Chennai, Delhi and Hyderabad followed by Odisha’s flagship Biennial Global Investor’s meet under the Make in Odisha Conclave 2018 atBhubaneswar. In this Global Investor’s meet presentation on the project background, technical and financial particulars and PPP incentives were briefed to prospective partners by Medica other support included developing bid documents such as RFP, concession agreement, applicable technical schedules, developing and making presentations to ECI (Empowered committee on infrastructure), Govt of Odisha & prospective investors, development of ToR for monitoring agency & independent engineer and other technical subject expertise as deemed necessary. In the upcoming activities bid evaluation and selection and contract signing shall be executed.

PULSE

Accessible Affordable Cardiac Care Plexus Heart Centre (Plexus Hospitals), committed to providing world class services, state-of-the-art technology and expertise to the underserved Indians

HEALTHCARE DELIVERY in India is complex with a number of care delivery model systems. Recently, this complexity has increased many folds as universal health coverage and cost management through price-capping is set to transform our hospital-centric industry.

Additionally, existing healthcare providers are being asked to deliver better, more efficient care with fewer resources. This task was not any simpler earlier, and it is even more difficult now. So how can providers optimise cost and improve quality in today’s evolving healthcare environment?

The answer is to re-look at care delivery models one step at a time and innovate. A young Indian company established in 2015 is doing exactly the same.

Plexus Hospitals a heart care delivery innovator aims to provide end to end heart care services to every Indian patient.

The company is looking to develop a nationwide network of worldclass healthcare infrastructure and services, starting from tier 2 and 3 cities.

“It has been a privilege to have witnessed the tremendous growth and progress of

our nation during these times of globalization and technology advancement. Healthcare has been one of the key beneficiaries of this growth; having been associated with this field for over 15 years I was always posed with certain questions and challenges,” says Sandeep Shekhawat, Founder and CEO, Plexus Hospitals. “We have the knowledge, we have the expertise, we have the technology available to us yet we have one of the highest mortality rates in the world due to poor healthcare services and infrastructure that has not penetrated to every tier of our country,” he laments.

In fact, cardiovascular disease is the number one cause of morbidity and mortality in the world, says WHO and some experts opine that Indians are the most affected amongst all ethnic population. According to recent studies the rate of increase of CVD in developing countries is almost double in comparison to developed countries.

Experts believe that younger generations will be affected more in developing countries; for example, about 52 per cent of deaths from CVDs in India occur before 70 yrs of age, compared with 23 per cent in establishedm a r k e t economies.

Sandeep Shekhawat, Founder and CEO, Plexus Hospitals

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PULSE

In view of this large and upcoming disease burden, proper strategies toimprove health in India require consistent efforts to identify and address this effectively.

In a survey conducted in rural villages in India, 32 per cent of all deaths were due to CVD. It shows that the epidemic has reached its advanced stage even in rural India.Neglect of this scenario, particularly ignoring the socioeconomic context will furtherfuel the rapid rising of CVD among Indians.

Experts believe that younger generations will be affected more in developing countries; for example, about 52 per cent of deaths from CVDs in India occur before 70 yrs of age, compared with 23 per cent in establishedmarket economies 26

January 2019

“I founded Plexus to address this immediate need of providing treatment to this large CVDs burden, in the underserved parts of the country.

At the forefront of our strategy is the aim of extending cardiology services to the neglected tier 2 & 3 cities of the country. Making these services and facilities affordable and accessible to the common man is what we pride ourselves on,� says Shekawat.

Overcoming Challenges The key challenges faced in cardiac care in India are lower availability, accessibility and affordability of effective and efficient treatment, coupled with lack of a focused policy towards CVDs. Lack of economical and efficient service delivery infrastructure contributes to low availability. This is in addition to limited availability of affordable preventive and curative cardiac care across the country.

Another challenge is trained personnel.

India trains only about 150 cardiologists every year, and the number is not enough given the huge disease burden.There is a shortage of adequately trained specialist, nurses and

technicians for cardiology to cater to the masses for preventive health check-ups, interventions and disease management. Around 60 per cent of the hospitals in India are located in the urban areas and cater to only 30 per cent of the population. Only 13 per cent of the rural population has access to a primary healthcare facility and less than 10 per cent to a hospital.

Affordability of quality care is a key concern for most of the population, both for preventive check-ups and treatment. Big hospitals in tier 1 cities are typically driven by use of advanced medical technology, thus raising the cost of treatment. The issue of affordability is further magnified by the low penetration of health insurance in India. Since most of the population can’t afford preventive health check-ups available at tertiary care hospitals, it aggravates the already rising risk factors in the affected population leading to serious ailments in the future.

Plexus combines world-class patient care, skilled specialists, new technologies and education to markedly improve CVD management in India.

Plexus Heart Center is a chain of cardiac units based across the country with the vision to establish ‘Excellence in CardiovascularIntervention’. It provides a standard model of operations with state-ofthe-arttechnology run by a highly trained and experienced team of doctors, nurses andtechnicians.

“We have Flat Panel Digital Cath Lab, Modular Theaters ultra-modern fully equipped CCU’s.Our patient service charges and packages are very competitive and economical. Theemergency services function 24X7which includes emergency admissions, patientmanagement, pathological, radiological and other investigations,” informs Shekhawat.

Plexus Hospitalshas astrong focus on strategic acquisitions and partnerships.

“We wish to work in areas that are deprived of cardiology services or trained specialists and modern equipment. Our center at Dibrugarh is the first-of-its-kind in eastern Assam. The other operational and underdevelopmentcenters are also based in areas with lack of infrastructure and faculty toservice critical cardiac patients.

Each center is led by a team of highly experiencedcardiologists, surgeons and support staff.The centers are also equipped with sophisticatedmedical equipmentto assist and provide the best possible diagnostic services to the patient,” adds Shekhawat. At present Plexus is present in Dibrugarh, Kanpur, Jaipur, Gorakhpur, Bangalore, Abu Road and Kathmandu.

Plexus Consultancy is a hub for infrastructure and clinical expertise for settingup hospitals ranging from 50 to 1000 beds. Plexus is a home to a large clinicalteam that enjoys serving at different locations across the globe.

Plexus Training Academy is an important link to implement the company’sphilosophy of creating cardiac excellence.In order to successfully operate centerswith evolving technology, there is a continuous need to create a pool of skilledand experienced manpower across emerging countries. Plexus provides the best inclass curriculum with a true hand on experience and 100 per cent merit basedplacement assurance for anyone willing to grow and excel with the growing Plexus network. “We are driven to maximize access and affordability to qualityhealthcare for all patients. At Plexus we cherish the sound of a healthy heartbeat and a hearty laugh!” signs off Shekhawat.

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OPINION

Fighting Cancer Digitally Why the virtual world could hold the key to beating breast cancer

Anoj Viswanathan, President and Co-founder, Milaap

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THE INTERNET and social media have transformed our lives. Global connections have been created among people with similar interests and passion. An important domain in which Internet plays a significant role is access to health information. In fact, it has been reported that the Internet, rather than physicians, is the first source of information for many people.

Talking about health information, breast cancer rates are alarming in India with 1 in 22 women likely to develop breast cancer intheir lifetime. It is expected that by 2030 breast cancer will cause more deaths among women than any other cancer. According to the PBCR and HBCR report, 60 per cent of breast cancer cases in India are diagnosed at stage 3 or 4. Also, four out of 10 women don’t complete their treatment due to lack of financial support.

It has been found that in India, there is only 66 per cent chance of surviving five years whereas patients in Australia have 89 per cent chances of survival, as per the CONCORD 3 report. Given the number of lives that are af-

fected by breast cancer and the huge potential of the virtual world to optimize information, support and treatment, patients and advocacy groups are looking to the digital world as one of the best routes to enhance patient care and broaden financial help.

With clear benefits for reach, the virtual world has the ability to keep the population engaged, develop encouraging social network, connect donors and patientsand helpin collecting extensive data to aid cancer research.

Patients these days are taking the help of digital platforms to connect with people in transforming their experience with the disease and treatment and also to seek financial help.

In a country like India, where talking about breasts itself is still a taboo, it isnot easy yet for all women to come out in the open and talk about breast cancer. The virtual world is addressing this gap quite effectively. The digital world has helped in creating networks including social media and digital crowdfunding platforms where people can connect for information, peersupport and financial aid.

Social support, health communication, selfregulation, motivation enhancement and engagement are some key benefits of the digital world for patients of breast cancer that is helping them battle the disease.

The major reason for people requiring financial help for breast cancer is due to its high treatment expenses. On an average, the cost for breast cancer treatment through a private hospital is almost Rs5-6 lakh, in which surgery and radiotherapy is included. With targeted therapy, about six cycles of chemotherapy can cost up to Rs 20 lakh, and for a middle class or upper middle class family, this is not quite affordable.

This is where crowdfunding comes into the picture - bridging the gap and making it easy to ask and provide financial aid. To make the process easy for patients, crowdfunding platforms work closely with hospitals so that the proce-

dure of verification, collection of documents and updates on the progress of the patients can be quick and hassle-free.

With numerous benefits, the virtual world is opening doors where strength and support can flow to the needy. Heartwarming messages of solidarity from donors bring new vigor in patients. Brave souls who have and continue to battle breast cancer share their stories on digital platforms from across the world which gives motivation to others and widens the scope for alternatives.

Taking the online fundraising route opens platforms for discussion on medical practices, challenges and costs. These exchanges of ideas and thoughts can create a force in shaping the healthcare policy of a nation, besides making quality healthcare accessible without financial constraints.

Breast cancer rates are alarming in India with 1 in 22 women likely to develop breast cancer intheir lifetime. It is expected that by 2030 breast cancer will cause more deaths among women than any other cancer

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APPROACH

Human Approach towards Patient Patients’ sentiments and expectations are overshadowed by treatments and procedures. How to balance present day’s healthcare challenges

Joydeep Das Gupta, Director India GIOSTAR USA, Author - Hospital administration and management – a comprehensive Guide

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LET US look at a communication between patient relative and Bill Executive.

Patient relative to Bill Executive (Discharge Counter), “Doctor written discharge advice during morning round at 8 am but our patient discharge still waiting now at 2.30 pm.”

Bill Executive to patient,” Sir, we are already processing your bill via your Insurance authority. Without their approval we unable to finalize your patient’s discharge documentation.”

Starting with above communication, it reveals that such communications arevery common now a days. Technical delay is not in the hand of hospital authority but how can we create a situation so that patient and their relatives do not feel delayed. My concern points in this small article to show how inspite of all nice approach from hospital authority still patient feel lack of human approach while delivering services to patient.

All healthcare units always prepare their team to provide best service to each and every patient knocking at their center; but still patient and their relatives expectation are unable to connect right way. The reason of such differences may be enumerated as follows:  Faulty Approach to patient for proper documentation –( both way)  Mentality of patient and their relatives not connect right way with Guest relation Team member  Proper communication about hospital procedure not intimatedby executive in time.  Lack of proper and uniform attention to each and every patient and their relatives.

Each delay in providing service notintimated to patient and their relatives immediately Good behavior to patient and their relatives always minimizes hospital incidents.But proper and uniform behavior from each corner of the hospital is very difficult until and unless all team member are having good connection and information. Sometimes it so happens in centre, one patient attended by multiple team member resulting said patient and their relatives treated such care as disturbance. Means we should provide balance and coordinated approach which ultimately gives opportunity to provide human approach to each patient.

Generally speaking soft skills give over 80 per cent of good word of mouth while technical superiority contributes 20per cent or less. Controlled training initiatives on soft skill relating to preparing guest relation team member to face patient and their relatives should be taken very seriously by human resource wing of each Institution.

Patients need guidance and minute-to-minute holistic gesture during their treatment procedures in the hospital. Family members of patient not able to accompany the patient at each service point. To fulfil this important gap we may explore patient co-ordination and welfare department with staff position of “Patient Coordinator”, “Executive (Patient relation)” and “Patient Guide”. This department and its team member will help for better patient service and for better inter-departmental co-ordination during service delivery to any patient. 

Due to the growing awareness about health amongst the masses, healthcare institutions all over the world are therefore under big pressure to improve their services. Therefore, in the years to come hospital administration and management will become more important in any healthcare set up.

With new innovations in medical technology, patients have become much more demanding and dependent on technologies that understands the patient, their feelings and emotions.

Now-a-days patients’ sentiments and expectations are overshadowed by treatments and procedures. The increasing gap between what patients want and what general practitioners perceive as important has resulted in increased dissatisfaction of patients with the health care system. While streamlining hospital procedure we should give major emphasis so that said procedure is always patient friendly.

The claim for the measure of satisfaction may be the final common pathway for all health

Healing yourself is connected with healing others - Yoko Ono care outcomes. Over a lifetime, patients’ expectations of health care may change dramatically.

Some patients may place more emphasis on technical competence where as other patients fulfilment of personal needs, comfort, dignity, human approachand supportive services will be of paramount importance. Understanding how things look through the patient’s eyes should be a central part of any healthcare quality improvement program. Therefore, in order to provide the best patient care with a human approach, we should promote human element in healthcare andinitiate more and more patient and hospital relation building aspects in each and every healthcare set up.

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HEALTH IT

Fear the Five Common cybersecurity threatsto be weary of in 2019 Erik C. Decker, Health Sector Coordinating Council Co-LeadChief Security and Privacy Officer, University of Chicago Medicine Chairman of the Board, Association for Executives in Health Care Information Security

THREATS AND vulnerabilities are two different types of exposure to cyber-attacks.

Why is it important to understand the difference between the two? The ability to distinguish between the two helps determine which cybersecurity practices and tools are necessary and appropriate for your organization to mitigate the harm that may come from an attacker or from a mistaken or uninformed but authorized individual

Julie Chua, Health Sector Government Coordinating Council Co-Lead Risk Management, Office of Information Security Office of the Chief Information Officer U.S. Department of Health and Human Servicesy

Threats and Vulnerabilities Threats and vulnerabilities go hand in hand, but they are not interchangeable. Threats are internal or external activities or events that have the potential to negatively impact the quality, efficiency, and profitability of your organization. Threats may be internal or external,

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natural or manmade, intentional or accidental. Think of hurricanes and floods causing power outages. These are examples of external, natural, accidental threats. A threat may also be a person, including an existing employee, who decides to steal data or do harm to your practice.

A threat is anything, or anyone, with the potential to harm something of value. Take an example that most health care practitioners are familiar with: the influenza virus. The flu can infect nearly anyone exposed to the virus. The extent of harm caused by the virus depends on that person’s vulnerability. Comparing an elderly person with a college athlete, most would say that the elderly person is more vulnerable to harm caused by the flu. What is it that makes the elderly person more vulnerable?

Vulnerabilities are weaknesses that, if exposed to a threat, may result in harm and, ultimately, some form of loss. A threat often exploits a vulnerability. Using the above example, most people would assume that an elderly person is more vulnerable than a college athlete to harm from the flu. This increased vulnerability is due to the diminished function of an aged immune system, reduced physical strength, and even compromised mental capabilities that result in an inability to adhere to a prescribed treatment plan. In addition to these factors, the failure to get a flu shot may increase an elderly person’s vulnerability to harm even further.

Five of the most current and common cybersecurity threats to healthcare organizations are:  E-mail phishing attack  Ransomware attack  Loss or theft of equipment or data

 

Insider, accidental or intentional data loss Attacks against connected medical devices that may affect patient safety

E-mail Phishing Attack E-mail phishing is an attempt to trick you, a colleague, or someone else in the workplace into giving out information using e-mail. An in bound phishing e-mail includes an active link or file (often a picture or graphic). The email appears to come from a legitimatesource, such as a friend, coworker, manager,company, or even the user’s own e-mail address. Clicking to open the link or file takes the user to a website that may solicit sensitive information orproactively infect the computer. Accessing the link or file may result in malicious softwarebeing downloaded or access being provided to information stored on your computer or other computers within your network.

Threats and vulnerabilities go hand in hand, but they are not interchangeable. Threats are internal or external activities or events that have the potential to negatively impact the quality, efficiency, and profitability of your organization

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HEALTH IT Real-World Scenario

Your employees receive a fraudulent e-mail from a cyber-attacker disguised as an IT support person from your patient billing company.

The e-mail instructs your employees to click on a link to change their billing software passwords. An employee who clicks the link is directed to a fake login page, which collects that employee’s login credentials and transmits this information to the attackers. The attacker then uses the employee’s login credentials to access your organization’s financial and patient data.

Impact

A pediatrician learns that an attacker stole patient data using a phishing attack and used it in an identity theft crime.

Ransomware Attack The HHS Ransomware Factsheet defines ransomware as a type of malware (malicious software) distinct from other malware; its defining characteristic is that it attempts to deny access to a user’s data, usually by encrypting the data with a key known only to the hacker who deployed the malware, until a ransom is paid.

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After the user’s data is encrypted, the ransomware directs the user to pay the ransom to the hacker (usually in a cryptocurrency, such as Bitcoin) in order to receive a decryption key.

However, hackers may deploy ransomware that destroys or exfiltrates data, or ransomware in conjunction with other malware that does so. Paying a ransom does not guarantee that the hacker will unencrypt or unlock the stolen or locked data. Ransomware threats may incorporate tactics or techniques that are the same as or identical to other threats. For example, successful phishing attacks may lead to the installation of ransomware.

Real-World Scenario

Through an e-mail that appears to have originated from a credit card company, a user is directed to a fake website and tricked into downloading a security update. The so-called security update is actually a malicious program designed to find and encrypt data, rendering them inaccessible. The program then instructs the user to pay a ransom to unlock or unencrypt the data.

E-mail phishing is an attempt to trick you, a colleague, or someone else in the workplace into giving out information using e-mail

Impact

A practitioner cannot view patient charts because of a ransomware attack that has made the EHR system inaccessible.

Loss or Theft of Equipment or Data Every day, mobile devices such as laptops, tablets, smartphones, and USB/thumb drives are lost or stolen, and they end up in the hands of hackers. Theft of equipment and data is an ever-present and ongoing threat for all organizations. From January 1, 2018, to August 31, 2018, the Office for Civil Rights received reports of 192 theft cases affecting 2,041,668 individuals.

Although the value of the device represents one loss, far greater are the consequences of losing a device that contains sensitive data. In cases where the lost device was not appropriately safeguarded or password protected, the loss may result in unauthorized or illegal access, dissemination, and use of sensitive data.

Even if the device is recovered, the data may have been erased and completely lost. Loss or malicious use of data may result in business disruption and compromised patient safety, and may require notification to patients, applicable regulatory agencies, and/or the media.

Real-World Scenario

A physician stops at a coffee shop for a coffee and to use the public Wi-Fi to review radiology reports. As the physician leaves the table momentarily to pick up his coffee, a thief steals the laptop. The doctor returns to the table to find the laptop is gone.

An accidental insider threat is unintentional loss caused by honest mistakes, like being tricked, procedural errors, or a degree of negligence. For example, being the victim of an e-mail phishing attack is an accidental insider threat.An intentional insider threat is malicious loss or theft caused by an employee, contractor, and other user of the organization’s technology infrastructure, network, or databases, with an objective of personal gain or inflicting harm to the organization or another individual.

Real-World Scenario

An attacker impersonating a staff member of a physical therapy center contacts a hospital employee and asks to verify patient data. Pretending to be hospital staff, the imposter acquires the entire patient health record.

Impact The patient’s PHI was compromised and used in an identity theft case.

Ransomware threats may incorporate tactics or techniques that are the same as or identical to other threats. For example, successful phishing attacks may lead to the installation of ransomware

Attacks Against Connected Medical Devices That May Affect Patient Safety The Food and Drug Administration (FDA) defines a medical device as an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including a component part or accessory which is recognized in the official National Formulary, or the United States Pharmacopoeia, or any supplement to them; intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease.

Impact

Loss of sensitive data may lead to a clear case of patient identity theft, and, with thousands of records potentially stolen, the physician’s reputation could be at stake if all the patient records make it to the dark web for sale.

Insider, Accidental or Intentional Data Loss Insider threats exist within every organization where employees, contractors, or other users access the organization’s technology infrastructure, network, or databases. There are two types of insider threats: accidental and intentional.

Real-World Scenario

A cyber attacker gains access to a care provider’s computer network through an e-mail phishing attack and takes command of a file server to which a heart monitor is attached.

While scanning the network for devices, the attacker takes control (e.g., power off, continuously reboot) of all heart monitors in the ICU, putting multiple patients at risk.

Impact

Patients are at great risk because an attack has shut down heart monitors, potentially during surgery and other procedures.

Excerpts from Health Industry Cybersecurity Practices: Managing Threats and Protecting Patients. The Department of Health and Human Services (HHS) USA.

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HEALTH IT

Personal Health Record and Data protection

Revisiting DISHA (Digital Information Security in Healthcare Act) in light of the Personal Data Protection Bill, 2018

Apurba Kundu, Lawyer, Bangalore

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THE WORLD’S most valuable resource is no longer oil but data. Health data even more so as hospitals, health information exchanges routinely collect a lot of data that is not limited to name, address, date of birth, telephone number, email address, password, financial information such as bank account, credit card, debit card or other payment instrument details, physical, physiological and mental health condition, sexual orientation, medical records and history, biometric information, vehicle number, any government number, including Aadhar, Voter’s Identity, Permanent Account Number (‘PAN’), passport, ration card, Below Poverty Line (‘BPL’) information- in short all the information pertaining to one’s identity.

The draft of “Ditital lnformation Security in Healthcare Act (DISHA)” was placed in public domain for comments on March 21, 2018, but there seems to be no further development and

in light of Justice B.N. Srikrishna Committee report on the draft ‘Personal Data Protection Bill 2018’ being submitted to the minister of law and justice, Ravi Shankar Prasad on July 27, 2018, it is useful to revisit DISHA. DISHA will enable the digital sharing of personal health records with hospitals and clinics, and between hospitals and clinics-basis for the creation of digital health records in India.

DISHA lists what may constitute as Personally Identifiable Information. Sensitive healthrelated information if lost, compromised, or disclosed, could result in substantial harm, embarrassment, inconvenience, violence, discrimination or unfairness to an individual, including one’s physical or mental health condition, sexual orientation, use of narcotic or psychotropic substances, consumption of alcohol, sexual practices, Human Immunodeficiency Virus status, Sexually Transmitted In-

fections treatment, and abortion. The Personal Data Protection Bill introduces new definitions of “personal data” and “sensitive personal data”.

Personal data refers to any data of a natural person which allows direct or indirect identification. Sensitive personal data includes financial data, biometric data, positive additions such as religious and political beliefs, caste, intersex/transgender status, and official government identifiers like PAN etc.

DISHA mandates that there shall be no access to, or disclosure of personally identifiable information, except personally identifiable information may only be used for the purposes of direct care of the owner of the data. DISHA requires that Digital health data, whether identifiable or anonymized, shall not be accessed, used or disclosed to any person for a commercial purpose and in no circumstances be accessed, used or disclosed to insurance companies, em-

ployers, human resource consultants and pharmaceutical companies, or any other entity as may be specified by the Central Government.

DISHA requires that any entity collecting or generating this information is required to furnish a copy of the consent form to the owner, entity that collects any digital health data shall remain the custodian of such data and shall be duty bound to protect the privacy, confidentiality and security of such data, no digital health data shall be stored by any entity in any manner, and no digital data shall be transmitted by any entity. DISHA requires that the digital health data is transmitted by the entity only upon the consent of the owner after being informed of the rights of the owner. Further, any other entities that seek to access digital health data would require the consent of the owners. High degree of care is expected from the entity collecting data.

According to DISHA, the owner of digital health

DISHA will enable the digital sharing of personal health records with hospitals and clinics, and between hospitals and clinics-basis for the creation of digital health records in India

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HEALTH IT data shall have the right to refuse consent to the access or disclosure of his or her digital health data, Also, the owner of the digital health data shall have a right to access their digital health data with details of consent given and data accessed by any Clinical Establishment/Entity.

Further, there could be the right to require explicit prior permission for each instance of transmission or use of digital health data in an identifiable form. Sadly, the Personal Data Protection Bill allows only for a summaryof that information to be accessed and data ownership is not the sole domain of the data subject in the Personal Data Protection Bill which weakens the foundation of a data protection bill.

Lastly, DISHA requires that a clinical establishment or health information exchange shall ensure through regular training and oversight that their personnel comply with the security protocols and procedure. In case of any breach of health data, a clinical establishment, or a health information exchange, shall provide notice immediately, and in all circumstances not later than three working days to the owner while the Personal Data Protection Bill states that data breach notifications are to be made to the Data Protection Authority only if the breach is likely to cause ‘harm’ to the data principal.

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Personal Data Protection Bill states that data breach notifications are to be made to the Data Protection Authority only if the breach is likely to cause ‘harm’ to the data principal Leaving the discretion to the data fiduciary to judge is problematic. Further, the topic of data localisation is not dealt with in DISHA and needs to be addressed.

Evidently, there is a surge of health related apps, in addition to hospitals that collect sensitive health data; even non-profit sector working with vulnerable groups routinely collect sensitive health data. In light of DISHA, most would need a complete revamp, in the manner in which data is collected, stored, used, and disseminated. There is no update on DISHA since the depart of Health and Family Welfare sought comments on the draft earlier this year and with the Personal Data Protection Bill garnering attention since the Ministry of Electronics and Information Technology has opened it for comments, it is only hoped that DISHA is debated as much and doesn’t get lost in bureaucratic maze.

NetHealth 2019 Harmonising Healthcare & Technology in India Dr Rohan D’Souza & Abhishek Appaji, Co-chairs, NetHealth 2019

“AFFORDABILITY IS the key to accessibility but not at the behest of quality.”

Healthcare is one of the fastest growing sectors in India, and the Indian government has aggressive plans to develop India further into a global healthcare hub, leveraging its relatively lower priced treatment options. It presents an excellent opportunity for the growth of the entire health industry – medical devices, healthcare providers and pharmaceutical manufacturers.

However, we see a gulf between the high-quality healthcare that makes us a hub for medical tourism and at the other extreme, Indians struggling to access essential health services.

Developing countries such as India are confronted with a host of daunting challenges.

We find ourselves straddled between old world infectious diseases and new age noncommunicable epidemics. Cardiovascular diseases, cancers, chronic respiratory diseases, diabetes, and other NCDs are estimated to account for 60% of all deaths in India, making them the leading cause of death, ahead of injuries and communicable, maternal, prenatal, and nutritional conditions. Non-communicable diseases affect not only health but also productivity and economic growth. As India ages, it is likely to find the burden even more substantial. While the overall population of India will grow by 40% between 2006 and 2050, the population aged 60 years and above will increase by 270%. Elderly Indians will make up 20% of India’s population by 2050, which means healthcare costs could jump substantially as a significant number of people will need frequent

hospitalisations and regular follow-up and preventive care. However, since independence despite the low healthcare spend and enormous population, we have made massive strides in life expectancy, maternal and infant mortality, HIV and tuberculosis.

We have always found ways to make things affordable, but healthcare is a different beast.

India’s contribution to affordable healthcare goes much beyond being a pharmacy of the world. It extends to affordable innovation which goes to the core of ensuring a global right to healthcare.

Helped by a significantly lower cost base that supports a large talent pool of scientists and engineers, India’s research engine is now driving a new model of innovation that draws on the philosophy of affordable access. With returns on investment plummetting to unsustainable levels in the West, companies are now rapidly leveraging India’s “affordable innovation” platform However, affordability is not simple to implement; it requires creative, out-of-thebox thinking. To deliver affordability, we need innovation— be it devices, drugs or services.

It is only by creating innovation in technology, strategies, practices and policies that we can take on local and global healthcare challenges.

Every year, the NetHealth Workshop brings together a multi-disciplinary audience from across the healthcare spectrum to share their ideas and break the conventional silos that exist in this field. Net Health is centred around people and technology that are changing the face of healthcare. This year’s NetHealth will cover healthcare specific topics like Artificial Intelligence, Bio-entrepreneurship, Telemedicine, Nanotechnology, 3D printing, and Investment & Incubation opportunities as well as ground-breaking academic research. This day-long workshop is for those working within the sphere of healthcare, be it clinicians, students, engineers, designers, innovators, policymakers or regulators, industry experts or anyone else working in support of healthcare.

We hope platforms like NetHealth can bring about innovation in every facet of healthcare so that no one in India lacks access to the latest that the ever-changing world medical technology has to offer.

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39

EVENTS

EVENTS

AHPI GLOBAL CONCLAVE 2019 Date: Feb 15-16, 2019 Venue: Hotel Radisson Blu, Kaushambi

(Delhi-NCR) Organiser: AHPI Click: http://ahpi.in/ahpi_global_conclave/ Contact: Shikhar Gupta - Assistant Direc-

tor, 9540859694

A

ssociation of Healthcare Providers (India) represents the majority of healthcare providers in India. It works as “not for profit” organization and advocates with the government, regulatory bodies and other stake holders on issues, which have bearing on enabling its member organizations to deliver appropriate healthcare services to community at large.

The association functions through an empowered secretariat which facilitates the member organizations in improving

CLINLAB INDIA CONFERENCE Date: 21-22 Feb, 2019 Location: Medical Fair India, New Delhi Venue: Pragati Maidan, New Delhi Organizer: Healthcare Events; Messe

H

Date: Feburary 21 - 23, 2019 Organiser: Messe Düsseldorf India Pvt. Ltd. Venue: PragatiMaidan New Dehli, City: New Dehli, India Click: http://www.medicalfair-india.com/ Contact: Love Bhardwaj, BhardwajL@md-

india.com edical Fair India is held alternately at venues in Mumbai and New Delhi every year. Focal ranges include: medical products and medical device technology, laboratory technology and diagnostics, equipment and furnishings plus furniture for hospitals and health centres and the global trend areas of Health IT and Mobile Health solutions, to name but a few themes.

M

Date: Mar 08 - 10, 2019 | Organiser: Medexpert Business Consultants

Pvt. Venue: Hitex Exhibition Center City: Hyderabad, Telangana Contact: Mr.KSundararajan, 91-7305789789 Click: info@medicall.in

M

edicall is India’s largest B2B trade fair for medical devices and hospital supplies. Approx. 750 exhibitors and 15,000 trade visitors from over 20 countries, among them physicians, but also biomedical engineers, sales people, decision makers, consultants and hospital owners, are represented at this important industry event. In addition to the presentation of the best and the latest medical and medical-technical equipment, software, supplies and other devices the market has to offer the fair mainly serves as a platform to exchange knowledge and experiences among renowned industry experts. Various conferences and innovation awards in different categories complement the event.

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VOLUME 2 ISSUE

12 `200

today.com

www.indiamed

INTERVIEW IAN YOUNGMAN, UK

ARTIFICIAL INTELLIGENCE IN RADIOLOGY SYMPOSIUM

SPECIAL FEATURE, DEEPAK PAWAR FICCI DALIP KUMAR CHOPRA

n Jewel India’s Next Crow

2018

January 2019

MEDICAL FAIR INDIA 2019

MEDICALL 2019

DECEMBER

40

a Panel Discussion OR ProCon Session followed by a Q &A Session. Themes are designed based on Market needs and the same shall empower participants to go back with key takeaways to implement some of those suggestions.

The target group encompasses decisionmakers from the medical field (such as physicians and medical professionals), hospital managers as well as representatives from the medical trade and industry. Due to its spectrum of topics covered the event is equally attractive for architects and building planners, for enterprise consultants or for the scientific and research community.

INDIA MED TODAY

Dusseldorf India Contact: info@events.healthcar.com ospital sector is witnessing major turnarounds like Corporatization, New Marketing Revival Strategies, Innovative Service management tools and much more. To - sustain and grow in this highly competitive and science driven sector, Hospital needs to be managed with ultra-organized and optimized management system.

Keeping in mind the changing dynamics of healthcare scenario, Healthcare Events is organizing these conferences which shall be attended by Healthcare Professionals from various regions.

These are Theme based Conferences and each Conference will have Three Theme Topics. Format of each Theme Topic will have a Speaker Session,

their systems, processes and outcomes on continuous basis, in line with the vision, mission and objectives of the association.

The theme for its Global Conclave is ‘Outcome Based Healthcare Delivery Systems’ through collaborative efforts of Hospitals, Pharmaceuticals, IT and Medical Equipment companies. AHPI believes that ‘Health for All’ can only be realised through collaborative approach involving all Stake holders. The conclave will take holistic view of composite issues and would try to present practical solutions to meet with the emerging challenges. Attempt will be made to present a model by which Universal Health Coverage can be made possible within the existing resources. There will be comprehensive debate by experts on; Patient Safety, Patient Centric Hospitals and How to make use of it tools and develop Smart Hospitals.

MEDICAL TOURISM

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. o

Q&A

ASK THE EXPERT

Running a private medical practice in India comes with the risk of lawsuits and property damage. As

e o

a medical professional, you are probably well aware of the devastating effects of legal cases and se-

e

your queries and concerns regarding legalities of practicing medicine in India to learn more about

curity threats that await doctors who face the blunt of an angry patient. We encourage you to share legal framework, legal cases and the experience of fellow doctors Q: I am working as gynecologist at government hospital.In our unit one baby was delivered with major congenital anomalies.

s

She was not advised anomaly scan as level 2 ultrasound is not available in our hospital and we can’t advise the patient to go

-

e

e

n

e

n

-

s

a n

.

r

police decide that in a brought dead person, post-mortem is not needed? All post-mortems are waived off only on recommendation of doctor. If police does it, ask them to give cause of death too.

Prof ( Dr ) R K Sharma, President, Indian Association of Medico-Legal Experts , New Delhi will answer questions from our readers. Please send in your queries to editor@indiamedtoday.com

to a private centre.What are legal implica-

Q: Is it illegal for a doctor registered in one

tions in present scenario? Is this a medi-

State medical council to practice in another

cal negligence case and who is responsible

state? And if so, could he take additional

treating doctor or authorities.

registration in present state? Is above rule

Name withheld Ans: Please note that if a doctor is working in a government setup, it does not mean that proper advice would not be given if facilities are not available at that center. In above mentioned case, level 2 ultrasound was must and should have been recommended. It is patient choice to get it done from private center if facilities are not available at government setup. Non advice of level 2 ultrasound is negligence in this case which is done by gynecologist.

Government authorities are rarely held liable for negligence as government can say that they cannot provide all facilities at all places.In this case, gynecologist should have sent this case to higher center for level 2 ultrasound.

applied to doctors working under central

Q:

For a brought dead patient, police is

informed; they came and decided that PM exam not needed.The problem is how to release the body without death certifi-

governmentorganizations?

Name withheld Ans: As per Indian Medical Council Act, which is a central Act, registration in any state medical council makes a doctor eligible to practice anywhere in India. It was one time affair and lasted lifelong. This was going on till few years ago.

Now almost all state medical councils (which are established as per State Act) are insisting on all doctors to register if they want to practice in that state. They have introduced registration to be done every five years in order to make money.

This rule applies to doctors working under central govtorganisations too but most of doctors are ignoring it.It is creating chaos as doctors are now registered with multiple medical councils.MCI is known of this matter, let us see what comes.

cate? Then how the body would be cremated because they want death certificate

Q: A

even for cremation.

a tertiary care Hospital. On admission the

Name withheld Ans: This is a hypothetical question. How can

reception staff insisted for relative sign on

patient went for cataract surgery in

consent prewritten on admission ticket but

d

www.indiamedtoday.com

41

patient insisted to sign the consent since

faction.However, 5 months after proce-

there was no relative with him. He was ac-

dure, he now complained to State Medical

What should I do?

companied by his servant only. The staff

Council that he was charged excessively to

refused to take sign of patient on print

the tune of 10,000. Council asked for our

consent form. Is it not legally valid the

explanation in 9 sets.Sir, does the Council

patient’s own consent for surgery? Can

have jurisdiction in this matter. Can a pa-

patients care giver sign the consent in ab-

tient complain of excess charging long af-

Ans: There is no bar for giving opinion on the reports of Chinese patients with hepatitis C infection and the prescription given by a doctor from China. Just be sure that you are duly qualified to give second opinion.

sence of relative?

ter he himself has chosen the procedure,

Ans: The consent for any operation / procedure must come from patient only if he is competent to give. Care giver/ relative/ next of kin can only sign if patient is not competent to give consent.

The signatures of Care giver/ relative/ next of kin should be taken only in witness column. I am surprised that above said thing happened in tertiary care hospital.Care giver like servant can sign in absence of relatives.

which costs even more in other centres in

Q:

the city.Kindly enlighten me on how to re-

where 5–6 lakh people will come. To meet

spond to this query from medical council.

any emergency we are having first aid posts

Ans: I hope you must have taken his consent on procedure which he has opted and signed on cost or procedure namely customised CARD. Show this to medical council which has jurisdiction over ethical behavior of doctors which are registered with them.Patient can complain to medical council any time after procedure is completed. There is no fixed time limit is there. However complaints after 2 years are seldom entertained but council has power to condone delay.

and temporary dispensary, in that dispen-

Q: I am an Ophthalmologist in private practice.One patient was counseled regarding various options available for Lasik surgery.

He opted for Customized CARD Lasik as opposed to Planolasik. Card Lasik costs Rs. 50,000 whereas Plano Lasik costs 35,000.

Q:

He was given our Hospital tariff card and

has approached me to see the reports of

he willingly opted for costlier surgery. His

Chinese patients with hepatitis C infec-

vision improvement was up to his satis-

tion and the prescription given by a doctor

42

January 2019

A Chinese medical tourism company

from China and then give a second opinion.

We are having spiritual programme

sary MS, MD doctors will give voluntary sewa. After emergency treatment we used to refer to nearby govt Hospital.If anyone died during treatment in ground, Or brought dead can we issue death certificate?

Ans: You can issue death certificate but do examine person in detail before certifying death as natural.

Disclaimer: This material has been prepared for informational purposes only, and is not intended to replace, and should not be conveyed or constitute legal advice. You should consult professional lawyer and legal advisors before engaging in any legal matter.

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