Express Healthcare (Vol. 15, No. 10) November 2022

INTERVIEWS Ron Emerson Global Healthcare Lead, Zoom Video Communications Dr Arjun Kalyanpur CEO & Chief Radiologist, Teleradiology Solutions

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CONTENTS

Cybercriminals consider healthcare institutions to be soft targets

Chairman of the Board Viveck Goenka Sr. Vice President-BPD Neil Viegas

P10: INTERVIEW VINAYAK GODSE CEO, Data Security Council of India (DSCI)

Asst. Vice President-BPD Harit Mohanty Editor Viveka Roychowdhury* BUREAUS Mumbai Lakshmipriya Nair, Kalyani Sharma

HEALTHCARE IT

MEDTECH

RADIOLOGY

Delhi Akanki Sharma

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DESIGN Art Director Pravin Temble Senior Designer Rekha Bisht

Marketing Team Rajesh Bhatkal Ambuj Kumar Ashish Rampure Debnarayan Dutta Production Co-ordinator Dhananjay Nidre

HOW CAN HOSPITALS BECOME MORE ENERGY EFFICIENT?

DIAGNOSTICS

Senior Artist Rakesh Sharma Digital Team Viraj Mehta (Head of Internet)

HOSPITAL INFRASTRUCTURE

34 P12: INTERVIEW

P30: INTERVIEW P32: INTERVIEW

RON EMERSON Global Healthcare Lead, Zoom Video Communications

GIRISH GOPALAKRISHNAN Regional Director - South, GE Healthcare

RISE OF TELEDIAGNOSTICS IN INDIA

DR ARJUN KALYANPUR CEO & Chief Radiologist, Teleradiology Solutions

Express Healthcare® Regd. With RNI No.MAHENG/2007/22045. Postal Regd.No.MCS/162/2022 - 24. Printed and Published by Vaidehi Thakar on behalf of The Indian Express (P) Limited and Printed at The Indian Express Press, Plot No.EL-208, TTC Industrial Area, Mahape, Navi Mumbai-400710 and Published at Mafatlal Centre, 7th floor, Ramnath Goenka Marg, Nariman Point, Mumbai 400021.

Scheduling & Coordination Pushkar Waralikar

Editor: Viveka Roychowdhury.* (Editorial & Administrative Offices: Mafatlal Centre, 7th floor, Ramnath Goenka Marg, Nariman Point, Mumbai 400021) * Responsible for selection of news under the PRB Act. Copyright © 2017. The Indian Express (P) Ltd. All rights reserved throughout the world.

CIRCULATION Mohan Varadkar

Reproduction in any manner, electronic or otherwise, in whole or in part, without prior written permission is prohibited.

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EDITOR’S NOTE

Speed, community engagement, trust and training vital to contain epidemics

D

iwali had special significance this year, as we tried to re-capture the joy of a pre-pandemic Diwali. But for many families, the festive season was bitter-sweet, with memories of lost family members tempering the celebrations. And no one can be blamed for that quick crossing of fingers that our unmasked festive get-togethers in October will not result in COVID waves in December? Have our immune systems re-bounded and will our COVID-19 shots prevent a COVID-23?

Beyond COVID, there are concerns that the climate change is one of the factors leading to more disease outbreaks. As leaders meet in Egypt for COP27 climate summit, a recent WHO analysis of the seven countries in the greater Horn of Africa - Djibouti, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda – recorded 39 reported outbreaks, flooding and other acute public health events just between the first 10 months of 2022 (January 1 - October 30, 2022). This is reportedly already the highest annual reported number since 2000. The WHO report lists outbreaks of anthrax, measles, cholera, yellow fever, chikungunya, meningitis, and other infectious diseases as accounting for more than 80 per cent of the acute public health events reported, with drought, flooding and other disasters accounting for 18 per cent.

But as we near the third anniversary of the COVID19 pandemic, there is also hope that the lessons of the COVID years are being translated into better implemented public health policies. Cautious hope comes from studies like the recently released second “Epidemics that Didn’t Happen” report where the non-profit Resolve to Save Lives features six disease outbreaks that public health authorities managed to contain in 2021, even as healthcare staff were coping with the worst of the COVID-19 waves. This report follows the inaugural “Epidemics that Didn’t Happen” report that featured nine examples of outbreaks that were contained quickly, ‘because of careful planning and swift strategic action.’

One of the six examples in the 2021 report details how Kerala took to heart the lessons from past Nipah outbreaks and succeeded in restricting the 2019 outbreak to just one case. The facts have learnings for all of us. On August 29, 2021, a 12-year old boy was bought to a clinic with headache and low-grade fever. In hindsight, the symptoms were obviously too general to be immediately linked to past Nipah outbreaks which delayed diagnosis by a few days. The boy’s health deteriorated as he was transferred from one hospital to another.

It was only on September 3 that his samples were sent to Pune's National Institute of Virology. The samples tested positive for antibodies on September 4 but it was too late for the patient: the boy passed away on September 5. However, this was the only case in this outbreak, an indication of the state's high preparedness and response levels.

These “Epidemics that Didn’t Happen” must serve as beacons of light to all policy makers and practitioners across the public health ecosystem. These success

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Why wait for an epidemic/ pandemic when it is cheaper and less painful to prevent it?

stories must be studied, to understand how they can be adapted and adopted to prevent, detect, contain and treat existing and future disease threats. The report discusses ‘how global and local investments in preparedness, combined with swift, strategic responses by public health authorities, can transform the trajectory of disease outbreaks, saving lives and preventing suffering.’

More importantly, these successful outbreak responses from around the world - from Brazil, Burkina Faso, Democratic Republic of Congo, Guinea, Indonesia, and Tanzania, besides India - ‘demonstrate the returns of investing in preparedness and response systems’ and ‘are a testament to the power of preparedness and a roadmap for future success in preventing epidemics.’

In other words, these stories prove that investment in public health infrastructure pay dividends many times over. Why wait for an epidemic/pandemic when it is cheaper and less painful to prevent it?

The report highlights four themes or learnings from these stories. Firstly, speed of response is essential.

Secondly, local communities need to be part of the well-coordinated initial reporting of cases as well as containment measures. But this can only happen if there is trust between the community and the health authorities, which is the third observation. The fourth observation is that health care workers, especially community and frontline workers, need to be trained, supported and provided with access to resources and assistance to stop epidemics. As the report summarises, the bottom line is: when countries prepare consistently and act decisively, they can prevent epidemics.

How does India’s public health response fare on these four points? As the example from Kerala demonstrates, detecting and responding quickly to an outbreak, with cooperation of the community, is the difference between an outbreak that is contained and one that spreads unchecked.

Hopefully, these examples will silence critics who argue that health budgets need to be diverted to other sectors, now that COVID seems to be under control. Some states in India are already good examples with well-implemented tele-health schemes, closer monitoring of health budgets, successful systems to track beneficiaries of health subsidies to detect frauds.

But where are we on the tougher problems like matching disease burden with fund outlays to reach out to marginalised populations with special needs like tribals in hard-to-reach areas or TB/HIV patients who face a double burden of disease and social stigma? In future editions of Express Healthcare, we hope to delve deeper into how public health authorities have incorporated the learnings of the pandemic into various aspects. Do write in with suggestions.

VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com viveka.roy3@gmail.com

HEALTHCARE IT I N T E R V I E W

Cybercriminals consider healthcare institutions to be soft targets Vinayak Godse, CEO, Data Security Council of India (DSCI) in an interaction with Kalyani Sharma emphasises on the ways to safeguard healthcare data in the era of increasing cyber-attacks and highlights that ensuring security while designing, developing, and deploying applications will be critical in the fast-moving pace of digitisation What are the crucial steps to safeguard data security in hospitals?

Today, hospitals are spread across the geographies, nationally and some even globally. The hospital system evolved to manage data and technology operations centrally.

Applications for health information management, patient service platform, chronic disease management, mobile service delivery, and ERP/SAP are increasingly managed centrally. Now, hospitals are focusing on deploying intelligent platforms and integrating various devices and types of machinery.

Healthcare operations are becoming data-centric, emphasising recording, processing, inferring, and sharing for better patient experience, enhancing diagnostic decision-making, improving the productivity of operations, and exploring new possibilities. Pandemicinduced acceleration of video consultation, remote expert opinion, remote monitoring, and increasing collaboration for clinical research.

Robust security architecture and infrastructure protect data flowing within and outside hospital systems. Ensuring security while designing, developing, and deploying applications will be critical in the fast-moving pace of digitisation. More importantly, as health data is classified as sensitive information, hospitals should adopt a data-centric

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A sudden increase in offering digital health care, remote diagnosis and consultations, and remote monitoring is leading to increased collection and processing of data, primarily sensitive in nature, attracting strict provisions, obligations, and liabilities

approach to security.

Expectations of privacy for sensitive personal information are stringent, demanding extra care and caution. Obtaining comprehensive visibility over how data is collected, processed, generated, shared/received, and shared can help extend the coverage of the security program to the possibilities that can create significant ramifications. Augmenting a data-centric security stack, in combination with privacypreserving technologies, would help safeguard the data. Vulnerabilities and weaknesses in the configuration of devices, machinery, and systems connecting to the network tend to expose data and make it easy for attackers to steal information. Hence, healthcare systems need competent vulnerability and configuration management.

The adoption of Internet of Things (IoT) in the healthcare system exposes them to attacks on the hardware level. In the overall data-centric security design, equal attention should be given to hardware and embedded security.

Can you throw some light on the current challenges, which need to be addressed while dealing with patient data?

A sudden increase in offering digital health care, remote diagnosis and consultations, and remote monitoring is leading to increased collection and processing of data,

primarily sensitive in nature, attracting strict provisions, obligations, and liabilities. The policy regime in the country for privacy is still evolving, leaving notable gaps in how data is collected, processed, stored, and shared. Although the Supreme Court underlined the Right to Privacy, without well-defined content principles and competent regulatory and enforcement structure, the privacy of patient data might not get due attention. Individuals involved in collecting patient data are often unaware of the need to safeguard patient information from unauthorised access.

Application design, development, and deployment might not adhere to privacy by design principles. The collection of data might not be proportionate. The patients might not get to exercise their rights on the data collected. The data gets locked in one hospital system, making it difficult to port and increasing the costs of healthcare services.

Redressal to data breaches might not be effective.

What needs to be strengthened at the governance and policy level for a better data security ecosystem in India?

Supreme court's judgment of privacy as a fundamental right provides a constitutional guarantee, serving as a critical driver for a better data security ecosystem. Comprehensive

privacy regulation and enforcement and regulatory mechanism unveiled by it will improve governance at the ground level. Regulatory norms associated with data collection, process, usage, storage, and sharing would guide the implementation of privacy programs.

Frameworks and best practices would also help.

The DSCI developed a privacy framework [DPF] to help systematically implement privacy programs. Regulatory rules, guidance, and standards in specific areas, such as anonymisation, will also help improve data security and privacy. The creation of privacy assurance mechanisms and certification schemes are suggested for enhancing privacy governance.

Developing an ecosystem for data-centric security research and innovation will create privacy-preserving technologies. Due to their all-pervasiveness, associated sensor systems, and data-heavy applications, IoT systems demand specific attention from the efforts for security and privacy assurance.

The National Digital Health Mission (NDHM) has completed two years.

How do you see its progress so far? Where are we and what is yet to be achieved?

Connected, integrated, and systematised healthcare promises to remove pain, enhance the patient experience, improve operations productivity, avoid duplications and cost overruns, and create new possibilities for reach and inclusion. NDHM promises these benefits through national architectural and infrastructural intervention.

It emphasises access to realtime health records to provide informed decisions quickly while reducing the cost of services. With 24 crores of Ayushman Bharat Accounts, 162 thousand plus registered health facilities, 91 thousand plus registered

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healthcare professionals, and, more importantly, linking of 1.5 crores plus medical records, NDHM achieved notable success.

We would like to see its adoption improved across the states, especially in the linkage of medical records.

From the security

perspective, attempts are being put for a robust security architecture.

However, we would like to see how the architecture responds to contemporary trends in distributed computing for more resiliency and data protection, as announced by

AADHAAR in the recent past. It would also be remained to be seen how security is maintained in the expanding ecosystem, how applications onboarded address security threats, and how trends like anonymisation are adopted for privacy protection and

ethical processing. From a privacy perspective, NDHM is being envisaged as a significant intervention to transform the delivery of health care services, DSCI would like to contribute to the deliberations and efforts Continued on Page 13

HEALTHCARE IT I N T E R V I E W

Modern healthcare spaces must be designed with hybrid teams in mind Ron Emerson, Global Healthcare Lead, Zoom Video Communications in an interaction with Kalyani Sharma discusses the future of hybrid healthcare and highlights that digital solutions, such as telehealth consultations, can serve as entry points to provide speedier access to treatment and make it simpler for patients to attend non-physical examination follow-ups How are healthcare providers approaching a hybrid future?

With providers now seeing more patients via telehealth, many in the healthcare sector believe that telehealth has evolved faster in the last two years than it has in the previous decade. New telehealth solutions are being implemented and existing healthcare programs are improvised to include digital solutions to meet the growing demand for telehealth services. By addressing groups that have long been neglected or challenged due to the lack of access to medical treatment, the increasing adoption of telehealth services helps strengthen public health systems and enhance equality and accessibility in health services. People who live in remote places, lack dependable transportation or the capacity to take time off work, and have medical issues that make it difficult for them to visit doctors, can now receive quality care whenever and however it is most convenient for them.

When it comes to hybrid healthcare, digital first does not mean digital only. Digital solutions, such as telehealth consultations, can serve as entry points to provide speedier access to treatment and make it simpler for patients to attend nonphysical examination followups. Because of the link between access to treatment and quality of care, the digital

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components of the continuum of care are critical to ensuring equity in healthcare.

Telehealth has altered the competitive environment for private healthcare, allowing providers to give a larger group of patients access to high-quality, cost-effective and convenient care delivery.

Virtual consultations have become an essential alternative for patients seeking remote care, spurring a permanent transition to a hybrid form of healthcare.

Collaboration platforms are critical in allowing healthcare companies to interact with and care for patients. It allows clinicians to contact their patients no matter where they are and assist teams in collaborating on medical breakthroughs

What role are collaboration platforms playing in enhancing healthcare delivery and services?

Collaboration platforms are critical in allowing healthcare companies to interact with and care for patients. It allows clinicians to contact their patients no matter where they are, assists teams in collaborating on medical breakthroughs, and enables connections between family members, specialists, and world experts like never before.

Data indicates that videoassisted virtual visits will continue in the long run.

According to a May 2021 Qualtrics survey commissioned by Zoom, 45 per cent of respondents surveyed in India wanted access to healthcare both inperson and remotely in the future. A further 13 per cent planned to solely use virtual health services, the highest figure of all of the countries

HEALTHCARE IT polled. This emphasises the need to offer telehealth alternatives to reach individuals that do not otherwise have access to medical care.

Can you outline a few parameters for designing hybrid spaces that make telehealth collaboration easier and more effective?

More and more, healthcare and administrative interactions are happening among hybrid teamsclinicians joining a consultation from a different facility, and staff meeting over the video while working from home. Modern healthcare spaces must be designed with hybrid teams in mind. Here are a few considerations for designing spaces that make hybrid collaboration easier and more effective: ◆ Parity of communication: Remote participants in a video meeting may find it harder to see or hear their colleagues in a conference room, making it more difficult to follow the conversation, read facial expressions, and assess body language. Features like

Zoom Rooms Smart Gallery can help bridge that gap and give remote participants a more equitable experience. ◆ A consistent experience: It’s important for physicians and staff working at multiple facilities to always have a consistent video experience, no matter what conference room or telehealth cart they’re using. With Zoom Rooms, they can join video calls or share content with one touch, and easily move between rooms or facilities without having to learn how different systems work. ◆ Mobile carts for hybrid patient interaction: When a patient needs a telehealth consult or virtual interpreter, it’s often easier to bring technology to them than transport them to a room equipped with video capabilities. This is possible with Zoom Rooms and an all-in-one video conferencing device to build mobile carts that can go wherever your patients are.

Can you share some global healthcare use cases where Zoom is being leveraged and the outcomes thereof?

Zoom is being utilised across

the continuum of care from virtual consultations to patient care, and enabling the hybrid workforce in healthcare organisations to stay connected and agile and used as an important tool for medical education to healthcare professionals and patients. ◆ In India, Shyft - a global wellness platform was able to replicate the near-physical experience through an online medium and has made its presence felt in almost every corner of India. ◆ Butler Health System created customised telehealth workflows for scheduled appointments and unscheduled urgent care visits using Zoom. Zoom enabled providers to recreate much of the clinical experience for primary, specialty, and urgent care appointments, resulting in improved access to care for those who need it. ◆ Replacing multiple, disparate point solutions with a single platform to bridge the communication gap between locations was a top priority, and Moffitt Cancer Center created a holistic, single-point communications

experience and helped to enable HIPAA compliance using Zoom. ◆ From training rural nurses to expanding calling capabilities, Zoom’s solutions enabled Australian nursing agency Caring For You to thrive. Caring For You is an award-winning nursing agency with over 5,550 members working nationally across private and public healthcare.

Looking ahead beyond 2022, what are the trends you foresee in the healthcare market?

While prioritising treatment where and how patients prefer at home, on the go, or in person-telehealth will continue to play an important role in a hybrid model of care.

This transformation will enable the healthcare industry to lower costs, waste less resources, improve access to quality care, and provide better patient outcomes. Looking ahead, we can foresee continual innovation in the application of technology in areas ranging from care delivery to medical training.

As decentralised clinical

trials gain popularity, decentralisation will become a key theme for health and life sciences organisations as it allows pharmaceutical companies and contract research organisations (CROs) to unbind their research from specific trial sites, provide a more accessible patient experience, and reach a more diverse pool of patients. Decentralised business models will also enable firms to interact on a global scale and collaborate with the brightest minds across the world.

Communication will remain a key pillar for all of these advancements. Virtual collaboration technology will be used to improve care delivery, develop life-saving pharmaceuticals and equipment, and improve the patient experience across the continuum of care in the future. Similarly, techniques and practices connected to general wellness and healthy living will also transition into being serviced virtually through collaboration platforms.

Kalyani.sharma@expressindia.com journokalyani@gmail.com

Cybercriminals consider healthcare...

Continued from Page 11 of making privacy central to its design and execution. As an enabler of processing health data at a large scale, we would like to see it as a reference example in adhering to contemporary privacy virtues and values, including transparency, openness, and accountability.

It can ensure increased participation of patients by offering easy, effective, and informed ways to exercise the subject access rights. We would also like to see attention on data security and privacy use cases and active efforts in developing innovative solutions with the help of researchers and the start-up community. NDHM

and its plans could create a pipeline of new security and privacy start-ups in the country.

What are your views on the implementation of Electronic Medical Records (EMR) in the Indian healthcare system?

(Current status and any challenges)?

From the privacy perspective, one of the most challenging parts is to set interoperability standards.

Data portability is especially important in this National health mission vision as every citizen should have the right to port data from one place to another and continue getting services. This will change the entire paradigm where data

is available and not binding to a particular hospital.

Individual hospitals are getting integrated with the national systems, and with that structure in place, we will see quite a significant portability of data more effectively and efficiently.

These portable medical health records would probably save the cost of the health services that are provided to the citizen and ensure data privacy.

How do you see the future of cybersecurity in healthcare in India? (In terms of scalability and other factors) Healthcare is one of the largest sectors in India, both in terms of revenue and

employment. It is loaded with personal and critical data, making its security more important than ever before.

With the significant increase in data breaches in the healthcare segment, the focus on healthcare cybersecurity is expanding with new areas for investment. Cybercriminals are constantly seeking opportunities to gain access to health data, especially when many consider healthcare institutions to be soft targets. Data collected from such institutions also have significant value on the dark web.

Thus, to over these challenges, healthcare institutions need to focus more on safeguarding their

data by investing more in technological innovation and adopting holistic cybersecurity measures.

Steps like – integrating security into medical devices, security in the development and deployment of applications, data-centric security approaches, spreading awareness and training on cybersecurity measures, regular assessment of threats and sharing information to mitigate them, and setting up competent security operations could help the sector create a shield and to minimise the impact of cyber threats.

Kalyani.sharma@expressindia.com journokalyani@gmail.com

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HEALTHCARE IT

5G technology: Ushering in a new era of healthcare Nadeem Anam, Manager- Government Affairs, Communications & Partnerships, MTaI talks about recently launched 5G services in India and explains its impact on healthcare sector

P

rime Minister Narendra Modi launched 5G services earlier this month, marking a significant milestone for the ‘Digital India’ vision. It is expected to bring economic and societal benefits and spur a new wave of innovations and applications such as machine to machine communications, Artificial Intelligence (AI), Internet of Things (IoT), blockchain, etc. With the emergence of 5G mobile technology digital transformation will accelerate through a wide range of new services, technologies and ecosystems. It will revolutionise businesses, industries, innovation, and R&D in the country and is expected to contribute $450 billion to the economy by 2030.

Among the industries with the greatest potential for transformation is healthcare.

From homecare to healthcare, 5G technology has many applications in the ecosystem.

The high-speed network brings dedicated network slicing, guaranteed throughput, ultra-high speeds and zero latency. It promises to enable real-time data transfer and health monitoring, telemedicine, emergency care response and remote surgery

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From homecare to healthcare, 5G technology has many applications in the ecosystem.

The high-speed network brings dedicated network slicing, guaranteed throughput, ultrahigh speeds and zero latency

among other services.

In spite of recent positive developments, access to high quality and affordable healthcare remains a challenge in large parts of the country.

Over 65 percent of the population lives in rural areas with unevenly distributed health infrastructure, from limited or no access to quality care to overburdened facilities.

COVID-19 has opened up possibilities and opportunities in digital health over the past few years. With this experience, healthcare for all can be achieved through digital connectivity irrespective of economic, social and geographical conditions.

5G connectivity has potential to change the face of healthcare delivery with the emergence of a new connected healthcare ecosystem. This will impact the entire value chain from policy makers to payers and providers to the pharmaceutical & medtech industry. At the centre of the value chain will be patients who are no longer passive consumers, but actively engaged and driving outcomes.

It can play a vital role in solving many problems at the provider's end. There will be benefits to providers in opti-

mising their services from telemedicine frameworks, bed occupancy, inventory management of critical/emergency medications and devices, Electronic Health Records (EHRs), drone ambulances, and more.

Many of the problems in healthcare can be addressed through medtech. Integration of 5G with other advanced technologies like AI, the Internet of Medical Things (IoMT), the cloud, big data analytics, geolocation sensors, real-time monitors, robotics, 3D printing, IR/VR, medtech can bridge the distance between the care provider and the patient. Through the use of 5G enabled devices, reliable data can be collected and clinical trials can be improved and accelerated.

5G has enormous potential in healthcare, provided that it is properly implemented and coordinated among all stakeholders. The challenge is to ensure end-to-end security and data privacy protocols to protect personal and highly sensitive data. It is imperative that regulators and policymakers develop rules to protect misuse of sensitive data for faster adoption of 5G in healthcare.

HEALTHCARE IT

Blockchain in healthcare: Assessing its potential to disrupt the sector Nilesh Jahagirdar, Co-Founder & VP of Marketing & Solutions, Xcube Labs stresses that blockchain in healthcare has moved beyond the trigger of innovation. Understanding the scope of the technology disruption in healthcare is necessary to make sense of the current healthcare landscape, the problems it intends to solve, and the future of healthcare

T

he healthcare industry has undergone a dramatic transformation with the emergence of technology-driven innovations.

These developments have made patient treatment more straightforward and focused on a patient-centric strategy for improved care delivery.

Considering the expedited digital adoption in healthcare, it is one of the most likely sectors to be among the first to embrace blockchain technology and other Web3 features.

By 2030, the market for blockchain technology in healthcare is projected to attain a valuation of USD 121 billion, growing at a CAGR of 68.3 per cent between 2022 and 2030. Blockchain in healthcare has moved beyond the trigger of innovation. Understanding the scope of the technology disruption in healthcare is necessary to make sense of the current healthcare landscape, the problems it intends to solve, and the future of healthcare.

On the broader front, it improves security and data interchange, boosting the credibility of the healthcare system and providing patients with the privacy of their medical records.

Transparency in supply chain In 2022, supply chain transparency is the most pressing need across all sectors. In healthcare, it is necessary to ensure the origin of medical goods for the authenticity and credibility of the healthcare provider. Blockchain-based systems enable the tracking of products from manufacturing to the endpoint of the supply

Considering the growing number of patient death due to the supply of illicit medicines and appliances, blockchain-based systems at every stage of the production and distribution processes increase coordination between producers and end consumers chain. As a result, it enables visibility and transparency of the goods, increasing customers’ confidence in the supply chain.

Considering the growing number of patient death due to the supply of illicit medicines and appliances, blockchain-based systems at every stage of the production and distribution processes in-

crease coordination between producers and end consumers. It is crucial in optimising inventory management and building new data ecosystems to support research and development and new product development.

Continuous interoperability among healthcare professionals

The exchange of patient data between healthcare providers has been challenging, given the need to maintain the privacy of patient records. Traditionally, handling patient data was a complex task and raised complications in different healthcare databases.

Blockchain is a decentralised ledger technology system that resolves privacy issues by delivering a unified platform for storing and managing relevant patient data while preserving security with control over accessibility.

Various pilot initiatives in the blockchain healthcare domain potentially enhance the interoperability of the healthcare industry. This empowers patients to share their data and manage the accessibility with a higher degree of security.

Cryptocurrency acceptance for healthcare transactions Cryptocurrencies have gained more recognition as use cases in healthcare-related payments. Several nations have approved the usage of cryptocurrencies, making it possible for medical professionals to accept the new payment method in cryptocurrency.

For instance, technologydriven medical groups have acknowledged the use of bitcoin virtual currency in initiating healthcare transactions.

With blockchain, healthcare stakeholders can enjoy greater freedom to carry out transactions on a global scale.

The cost of transfers may fluctuate along with exchange prices, but it serves value and rewards patients on the monetary front.

Advancing medical tourism sector Patients looking for better medical treatment overseas continue to be successful businesses worldwide. The dependence on bitcoin and other blockchain-derived approaches in medical tourism has become a new priority. The demand for blockchain technology is more pressing than in local healthcare contexts as people travel globally to benefit from better and advanced treatment.

Patients leverage blockchain-enabled digital payment systems to provide safe, quick, and direct cryptocurrency payments, reducing the inconveniences related to bank intermediation, currency volatility, and transaction delays. Besides, the instant access to blockchain-stored medical records assists patients in avoiding unnecessary diagnostic procedures and consultations and provides trustworthy patient information in an emergency.

The bottom line Blockchain technology is a disruptive breakthrough affecting several industries, from fintech to gaming, and healthcare is no exception. Healthcare stakeholders similarly leverage the possibilities offered by blockchain technology and have made significant investments to support the development of more effective healthcare systems. It has already shown the potential to upend the global healthcare sector.

The industry is projected to undergo further transformations due to the growing acceptance of blockchain and its associated technologies.

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The new era of communicable diseases demands fresh strategies and a balance of resources, policies and technology

By Kalyani Sharma

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part from already existing communicable diseases like Tuberculosis (TB), AIDS and Malaria, there is an increase in the frequency and scale of communicable diseases with pandemic potential. The most recent being COVID-19. This new era of communicable diseases is defined by outbreaks of emerging, re-emerging and endemic pathogens that spread quickly, aided by global connectivity and shifted ranges owing to climate change.

Talking about the impact of infectious diseases on society, Dr Gunisha Pasricha, Principal Scientist, Infectious Disease Expert, MedGenome Labs said, “Infectious diseases present a critical threat to global health security with high morbidity, mortality, and healthcare costs. A key contributor to the emergence and re-emergence of infectious diseases is human behavior.

The movement of human beings, growing population, social and health inequalities, and climate change have caused imbalances in the complex ecosystem which have caused newer communicable diseases or the re-appearance of the older ones. There is a constant need for the development of rapid and cost-effective diagnostics, prevention, therapeutic strategies and maintaining real-time epidemiological surveillance for these diseases.”

Dr Monalisa Sahu, Consultant Infectious Diseases, Yashoda Hospitals, Hyderabad highlights, “Communicable diseases with pandemic potential pose a real public health threat, and these disease outbreaks can have serious social, political, and economic impacts. Lessons were learned from the previous outbreak events, and farreaching advances have been made. Although, pandemic preparedness remains a global challenge. The global need for funding for pandemic preparedness and response is presently falling short in com-

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The movement of human beings, growing population, social and health inequalities, and climate change have caused imbalances in the complex ecosystem which have caused newer communicable diseases or the re-appearance of the older ones Dr Gunisha Pasricha Principal Scientist, Infectious Disease Expert, MedGenome

Lessons were learned from the previous outbreak events, and far-reaching advances have been made.

Although, pandemic preparedness remains a global challenge Dr Monalisa Sahu Consultant Infectious Diseases, Yashoda Hospitals, Hyderabad

Now since the storm of the pandemic has settled, there is an imminent need to prioritise communicable diseases, such as malaria in the post-pandemic world Pratik Kumar Country Director, Malaria No More

Sexually transmitted diseases could be controlled by organising awareness programs. However, in the light of COVID-19, when the pandemic has become endemic, the need for detecting these diseases faster has become a prime concern Neeraj Gupta Founder & CEO, Genes2Me

parison to its requirement.

Several important factors relating to human behavior and activities, pathogen evolution, poverty, and changes in the environment as well as dynamic human interactions with animals have contributed to infectious disease emergence and transmission.”

Where do we stand: Current status?

There are enormous advances in medical sciences accompanied by innovations, more R&D, new technologies and realisation of incorporating mass awareness programs, especially in case of diseases like HIV/AIDS, TB, Malaria, Severe Acute Respiratory Syndrome (SARS), Avian Flu, and Antibiotic-Resistant Infections (superbugs). But we still have a long way to go to completely eradicate them from the system, considering the rise in factors like globalisation, climate change, urbanisation and mass travel.

India had been making progress in diagnosing and treating a progressively increasing proportion of communicable diseases like TB, Malaria and HIV but this was before the pandemic. There was a significant disruption of this positive trend during the pandemic.

One of the examples is, in 2020, fewer people were diagnosed with TB than the year prior for the first time in many years. However, this did not mean that TB incidences were declining, but rather more resources were allocated and redirected toward COVID-19.

Applying some of the lessons learned to respond to other infectious diseases effectively is the need of the hour. One of the lessons is introduction and incorporation of new medical technologies in the system.

Elaborating on the impact of the pandemic on Malaria management, Pratik Kumar, Country Director, Malaria No More said, “The year 2020 brought along with it a myriad of challenges as it exposed us to the deadly COVID-19 pan-

Without access to cheaper and widely available sequencing technology, it will be difficult to face new/emerging pathogens. There was also a huge amount of unscientific and unnecessary use of diagnostics - especially among biomarkers of inflammation during the COVID Dr Anup Warrier Consultant- Infectious Disease & Infection Control, Aster Medcity, Kochi

In the last decade or so, digital advances like AI, machine learning, the internet of things, and deep tech have shown their promise in the automated detection of various infectious diseases. AI algorithms have proven to be highly accurate and useful triage tools for TB detection, especially in remote low-resource settings where skilled radiologists are in shortage Madhav Joshi CEO, India Health Fund (seeded by Tata Trusts)

Technology has evolved from simple culture to polymerase Chain Reaction-Based Markers for gene tagging in the past few decades. This has changed how diseases and conditions are diagnosed. However, the challenge at the current time is to identify and analyse new threats at high speed so that it saves valuable time and enables us to combat the condition in a faster manner Dr Rahul Pandit Director-Critical Care, Fortis Hospitals Mumbai, Member of National COVID19 Taskforce & Maharashtra’s COVID-19 Taskforce

A global, risk-based, multisectoral viral surveillance network would focus on detecting new “high consequence” viruses in humans and animals in hotspots for emerging risks. However, establishing such a network for longitudinal surveillance has considerable challenges, particularly in under-resourced, hotspot regions, where basic health and laboratory capacities are weak Vikram Thaploo CEO, Apollo Telehealth

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cover ) demic. The world responded by focusing all resources and attention towards battling the disease, as was the need of the hour. Thankfully, we have now reached a situation where COVID is more under control, and hopefully, the worst of the pandemic is behind us. While prompt redirection of public health priority towards COVID at its onset was essential, a byproduct of that was also the de-prioritisation of other public health issues communicable diseases such as mosquito-borne diseases amongst them. An illustration of this decreased priority is the reduction in malaria surveillance by approximately 38 per cent between 2019 and 2020, as highlighted by official numbers.”

“Now since the storm of the pandemic has settled, there is an imminent need to prioritise communicable diseases, such as malaria in the post-pandemic world. India has observed tremendous progress over the last few years in controlling the spread of malaria. However, as the country approaches elimination, realising the honourable prime minister's ambition of eliminating malaria by 2030, we need an aggressive and targeted strategy that addresses the key gaps and challenges currently existing in our malaria elimination drive.”

The new era of communicable diseases demands fresh strategies and a balance of resources, policies and technology.

Neeraj Gupta, Founder & CEO, Genes2Me said, “There is no shadow of a doubt that 2020 has been a year which taught all of us a lesson in some way or the other. If cleanliness may not be next to godliness, it will surely be next to healthy living. At times when even breathing without a mask in public was stifled, it taught a lesson that it's not too late to be prepared. This hang of COVID-19 has helped people understand the need for sheer protection from spread-

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AI and machine learning techniques are increasing in healthcare and have been widely applied to infectious disease outbreak detection & early warning, trend prediction & public health response modeling & assessment. AI is still in its early stage of development with a lot of potential to be explored in the future Dr Rashmi M Consultant-Microbiology & HIC, BGS Gleneagles Global Hospital, Bengaluru

It is difficult to prioritise diseases for surveillance as it involves extensive value judgments, such as weighing the importance of early detection of a highly infectious disease versus monitoring endemic, common, but less severe diseases. Therefore, priorities must be established that guarantee that both planning and resource availability are rational, explicit, and transparent. Priorities should also be reviewed regularly because dangers evolve over time Dr Preet Pal Thakur Co-Founder, Glamyo health

Political interests and National trade priorities should be set aside and a rigorous international collaboration is essential for the detection, prevention and control of an emerging infectious disease outbreak with potential for global spread Dr Sravani Reddy Global COO & Executive Director of Board, Ojaska

COVID has given us a very good template. We are better prepared to handle an outbreak as compared to where we were three years ago. We are able to identify an outbreak quickly and take the necessary precautions and measures to control it. There are disease notification systems and epidemiologists are working on identifying an outbreak Dr John Paul Infectious Disease specialist, SPARSH Hospital

ing diseases which is indeed a good thing It can be conceded that after years of campaigning, people could be made aware of the gravitas of safe sex. Sexually transmitted diseases could be controlled by organising awareness programs. However, in the light of COVID-19, when the pandemic has become endemic, the need for detecting these diseases faster has become a prime concern.”

Access to high-quality diagnostics to manage the burden of communicable diseases As per WHO, an estimated 66 million lives were saved through TB diagnosis and treatment between 2000 and 2020. World Hepatitis Alliance highlights that more than 300 million people are infected with the hepatitis B virus (HBV) or the hepatitis C virus (HCV) and 9 out of 10 people living with viral hepatitis are unaware. Access to high-quality testing and treatment monitoring is important for managing the burden of communicable diseases. The diagnostic landscape of infectious diseases has undergone major growth, especially during the pandemic which highlighted the role of the 3T (Test, Track and Treat) strategy in containing and managing the infectious disease.

Stressing on the current status of diagnostics, Dr Anup Warrier, ConsultantInfectious Disease & Infection Control, Aster Medcity, Kochi said, “Molecular diagnostics has entered the arena in a big way with lots of PCR testing capable labs coming up and the regular labs ramping up to accommodate PCR based testing. This infrastructure can be used for the diagnosis of many other infectious diseases other than COVID-19, including newer pathogens. The gaps are in the cost barrier with sequencing and the high investments required for sequencing. Without access to cheaper and widely available sequencing technology, it will

The corona pandemic has made it very clear that infectious diseases and infrastructure are closely linked and how infrastructure can be impacted by infectious diseases. We need to be better prepared for future infectious disease threats – for this, we need to have proactive measures in place rather than acting in times of crisis Dr Manav Manchanda Director & Head- Respiratory, Critical Care & Sleep Medicine, Asian Hospital

In India, the doctor-patient ratio is poor, at 0.7 doctors per 1,000 people. By increasing the number of training institutes, one can address the poor doctor-patient ratio to some extent. Considering India’s mammoth population, we need significantly a greater number of hospitals and doctors and other medical staff Pramod Kutty CEO & Co-Founder, Connect2MyDoctor

Regardless of one's economic, social, cultural, religious, or political background, achieving one's right to health is a core objective of the state's policies and programmes. However, for millions of people around the world, fully achieving their right to health remains a distant dream, in part because of barriers to accessing high-quality, timely, and affordable medicines, which are typically found in developing nations Vani Ahuja Co-Founder and Director, NatureCode

India needs to remain vigilant and develop 'safe' practices that include regular preventive diagnostic testing both to reduce the impact of future pandemics and to reduce and eliminate the prevalence of communicable diseases like TB Ashish Vikram CEO, Flebo.in

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cover ) be difficult to face new/emerging pathogens. There was also a huge amount of unscientific and unnecessary use of diagnostics - especially among biomarkers of inflammation during the COVID.” Ashish Vikram, CEO, Flebo.in stresses that, “One of the important means to prevent the spread of communicable diseases and also prevent other diseases from becoming serious and lifethreatening is to get tested quickly for any suspected diseases. This allows for timely preventive measures such as self-isolation or changes in lifestyle and if required start medication early. Prevention is better than cure is an adage that everybody has heard of but most of us still take an avoidance-avoidance approach to medical tests.

India needs to remain vigilant and develop 'safe' practices that include regular preventive diagnostic testing both to reduce the impact of future pandemics and to reduce and eliminate the prevalence of communicable diseases like TB.” Dr Pasricha adds, “COVID19 has thrust diagnostics to the forefront of healthcare conversations across the globe. Before COVID hit, diagnostics as a sector was not given its due importance although doctors rely heavily on it for making clinical decisions. Awareness about molecular diagnostic tests has also increased by leaps and bounds among consumers since then.

Presently over 3000 diagnostics laboratories across India offer Real-time PCR-based tests for COVID-19. Now when the COVID-19 pandemic is plateauing towards endemicity, it is very important to leverage and harness the infrastructure and talent pool already available for molecular testing. Infectious diseases are here to stay as stated by World Health Organization (WHO) in its 2007 report wherein it mentions that infectious diseases are emerging at a rate that has not been seen

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before. Since the 1970s, about 40 infectious diseases have been discovered, including SARS, MERS, Ebola, Chikungunya, Avian flu, Swine flu, Zika and most recently SARS-CoV-2 and Monkey Pox.” Dr Sahu emphasises that advances in molecular diagnostics and sequencing technology have played a pivotal role in the control of many infectious diseases. She said, “The development of nucleic acid detection and genome sequencing technology has tremendously revolutionised infectious disease research and helped better delineate the pathogenesis, diagnosis, and treatment and hence optimum patient care and management. For the early and accurate detection, characterisation, and quantitation of the ever-increasing number of infectious pathogens, newer molecular assays have been developed as compared to traditional methods.”

“The newer nucleic acid amplification methods today have a high-throughput capacity to generate a wealth of data on various types of pathogens including bacteria, parasites, and viruses, with specific disease markers such as virulence, antibiotic resistance, and susceptibility factors.

Multiple types of specimens including blood, stool, swabs, urine, Cerebrospinal Fluid (CSF) samples, and respiratory secretions can be used for these studies. Automation of nucleic acid detection technology provides “cutting-edge” platforms, which ultimately greatly impact patient management and afford more efficient epidemiological and public health interventions. The genomic and protein data, elucidated in the genomic and proteomic studies, has contributed mainly to successful vaccine design and drug development against most infectious disease pathogens”, she added.

Madhav Joshi, CEO, India Health Fund (seeded by Tata Trusts) considers technology

as a major boom in the diagnosis of TB. He explains, “While the traditional screening for TB using a lung X-ray, is the most sensitive and cost-efficient way, it is also a workforce-heavy and time-consuming process. As India continues to face an acute shortage of trained radiologists, TB diagnosis can often take weeks leading to missed cases, increased disease spread, delayed treatment, and higher mortality. In the last decade or so, digital advances like Artificial Intelligence (AI), machine learning, the internet of things, and deep tech have shown their promise in the automated detection of various infectious diseases, including tuberculosis where AIpowered deep learning neural networks are increasingly being used to analyse medical images, such as chest radiographs or x-rays. AI algorithms have proven to be highly accurate and useful triage tools for TB detection, especially in remote low-resource settings where skilled radiologists are in shortage.”

Talking on similar lines, Dr Rahul Pandit Director-Critical Care, Fortis Hospitals Mumbai, Member of National COVID19 Taskforce & Maharashtra’s COVID-19 Taskforce also highlights, “The global medical field has come a long way in diagnostics. Technology has evolved from simple culture to polymerase Chain Reaction-Based Markers for gene tagging in the past few decades. This has changed how diseases and conditions are diagnosed.

However, the challenge at the current time is to identify and analyse new threats at high speed so that it saves valuable time and enables us to combat the condition in a faster manner. To achieve this, techniques like molecular, immunological diagnostics, signature gene and proteomicbased platforms will always have to be available. Also, quick sampling from small outbreaks and surveillance samples for sewage water and

other materials will have to be screened for any potential threats of a large outbreak.

Similarly, the home-based kits will have to be more specific and sensitive, with an inbuilt default mode so that any test result is immediately reported to a central agency. By doing this, the onus of reporting does not fall on the patient’s shoulder.”

Disease surveillance and technology The effectiveness of India's current available surveillance systems is inadequate.

Surveillance systems like Integrated Disease Surveillance Program (IDSP) are in place already but the overall reporting and upkeep of the data through it is very limited. Increasing the scalability of technology in these systems will not only strengthen its overall implementation.

Genomic surveillance has also proved to be promising in the management of spread of emerging infectious diseases.

This helps researchers, epidemiologists and public health officials monitor the evolution of infectious disease agents, signal alerts on the spread of pathogens, and develop countermeasures such as vaccines.

Pointing out exploiting the intersection of technology and healthcare in the interest of the public at large, Arvind Sharma, Partner, and Pallavi Mall, Associate, Shardul Amarchand Mangaldas & Co shares, “There is immense scope to exploit the intersection of technology and healthcare in the interest of the public at large. By implementing adequate measures, allocating sufficient resources towards the cause, and encouraging this intersection to grow to cause further innovation, technology as a tool will prove to be a great solution to the problem of increasing communicable diseases. Additionally, the implementation of technology with respect to communicable diseases may also help in reducing the transmissibility of diseases from one

affected person to another by doing away with physical inter-personal contact, as was helpful in the case of COVID19, as a prevention and containment strategy. Further, technology can offer holistic approaches to managing communicable diseases by enabling tracking, surveillance and prevention. However, placing increasing reliance on technology in the healthcare sector would also call for adequate data protection and privacy safeguards to be set in place.”

Stressing the need to establish a formal global surveillance network specifically to prevent pandemics, Vikram Thaploo, CEO, Apollo Telehealth said, “A global, risk-based, multisectoral viral surveillance network would focus on detecting new “high consequence” viruses in humans and animals in hotspots for emerging risks.

However, establishing such a network for longitudinal surveillance has considerable challenges, particularly in under-resourced, hotspot regions, where basic health and laboratory capacities are weak.”

“Technical and logistical challenges exist in designing sampling frames for viral surveillance, establishing mechanisms for information sharing about rare spillover events, training a skilled workforce, and ensuring infrastructural support across public and animal health sectors for the collection of biological samples, transportation, and laboratory testing. For the sustainability of an early warning system, strong political commitment, a sound governance structure, and long-term financing will have to be assured. The opportunity exists to leverage political and financial support to establish and implement a global early warning surveillance network to detect emerging threats”, he added.

Explaining the role of disease surveillance, Dr Rashmi M, Consultant-Microbiology & HIC, BGS Gleneagles Global

Hospital, Bengaluru said, “Main role of surveillance is to detect an outbreak, identify variants, map geographical spread, and monitor vaccine efficacy. The WHO oversees developments globally. In India surveillance and coordination are taken care of by the national center for disease control (NCDC). Integrated health information platform (IHIP) is a decentralised state saved surveillance system for epidemic-prone diseases to detect early warning signals so that timely and effective public actions can be initiated.

Artificial intelligence/ machine learning techniques are increasing in healthcare and have been widely applied to infectious disease outbreak detection & early warning, trend prediction & public health response modeling & assessment. AI is still in its early stage of development with a lot of potential to be explored in the future.”

Stressing the need for prioritising surveillance, Dr Preet Pal Thakur, Co-Founder, Glamyo health said, “The primary goal of priority surveillance is to make the best possible use of restricted human and financial resources for disease control while keeping changing needs in mind. It is difficult to prioritise diseases for surveillance as it involves extensive value judgments, such as weighing the importance of early detection of a highly infectious disease versus monitoring endemic, common, but less severe diseases.

Therefore, priorities must be established that guarantee that both planning and resource availability are rational, explicit, and transparent. Priorities should also be reviewed regularly because dangers evolve over time.”

Dr Sravani Reddy, Global COO & Executive Director of Board, Ojaska also agrees that “Web-based surveillance systems can help better reporting if geographical surveillance gaps are filled. This will ensure accurate acquisition and analysis of data from the

internet.”

Dr John Paul, Infectious Disease specialist, SPARSH Hospital emphasises, “COVID has given us a very good template. We are better prepared to handle an outbreak as compared to where we were three years ago. We are able to identify an outbreak quickly and take the necessary precautions and measures to control it. There are disease notification systems and epidemiologists are working on identifying an outbreak. We now have robust systems in place to respond to such outbreaks.

There are certain disease surveillance practices in place led by the government. A lot of diseases are classified as notifiable diseases. Once there is an increase in the notifications or incidences of these diseases, there would be a response from the government. For example, for a given area, if the number of deaths due to dengue crosses a particular limit, then it automatically activates a particular vertical which will look into the reasons behind it and figure appropriate response for it.”

Infrastructure to deal with communicable diseases The biggest example of an intrinsic linkage between infrastructure and infectious diseases was COVID-19. A well-managed, implemented and strengthened healthcare infrastructure in place is the most crucial parameter when dealing with infectious diseases.

Commenting on this, Dr Warrier said, “Managing communicable diseases requires the development of infrastructure for both diagnostics (molecular diagnostics and sequencing, genotyping, etc.) and treating patients in "isolation rooms". Presently hospitals are poorly equipped to admit and manage infections requiring airborne isolation.

We need to look at cost-effective and scalable solutions to handle the influx of airborne infections from the communi-

ty. Also, we need to build up resilience in our supply chains for access to personal protective equipment (PPE) and diagnostic kits/reagent, etc.

Capacity building for healthcare facilities that can handle infectious diseases and labs that are capable of advanced sequencing will be required.”

Dr Manav Manchanda, Director & Head- Respiratory, Critical Care & Sleep Medicine, Asian Hospital believes that we need to have proactive measures in place rather than acting in times of crisis. He said, “The corona pandemic has made it very clear that infectious diseases and infrastructure are closely linked and how infrastructure can be impacted by infectious diseases. We need to be better prepared for future infectious disease threats – for this, we need to have proactive measures in place rather than acting in times of crisis. Besides, the interconnectedness of the world today means emerging outbreaks can have far-reaching impacts within a very short time. Infrastructure settings can become safer and more resilient spaces within their limits. A pandemic resilient infrastructure can contribute to a more stable economy by continuing to provide employment and enable continuity of necessary services thereby improving social outcomes for all.”

Pramod Kutty, CEO & CoFounder, Connect2MyDoctor considers poor doctor-patient ratio as a major gap in the infrastructure. He said, “In India, the doctor-patient ratio is poor, at 0.7 doctors per 1,000 people. By increasing the number of training institutes, one can address the poor doctor-patient ratio to some extent. Considering India’s mammoth population, we need significantly a greater number of hospitals and doctors and other medical staff.

Technology adoption is crucial and so is the rate of adoption.

To streamline the operational and clinical process technology can play a huge role besides

keeping the patient-doctor ratio in check. “ “Small clinics and hospitals constitute a significant part of the healthcare chain in India and it’s crucial that the bulk of these centres adopt healthcare tech in their daily lives.

Many are worried about their return on investments but in the long run, they will benefit immensely through digital adoption. The faster they realise this; the safer will be their business models. While the government is taking up measures to set up specialised units like AIIMS in multiple cities, we have to also set up medical colleges in every district, increase bed capacities at private and government facilities, and build and develop ICU type facilities in all districts. We have to also pay our nurses better”, he added.

Policy intervention COVID taught us how prompt and well-implemented policy interventions can help in quickly turn the tide against infectious diseases. The government and private sector need to work together and in sync for better outcomes of the policies. India already has strong policies and goals to eradicate and manage communicable diseases focusing on creating awareness, diagnosing them on time and making their treatment and medication accessible and affordable to the population. But there are gaps and challenges which require an integrated approach across the ecosystem.

Elaborating on the accessibility and availability of medicines part, Vani Ahuja, CoFounder and Director, NatureCode states, “Regardless of one's economic, social, cultural, religious, or political background, achieving one's right to health is a core objective of the state's policies and programmes. However, for millions of people around the world, fully achieving their right to health remains a distant dream, in part because of barriers to accessing high-quality, timely, and affordable

medicines, which are typically found in developing nations.

The values of equality, non-discrimination, openness, participation, and responsibility are inextricably intertwined with the availability of medications.

Although the issue of access to medicine concerns us all, those who are most impacted reside in low- and middle-income nations. Since everyone should have equal access to good health, this inequality should not be tolerated. These businesses have the resources and influence to increase the accessibility, affordability, and acceptability of their medications for those in need. No one will be left behind if they take steps to increase access to their medications.”

Dr Manchanda believes that “For effective access to healthcare during pandemics, the research and the guidelines must be systematically directed by a systemic framework. Availability of medicines and essential resources was hard hit during the first phase of COVID-19. As countries across the globe went into lockdown shutting down or limiting transport, this in turn affected manufacturing, supply and ultimately availability of medicines. Ensuring access to medicines and necessary healthcare services is critical to prevent illness and death.”

Dr Reddy said, “Political interests and National trade priorities should be set aside and a rigorous international collaboration is essential for the detection, prevention and control of an emerging infectious disease outbreak with potential for global spread.”

Way forward Characterising pandemic risk and identifying gaps in pandemic preparedness is essential for prioritising and targeting capacity-building efforts, which can be used to eradicate and manage communicable diseases in the post-pandemic world.

Kalyani.sharma@expressindia.com journokalyani@gmail.com

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cover ) Thinking differently for the future preparedness Aditya Kohli, CFO & Director-Sales, Allied Medical Limited (AML) highlights that it is important to look beyond the context of the current crisis to how infrastructure can be made more resilient across multiple dimensions in the face of numerous contagious diseases

M

any years from now we will remember 2020 as the year the world faced a global pandemic – a health crisis of this type and magnitude, defined by the pathology, transmission, and novelty of the virus, had not been experienced in recent memory. The resulting impact of COVID-19 on human health and wellbeing has been swift and devastating, presenting serious challenges to health systems and calling for rapid response to contain the virus, protect vulnerable populations, and intensify a search for a vaccine and treatment.

We are now keenly aware of this threat, and to weaknesses in healthcare systems and in societies more generally. In fact, the pandemic is a reminder of our own fragility, an uncomfortable thought perhaps, but risks to wellbeing may be difficult to foresee or control and can have drastic impacts. Yet preparedness and resilience are a silver lining to this crisis: healthcare infrastructure that are put in place that can respond to medical threats and shocks.

In this context, it is timely to assess healthcare facilities considering the impact of COVID-19. It is also important to look beyond the context of the current crisis to how infrastructure can be made more resilient across multiple dimensions in the face of numerous contagious diseases. Policy choices and decisive action to build healthcare systems has become a defining moment in the recovery of COVID-19. Hospitals were at the frontlines of impact and response to the pandemic yet are part of healthcare systems that only function well when all aspects

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We are at a point in emerging from the COVID-19 crisis to reassess healthcare infrastructure toughness and to also consider the possibilities of how medical industry can contribute more generally to preparedness for such types of communicable diseases in future are resilient. Preparation and response to the crisis was demonstrated in several areas, including setting up temporary hospitals in some jurisdictions to handle the influx of patients, prioritising care, or even “telehealth” solutions where care and information can be administered remotely through

telecommunication services. It remains extremely tough for patients and their families who are diagnosed with COVID-19 and non-COVID-19 patients with other serious ailments who need medical care and treatment. Health professionals did not have enough PPE. There was shortage of ventila-

tors and PPE all over the country. India’s economy dropped for the first time to full-year contraction in more than four decades. Everyone in the medical community including doctors, nurses, administration staff, cleaning staff, medical companies and all those who are in a support role tried to make a positive environment everywhere.

Allied Medical Limited (AML) extends its gratitude to all primary medical care providers and empathises with everyone who suffered in those challenging time.

When it comes to medical care and the approach towards patient management, we agree that a lot has changed. Doctors have adopted new ways to monitor and treat patients.

Hospitals have implemented new procedures and solutions for people across the globe.

Many new business models have emerged that offer disruptive and revolutionary patient management solutions.

Some of the trend that will stay post covid-19 are capital efficiency in hospitals as they start to view technology to be an enabler that helps them expand their reach beyond the brick-and-mortar boundary walls, realisation and adoption of the digital solution, a new kind of medical workforce equipped with the latest technology in remote patient monitoring and proactive patient management.

We are at a point in emerging from the COVID-19 crisis to reassess healthcare infrastructure toughness and to also consider the possibilities of how medical industry can contribute more generally to preparedness for such types of communicable diseases in fu-

ture. There is an opportunity for healthcare infrastructure systems to emerge from the crisis stronger, with a focus on “returning to better” through technology and innovation.

What is evident is that the cost of crisis can be much higher than the incremental cost implied to invest in Research and Development (R&D) for the medical industry. Building resilience is an investment to increase asset life and enhance long-term value. Resilience needs to also be considered at multiple levels, across the project life cycle, including aspects such as physical, operational, financial, and governance, while taking into account broader considerations such as shifting demographics or technological change. COVID-19 has highlighted vulnerabilities in healthcare, particularly as infrastructure, such as hospitals, has tended to be overlooked as part of critical systems.

COVID-19 has also accelerated or amplified trends that were already underway particularly related to demand for healthcare needs and potentials. Innovative and proactive responses to flexibility are needed to overcome the current crisis and to prepare for future ones, drawing together the elements of strength for what could become a new landscape. In this way, healthcare has emerged as improved and better vertical to withstand future challenges.

“Many times, what we perceive as an error or failure is actually a gift. And eventually we find that lessons learned from that discouraging experience prove to be of great worth.”

-Richelle E.

We must break the cycle of “panic then forget”after a public health emergency and make diagnostics a priority Dr Sanjay Sarin, Vice President-Access & Country Programmes, FIND discusses five key areas that need to be prioritised and funded in a post-pandemic world for better management of communicable diseases

T

he devastation wreaked

by COVID-19 over the last 2 years has shown us how vulnerable we are to infectious disease outbreaks. Unfortunately, future epidemics are inevitable, and may become more common because of factors such as intensive farming, climate change and increasing globalisation. As the pandemic showed us, when facing disease outbreaks, testing remains our first line of defence for early warning, response and containment, as we seek to avert future pandemics.

During the COVID-19 pandemic, we saw all too well the impact of weak diagnostic and surveillance networks, as countries scrambled to mobilise resources both to control transmission and inform public health decisions. Yet, diagnosis remains the weakest link in the care cascade, particularly in Low- and Middle Income Countries (LMICs), with almost 50 per cent of the world’s population having little to no access to diagnostics – a critical gap in our ability to defend against future health threats.

We must break the cycle of “panic then forget” after a public health emergency and make diagnostics a priority. As India prepares to take on the presidency of the G20, it’s important that we learn from the lessons of the COVID-19 pandemic to bring about a future where diagnostics are accessible whenever and wherever they are needed to defend against health threats and improve patient outcomes. Here, we discuss five key areas that need to be prioritised and funded in a post-pandemic world.

A concerted and targeted R&D effort would also accelerate availability of the different types of tests and platforms required to meet day-to-day diagnostic needs in clinical care Prioritised Research and Development (R&D) for diagnostics To contain future outbreaks, we need to make sure that the types of diagnostics needed for outbreak-prone pathogens,

such as SARS, MERS, Zika, Ebola and monkeypox, exist.

Currently, there are no suitable diagnostic tests for 60 per cent of priority infectious agents with outbreak potential. We are seeing the impact of this today,

as Uganda is dealing with a concerning outbreak of a rare Ebola strain, for which there are fewer validated diagnostic tests and no suitable rapid tests at present. An Ebola test directory has been set up to help track available tools to combat the outbreak.

Research efforts should be focused on the pathogens that the World Health Organization has identified as priorities for R&D. Alongside COVID-19 and Ebola, this list includes diseases such as Marburg virus disease, Lassa fever, MERS, SARS, Zika, as well as “Disease X”, the name given to a future unknown pathogen that could cause a serious outbreak.

The ambitious 100 Day Mission has been conceived with the aim of ensuring we have the tests, treatments and vaccines needed to respond to a new global health emergency within the first 100 days of an outbreak being identified. On the diagnostics side, the Coalition for Epidemic Preparedness Innovations (CEPI) and FIND, the global alliance for diagnostics, have been working with partners to devise a process to prioritise and develop diagnostic tests for key pathogens.

A concerted and targeted R&D effort would also accelerate availability of the different types of tests and platforms required to meet day-to-day diagnostic needs in clinical care – for example, the affordable, yet highly sensitive molecular tests that we need at the point of care, rather than in a laboratory, to tackle treatable diseases such as tuberculosis. In addition, developing rapid tests and self-testing approaches could help quickly interrupt the

transmission of many infectious diseases, enabling people to test regularly in the comfort of their homes – empowering the community with the tools needed to seek appropriate care and thereby breaking chains of transmission.

Expanded access to testing Even when they do exist, access to diagnostics remains highly inequitable; in some LMICs, basic diagnostic capacity is available in only 1 per cent of primary care clinics and 14 per cent of hospitals. Expanding access to tests in primary healthcare for both communicable and non-communicable diseases is therefore a critical priority to make progress towards universal health coverage (UHC) goals. It is also an essential component of outbreak preparedness – if people are unable to access regular clinician visits, it will be impossible for health professionals to spot anomalies or new infections before they spread. It is also important to leverage the capacity and expertise available in the private sector to complement the public sector efforts to increase access to diagnosis.

Strides are being made to bring diagnostics closer to patients, for example through initiatives such as the Joint Effort for Elimination of Tuberculosis.

Increased local manufacturing capacity The COVID-19 pandemic demonstrated the fragility of supply chains due to the overdependence of countries across the world on a limited number of diagnostic test manufacturers. This scenario in turn had a

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cover ) devastating impact on availability and accessibility of tests.

Building local manufacturing capacity for diagnostics is therefore vital to increase equitable access to testing and empower LMICs to meet their own diagnostic needs without reliance on global supply chains.

During the COVID-19 pandemic, the Access to COVID-19 Tools (ACT) Accelerator initiative worked to build local capacity for COVID-19 testing in India, Africa and South America, through expansion of local manufacturing infrastructure and technology transfers. A robust local diagnostic manufacturing capacity will also help LMICs respond rapidly to outbreaks and pandemics of diseases beyond COVID-19 in the future.

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Strengthened surveillance systems Diagnostic systems strengthening must encompass robust local surveillance systems, for rapid detection of outbreaks.

Connecting local surveillance systems with global surveillance networks like Global Antimicrobial Resistance and Use Surveillance System (GLASS) will also enable more comprehensive characterisation of existing and emerging threats at a global level.

In addition to abetting in spotting future threats, surveillance is also critically important to address current needs, including the silent pandemic of antimicrobial resistance (AMR). This is a par-

ticular concern in India that is threatening to undermine our ability to treat even common infections, as pathogens develop resistance to antibiotics.

Without action to address AMR, a shocking 10 million people a year are predicted to die of drug-resistant infections by 2050 – with 2.5 million of those deaths projected to be here in India.

Integrated health systems When it comes to disease outbreaks in our globally connected world, no one is safe until everyone is safe. Building our ability to respond to future disease outbreaks is ultimately part of broader health system strengthening

that encompasses tests, treatments, and vaccines. It must also be rooted in the One Health approach that recognises the interconnection of people, animals, and the environment.

Prioritising diagnostics for infectious diseases also needs to be driven through broader political and structural changes, sustained investment and public–private collaboration. India is a hotbed of innovation and continues to demonstrate great leadership in diagnostic testing, being the first country to implement a National Essential Diagnostics List, to make quality diagnostics an essential component of our health system.

The COVID-19 pandemic

has spurred a wave of investment in diagnostic innovations – not just in new testing technologies, but also for local manufacturing, resilient supply chains, operations research, and policy development. In particular, advances in point-of-care testing and multiplex platforms (individual instruments that can diagnose many diseases), have the potential to transform testing across levels of healthcare, making it accessible and affordable for everyone who needs it. As India prepares to take the reins of the G20, we have an opportunity to demonstrate the impact of strong leadership in healthcare, for our own country, and the world.

Acting now,protecting tomorrow: An overview into India’s fight against malaria Dr Sarthak Das, Chief Executive Officer, Asia Pacific Leaders Malaria Alliance (APLMA) emphasises that the robust surveillance systems help in capturing the true burden of the disease, which is key to designing and sustaining existing and new interventions

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s the most ambitious plan to tackle the problems of humanity recorded in history, the 17 United Nations Sustainable Development Goals (SDGs) lay out a vision for a sustainable future. Within the SDGs, one priority remains clear: the need to ensure good-health and well-being for all.

Though tremendous progress has been made, particularly prior to the pandemic, in improving the health of millions, preventable morbidity and mortality from HIV, tuberculosis, malaria, and neglected tropical diseases continued to cause needless suffering while imposing significant costs to a country's long-term social and economic development. Tackling these diseases, many of which have been around for centuries, is vital.

Take malaria, the world’s longest running pandemic. We have made tremendous strides towards eliminating the oldest known fever from the Asia Pacific region. Although the region only accounts for about one to three per cent of the global malaria burden, progress is uneven, and two billion people remain at risk of malaria in the region. Asia Pacific is also faced with a very localised epidemic across the region more than 90 per cent of malaria is in just five countries: India, Indonesia, Pakistan, Afghanistan, and Papua New Guinea. The end game for malaria must take the fight to rural sub-regions and remote pockets of malaria endemic countries where the

burden remains high.

Historically, malaria dropped from 100 million cases in the early 20th century to 100,000 in India by 1965, after which progress waned.

While India remains in the top five high-burden countries in the region, there have been impressive gains in the fight against malaria in the past two decades. Not only has India reduced malaria cases by almost 50 per cent from 2019 to 2020, it was also the only country among the 11 countries part of the WHO's High Burden to High Impact Initiative, to register progress against malaria in 2020, while also combating COVID-19. Still, there are five states where malaria cases are concentrated: Chhattisgarh, Odisha, Jharkhand, Mizoram and Tripura. The cases in these states account for almost two thirds of cases in the country and continue to pose

a serious threat to vulnerable communities.

India’s vision of eliminating malaria effectively by 2030 can be realised. Improving data and surveillance and strong operational management systems embedded within programs that reach at risk communities are critical.

Lessons from other diseases and malaria efforts may offer potential solutions.

The landmark National Polio Surveillance Project has taught us that the bedrock of disease elimination in any country is data on cases and deaths, as well as surveillance.

Robust surveillance systems help in capturing the true burden of the disease, which is key to designing and sustaining existing and new interventions. Presently, most states in India have made malaria a notifiable disease: every healthcare facility (public or private)

must report cases in both central and state health database.

The country should work to enforce this rule through a central gazette notification and developing systems which enable the private sector to report cases of malaria with ease and in real-time.

Strengthening data and surveillance systems is fundamental to a real-time fight which enable identification of hot spots and breaking the chain of transmission.

India is a rare example of a country that possesses indigenous high-quality evidence of malaria elimination in various settings in a time bound manner. In recent years, two initiatives and model elimination projects from Madhya Pradesh and Odisha have delivered successful results. The Malaria Elimination Demonstration Project (MEDP), which aimed to demonstrate that malaria elimination is possible in the 1,233 villages of the Mandla district in Madhya Pradesh, achieved a 91 per cent reduction in indigenous cases in this tribal district. MEDP also developed a sustainable and replicable model of malaria elimination for the country.

Through public outreach and mass surveys, the Odisha model improved access to malaria control tools, treatments and reduced the reservoirs of indigenous malaria by almost 90 per cent in hard-toreach terrains of Odisha.

Reaching the end game is not viable without targeting the places that are hardest to reach and building equitable health systems in those places.

The lessons learned from these initiatives provide interesting information and groundwork which could be tailored and replicated to scale up malaria eliminations efforts in states and communities, where malaria persists.

Such efforts may also reduce the burden of other vectorborne diseases.

Eliminating malaria has always remained a top priority for the Indian government. In 2016, India introduced the National Framework for Malaria Elimination to eliminate malaria in India in a phased manner by 2030. The Government of India has to date contributed US $60.5 million as a donor towards the Global Fund to Fight AIDS, Tuberculosis, and Malaria demonstrating the country’s shared commitment towards ending these three epidemics. In India, 94 per cent of malaria programme resources were funded domestically in 2020.

The outlook for India is promising. To accelerate malaria elimination efforts over the next eight years political leadership, a whole-of-government approach and strong inter-ministerial collaboration mechanisms will be key. The SGDs recognise that ending poverty and diseases must go hand-in-hand with strategies to support strong environments and protect health and wellbeing. Eliminating malaria in India is not only essential for the malaria-free future envisioned in the SDGs, but for also achieving the UN Sustainable Development Goals to ensure a better world by 2030.

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cover ) Embracing innovation to end drug-resistant TB in India Sandeep Juneja, SVP Market Access, TB Alliance stresses that having just combatted a dire health threat in COVID-19, it’s important we apply some of the lessons learned to respond to TB effectively

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ndia suffers the greatest number of Tuberculosis (TB) cases and deaths globally. As one of the world’s oldest and deadliest diseases and a strong contributor to poverty, TB should be a major priority for the health sector in India and the world. Over recent years prior to the COVID-19 pandemic, India had been making progress in diagnosing and treating a progressively increasing proportion of those with TB. This trend was significantly disrupted by the COVID-19 pandemic.

In 2020, fewer people were diagnosed with TB than the year prior for the first time in many years. However, this did not mean that TB incidence was declining, but rather that as more resources were allocated and redirected toward COVID-19 and as people were hesitant to leave their homes—even to seek medical care—more individuals with TB fell through the cracks.

In 2021, as the pandemic slowed in India, the National Tuberculosis Elimination Programme (NTEP) reported a 19 per cent increase in TB notifications from the previous year, confirming that TB remains a health threat in India as ever.

Having just combatted a dire health threat in COVID19, it’s important we apply some of the lessons learned to respond to TB a effectively.

One of these lessons is the key role that new medical technologies, such as diagnostics, vaccines, and drugs, can play in responding to a disease threat.

In response to TB, The NTEP has been active in adapting newer drugs and

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In 2021, as the pandemic slowed in India, the National Tuberculosis Elimination Programme (NTEP) reported a 19 per cent increase in TB notifications from the previous year, confirming that TB remains a health threat in India as ever treatment modalities. For example, an injection free treatment regimen for drug-resistant TB (DR-TB) has helped drive progress against TB in India. The NTEP has further reduced impediments to managing DR-TB by decentralis-

ing TB services to Ayushman Bharat – Health and Wellness Centres (AB-HWC). Additionally, in response to the release of “Guidelines for Programmatic Management of Drugresistant TB (PMDT) in India – 2021,” a shorter oral be-

daquiline (Bdq)-containing multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB) regimen was introduced and scaled up across the country. These are important steps and set the stage for more that can be done to improve the national response to DR-TB. DR-TB treatment remains at least 9-11 months long, lasting potentially up to 18 months (and more in some cases) and requires patients to take as many as 14,000 pills. Despite improvement in recent years, including the ones stated above, DR-TB treatment cures only about half of those treated. But there are now new tools available and the NTEP is taking steps to ensure proper conditions for implementing them.

TB Alliance has developed the drug, pretomanid, for treatment of DR-TB, which can be used as part of regimen to DR-TB. The threedrug, all-oral, six-month regimen, known as BPaL (bedaquiline + pretomanid + linezolid). BPaL displayed a treatment success rate of about 90 per cent in clinical trials. This new therapy allows, for the first time, DR-TB to be treated with similar success rates and duration of treatment for the much simpler form of TB, drug-sensitive TB (DS-TB).

Earlier this year, based on success observed in trials such as ZeNix and TBPRACTECAL, which added to the initial evidence on the BPaL regimen, WHO issued a rapid communication which will permit use of BPaL—with or without a fourth drug, moxifloxacin, (BPaL/M regimens)—for almost all forms of

DR-TB. Specifically, WHO’s communication states that BPaL/M may be used programmatically in place of 9month or longer (>18 months) regimens, in a vast majority of patients e.g., those aged =15 years and with those who have not had previous exposure to bedaquiline, pretomanid, and linezolid.

This is good news for all countries with high burden of DR-TB, such as India, which accounts for more than a quarter of the global caseload of that form of the disease. In fact, India has an opportunity to be a leader in adopting innovative DR-TB therapies like BPaL/M, as pretomanid is being produced in India by many licensees of TB Alliance in the country, such as Viatris, Lupin, and Macleods. Further, in support of universal health coverage the NTEP has expanded access to diagnostic molecular testing at the sub district level to ensure patients across the country are tested for DR-TB sooner and put on appropriate therapy.

The Indian environment is well suited to move fast to implement BPaL. Pretomanid for use in the BPaL regimen has been procured by more than 40 countries in the last two years. Evidence from trials and real-world use indicates BPaL is a shorter, more effective, less toxic, cost saving, cost-effective, and easier to administer treatment for DR-TB. Further scaling up the use of BPaL in India and around the world could have a transformative effect on DR-TB care, saving lives and health system resources, and putting us back on track to gain progress combatting TB.

Apanacea for public health care in India Dr Sita Rama Budaraju and Dr Satish V. Khalikar from Tata Trusts highlights that underutilisation of healthcare services due to lack of availability and accessibility not only leads to increase in morbidity and mortality of the communities, but also increases the transmission of communicable diseases

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ccess to safe, effective, quality, and affordable essential medicines is an important element of Sustainable Development Goals (SDG) for achieving universal health coverage by 2030. Medicines are not only to be looked upon in health perspective; their nonavailability in public health system makes it an issue to be solved because of the burden of Out of Pocket (OOP) expenses on poor patients.

Effectiveness of healthcare delivery entails access to medicines and other resources like healthcare facility, physician consultation, diagnostics and referral services. Medicines approximately comprise around 60 per cent of total outpatient expenses and 30 per cent of total inpatient out of pocket expenses.

Inadequate access compels people to seek private healthcare even for minor illnesses thereby straining their scarce financial resources. Accessibility is a major factor impacting healthcare delivery and this is more pronounced in rural and tribal areas as compared to urban areas.

Government of India’s “Janaushadhi scheme”, launched in 2008 with only 80 stores till 2014, was revamped as Pradhan Mantri Bhartiya Janaushadhi Pariyojana in 2015 and as on date has reached 8,600 across country. This scheme is making more than 1000 medicines and surgical items accessible and affordable across the country with one such pharmacy in every district.

Though initially the scheme faced challenges due to supply chain issues, those have been resolved through improvements in warehousing, transport etc.

Under-utilisation of healthcare services due to lack of availability and accessibility not only

Dr Sita Rama Budaraju

Dr Satish V. Khalikar

Availability, accessibility and affordability are the three “A’s”influencing the success of healthcare delivery mechanisms which lead to better utilisation of the services leads to increase in morbidity and mortality of the communities, but also increases the transmission of communicable diseases.

Drug Price Control order in 2013 placed more than 340 national essential drugs under price control thus making medicines more affordable and accessible. Epidemiological transition from communicable to non-communicable diseases was considered while placing drugs for cardiovascular diseases, diabetes etc. under price control.

Rise of e-Pharmacies in India has further improved accessibility of drugs to some extent.

With increasing acceptance of and regulations on quality and

safety, generic drugs will be helpful in achieving SDG goal of universal health coverage. This will increase affordability and access to the remote areas.

Recent trials using modern technology to improve access to healthcare resources provide a promising future, which include: Instant drug delivery: Drone delivery of medicines in remote areas: Currently there are few pilot initiatives demonstrating use of drones for vaccines and essential medicine delivery.

“Medicines from Sky” was one such pilot conducted in Telangana to deliver medicines to rural geography. Considering national policies for drones and overall technology growth, drones will

be used for even common medicines E pharmacies: E pharmacy market is expected to grow in the future at a robust growth rate of about 21 per cent compound annual growth rate during 2022-2027. Future growth in internet users will be a driving force for e-pharmacies, and there is large untapped potential in tier II and III cities, which can be catered to by e-pharmacies.

Door delivery of medicines by health workers post virtual consultation: Telemedicine platforms like e-Sanjivani OPD platform allows patients to virtually consult doctors from home but patients need to visit health facility for medicines. In

future, medicine prescribed in virtual consultations can be delivered at doorsteps by health workers if an integrated platform is made available for consultation and medicine dispensing.

Improving Janaushadhi scheme: Customising stock keeping units of Janaushadhi stores as per local population needs and parallel awareness activities on generic drugs is the need of the hour to streamline the programme.

Maintaining sync between virtual consultations and medicine accessibility: Integrated portal in public health system to ensure dispensing of medicines prescribed during virtual homebased consultations is very essential for sustainability of virtual consultation service. This helps in overcoming the shortages of health manpower to some extent.

Regulated encouragement to drone delivery: Though there are start-ups mushrooming to demonstrate drug delivery by drones, there is need to maintain cost of such tech-enabled drug delivery and regulations in terms of aviation policy.

Collaboration with e- pharmacies: Considering limitations of infrastructure and poor response/ adherence of population to drug regimens, there is a need to collaborate with private epharmacies to dispense essential drugs to chronically ill patients under treatment at public health facilities.

Availability, accessibility and affordability are the three “A’s” influencing the success of healthcare delivery mechanisms which lead to better utilisation of the services. These factors help in reaching out to the underserved communities thereby improving overall health outcomes.

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MEDTECH I N T E R V I E W

Rising cancer burden requires medtech companies to innovate and develop technologies that support critical stages of patient’s care journey Girish Gopalakrishnan, Regional Director – South, GE Healthcare in an interaction with Express Healthcare emphasises that a patient-specific approach holds promise in the areas of cancer, heart health and several genetic disorders We are witnessing that healthcare industry is increasingly prioritising patient centricity. What is driving this paradigm shift, and how can we work towards this end goal?

It is important to recognise that we are not all the same, and that grouping an individual by a disease alone will not facilitate precision diagnosis or therapy.

A lot changes when we begin to understand each individual’s family history, genetic makeup, and lifestyle. In the recent decade, we have seen rapid transitions from ‘Patientscentric’ to ‘Patient-centric’ solutions. Firstly, patientcentric care through clinical and technology solutions continue to focus on improving patient comfort, reducing wait times, accelerating the process of diagnosis-treatment, designing for lower exposure to dose/ radiation, and increasing transparency in treatment protocol. Thereafter, the transition to precision healthcare for the individual is being driven simultaneously by recognising the need for unique clinical pathways and advancing capabilities in genomics, and data computation.

Today, solutions using the power of Artificial Intelligence (AI), 5G, robotics, virtual and augmented reality are steering this shift. To a patient, this can lead to reduced risks and minimal trauma. In the Indian context, to work towards this goal, we must invest in tools, technologies, and infrastructure that enable patient centricity at scale. To shift the ecosystem towards collective adoption and large-

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scale implementation of precision care, we cannot act in silos. We need to build multistakeholder collaborations, across government, industry bodies, academia, private players, and startups. Evolving precision health and population health simultaneously to arrive at a sweet spot is the challenge and opportunity that we are staring at.

A patient-specific approach holds promise in the areas of cancer, heart health and several genetic disorders.

With a widespread digital transformation, the healthcare industry is turning a new leaf. Could you discuss some prominent

technology-led innovations that have impacted care across oncology, cardiology, and women’s health?

Over the past few years, we have seen the introduction of technologies that have had a massive impact, spanning various disease areas. Take, for instance, the rising complexities of patient profiles and shifting patterns within the cardiology, oncology, and women’s health. As India enters the ‘techade’, digital possibilities within the sector and across therapy areas are endless, whether it is with 5G or cloud computing. Today, we have more data than ever before, guiding careful analysis and precision medicine.

When we speak about oncology alone, investments are being made in the space of biomarkers that will decide what type of treatment would work best. Screening technologies that are selfscreening, causing minimal discomfort and increasing precision in diagnosis are crucial for early detection.

Genetic tests are becoming more affordable, AI & Machine Learning (ML) algorithms are leveraging data to address complex manifestations.

Surgery through robots that assist the surgeon are able to provide previously unattainable precision.

Similarly, technology-led innovations in cardiology are able to automatically measure Ejection Fractions (EF) through FDA approved AI/ML algorithms in Ultrasound.

High-end wearables can detect arrhythmias and provide an early warning to the patient and doctor. A high-end cardiac CT scanner uses AI algorithms to perform calcium scoring that can quantify the risk of heart disease. Moreover, robotic catheter navigation technology in conjunction with a cath lab allows for remote manipulation of catheters by the operators thereby limiting their exposure to radiation and reducing the discomfort of wearing leadaprons during long procedures.

Fractional Flow Reserve (FFR), a step used to determine the need of a stent for a coronary lesion has become faster, less invasive, and more affordable through image based FFR that has recently been approved by the FDA. Now, when we speak about Women’s health – FemTech, a

term coined by Ida Tin (Danish Entrepreneur) refers to technology innovations that focus on women’s health.

Interest and investment in this space is growing exponentially as there is both a clinical need and a market opportunity worldwide. Majority of the Healthcare workforce and care givers are women. They are also the primary decision makers around healthcare spends within families giving them the title of Chief Medical Officer in their homes. In this space the investments are around education, awareness, wellness, screening, tracking and treatment.

In summary, despite several technology breakthroughs in the industry, we are still just scratching the surface in each of these care areas for more coordination, affordability, and scale.

With National Cancer Awareness Day, on November 7th, fast approaching, could you elaborate on the cancer burden in our country, and the status of care? What are the game-changing solutions to better manage this disease across the continuum of care?

As per a report by The Indian Council of Medical Research (ICMR) and National Centre for Disease Informatics & Research (NCDIR, the number of Indians suffering from cancer is projected to increase to 29.8 million in 2025 from 26.7 million in 2021. Another report

by ICMR on the ‘Burden of cancers in India’ revealed that, seven cancers accounted for more than 40 per cent of the total disease burden in our country, with lung and breast

cancer collectively accounting for roughly half of this burden.

The post-covid window is an ideal opportunity to push the wellness mantra within our population. Investment in awareness and infrastructure for lifestyle modifications is the need of the hour.

The current cancer care system in India is burdened with gaps, leaving several millions vulnerable. There is a huge shortfall of qualified human resources and infrastructure. This obviously leads to long wait times for procedures such as radiation therapy and surgery.

This rising cancer burden requires medtech companies to innovate and develop medical technologies that support critical stages of a patient’s care journey – from diagnosis to therapy to prognosis – to superior outcomes.

For example, AI can be leveraged to gain actionable insights from data, which in turn can guide precise diagnosis and treatment, by identifying risk factors from holistic patient data to determine whether a lesion is malignant. With more integrated platforms and AIenhanced applications solving the problem of fragmented and disparate storage of data, practitioners can also access holistic patient data through unified interfaces. This can ensure that the trends or patterns are studied in detail and diagnostic and treatment decisions are made more swiftly.

Elaborate on how precision care can support breast cancer in Indian Women.

Breast cancer among Indian women is on an exponential rise and its incidence has overtaken uterine, cervical cancers.

Mortality due to breast cancer is alarming in India. In 2020, it was at 37 per cent compared to 17 per cent in the US. 65 per cent of patients in India present with stage III or IV of the disease, thereby severely restricting treatment options. The primary reason for this is the lack of awareness & screening resulting in diagnosis at an advanced stage of disease. Outside of genetic

One of the biggest reasons why women avoid a routine mammography is the awkward and painful process of breast compression with the assistance of a technician.Today, Mammography technology advancement, allows the women to use selfcompression techniques, where the woman is in charge of her own compression factors, a lot is attributed to rapidly changing lifestyles such as obesity, alcohol consumption, lack of exercise, reduced duration of breast feeding, etc. Our Indian healthcare system, despite advancements, is unable to cater to the rise in demand owing to lack of resources and trained staff.

Regular high-quality screening mammograms using latest digital technology such as Tomosynthesis and clinical breast exams are the most sensitive ways to screen for breast cancer. In Asymptomatic women especially, a screening mammogram, using low dose xray, is performed to detect early stages of breast cancer. The good news is when caught early, the disease is completely treatable. It not only helps to save a life but also helps save the breasts. One of the biggest reasons why women avoid a routine mammography is the awkward and painful process of breast compression with the assistance of a technician.

Today, Mammography technology advancement, allows the women to use selfcompression techniques, where the woman is in charge of her own compression.

Guidelines for women at average-risk recommend alternate year or annual mammograms above the age of 40. Large population-level screening camps in both urban and rural geographies can pick up cancers early and further reduce the disease burden.

High data volumes of images from the population can leverage AI-based algorithms thereby lowering the workload for clinical experts.

Other diagnostic technologies such as

Ultrasound and MRI are also utilised in diagnosis.

Ultrasound technology is used for localised imaging and in younger women with dense breasts. MRIs on the other hand are beneficial for imaging high-risk individuals. Timely diagnosis needs to be followed up with high quality treatment.

The challenge around treatment, is complexity, affordability, and geographic accessibility. Technology solutions along with synchronised efforts through government, private and public-private-partnerships will augment positive outcomes.

India’s cardiovascular disease burden is now increasingly impacting the younger population and rural communities. What are Wipro GE Healthcare’s latest initiatives in the field of cardiac care to address these shifting demographics?

When it comes to Cardiovascular Diseases (CVDs), shifting disease demographics and changing patient profiles have now become a reality. As per a report by The National Centre for Biotechnology Information (NCBI), we are increasingly seeing the younger generation, below 40 years of age, as well as tier 2 and tier 3 populations, being affected by CVD burden.1 With changing characteristics in demography, we must also change our approach to care.

We are well placed to support our cardiovascular stakeholders to address this clinical area through a wide range of technology and service solutions. In the early risk assessment phase, we design and produce ECGs, cardiac ultrasounds, cardiac CTs, MRI,

PET-CTs and Nuclear Medicine. Surgery equipment and Cath Labs are central to the treatment phase. And finally, during the monitoring phase our monitors, ECGs and Echo machines are crucial. We have been actively investing in technologies that tie them together through advanced visualization, image processing and other digital platforms. In addition, GE Healthcare has a distinguished heritage in contrast media development catering to cardiology and beyond. Specific to India, our focus has been to localise high end technology through investment in India manufacturing. With 4 factories in Bangalore, we continue to scale our capabilities and provide a platform for India talent in human resource and supply chain.

Wipro GE Healthcare recently launched a ‘Made in India’, AI-powered Cath Lab Optima IGS 320, to advance affordable cardiac care in India.

The Cath Lab, using a neural network-based interventional image chain (AutoRight technology), is designed to aim at automatically optimizing image quality and dose parameters at the lowest possible dose. These features can help clinicians focus their attention on patients during procedures where every second matters. Through the introduction of such innovative devices and by paving strategic partnerships with innovators like Boston Scientific, we aim to scale comprehensive end-toend cardiac care offerings across India that cater to a diverse range of patients.

There is a clear need to scale access to affordable quality

healthcare solutions nationwide, with currently low levels of digital medical technology penetration in rural (Tier 2 and Tier 3) regions. What is Wipro GE Healthcare doing to bridge this gap and reach a larger section of the population?

In India, if we want to reach a patient in the furthest corner of our country, we must embrace the ongoing digital transformation of the healthcare ecosystem. For instance, we can take advantage of high data speeds, low latency, and highly reliable connectivity that solutions like 5G provide, bridging gaps between practitioner and patient, or even amongst members of different medical specialties.

Through the launch of the 5G Innovation Lab in July this year, GE Healthcare aims to explore 5G connectivity use cases that could lead to groundbreaking advances in patient care, including by potentially bridging access gaps relating to cutting-edge technology and thus reaching Tier 2 and Tier 3 communities with enhanced care.

Another area where Wipro GE Healthcare aims to scale care in this regard is the GE Shop – a one-stop B2B ecommerce platform we introduced. Here, all our products can be easily purchased. Additionally, we have a team of strong and mature channel partners who form our natural extension to support us in reaching the length and breadth of our geography.

With such initiatives, we continue to remain committed to scaling easy access to needed devices, services, and technologies nationwide.

However, none of this is possible without several key players within the ecosystem coming together, leveraging their shared resources and comprehensive portfolios to deliver care more effectively for diseases that cause enormous regional burden.

At GE Healthcare, our purpose not only drives us to build a healthier future, but to create a world where healthcare has no limits.

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RADIOLOGY I N T E R V I E W

Teleradiology sector in India cannot grow on the back of governmental machinery alone Dr Arjun Kalyanpur, CEO & Chief Radiologist, Teleradiology Solutions in an interaction with Kalyani Sharma throws light on his company’s recently launched centre at AMTZ which will help providing teleradiology services to its rural health missions. He also highlights that the ruralurban gap in terms of radiologists' availability is bridged by the teleradiology process wherein the images are brought to the specialist What is the objective behind launching a new centre at Andhra Pradesh Medtech Zone (AMTZ)? What will be the key features of this centre?

The Teleradiology Solutions centre at AMTZ is being launched with the goal of engaging with the Government of India to help provide teleradiology services to its rural health missions (in keeping with the vision of the National Digital Health Mission), as well as to public sector units and state government health departments. In parallel, the centre provides access to a larger ecosystem of medical technology and device companies which are synergistic with teleradiology in their scope of enterprise.

Finally, its location in the AMTZ PyraMed complex is in symbolic alignment with the futuristic nature of teleradiology and its potential transformational impact within India.

The centre has an operations centre/reporting area with state-of-the-art equipment wherein high-quality reporting will be provided by skilled diagnostic imaging professionals. It also has an HR office, a boardroom/conference room and meeting rooms for business interactions.

Can you throw some light on the accessibility and affordability of teleradiology in rural parts of India? What are the current gaps and how can they be filled?

Our work in the state of Tripura along with our prior

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100,000+ beneficiaries and Poornasudha beneficiaries for Mammo screening were 4000+ where we provided mobile remote screening at a faster pace. The Telerad Foundation has contributed to the cause by completing 92,000 projects.

collaborative research with the NHSRC, New Delhi, has demonstrated that in the rural part of India, there is availability of imaging equipment in governmental centres, albeit in some cases legacy analog equipment, which largely remains unutilised due to the lack of radiologists to report the images. In this setting physicians are reluctant to obtain radiographs on patients who end up being referred/transferred long distances just to obtain a diagnosis, often at a huge cost to the patient's family. This is a significant gap in our healthcare delivery system. Implementing a teleradiology network allows for improving immediate radiologic diagnosis of high quality at the point of care which obviates the expense of patient transfer and benefits the patient's family greatly.

Moreover, the utilisation of imaging equipment is also enhanced. The rural-urban gap in terms of radiologists' availability (related to most radiologists being concentrated in metros) is bridged by the teleradiology process wherein the images are brought to the specialist. We have 1 radiologist in India per 100,000 people as compared to Europe which has 13 radiologists per 100,000 people or the US which has one radiologist for every 10,000 people. TRS has reported scans for over 6 million patients worldwide and counting.

Another gap is related to the legacy analog technologies, which require a digitisation process to enable teleradiology.

Our work in Tripura incorporated the use of a novel digitisation process to digitise legacy analog images to enable teleradiology review helping

Do you think teleradiology services still needs to be more inclusive in India in terms of better sync with the clinical profile of the patient and problem solving attitude?

The use of teleradiology incorporates the collection and transmission of clinical data (detailed patient history and clinical examination findings) in order that the interpretation is more meaningful and relevant.

The approach in India needs to be focused on delivering the relevant solution to the specific challenge. This includes image digitisation to overcome the challenge of legacy analog images which are still available in the primary care setting, as well as the use of low-cost router technology such as is represented by Telerad Tech's RADSpa which allows for efficient image upload to a cloud based infrastructure for efficient Teleradiology reporting.

The diverse nature of medical data, from records to images and live teleconsultations results in a wide range of volume that must be managed in teleradiology. What could be the possible solution for this?

Integrating with existing networks and programs such as the Ayushman Bharat Digital Mission and the National

Knowledge Network will ensure that teleradiology is deployed in the most clinically relevant environment with maximal scale of deployment and in sync with telemedicine networks.

Initiatives such as the unified health interface will enable teleradiology to be delivered at maximal scale and efficiency.

How can Public-Private Partnerships (PPP)s transform the teleradiology sector in India?

The teleradiology sector in India cannot grow on the back of the governmental machinery alone. PPPs can help fill the gaps and provide complementary strengths from the perspective of both technology, and service delivery.

The massive public health network of the government is ripe for innovation and private enterprise can bring in such innovation. Our work in Tripura provided us with valuable insights into the power of this collaboration. By providing lowcost innovative digitisation tools as well as training to the last mile providers, and by establishing a cloud-based teleradiology reporting infrastructure, we were able to address the radiology diagnostic needs of an entire state and ensure quality diagnostics to the largely tribal population of a remote north eastern state, delivered from the Indian metros, with the fulcrum being our headquarters in Bengaluru, India. This is ultimately what our country needs.

Kalyani.sharma@expressindia.com journokalyani@gmail.com

HOSPITAL INFRA

How can hospitals become more energy efficient?

Reghu Kumar, Head-Sustainability, BSI India highlights that given the current environmental impact, rising fuel costs and legally binding net zero commitments, it is vital for every hospital to reduce its energy usage

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nlike many other industries, hospitals operate 24 hours a day, and they depend on energy to run their services. They are required to keep their equipment always running. This includes running lights and ventilation as well as heating and cooling the building. As the largest consumers of energy in the world, hospitals are incredibly expensive to run. Heating, ventilation and lighting are responsible for about half of a hospital's energy costs.

Given the current environmental impact, rising fuel costs and legally binding net zero commitments, it is vital for every hospital to reduce its energy usage. Upgrading a hospital's power-draining equipment is an effective way to reduce energy use by 25 per cent. Other ways could include installing energy-efficient windows and using empty roof space for solar-generated electricity.

The huge energy consumption of our hospitals is a concern due to both the rising costs and the impact on the environment. While hospitals are places to save lives, their energy consumption can contribute to climate change. Although some progress is evident with reductions in carbon footprints, the challenge remains. The world is witnessing an unprecedented consensus across the globe on the need for closer alignment between enterprises and individuals on climate change. The adoption of global best practices over the environment, social, and governance (ESG) is topping the list of strategic business priorities for organisations to stay ahead of the curve.

Hospitals that can become more efficient through sustain-

The huge energy consumption of our hospitals is a concern due to both the rising costs and the impact on the environment.While hospitals are places to save lives, their energy consumption can contribute to climate change ability initiatives have more resources to direct toward patient care. In addition to cost savings, hospitals and care systems reap other benefits from

becoming more sustainable, including improved brand image and reputation, lower operational costs, and increased employee satisfaction and reten-

tion. They can also manage risk and regulatory compliance with improved facility operations and demonstrate corporate social responsibility.

Improving waste management is one of the most straightforward opportunities to go green in hospitals. Reviewing the waste management process will also ensure energy efficiency. Establishing sustainability criteria in waste management and/or procurement is the perfect opportunity for reinforced sustainability practices and commitments.

To support hospitals in managing their energy use and reducing their impact on the environment, it is helpful to have a set of standards to follow. Standards are an agreed way of doing things. They provide powerful tools for organisations to improve performance, reduce risk, and become more sustainable. Importantly, they can help hospitals monitor their energy use and identify how they can become more energy efficient.

Standards such as ISO 14001:2015, ISO 5001:2018 and ISO 20400 are the world's most recognised environmental management systems and provide a set of framework and guidelines to ensure effective environmental management, improve energy efficiency and adopt sustainable procurement practices. They can help hospitals to reduce carbon emissions, contribute to a low-carbon economy and become more resilient to environmental shocks.

Hospitals will need to show they are reducing their carbon emissions and meeting required targets. They can be supported in making their systems, controls and practices more sustainable by using standards that provide guidance on reducing the impact of their operational activities on the environment as well as streamlining costs.

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DIAGNOSTICS

Rise of telediagnostics in India Dr (Hon) S Senthil Kandeepan, Founder, MD and CEO, Healthwatch highlights the importance of telediagnosis in a healthcare system The road ahead

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he advancements in health technology have created a new branch of the healthcare system called telemedicine which encompasses consultations, diagnosis, nursing, medications and treatment, psychiatry and psychology, rehabilitation, and some specialised services.

The healthcare system in India has also witnessed a significant boom in recent years.

According to the CAGR report, the Indian healthcare sector is expected to rise threefold. At a CAGR of 16–17%, the hospital sector in India is predicted to grow from Rs 4 trillion (US$ 61.79 billion) in FY17 to Rs. 8.6 trillion (US$ 132.84 billion) by FY22. The digital healthcare market in India stood at US$ 116.61 billion in 2018 and is expected to increase at a CAGR of 27.41% to US$ 485.43 billion by 2024.

Although technological advancements have empowered and given a new approach to a health diagnosis, in a country like India, the deep penetration to the grassroots level is still missing due to a lack of trust in the technology. To handle the doubts and establish trust in the technology used, various health service providers use accurate methods and tools to monitor the health status, thus ensuring the reliability of telediagnosis methods. The healthcare experts believe that other than listening to the heart and lungs and visualising the tympanic membranes, telediagnosis can be very effective and successful in monitoring the health condition.

As the population in India is growing rapidly and in the upcoming future the elderly population will also increase and that’s where the implications of telediagnosis will come into play resulting in fewer hospital and clinic visits to get the tests done. The need for quick and reliable health data will be facilitated by the growing telediagnostic service providers.

Understanding telediagnositcs The transfer of actual medical records to a healthcare practitioner is termed telediagnosis.

The technology used for telediagnosis ensures that medical information and photos are kept safe after being digitised and uploaded so they may be sent electronically to a healthcare professional who can further access and examine those documents and photos to diagnose patients. It plays an important role in providing healthcare services to the public residing in the country's rural areas, as they do not have proper access to advanced healthcare facilities.

The benefits of telediagnosis The stringent lockdown in the country due to the COVID-19 outbreak prompted the need for telediagnostics as people could not visit hospitals and clinics for their health checkups. An existing telediagnosis system could have helped people to detect the symptoms

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Summing up

One of the major focuses of telediagnosis is the outreach to the country's rural population. It helps to cut down the distance allowing people to get easy access to consultation and medication and consult doctors easily.

Let’s look at some points highlighting the importance of telediagnosis in a healthcare system. ◆ One of the major focuses of telediagnosis is the outreach to the country's rural population.

It helps to cut down the distance allowing people to get easy access to consultation and medication. New healthcare startups with advanced tech-

nologies are coming up in the country, which helps in enabling diagnosis and providing people with effective medical intervention. ◆ The growth of telediagnosis services has reduced the costs of the medical tests conducted because it has provided the option of home-based tests. ◆ The long waiting period to get the test results is also done away with as telediagnosis

allows people to get their reports shortly. The service available in the healthcare sector ensures that people get their test results within 24 hours. ◆ For people to get their tests done, they do not have to be tech-savvy as the developments in the telediganositc sector have led to the emergence of service providers who help people and get their tests done.

Healthcare startups are expanding in India; hence it is important for these healthcare service providers to win the public's confidence in technologically based healthcare solutions. As more health start-ups emerge, the demand and supply sides of the ecosystem for digital health services in the country are predicted to explode. India will benefit from focusing on creating a technology-enabled healthcare ecosystem as the foundation for resolving numerous health issues. Because it is easily accessible, affordable, and has a greater reach to the public throughout the entire nation, a tech-based ecosystem of diagnosis, monitoring, assessment, and consultation will assist to improve the present healthcare sector.

HEALTHCARE TREND

Automated cath labs to enhance cardiovascular care in India: GlobalData GE Healthcare has recently introduced its first made-in-India Artificial Intelligence (AI) enabled cath lab diagnostic imaging platform, the Optima IGS 320

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E Healthcare has recently introduced its first made-in-India Artificial Intelligence (AI) enabled cath lab diagnostic imaging platform, the Optima IGS 320. This sophisticated interventional cardiology system will guide non-invasive cardiovascular procedures with better precision and versatility, says GlobalData GlobalData forecasts the Indian cardiovascular devices market to grow at a compound annual growth rate of 5 per cent between 2022 and 2030.

Research and development of advanced technologies are ex-

GlobalData forecasts the Indian cardiovascular devices market to grow at a compound annual growth rate of 5 per cent between 2022 and 2030.

Research and development of advanced technologies are expected to further drive the market pected to further drive the market.

Shachee Singh, Medical Devices Analyst, GlobalData, comments, “Cardiovascular disorders (CVD) are becoming more prevalent in India, highlighting the need for affordable

technology to match the rising demand for less invasive procedures. Products such as the Optima IGS 320 will support personalised treatment regimens for patients, with greater accuracy through automation of intricate cardiac and electro-

physiology operations and intelligent imaging.”

GE Healthcare claims that Optima IGS 320 is a cost-effective visualisation and imaging system with built-in neural-network-based AutoRight technol-

ogy that can optimise dose settings in real time. Features such as the PCI ASSIST will enhance the quality of images during risky procedures and make it an ideal solution for complex cardiac treatment interventions.

Singh concludes, “With a shift in disease patterns and a rise in CVD incidence among the younger population of the country, quality cardiac care requires innovative healthcare solutions. Automated cath labs will reduce the workload of cardiologists and allow them to focus on providing better patient care.”

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BUSINESS AVENUES

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HEALTHCARE TRACKER

Agappe foray into CLIA Thomas John, MD, Agappe gives an overview of his company’s recently launched cutting-edge CLIA system with 180 tests throughput branded as i1000

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gappe, your best partner in diagnostics, has very recently launched cutting-edge CLIA system with 180 tests throughput branded as i1000. After receiving patronage of our customers for over 27 years in the IVD segments such as biochemistry, haematology, immunochemistry, urine, MDx etc. this major foray into higher end Immunology systems further boosts Agappe’s dominant position among Indian IVD companies.

We are extremely proud and pleased to announce that Agappe is the first company in India to hold a manufacturing licence from CDSCO for CLIA reagents. In the first phase, already over 35 key parameters available. Company has R&D and manufacturing geared up to add another 100 or so parameters more. These will make Agappe range unarguably the most comprehensive one in CLIA in the Indian IVD market.

Current offerings include the most frequently used such as hormone and fertility, infectious panels, cancer indicators, thyroid panels, metabolic panels, etc. High quality and affordability are the hallmarks of these Reagents as our esteemed customers are experiencing them.

It has been really satisfying to overcome numerous technological obstacles in the indigenous development of these parameters and successfully contribute to the admirable concept of Atma Nirbhar Bharat. We can now take pride in having an AMH assay that has the best open vial stability, the quickest testing times, and the smallest sample volumes among all CLIA platforms.

For all these years, both CLIA equipments and reagents have been imported into India.

Agappe now intends to reduce the import dependence and improve the patients’ access to technology at reasonable costs

and offer convenient pack sizes to the Labs.

The magnetic microparticles-based Acridinium Ester (AE) direct chemiluminescence technology is used by the i1000 Automatic CLIA System.

It is apt for the laboratories due to its consistent performance, 180 test capacity, quick turnaround of reports, easy and convenient operations and accurate results. The architecture of the i1000 might enable large hospitals' assay needs and STAT tests in addition to meeting the needs of medium and small hospitals/labs for routine tests. High accuracy of the results are made possible by the compatible reagent sets and well-defined traceability system.

With the support of 30 reagent positions and 50 sample loading capacities simultaneously, the i1000 CLIA analyzer can process 180T per hour. For the initial test result, it takes 14 minutes to test cardiac parameters and 28 minutes to test all other parameters. Reagent vials with RFID integration enable an error-free reagent management system. Each test is handled by a

sophisticated cuvette handling system employing disposable cuvettes with barcode assistance.

The main cause of immunoassay result discrepancies is insufficient sample volume. When the sample is introduced to the cuvette first, there is no reagent loss in the case of insufficient sample volumes. Unlike many other equipments with segmented cuvettes, where unused trash cuvettes may incur greater expenses, individual cuvette-type instrumentation ensures lower recurring costs in the case of low workloads. The i1000 user can run more samples per run and save time by randomly placing emergency samples.

With online reagent substitution and more tests per batch, i1000 users can save time. The i1000 enjoys greater result precision with the minimum impact of interference factors and the lowest recurrent costs with defined traceability system and less frequent replenishment of consumables. It also saves space and money on substrate storage.

Agappe CLIA reagents are available in 1x100 T packs with integrated RFID and two-point calibrators. The package comes with the calibrators and there is enough volume for five calibrations to meet the 35-day stability requirement for open vials.

There are various pack sizes for the mono- and multi-analyte controls. The reagents can be tracked against external quality assurance programs too.

Agappe manufactures and markets a wide range of IVD equipments and reagents in its world class manufacturing facilities integrated with one of Asia’s largest sophisticated warehouses and cold rooms.

Agappe has an equal number of service personnel as sales to ensure the industry best uptimes to its customers. Agappe now makes for the world, exporting its products to over 65 countries.

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HEALTHCARE TRACKER

Low flow anaesthesia: Need of the hour for safe,patient-centric,environmental friendly anaesthetic delivery and care Dr N. P. Singh, Interventional Pain Physician and Senior Consultant-Anesthesia & Pain Management, M.M, Super Specialty Hospital, Mullana-Ambala talks about the advantages of lowflow anaesthesia

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hile advances in anaesthesia safety have helped reduce the gap between practice and actual care provided to the patients, safety in anaesthetic delivery is not limited to the surgical table. It is way beyond the hospital infrastructure and healthcare practice. The current need of the hour is to make anaesthesia practice safe, economical, patient-centric, and environmentally sustainable.

Through the years, anaesthetic delivery has evolved from Morton's demonstration of ether as an anaesthetic agent in 1846 right up to the current day modern integrated anaesthesia workstation, which incorporates sophisticated technologies for ventilation, monitoring, and agent gas analysers, lowflow anaesthesia, and closedloop anaesthesia.

Our volatile anaesthetics have a considerable contribution to greenhouse gas, and the carbon footprint of volatile agents indirectly affects all humans. With the advent of such superior technology, it makes more sense to switch to methods where the anaesthetic agents are retrieved and reused to their maximum potential, thus enabling economic and environmentally less burdensome practices.

How can Low-Flow Anaesthesia (LFA) help save the environment?

Since the anaesthesia machine has evolved from the open-drop method to the semi-closed system and finally to the closed breathing system, the concept of using lower fresh gas flows (FGF) has become popular.

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and humidity homeostasis, and reduced environmental pollution. Decreasing volatile anaesthetic delivery provides safe and effective strategies for anaesthesia providers to decrease costs and reduce environmental pollution. In addition to pure economic or ecological benefits, the low flow may have a positive impact on the quality of patient care.

Economic benefits

The low solubility and low anaesthetic potency in the new volatile anaesthetic agents have increased the need to reduce anaesthetic agent consumption by lowering fresh gas flow.

Though there is no set definition for LFA, it is outlined as utilising an FGF significantly lower than the patient's minute volume. The idea is to restore the inhaled agents with the minimum FG allowable while simultaneously removing CO2 before recirculating. This way, more fraction of gases gets re-circulated around the circle system, and the amount of gases excreted from it becomes lesser. This reduces the loss of anaesthetic agents into

the environment.

The benefits and feasibility of LFA have been suggested for nearly two decades. In 1995, Baum and Atikenhead proposed the idea of LFA and stated the potential risks associated with LFA. They predicted that modern anaesthesia machines, in conjunction with inhaled and exhaled gas concentration monitoring, will meet all the technical requirements for the safe use of lowflow techniques.

Other advantages of LFA The benefits of LFA include decreased use of inhaled agents, improved body temperature

Several studies have shown that more than 80 per cent of inhalational agents get wasted when used at FGF >5L/min. When the FGF is decreased from 3L/min to <1L/min, wastage is brought down by almost 50 per cent.

The inhalation anaesthesia is cost-effective and associated with lower drug costs than intravenous techniques. Literature has shown that FGF of 1 L/min FGF led to an almost 50 per cent reduction in costs of volatile anaesthetics. Hence the decreased consumption of volatile anaesthetic agents can markedly cut costs and improve savings.

Patient benefits Another advantage of using LFA is preserving the patient’s inherent heat and humidity at no cost. Higher FGF results in the delivery of anaesthetic gases that are drier and cold, adversely affecting the patient’s airway. The reduction of FGF causes recirculation of the gases within the circle system through the CO2 absorber.

Through this process, the humidity and heat of inspired gases are maintained. The warmth of the recirculated inspired gases preserves the pa-

tient’s body temperature by preventing heat loss. Hence potential post-operative hypothermia and shivering are also decreased.

The added benefit of inhaling humidified warm gases is avoidance of airway and bronchial drying. This promotes better mucociliary clearance and maintains airway epithelial health as opposed to inhalation of gases at higher flows.

Ecological benefits All inhaled anaesthetic agents are hardly metabolised in the body, and hence the gases that are exhaled remain relatively unchanged and escape out into the atmosphere. These gases stay in the atmosphere for longer and act as “greenhouse gases”. These gases increase the earth's temperature by absorbing infrared radiation and trapping heat energy inside the atmosphere. All volatile agents eventually reach the atmosphere and cause ozone depletion. High FGF results in pollution of the environment.

Reducing the fresh gas flow causes fewer anaesthetic agents to reach the environment and thus lesser atmospheric pollution. Hence, there is an overall decreased greenhouse effect and damage to the ozone layer.

In short, a safe, patient-centric, environmental friendly anaesthetic delivery and care is the need of the hour and possible with low flow anaesthesia. A significant step must be taken to get the system to accept this reality and embrace low-flow anaesthesia to provide safety beyond the surgical table.

HEALTHCARE TRACKER

Medikabazaar opens up exciting opportunities for bio-medical engineers and medical equipment service partners Over the next several months, Medikabazaar expects to create hundreds of jobs across the geographical location to support its MBARC portfolio

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edikabazaar steps up its actions to strengthen the on-field workforce and is inviting biomedical engineers and medical equipment service partners to join MBARC. The opportunity exists in 3 forms, biomedical engineers can join MBARC full-time and become on-roll representatives, then there are freelancing options, allowing individuals to find work regardless of where they live, whether in different cities or states across the country, and businesses can become part of us as business partners to accommodate the expanding demand.

With the mission to serve PAN India, the company’s hiring needs are in direct response to the continual rise in demand for servicing of equipment, components, training, support, and maintenance in metropolitan and tier-II, tier-

With the mission to serve PAN India, the company’s hiring needs are in direct response to the continual rise in demand for servicing of equipment, components, training, support, and maintenance in metropolitan and tier-II, tier-III cities III cities.

With the launch in September this year, MBARC addresses three key issues of equipment lifetime management. MBARC (Medikabazaar Asset Management, Recycle, and Care) was created as a onestop shop for hospitals to manage their biological assets.

MBARC is an on-demand service aggregation model by Medikabazaar, India's largest online B2B platform for medical supplies.

MB Asset Management will enable hospitals, clinics, and

medical institutes to manage the entire lifecycle of healthcare assets through a cuttingedge automated system. Monitor, measure, and manage all the hospital’s capital assets at the click of a button for seamless, cost-effective, and efficient operations.

MB Recycle of medical equipment will be done through restoration, reconditioning, repairing, replacement of worn parts, and installation of a device. Hospitals may also buy, recycle or sell old medical equipment that is fit to be used.

MB Care will provide a onestop shop to book all your biomedical services, including preventive maintenance, installation and commission, equipment safety test and audit, calibration, and user training.

India is the 4th largest market for medical devices in Asia, among the top 20 markets for medical devices worldwide, with the market size for the medical devices industry expected to reach $50 billion by 2030 and the service addressable market is projected to reach 6 billion.

Over the next several months, Medikabazaar expects to create hundreds of jobs across the geographical location to support its MBARC portfolio.

Vivek Tiwari CEO & Founder of Medikabazaar, said, "We are witnessing the emergence of new career possibilities that combine a wide range of skill sets. Our new workforce efforts will improve the quality of our Medical Equipment Lifecycle Management services. The aim is to enhance the ongoing servicing of equipment, components, training, support, and maintenance in metropolitan and tier II/III cities."

The geographical expansion is intended to reduce turnaround times and provide better Medical Equipment Lifecycle Management services in underserved areas and rural areas.

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HEALTHCARE TRACKER

Sequoia Healthcare introduces the inspiration 64 Slice CTScanner It provides exceptional CT experience for the end users

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equoia Healthcare, based out of Bangalore and intensely focused on driving global innovation in the imaging solution segment manufactured indigenously in the country, has launched an advanced yet affordable Inspiration 64 Slice CT scanner with smart features and bore design recently.

The Inspiration 64-smart large bore Slice CT Scanner

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comes with a 3D vision camera with auto-positioning and remote control. It brings in the finest quality of images and stable performance consisting of innovative workflow for topogram to diagnosis by generating HD Image Chain of 024 matrix. It is a new detector design for shortening the X-RAY path and improving on the image quality with the help of a 75 cm Gantry aperture that offers extra

scan facilities as compared to the standard scanning.

According to S. Viswanathan, Chief Executive Officer, Sequoia Healthcare, “The company’s purpose is to improve the quality of human life by helping healthcare providers to do more with technology. It guides our actions and is the key to deliver our strategy. Inspiration 64’s precision tomography is independently developed in a Hi-

Resolution, High-Definition Algorithm. Inspiration 64 adopts a unique low-dose technique to minimise the radiation dose to patients, which is better known as iDream. The adequate X-Ray tube heat storage and generator capacity are increased 2.7 times with the help of iDream software.

He further said, “Sequoia Healthcare strives to bring in advanced and affordable in-

ternational technology, which serves in cost-effective healthcare. Sequoia believes in delivering radiology equipment accessibility for cost-effective healthcare. In short, we want to bring diagnostic reach to all. With high-tech services accompanied with new world Artificial Intelligence (AI), robotics, etc., Sequoia aims to become the number imaging devices manufacturer in the world.”

REGD. WITH RNI NO. MAHENG/2007/22045, POSTAL REGD. NO. MCS/162/2022 – 24, PUBLISHED ON 8TH EVERY MONTH, POSTED ON 14TH, 15TH, 16TH EVERY MONTH, POSTED AT MUMBAI PATRIKA CHANNEL SORTING OFFICE, MUMBAI – 400001