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VOL.7 NO.8 PAGES 102

Strategy ‘Our USP is to produce people-centred leaders’ Knowledge Hepatitis: The silent killer In Imaging Old is gold: Aye or nay? AUGUST 2013, `50


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V O L 7 . N O 8 , AU G UST 2 0 1 3

Chairman of the Board


Viveck Goenka Editor



Viveka Roychowdhury*

STRATEGY ‘Our USP is to produce

Assistant Editor Neelam M Kachhap (Bangalore)

people-centred leaders’ PAGE 31


Internal audit and healthcare: A ‘Strategic

Sachin Jagdale, Usha Sharma,


Raelene Kambli, Lakshmipriya Nair,

Evaluating patient expectations for

Sanjiv Das




Delhi Shalini Gupta


Hepatitis:The silent killer

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Malnutrition: A malefic malaise PAGE 39

Harit Mohanty Assistant Manager Kunal Gaurav


Leveraging the power of data

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Leveraging the power of technology for

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Study: Reducing does not reduce smokers’ risk of early death


‘Piramal Enterprises’ diagnostic division business is expected to touch Rs 100 crore mark in next one year’


‘The geriatric services market is estimated to be worth about $250 million in India’


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Anaesthesiologists gather to latest developments in field SMBs: Rising above the challenges





EDITOR’S NOTE No country for the elderly?


Consider this: By 2050, India’s 60+ population is expected to total 323 million, more than the entire US population in 2012! Despite this, India's healthcare players are just beginning to invest in this segment of the population/patient base. With this year's International Day of Older Persons (Oct 1) almost around the corner, we decided to do an in depth analysis of this opportunity. 'Why should one invest in geriatric care?' asks our cover story (pages 11-15) and goes on to highlight the pioneer players in geriatric care in the country as well as the roadblocks. A long term solution would be to start right at the beginning, by giving geriatrics its due in medical curricula. As of today, only one medical college in the country, Madras Medical College, offers a full-time geriatric MD programme while Indira Gandhi National Open University (IGNOU) offers a one-year part-time Post-Graduate Diploma in Geriatric Medicine. KPMG International recently released a new global report, 'An uncertain age: Reimagining long term care in the 21st century' and again, India does not feature as we do not have an organised approach to elderly care. Amit Mookim – Partner and Head of Healthcare, KPMG in India makes an important point when he says that the Indian system of care is not patient centric and is still a reactive rather pro-active approach – with emphasis on treatment rather than management. (read more on page 25) We also need to recognise that senior care extends beyond the hospital and in fact, home care for the elderly is the thrust of such initiatives globally. Also, medical/clinical care is only one facet; meeting the psychological needs of this segment of the population calls for special skill sets. And thankfully, we already have a few efforts like Epoch. Another story in this issue, 'Sunset years of solitude', (pages 70-71) shadows an Epoch elderly care specialist as she helps a senior citizen go 'social' with Facebook as well as taking him down memory lane. If geriatric care is all about appreciating and acknowledging the right of our elders to healthcare and a place in our society, we carry forward this theme to the In Imaging section as well. The lead story, 'Old is gold: Aye or nay?' (pages 49-50) debates the pros and cons of the refurbished equipment market. Overcoming the mind block of

re-using medical equipment took time, but today players like Sanrad are meeting the growing demand for diagnostic imaging services from India's rapidly urbanising smaller metros. Sanrad's founder, Ratish Nair reels off the names of towns in rural Maharashtra and other states where his machines allow doctors and radiologists to have a decent practice even as they accommodate the numerous requests from family, friends and NGOs for 'free' tests. In fact, their success has convinced the big brand players, who used to initially look down on refurbished equipment, to go down the same path. Today, original equipment manufacturers (OEMs) have dedicated divisions for their own refurbished machines and have realised that at this price point a whole new market opens up to them. Even though corporate hospitals still don't trust or admit to using refurbished medical equipment, it is only a matter of time before this mental block is demolished. Using refurbished medical equipment is by no means a 'third world' strategy to balance cost with reliability and credibility. It is a recorded fact that the trend of refurbishing medical equipment started from Japan, where hospitals don't buy but lease such medical equipment and therefore need to buy afresh when each three-year lease period expires. Nair of Sanrad says that 40 per cent of such refurbished machines from Japan's hospitals find their way to medical facilities in the US, and this number is only going increase as Obamacare forces further cost cutting. This is one price war where the patient wins as both sets of players keep each other on their toes. A recent IMS Health study, 'Understanding Healthcare Access in India: What is the Current State?', once again underlined the urban-rural skew in healthcare. Urban residents, who make up 28 per cent of India’s population, have access to a lion's share (66 per cent) of the country’s available hospital beds, while the remaining 72 per cent who live in rural areas have access to just one-third of the beds. Thanks to refurbished radiological equipment, we can be assured that more of these areas will at least have better access to diagnostic imaging services. Old it seems, is truly gold, both when it comes to medical equipment, as well as our senior citizens. Viveka Roychowdhury





“The major problem in Indian healthcare delivery system is near total dependency on medical imports of diagnostic and therapeutic equipment and devices, including consumables. The common man is made to purchase or pay partly for the cost of the imported gadgets for healthcare. This clearly brings out that we need to create an infrastructure capable of producing our own medical equipment, devices and consumables, based on the technology available and to be developed within the country, at affordable cost�

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MARKET UPFRONT Ontario invites media to showcase med tech opportunities Sachin Jagdale, Ontario, Canada EH News Bureau o make the international community aware of the latest advances in the medical devices sector, Ministry of Economic Development,Trade and Employment (MEDTE), Government of Ontario, Canada, recently invited international media to Ontario. Journalists from India, France, Germany, US, UK, Japan and China attended this media tour.The unique combination of medical, manufacturing and international marketing expertise powers a diverse and advanced medical device industry in the province of Ontario, Canada. It is the largest life sciences jurisdiction in Canada with approximately 50 per cent of the country’s life sciences economic activity. While addressing media personnel, Minister Reza Moridi, Ontario Ministry of Research and Innovation, himself an immigrant from Iran said, “People from all over the world have made Ontario their home. In Ontario, we speak over 150 languages.” Speaking on Ontario’s strengths he added, “Ontario has a vibrant culture of research and innovation. We have advanced manufacturing capabilities. We also have close connections with the key business markets in the world. Ontario is very good at collaborations as well.” He also highlighted Ontario's prowess in the field of life science innovation. Ontario has 24 research hospitals. Government has invested $161 million in its life sciences strategy. Ontario Government has decided to make climate of innovation an ongoing priority. “We take a very proactive approach. We are working with companies and organisations across all sectors of our economy and research community to support their innovation activities,” informed Moridi. Government's positive approach coupled with talented workforce available in the Ontario province, are bound to consolidate Ontario's position as the leading suppliers of medical devices to the world. AUGUST 2013



Interview Dr Sita Naik Advisor to Chairman, Research Task Force, Apollo Hospitals

Pg 22

Interview Amit Mookim Partner and Head of Healthcare KPMG

Pg 25





H Hospitals treat patients of all age groups. In the recent years, two distinct patient age groups have been identified who need special consideration while treatment. One is paediatric and the other is geriatric. While paediatric is a widely accepted specialised medical stream and paediatric consultants dominate most private and public hospital OPDs; geriatric is little known and in fact not even taught formally at most medical colleges in India. Of late, the healthcare needs of elderly has come into focus, with the government announcing various schemes and allocating Rs 150 crores for ‘The National Programme for the Health Care of Elderly’ which is being implemented in 100



Orthopaedic Surgeon, Nova Specialty Surgery

(PROF) DR PK DAVE HOD-Orthopaedics, Rockland Hospitals, Delhi

selected districts of 21 states. Subsequently, private hospitals have also started taking notice of this population.

Ageing India The percentage of elderly people who require care in a hospital or home setting is increasing in India. “By 2050, India’s population of those aged 60 and above is expected to total 323 million, a number far greater than the entire US population in 2012,” says Amit Mookim, Partner & Head of Healthcare, KPMG, India. In addition to this, the elderly population in India is not uniform. They have different causes of morbidity spanning across several dimensions like gender, location and socioeconomic status in particular, as well as great diversity in cultures, religions, and languages. This presents a huge challenge for delivering healthcare services to this population. 'Attitudes and practices that fail the elderly may be reinforced by cultural values that reject long-term hospitalisation of the old because it is viewed as a sign of disrespect; traditionally younger family members tend to the needs of their elderly relatives,' says a study on geri-

Mental block (in healthcare providers) of being not very remunerative is depriving geriatric care at hospitals. Earning (in geriatric care) is by referral to super-specialities

It becomes imperative to set up a geriatric care facility keeping in mind the emotional requirements of elderly. Some facility for enabling social interaction must also be there

atric care in India. [Evans et al.: Activating the knowledgeto-action cycle for geriatric care in India. Health Research Policy and Systems 20119:42.]

Hospital in Lucknow have been started,” he further adds.

Pioneering centres Few centres have taken the bold step to establish geriatric care facilities and are doing well. “Currently we have eight regional centres across the country with geriatric care facility,” says (Prof) Dr PK Dave, HOD, Orthopaedics, Rockland Hospitals, Delhi. “These are at All India Institute of Medical Sciences (AIIMS), New Delhi; Institute of Medical Sciences, Banaras Hindu University, Uttar Pradesh; Sher-e-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir; Government Medical College, Thiruvananthapuram, Kerala; Guwahati Medical College, Guwahati, Assam; Madras Medical College, Chennai, Tamil Nadu; SN Medical College, Jodhpur, Rajasthan, besides Grant Medical College and JJ Hospital, Mumbai, Maharashtra,” he explains. “In the corporate sector, Apollo Hospital, Chennai has a department of geriatric medicine. Hyderabad-based Heritage Hospitals also have a separate geriatric department. Many hospitals in the metro cities including Max, Fortis, Rockland, Pushpanjali Crosslay and Jaipur Golden in Delhi have started programmes targeting geriatric care. Small standalone geriatric hospitals such as Vindhya Geriatric Hospital in Bangalore and Aastha

Unrecognised needs It is known that there are very few dedicated geriatric care facilities are available in India where it is most required. “Geriatric service across the country is very patchy, very few hospitals (metropolitan cities) have set up a geriatric department with in-patient geriatric care,' says Dr Dominic Benjamin, who is associated with Baptist Hospital, Bangalore. Adding to this, Dr Ramneek Mahajan, Orthopaedic Surgeon - Nova Specialty Surgery; Advisory Board - Geriatric Society of India says, “Mental block [in healthcare providers] of being not very remunerative is depriving geriatric care at hospitals.” “Earning is by referral to super-specialities like cardiology, orthopedics, ophthalmology, gastroenterology, renal and oncology surgery,” he adds. Agreeing, Dr Benjamin says, “Most of the healthcare in India is provided by the private sector and most of these hospitals promote speciality which generates seemingly larger monetary returns rather than specialities like geriatric.” This is because healthcare providers fail to recognise the needs of elderly patients and treat them as other adult patients. “Most healthcare organisations and individual providers in India fail to prioritise elderly patients and provide them with continuous and comprehensive geriatric care, which contributes AUGUST 2013



that 'old' means 'sick',” argues Dr Dave. “All age groups have similar diseases nowadays, however the old have their own challenges and are prone to certain age related disabilities. The old require home care more than hospital care if there is a old age related disability,” he adds after thought.

The geriatric services market is estimated to be worth about $250 million in India


Road-blocks to geriatric facilities There are many reasons why geriatric care is not pick-

to poor quality of care and poor health outcomes for the elderly,” explains Jenna M Evans, Researcher with the Institute of Health Policy, Management & Evaluation in Toronto, Canada. “This gap is due, in part, to the limited human and material resources available to manage the growing number of patients with complex chronic conditions,” she adds.

Money matters It is evident from the numbers that the need for elderly care in India is huge though the niche market for this service is large enough for corporates to sit up and take notice. “The geriatric services market is estimated to be worth about $250 million in India and expected to grow to over $1 billion by 2013 and $2 billion by 2017,” informs Mookim. This alone presents an untapped potential for focusing on geriatric care. In addition, life expectancy at the age of 60 has increased for both men and women in India, according to the UN report (2009) the present life expectancy at 60 for men is 16.3 years while for women it is 17.2 years. “There is definitely a market for hospitals to set-up purpose-built geriatric ward. There is a huge variation in the healthcare standards across the country, in big cities a significant proportion of older people come from upper class or middle class who will be willing to pay for comprehensive geriatric care, so it makes business sense to set-up a geriatric ward to cater to these patients,” opines Dr Benjamin. However, few experts disagree and feel that geriatric care is more of a home care domain and may not substantiate a hospital set-up. “No, we do not see a market for a standalone geriatric hospital as it's very important for the teams of doctors to have a mix of patients. It will also be wrong to assume AUGUST 2013

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ing up in India. One of the reasons is that it is fairly unknown to caregivers as well as care-seekers. “The primary problem is the lack of awareness about geriatric care and what it entails. However, over the last few years this seems to have been changing with people becoming more aware of the need to have specialised elderly care services,” Dr Anoop Amarnath, Director and ConsultantGeriatric Medicine, Apollo Hospitals, Bangalore. “In Baptist Hospital, we have a purpose built geriatric ward but we still feel the biggest challenge is to overcome attitude of lay people and professionals, most of them think that illness after 60 years is not worth treating as it is better to endure it,” adds Dr Benjamin. Another important consideration is the fact that the service make-up should be therapeutic along with rehabilitative and supportive. “Elderly does not need medical support alone but also require emotional support,” says Dr Dave. “Thus it becomes imperative to set up a geriatric care facility keeping in mind the emotional requirements of elderly. Some facility for enabling social interaction must also be there,” he adds. “To set up a geriatric care facility one needs dedicated

DR ANOOP AMARNATH Director and ConsultantGeriatric Medicine, Apollo Hospitals, Bangalore



VP-Sales & Marketing, Columbia Asia Hospitals

Associated with Bangalore Baptist Hospital

The primary problem is the lack of awareness about geriatric care and what it entails. However, people are becoming more aware of the need for specialised elderly care services

Geriatric service across the country is very patchy, very few hospitals (metropolitan cities) have set up a geriatric department with in-patient geriatric care

To set up a geriatric care facility one needs dedicated beds, specialists round the clock and nurses trained to handle geriatric in patients

beds, specialists round the clock and nurses trained to handle geriatric in patients. CAH is a multi-speciality hospital and we treat all old age related problems. However we are not a dedicated geriatric care hospital and do not provide rehabilitation for dementia and other related diseases,” offers Vinay Kaul, VP-Sales & Marketing, Columbia Asia Hospitals. Adding to this, Dr Benjamin says,“Setting up an inpatient geriatric care

facility needs a purpose built geriatric ward with multiple therapist input as most of the individuals have significant co-morbid illness. Most of the hospitals in the private sector would think long and hard to allocate entire ward for geriatric patients.”

in rural areas, of which 40 per cent live below the poverty line.” says Mookim. “Most crucial of all is to set up a geriatric facility which is affordable. Large geriatric population cannot afford healthcare,” adds Dr Dave. “Help Age India undertook a survey couple of years back in 12 big cities of people above 80 years, they found that 70 per cent of the individuals depended on the family for financial support. Most of the insurance

The big A Affordability is also a major road-block to geriatric care. “It has been reported that a majority of India’s elderly – about 80 per cent – live

● ●

Provide a safe and supportive environment for chronically ill and dependent people. Restore and maintain the highest possible level of functional independence. Preserve individual autonomy. Maximise quality of life, perceived well-being, and life satisfaction. Provide comfort and dignity for terminally ill patients and their loved ones. Stabilise and delay progression, whenever possible, of chronic medical conditions. Prevent acute medical and iatrogenic illnesses and identify and treat them rapidly when they do occur.

Ref: Chaubey PC, Vij A. Planning consideration of comprehensive geriatric care in India. J Acad Hosp Admin 1999;11:22-4.





providers do not provide comprehensive coverage if an individual is over 65 years, this hinders most of the older people to utilise medical services because of financial constraints.” explains Dr Benjamin.

Lack of manpower The other prominent reason for not having geriatric care at hospitals is lack of trained manpower. “There are lack of properly trained geriatricians, although some institutions have started a structured geriatric training programme. Hopefully this situation will improve in the coming years,” says Dr Benjamin. Adding to this, Dr Amarnath says, “The second major issue is the lack of qualified personnel. As of today, the only fully trained personnel that are available are the ones who have qualified abroad.” Talking about the demand and supply gap in geriatric care in India, Dr Dave says, “There are a handful of doctors who specialise in geriatric medicine. The government must start training doctors in geriatric care to cater to the needs of the increasing number of elderly. Both, the medical and emotional needs of the geriatric population differ from the young population and to cater to their needs doctors and paramedical staff must specialise in geriatric medicine.”

Lack of training facilities There is a lack of formal training in geriatric medicine in India. It is very unfortunate that out of 206 medical colleges in India only one college provides full-time geriatric MD programme. “Madras Medical College, has a full-time geriatric MD program. Indira Gandhi National Open University offers a one-year part-time Post-Graduate Diploma in Geriatric Medicine with fourweeks of practical training to doctors working in different streams of medicine,” informs Dr Mahajan. In a recent study of sen-


ior-level students from medical, nursing, and social work colleges in India, about 50 per cent were unaware of policies relating to the health and well-being of the elderly. None of the students demonstrated recognition of the clinical and functional implications of ageing. [Evans et al.: Activating the knowledge-to-action cycle for geriatric care in India. Health Research Policy and Systems 20119:42.] This

shows why capacity building is important and why geriatric training is important in India.

In future Healthcare delivery in India has evolved rapidly in the past few years, imbibing the trends in disease and treatments. If stand-alone diabetes centres are now seen in many cities, special centres for day-surgeries, or dialysis are also coming up.

Different models of healthcare delivery, from bare minimum to five-star experience, exists in the Indian healthcare landscape. There is a need for development of healthcare facilities for geriatric patients and hopefully Indian providers will understand the need and come-up with innovative, cost-effective and accessible services for the elderly population. There is a need for com-

prehensive all around development in geriatric care in India entailing home-based care, institutional care, education and training, non-medical resource development, sensitisation and involvement of NGOs and voluntary organisation and most importantly health insurance programme for elderly.


School of Health Systems Studies Admission Open to Executive Post Graduate Diploma in Hospital Administration (EPGDHA) The School of Health Systems Studies (SHSS) of Tata Institute of Social Sciences in Mumbai, pioneers of Hospital Admnistration education in the country, invites application for their prestigious EPGDHA programme. It is a 12-month (two semesters), dual mode programme consisting of online learning and two weeks of contact programme in each semester. The programme is intended to enhance the knowlege and skills of working personnel in the hospital. Eligibility: Graduates in any discipline with a minimum of 5 years of experience at the managerial and supervisory level currently working in hospital. Candidates sponsored by hospitals will be given due preference. Total Seats: 50 only. Application form and admission: Application forms can be downloaded from the Institute website: Filled-in application form and necessary documents should be submitted, along with the registration fee of Rs. 1,000 to be paid through DD in favour of Tata Institute of Social Sciences at Mumbai, to The Secretariat, School of Health Systems Studies, Tata Institute of Social Sciences, V.N. Purav Marg, Deonar, Mumbai 400088. The last date of receiving application is 13th September 2013. Admission will be based on the interview at TISS, Mumbai. Programme Fees: The total fees for the programme is Rs. 1,80,000/- (One Lakh Eighty Thousand Only), payable in two installments. The fees include tuition fee, learning resources, boarding and lodging during contact programmes, library and computer services and other programme related expenses.

CONTACT: Telephone: 022-2552 5510/ 5000 /5523 or E-mail:




Jaslok Hospital celebrates 40 years of service Hospital honoured the doctors by planting trees instead of bouquets


aslok Hospital & Research Centre celebrated the completion of four decades of service recently.The hospital organised a gathering to acknowledge the services rendered by 25 of its eminent consultants. The 25 specialist doctors, all leaders in their fields, have been part of the hospital since the inception of the hospital. The gathering was graced by Chief Guest Dr RK Sinha, Chairman Atomic Energy, along with Guests of Honour Dr R Chidambaram, Principal Scientific Adviser to the Government of India, Dr Suleiman Barau, Governor, Central Bank of Nigeria and Dr Gayatri Mahindroo, Director, National Accreditation Board of Hospital (NABH) who gave Jaslok Hospital the most prestigious and India's highest quality hospital accreditation award. Kanta Masand, Managing Trustee of the hospital said, “Forty years after Jaslok’s inception, I am proud to say that we have stayed true to the original goals of our Founders - to provide the best medical care possible to every section of society. This ideal would not have been possible without having the best doctors and the best staff, because ultimately they are what make this institution”. The hospital honoured the doctors by planting trees instead of bouquets, and presented each of them with a Tree Certificate. The hospital also announced the launch of a newsletter titled “Jaslok Times”, to be published quarterly. EH News Bureau



Healthspring strengthens business in Mumbai, plans countrywide expansion The company has raised Rs 22 crores through PE, plans to raise another Rs 50-60 crores in the next round Raelene Kambli, EH News Bureau


ealthspring has established its foothold in Mumbai and recently announced the launch of four new centres at Powai, Vashi, Thane and Andheri, making a total number of seven centres across the city. Speaking about the company's financials, Kaushik Sen, CEO and Co-Founder, Healthspring informed that their centres based in Khar, Juhu and Kemp's Corner have achieved breakeven. The company has also strengthened its city wide 24x7 medical emergency response system with a helpline number, tied-up with ICICI Lombard to support ICICI's corporate insurance scheme and raised its second round of funding with Asian Healthcare Fund (AHF), recently investing Rs 22 crores for the company's expansion. Healthspring’s helpline is a community service initiative for free, across the city of Mumbai through the rains,

from July 10, 2013 upto September 1, 2013. Apart from the helpline, during this period all of Healthspring’s services across its seven clinics in Mumbai will remain available 24x7. “We have completed two years since we launched our first centre in Mumbai and since then we have been evolving. Our concept and strategy was criticised by many; however we have proved ourselves and this is evident with the success of our concept of building a comprehensive healthcare delivery network in a worldclass environment. This kind

of service is the need of the hour. Our members are mainly elderly people and our services help them a lot,” said Dr Gautam Sen, Chairman and Co-Founder, Healthspring. According to Sen, the company will be launching ten additional centres across Mumbai by the end of this year and has set a target to branch out to other cities in India. It will be launching 200 centres across India in the next three years. It will also launch its community medical centres in cities like Delhi, Kolkata, Hyderabad, Bengaluru and Chennai by 2014. On being asked how the

company would utilise its new funds, Sen replied that the funds would be utilised to set-up their new centres and strengthen their existing centres. He also informed that the company plans to raise the next level of funding very soon in order to expand pan India. The company intends to raise additional Rs 50-60 crores from its existing investors that include Catamaran Ventures, Reliance Venture Asset Management and BlueCross BlueShield Venture Partners, which would be utilised to expand its business across India. Speaking of the company's marketing strategy, Dinesh Shenvi, Head, Sales and Marketing, Healthspring, said that the company has been conducting various awareness camps for the people of Mumbai to create brand awareness and in future will consider utilising electronic media such as television to advertise on a large scale.

The Mission Hospital, Durgapur receives NABH accreditation To invest Rs 200 crore for the for the first ‘only transplant’ hospital in India


he Mission Hospital, Durgapur has recently received NABH accreditation. Dr Satyajit Bose, Chairman, The Mission Hospital said, "The hospital is the first multi-speciality in Eastern India outside Kolkata to be awarded the prestigious NABH accreditation." Dr Bose added that the accreditation was given only after the hospital met 102 stringent standards and 636 objective elements that cover all aspects from infrastructure, facilities and services to skills of all the staff. The patients are the greatest beneficiary of NABH accreditation as it ensures a high quality of care and patient safety at the hospital. It implies that the patients are looked after by appropriately qualified medical staff and their rights such as respect for personal dignity,

confidentiality, refusal to treatment, record accessibility are protected. He said, “The NABH certificate is an added feather in the hospital’s endeavour to provide quality healthcare. This accreditation has reaffirmed our quest for quality of services and would help the hospital in performing up to its full potential and achieving benchmarks which it has set for itself.” The 250-bed Mission Hospital, Durgapur claims to be the first to introduce ‘close ended’ packages, wherein the patients would not spend beyond a pre-decided amount. Also the ‘Healthy Heart for All’ initiative offers 'treat now and pay later' facility for the patients based on equated monthly installments. The city of Durgapur was chosen to set up the medical institute keeping in mind the

excellent infrastructural facilities like rail and road facilities as well as the upcoming air connection, excellent economies of scale, good educational system and an equally knowledgeable, intelligent and health conscious population. Commenting on the expansion plans of the Group, Dr Bose said that the Mission Hospital has started work on its second phase of adding additional 150 beds, three operation theatres and a second cath-lab by September 2013. A dedicated cancer treatment hospital will be housed in a separate building within the same campus, with stateof-the-art Linear Accelerator, PET CT, in association with Royal Marsden Hospital, London to be completed by the year 2015. The hospital has also

acquired two acres of land in the upcoming airport city of Andal (Sujalam, The Sky City), wherein India’s first 'only transplant' hospital would be built with an investment of Rs 200 crore primarily performing heart, kidney, liver, pancreas and bone marrow transplants. The brand also has plans of procuring at the outset, two air ambulances for organ harvesting and patient transfer, based on its proximity to the airport. Keeping in view the Quality Improvement Plan, The Mission Hospital aims to acquire National Accreditation Board for Testing and Calibrating Laboratories (NABL) accreditation by year 2014 for all its offerings under Department of Laboratory Services. EH News Bureau- Kolkata AUGUST 2013


Indus Health Plus bags award for innovation IMA and AHPI supports ‘Save the Doctor’ movement


ndian Medical Association (IMA) and Association of Healthcare Providers India (AHPI), along with medical students’ representatives from across the country have announced a nationwide movement ‘Save the Doctor’ to equalise under graduation (UG) and post graduation (PG) medical seats. This mass movement is aimed to influence the policy makers and medical institutions in the country. Medical students want rural posting to be a part of internship and postgraduate training. Over two to three lakh medical students are expected to support this movement across India. Dr Devi Shetty, Treasurer, AHPI said, “It is a sad plight that nearly two lakh young doctors in our country at the peak of their youth spend few years in coaching classes mugging multiple choice questions rather than treating patients and learning the art of healing. These young doctors under the right circumstances can significantly improve the quality of health care offered to our citizens.” Dr Narendra Saini, Secretary General, IMA said, “Indian Medical Association supports rural posting. But, in the present situation making it compulsory is not feasible because there is no structured posting in rural areas. Every PG student must do six months of rural posting as part of their course/ internship.” He also added, “Every medical officer during their tenure is entitled for atleast four to five promotions. For every promotion, one year rural posting can be made mandatory.” Dr Navneet Motreja, Coordinator, Campaign – Save the Docto, said, “If situation does not change we are not far from desperate measures like importing surgeons from other countries. Recently, due to public pressure Brazilian PM agreed to import 6,000 specialist doctors from Cuba.” One can login to and post an appeal which will then be reportedly sent to the Union Health Minister.

Has received ASSOCHAM Gold Award in the Social Development Category


ndus Health Plus has been conferred with the ‘ASSOCHAM Gold Award in the Social Development Category’ during the 2nd National Innovation Summit cum Awards 2013. Harish Pillai, COO, Indus Health Plus received the award from Minister for

Science, Technology and Earth Sciences, S Jaipal Reddy during the function in New Delhi for its innovative work and service in the social development category. Pillai said that he is extremely delighted with this highly prestigious award and

would like to thank the esteemed jury on behalf of the entire Indus family. He also said, “A recognition as this would surely take us further ahead and we would continue serving the society with innovative health solutions in our category.” National Innovation

Summit cum Awards is organised by ASSOCHAM which is known as the highest body of the Chambers of Commerce of India, providing a forum for dialogue between business and government. EH News Bureau

EH News Bureau AUGUST 2013




Dr Batra’s introduces 3D skin assessment


r Batra’s Positive Health Clinic, recently introduced 3D skin assessment at its centres for analysis and evaluation of skin disorders. The powerful machine, based on advanced optical technology developed at Dublin’s Trinity College, reportedly allows the skin to be viewed in two and three dimensions and enables multi-spectral analysis of epidermis and dermis. One can also monitor the effectiveness by measuring the increase/ decrease in the number of lesions/abnormality. This feature gives a doctor as well as the patient the highly desired advantage of tracking the progress with exemplary precision. Moreover, it can also apparently help diagnose the exact concentration of melanin and haemoglobin in the skin. Another very important benefit of the technology is the predictive analysis which means that the 3D imaging diagnosis will help you measure the efficacy and progress of the treatment three months before it is visible to the naked eye. It helps gauge response of the patient to the treatment. As the problem is diagnosed much in advance, it can also be treated immediately with faster results. Commenting on the breakthrough technology, Dr Akshay Batra, MD, Dr Batra’s Positive Health Clinic said, “Having treated more than one lakh skin patients successfully through homeopathy, we constantly strive to bring the best innovative solutions for our patients. This new technology is the first-ofits-kind in the country for 3D imaging of skin. It generates state-of-the-art graphics showing 2D and 3D images of exceptional quality that both the doctor and the patients would find very useful. Our patients can now measure their response to the treatments prescribed and the improvement in their condition.” EH News Bureau



Apollo Munich Health Insurance launches health portal Increases the level of engagement with its customers leveraging Microsoft SharePoint


pollo Munich Health Insurance has deployed Microsoft SharePoint Server 2010 to launch a health and wellness portal, in a bid to enhance the level of engagement with its customers. The portal will supposedly enable customers to carry out their health and lifestyle assessments as well as manage medical reports on a single platform. Apollo Munich had an interactive website with several testimonials from satisfied customers. But, the company infomred that it wanted to deliver a personalised service that would enable its customers to manage their health goals. There was also a need to understand customers better based on which the company wanted to design and deliver targeted wellness plans to customers. Apollo Munich evaluated various portal technologies enabling ease of content management, ease of cre-

ating work-flows, customisation and out-of-the-box templates and widgets. Microsoft SharePoint Server 2010 was the chosen technology as it was reporetedly aligned with the company’s goals and offered a better total cost of ownership (TCO). “We offer end-to-end healthcare services through the Apollo ecosystem, which includes hospitals, pharmacies and insurance. We required a health and wellness management portal to meet our maximum customer needs. With the help of Microsoft SharePoint Server 2010, Apollo Munich has enhanced its engagement with its customers by letting them track their health goals proactively and inform them on lifestyle management through content distribution,” said Krishnan Ramachandran, COO, Apollo Munich Health Insurance. The portal apparently offers numerous advantages

to the company and its stakeholders. It enables users to: Manage health goals: The portal offers a dashboard to its enterprise customers. Users can input their medical test reports and health goals such as weight, BP and cholesterol management and create personalised wellness plans. They can also access health articles, medical test reports, prescriptions, and even track appointments. Access wellness plans: The portal enables companies to keep a tab on the health of their workforce. The company can get an insight into the percentage of employees suffering from diabetes or obesity. Having visibility into these trends enables the company to roll out targeted wellness programs for its employees. Engage and interact more: Apollo Munich has currently launched this portal for a few corporate customers but it soon plans to give access to its retail customers too.

“Apollo Munich has laid out a road-map for the portal and plans to include additional capabilities like device integration and analytics. With the support of Microsoft’s world-class technology, we aim to offer the Apollo ecosystem as a single product to the customer and be a one-stop shop for all health and wellness needs,” Krishnan adds. Ramkumar Pichai, GM Microsoft Office Division, Microsoft India stated, “We are happy to welcome Apollo Munich Health Insurance to the large community of corporates across the globe benefiting from Microsoft SharePoint. The technology delivers capabilities that simplify user experience making it easy to share ideas and information, protect communications and information, and empower users while meeting their demands for greater business mobility.” EH News Bureau

GE Healthcare Research: Bad habits add $33.9 billion to annual global cost of cancer Reducing bad habits such as smoking, alcohol consumption, poor nutrition and physical inactivity could potentially save $25 billion each year globally, reveals study


E Healthcare has released secondary research findings indicating that bad habits and lifestyle choices are contributing approximately $33.9 billion annually to the costs related to cancer. Furthermore, the same research revealed that by reducing bad habits, global healthcare systems could potentially save $25 billion each year. The research conducted by GfK Bridgehead on behalf of GE Healthcare in May and June 2013 focused on four key bad habits: smoking, alcohol consumption, poor nutrition and physical inactivity and their relationship to three types of cancer – breast, lung and colon. The study calculated the cancer costs attributable to bad habits in ten developed and developing markets. “The cumulative global cost of bad habits revealed in

this research is staggering. I am encouraged by the potential savings that could be achieved by all of us just making a few small lifestyle changes and committing to a personal monitoring schedule,” said Jeff DeMarrais, Chief Communications Officer, GE Healthcare. The research also breaks down the $33.9 billion annual global cost across ten markets by market and includes the current annual cost of treating cancer and the calculated potential annual savings. The US with $18.41 billion or 54 per cent of the total current annual global cost of cancer is followed by China at $8.57 billion (25.3 per cent) and France, Germany and Turkey at around $1.5 billion (4.4 per cent). Developing markets such as Brazil with $378 million (1.1 per cent) and Saudi Arabia $107 million (0.3 per cent) currently have

significantly lower annual costs of cancer at this point. While it has been long established that tobacco use is linked to the development of lung cancer, the data revealed that other bad habits, such as inactivity and poor nutrition, can also impact the risk of cancer. For example, inactivity and poor nutrition are often associated with weight gain, but this research also demonstrated that men who are inactive have an increased risk of developing colon cancer (relative risk score = 1.61, which means 61 per cent more likely to develop colon cancer than someone who is active). As a result, inactivity can be attributable for $160 million of the cost to treat colon cancer globally, as per the research. Up to half of all cancerrelated deaths can be prevented by making healthy choices, like maintaining a healthy weight, not smoking, eating

properly, being physically active and undertaking recommended screening tests. However, this research WHO data shows that bad habits continue to be prevalent in all markets. In seven of ten markets, over 25 per cent of those populations are still regular smokers. Smoking is most prevalent in France and Turkey where 31 per cent of adults over the age of 15 are smokers. French females and Turkish males were ranked highest groups for smokers at 31 per cent and 47 per cent respectively. In terms of physical inactivity, Saudi Arabia and UK ranked bottom. 68.8 per cent of Saudi nationals and 63.3 per cent of British nationals over the age of 18 lead sedentary lifestyles, compared to 15.6 per cent of Indians and 28 per cent of Germans. EH News Bureau AUGUST 2013


PDC Healthcare expands DuraSoft Laser Patient ID line The bar code laser ID system provides positive identification for patients of all age demographics


DC Healthcare has announced the extension of its DuraSoft Laser Patient ID System in a bid to encompass the entire patient population including infants, paediatrics, and adults. Through bar code technology, the DuraSoft Laser Patient ID System is expected to benefit both patients and caregivers by preventing misidentification caused by human error while improving work-flow efficiencies. DuraSoft is now reportedly offered in ten different formats to serve as an easy drop-in replacement of an existing laser patient ID system, eliminating the need for IT involvement or reformatting. One of the new formats, DuraSoft TenderCare, claims to help ensure that every infant is positively identified with its parents. The fourpart set includes one wristband for the mother, one for the father, and two for baby’s wrist and ankle. DuraSoft TenderCare claims to be ideal for labour and delivery departments, using laser printers for print-on-demand automated patient identification and helping to improve patient safety by reducing manual errors. Another new format includes an infantsized, paediatric-sized, and adult-sized wristbands on a single sheet, saving caregivers time and resources, as the age and size appropriate wristband can be selected on the spot and there is no need to dedicate two separate printers in the pediatrics unit or children’s hospital. “With the release of our new mother/father/baby and infant/paediatric/adult products, hospitals now have a better alternative that’s softer and easier to use,” said D’Albert Benoit, Patient Safety and ID Marketing Manager for PDC Healthcare. “DuraSoft not only provides time-saving convenience for caregivers, but also features an antimicrobial additive that protects the wristband sur-

face against tested non-pathogenic bacteria,” he added. A company release informs that DuraSoft is lightweight, ultra soft, and requires no assembly prior to application, unlike typical laser patient ID wristbands that contain a stiff laminate overlay that must be careful-

ly folded and applied to the wristband. It also claims that DuraSoft’s patented, innovative design is moisture-resistant and protects important patient information from fading or smearing from water, alcohol, or hand sanitiser. Its antimicrobial additive reportedly prevents wristband

degradation and discoloration. The DuraSoft product line is the only laser wristband series on the market compatible with PDC Healthcare’s Ident-Alert Color Coded Snaps. Hospitals can use a bar code system, such as DuraSoft, as part of their

electronic medication administration record (eMAR) system to meet stage 2 meaningful use requirements established by the Centers of Medicare & Medicaid Services for Electronic Tracking of Medications. EH News Bureau





Dr APJ Kalam visits CEMAST, impressed with its offerings Institute provides 'real reality' simulators to cope with problems and complications during actual surgery


r APJ Kalam visited and CeMAST, an educational institute that offers teaching methodology and the latest 3D laparoscopic surgery training stations. The visit was also to observe the advancement in the field of surgery, the vision, values and innovations of CeMAST. He was reportedly very impressed by CeMAST’s unique training imparting programme and methodology. Dr Kalam also highlighted few points on ‘Future of Surgery in India’ in front of the dignitaries present on this occasion. Also over 50 eminent doctors and surgeons of international repute from across the country personally were present to be part of this celebration, take a tour of the centre. CeMAST has adopted wherein aspiring doctors and surgeons learn on 'real reality' simulators to cope with problems and complications during actual surgery. They actually get animal cadaver organs and simulate the tissues using a device to make them alive and artificially bleed so that the surgeons can get a hands on experience in surgery before they practice on any human being. CeMAST courses has been recognised by “Maharashtra University of Health Sciences” Nasik as a soft skills learning center for fellowship courses in Minimal Access Surgery. At CeMAST participants learn on “real reality” simulators to cope with problems and complications during actual surgery. In the last one year, CeMAST has reportedly already trained over 500 surgeons and gynaecologists. Based out of Mumbai, CeMAST is supported by an educational grant from Karl StorzTuttlingen, one of the oldest and largest endoscopic manufacturers in the world. EH News Bureau



Rotary International and Gates Foundation join hands for polio eradication Shoulders funding commitment of over $ 500 million


otary International and the Bill and Melinda Gates Foundation (BMGF) have joined hands to address the funding gap in the new strategic plan announced by Global Polio Eradication Initiative (GPEI) towards polio eradication. Considering the projected cost of $5.5 billion in the six years GPEI ‘2013-2018 Strategic plan’ against polio, BMGF has announced to contribute twice the amount raised by Rotary International, one of the spearheading partners of the GPEI. Rotary International since the inception of the global campaign has contributed $1.2 billion and continues with its funding effort. In 2007, the Gates Foundation gave The Rotary Foundation a $100 million challenge grant for polio eradication, and in 2009, increased it to $355 million. Rotary agreed to raise $200 million in matching funds by 30 June 2012, but managed to raised $228.7 million toward the challenge. Rotary International‘s Annual Convention took place in Lisbon, Portugal (23-26 June) where John Germ, Vice Chair of the International PolioPlus Committee, asked Rotarians to

help the funding through their efforts and “reach out to their non-Rotarian colleagues to raise money for polio eradication.” “Going forward, the Gates Foundation will match two-toone, up to $35 million per year, every dollar Rotary commits to reduce the funding shortfall for polio eradication through 2018,” said Jeff Raikes, CEO, BMGF, at the Rotary International’s convention. The estimated cost of the initiative’s 2013-18 Polio Eradication and Endgame Strategic Plan is $5.5 billion and a funding commitment of $4 billion has been announced at the Global Vaccine Summit in April 2013. But unless the current deficit is met, the anti polio campaign is not fullproof. The campaign can be affected to an extent as the immunisation efforts need to be sustained in all parts of the world. The joint effort, called End Polio Now – Make History Today, “If fully realised, the value of this new partnership with Rotary is more than $500 million (approximately Rs 3000 crores). In this way, your contributions to polio will work twice as hard,” added Raikes. Analysing the critical

phase at which ‘Polio end game is at present, Deepak Kapur, Chairman Rotary’s India National Polio Plus Committee (INPPC), who has been leading the effort for Rotary in India for the last more than a decade said, “GPEI’s six year end polio strategy is a global immunisation plan with the goal of ending polio while improving efforts to protect all children, including the most vulnerable, with life-saving vaccines.” India has gone over two successful years without a case of polio and the surveillance and monitoring report indicate another strong year for India to finally clinch the regional Polio-free Certification in 2014. However, the danger of virus importation exists because of the neighbouring polio endemic countries looms large. The eradication effort in Pakistan has been sabotaged by radical groups who have targeted polio workers killing some despite which the campaign is struggling back to track in the country. Recent setbacks in the African countries and the conflict in Pakistan and Afghanistan, there are a lot of questions arising on whether the world can actually be

polio free by 2018 as set by GPEI. “Since the six-year plan addresses all possible issues related to polio outbreak, the strategy should not be affected due to financial crunches. If allowed, polio can rebound and consequently, within a decade more than 2,00,000 children worldwide could be paralysed every year challenging countries like India where a child is born every second and needs protection,” Chairman, Kapur added. Globally, polio has decreased by 99 per cent to just 69 cases this year (as of 19 June), and only three countries – Afghanistan, Pakistan, Nigeria – remain endemic for the disease. Rotary, the initial donor to the GPEI has pledged its commitment through 2018 to raise funds and mobilise support of the endgame strategy. The extensive polio eradication infrastructure established by the GPEI is also helping to fight measles, malaria, and other diseases, along with aiding response to disaster-related health emergencies. After polio is eradicated, the endgame plan calls for the transfer of the GPEI’s assets to ensure lasting public health benefits. EH News Bureau

13 per cent Indians under threat of Obstructive Sleep Apnea Men thrice as likely to suffer as women sian Heart Institute hosted a live robotic surgery course for treatment of obstructive sleep apnea (OSA), on two patients in the city recently, which was viewed real time by more than 2000 doctors from across the globe via a webcast. The workshop was conducted for doctors around the world to display the latest robotic technique called Transoral Robotic Surgery (TORS) on the base of tongue to treat OSA. It was graced by world renowned robotic surgeons for sleep apnea Prof Dr Claudio Vicini, Dr Filippo Montevecchi from Italy, Dr Ramakanta Panda, VC and Cardio-Vascular Thoracic Surgeon, Asian Heart Institute and ENT surgeon Dr Vikas Agrawal. This type of surgery is extremely challenging because the base of tongue is


a very heavy muscle situated deep in the throat. “Both these patients were non obese and had tried the continuous airway pressure (CPAP) therapy, however it did not benefit them. Studies suggest that obese people are four times more prone to obstructive sleep apnea syndrome, but now we are increasingly seeing even non-obese patients with severe OSA symptoms,” said Dr Agrawal. Building on a 2009 AIIMS study with his observations he added, "The prevalence of OSA in the Indian population is 13 per cent and the incidence is three-fold higher in men as compared to women." Explaining why Indians are more at risk, Dr Agrawal further elaborated, "Our faces are more flat; chin is not as protruded as Caucasians, as a

result of which our tongue presses on the back of throat more frequently. This is one reason why the CPAP mask is not as effective in our population as Caucasians.” Prof Dr Vicini, a world renowned expert said, “TORS of the base tongue for treatment of OSA has many advantages over conventional CPAP therapy option which delivers air through a mask while the patient sleeps, keeping the airway open. TORS is an extremely effective one time

treatment for OSA as it gives extreme precision of robotic arm which resects the obstruction in the base tongue which is otherwise very difficult to reach as well as to operate due to its heaviness.” Lending support to the activity, Dr Panda, added, “This live surgery course on TORS is a step towards honing the skills and expertise of the medical community who will benefit largely form this surgical knowledge sharing.” EH News Bureau AUGUST 2013


‘There needs to be an intense effort to educate the members of registered ethics committees for clinical trials’ India has become a hub for clinical trials due to availability of state-of the-art infrastructure, skilled medical professionals in the field of medical research and lack of stringent regulation. However, the subject continues to be mired in controversy and has been getting a lot of negative coverage in the media lately. The approach taken up by multinational pharma companies and hospitals to conduct clinical trials has been questioned on various occasions. Dr Sita Naik, Advisor to Chairman, Research Task Force, Apollo Hospitals, tries to clear the air around the issue and explains the role of ethics committees within India in regulating the conduct of clinical trials in the country, in conversation with Raelene Kambli

INTERVIEW Standard Operating Procedures(SOPs), preparations for accreditation, etc. Ethical reviews of non-regulatory studies (e.g., for approved/marketed drugs and noninterventional research) can be handled by a sub-committee made up of associate members.

lack of informed decision making.

The healthcare industry is being accused of conducting unethical clinical trails for multinational pharmaceuetical companies. What is your opinion on the same? How should the industry tactfully handle this situation? This perception has gained ground because of some unfortunate, but infrequent episodes. The regulatory authorities are aware that the overall conduct of trials is fair and ethical but they get constrained by public perceptions and the resultant political reactions. They would like to create a more transparent climate that can allay these negative public perceptions. The industry should work with the regulatory authorities and the clinical researchers to ensure that all activities are done in the best interest of the participants and for the ultimate benefit of the patients.

Although Ethics Committees (ECs) have been around for some time, why is there a lack of understanding about the issues? What has gone wrong? In the earlier days, trials were limited to larger academic centres which had adequate, senior persons with knowledge and integrity to run these committees. However, the rapid expansion of clinical research in the last decade, has led to a large number of new committees. This has led to less trained and experienced membership. Also, there has been no emphasis on training about ethical issues for the medical professionals who make up the bulk of the membership. It is important to realise that questionable decisions may not always be due to suspicious intent but is also due to



Is there a need for regulatory reforms and more stringent ethical safeguards? What are the key changes required on the regulatory and industry front? The need for reforms have been recognised and these have been discussed and processes to bring these into action are ongoing. Apollo Hospitals Educational & Research Foundation (AHERF), in partnership with the Indian Council of Medical Research, Sanofi India and Quintiles organised a day and a half meeting which had excellent participation from all the stakeholders – researchers, members of independent ethics committees (IECs), industry etc. The objective was to discuss the various issues that are currently hampering the free growth of the field. The following major recommendations of this group have been submitted to the Committee set up by the Ministry of Health & Family Welfare (MoHFW) to consider the changes that need to be introduced in the regulatory process. We have been assured by the Chairman of the Committee, Professor Ranjit Roychaudhury, that the recommendations have been reviewed seriously by them. ●Training to EC members on key principles of good clinical practice, foundations of clinical research ethics and ethical philosophy, ethics review methodology and check-lists, compensation review and calculations, special ethical issues in developing countries, and national/international regulations. ● Allowing use of technology as a recognised tool in clinical trials and EC process (e.g: use of multimedia in Informed Consent Process; EC review meetings via video-cons, teleconferences forserious adverse event (SAE) review, compensation discussions, etc.) ● Longer time-lines for submission of report about adverse event (AE)/SAE by Ethics Committee (the current 21 days is too short to make correct assessments) to avoid the practical difficulties ● Establishment of an Indian agency for accreditation of ECs; followed

How can we improve the current situation? How can we strengthen ethical conduct of clinical research in India?

by mandatory accreditation of ECs by this agency Dedicated full time staff to EC for administrative functions, documentation, filing and archival support Formation of more than one EC in institutions with more studies (with demarcation for studies for regulatory approval and for investigator initiated studies) Establishment of Regional/State ECs for smaller centres /non- institutional based studies The structure for EC can be such that in addition to a smaller core apex EC (6 to 10 members as it presently exists), a larger Ethics Organisation (up to 25-30 persons) that would include more junior energetic/enthusiastic associate members with less demand on their free time (such as junior doctors, internal Site Management Organisation (SMO) nominees, research associates and select nursing staff). While the Committee at the apex would be responsible for all approvals and key reviews, the associate members would help with administrative and analytical work, including review of SAEs for presentation to the EC, compensation related administrative activities, organisation of training activities, documentation of minutes of meetings, drafting of correspondence, drafting and periodic review of

There should be early implementation of the suggested changes to the current regulations. In the meanwhile, while the accreditation processes are being put in place, there needs to be an intense effort to educate the members of registered ECs. All the institutions conducting trials should ensure that only appropriately qualified persons are selected as members and also facilitate training for the members.

What should be the role of the ethics committee? The EC has the sole responsibility of ensuring the protection of the participants – patients and healthy subjects - of clinical trials.

What should be the role of the hospitals and research institutes that conduct clinical research and trials? They have the responsibility to conduct the trials being undertaken in their institutions in the best principles of good clinical practice and always ensure the rights and safety of trial participants.

What is your message to the industry on this matter? It is unfortunate that due to a small group of defaulters, the whole activity has been put into disrepute. For the benefit of Indian patients it is important that clinical trial activity should continue and the required climate should be generated at the earliest with the active collaboration of the industry, the Site Recruitment Organisations (SROs and Contract Research Organisations (CROs), the institutions and researchers. AUGUST 2013


RESEARCH Study: Reducing does not reduce smokers’ risk of early death The conclusion was reached by researchers at the Universities of Glasgow and Stirling


mokers are unlikely to extend their lifespan if they choose to smoke fewer cigarettes but don’t give up altogether. The researchers at the Universities of Glasgow and Stirling arrived at this conclusion after reportedly examining data from more than 5,200 men and women, living in the central belt of Scotland, who were smoking when first recruited to two studies in early 1970s. All of the participants were recontacted a few years later and asked again about their smoking. Some had stopped altogether, some had reduced the number of cigarettes they smoked, while others had maintained or increased the level of their smoking. All deaths were logged between the second screening and 2010, enabling the researchers to see whether there was any difference in the mortality rates between the quitters, reducers and maintainers. The researchers found that, compared to maintainers, the quitters had lower mortality rates, but there was no significant difference between the reducers and the maintainers. In one of the two studies, a sub-group of the reducers who had been among the heaviest smokers at the start did show lower mortality rates but this was not seen in the other study. The Scottish findings, published in the American Journal of Epidemiology, do not support those of a similar long-term study in Israel where smoking reduction did appear to reduce mortality rates, but are consistent with larger studies of shorter duration in Denmark and Norway where it did not. Professor Linda Bauld

from Stirling University, one of the paper’s authors said, “Our results support the view that reducing the number of

cigarettes you smoke is not a reliable way of improving your health in the long term. “However, what we do

now know is that it may have a valuable role as a step toward giving up altogether – through cutting down to quit,

an approach that has been recommended in recent guidance in the UK”. EH News Bureau





‘Piramal Enterprises’ diagnostic division business is expected to touch Rs 100 crore mark in next one year’ Recently, Piramal Enterprises’ diagnostic division launched three new innovative devices in the POC market. Among these was QdxA1c, India’s first voice guided diagnostic device which measures HbA1c QDx VitD, the world’s only device that helps detect Vitamin D in ten minutes. This was a second launch in three months, reflecting the quick ascent of the company in the market. M Neelam Kachhap speaks to Vijay Shah, Executive Director & COO, Piramal Enterprises to track the growth path

INTERVIEW What is the size of the diagnostic division of Piramal Enterprises? Piramal Enterprises entered the diagnostic business by acquiring Boehringer Mannheim India (Roche Diagnostics) in the year 1996. After a negotiated settlement with Roche in 2005 the business has grown up from scratch to Rs 75 crores. Currently, the diagnostic division caters to both traditional, lab-based diagnostic supplies and emerging point-of-care (POC) diagnostic market in physicians' office. It is primarily present in clinical chemistry, haematology, immunology, urine analysis and rapid tests segments with leading brands like Diasys, Swelab, QDx etc.

What is the size of POC market in India? Why are you focussed on this market? Recent estimates say that the size of POC market in India is approximately Rs 600 crores, growing at attractive rate of 20 per cent CAGR. However, this does not reflect the true potential of POC opportunities. Indian diagnostic service is in the phase of decentralisation and is gradually moving from lab-based diagnosis to physician clinics diagnosis and finally, to home diagnosis. The transition is very prevalent in developed countries like US and Europe; with India following the same trend. Few tests, for e.g. glucose monitoring, pregnancy screening have already travelled the path; many more tests will follow the same. In this scenario, POC is considered as an emerging segment. Introduction of various products and technology is helping the segment to shape up very fast. However, many multinationals, though

they have high-end products, are struggling to meet the price point expectations and reach out to the physicians’ network which has more than five lakh members in India. There we find our opportunity. Due to a long legacy of domestic formulation business (sold to Abbott) Piramal is a well known and respected brand amongst the network of five lakh physicians. Our objective is to bring affordable and instant diagnostic solutions to the physicians' office and we are partnering with doctors to move from empirical to evidence-based treatment ‘Right-Here-Right-Now’.


What are your revenue expectations in India through POC portfolio? It is very early to project the revenue in POC. However, the growth driver for Piramal Diagnostic Division will be the POC segment. This year we have launched four POC products named QDx Instacheck, QDx A1c, QDx HemoStat and QDx Vit D. With these new launches our diagnostic business is expected to touch the Rs 100 crore mark in the next one year.

What are your investments in this segment so far? Currently, our focus is on introducing new products in the POC segment. We are looking at technological collaborations, in-licensing and exclusive marketing rights to reduce the time needed to get our products to the market. In the last seven months, we have launched four new products in the POC segment under our in-house brand Qdx. At the same time, we have our R&D products in the pipeline which primarily focuses on diabetic and critical care testing. We expect to launch our R&D products in a couple of years. Our core strength is sales and marketing. We have a dedicated team for POC and will gradually scale up the team strength as we expand the business line.

How are your products different from the current products available in the market? While most of the currently available POC products are for cardiac, diabetes and critical care segments,


that the patients can avail the benefits of instant diagnosis at the same cost that they are currently paying to the labs.

Are you are looking to expand POC presence in India. Please elaborate? we are the first to introduce a comprehensive hormone testing panel that covers 80 per cent of the diagnostic needs at gynaecology clinics. We also provide the convenience of TSH-whole blood screening in QDx Instacheck as well as rapid quantification of procalcitonin test for emergency septicaemia cases. Besides, our products can provide rapid, Vitamin D, finger prick, whole blood qualitative testing. We have also introduced a voice-guided HbA1c testing device, QDx A1c, with two per cent CV, POC haemoglobin testing in just five seconds and 1μL blood with QDx HemoStat. We have been successful in offering products which are unique at a price point that is acceptable to the Indian market.

How would you address the price point issue as India is demanding less expensive diagnostics? Indian diagnostic market is highly price sensitive. Unlike developed economies we don’t get reimbursement for diagnostic services. Everything is paid through the patients' pocket. The reason why worldwide well known POC products are struggling to get a share in the Indian market is that the cost per test to the patient is very expensive. We have introduced POC products at price points acceptable to the Indian market. We have managed to price the products is such a way

Yes, we are looking to expand our POC presence in India through the physician segment. We are in the process the making our POC product portfolio comprehensive and market acceptable. Focus is on making the concept of physician office diagnosis popular. Gradually, we will increase our reach to physicians.

Would you be hiring new employees? We are not in a hurry to ramp up the POC team. POC sales and marketing requires some unique skill sets. Hence, we are being very careful in selecting people. Focus is on putting the right people in the right place and filling the current gaps in the system. However, we are not ignoring the market converge. We shall increase our coverage as business grows and may explore some alternative routes to scale up the business.

Would you be launching any more new products soon? What are your future plans? We have six more products in our pipeline which would be launched very soon. We are looking at lipid profile testing, allergy testing, neonatal bilirubin testing, fever panel, complete blood count (CBC) POC analyser and coagulation analyser for physicians' office in the near future. AUGUST 2013


‘The geriatric services market is estimated to be worth about $250 million in India’ KPMG International recently released a new global report, ‘An uncertain age: Reimagining long term care in the 21st century’, commissioned by The Lien Foundation. Amit Mookim – Partner and Head of Healthcare, KPMG in India compares the results of the report with the realities of India


What is the status of healthcare for the elderly in India? By 2050, India’s population of those aged 60 and above is expected to total 323 million, a number far greater than the entire US population in 2012.It has been reported that a majority of India’s elderly – about 80 per cent – live in rural areas, of which 40 per cent live below the poverty line. A major portion of the elderly population has no social security such as Provident Fund, Pension scheme, Gratuity and healthcare. Most major hospitals in India have no separate geriatric care specialties and most of the elderly patients are treated in common wards. Geriatric care comprises special components such as emphasis on orthopaedics, CVS, visual and auditory impairment etc and the treatment perspective varies considerably. It is important to treat geriatric care as a different field to do complete justice to the treatment and care of the elderly. So far in India, only a minor affluent portion of the population has access to geriatric focused wellness centres and other elder care modalities.

What is the projected impact of healthcare for the elderly in India, in terms of demographic profile and burden on healthcare spends, both on a personal as well as national level? The elderly face an array of health conditions including co-morbid complexities and in many cases find only insufficient treatment options. Given the rising demand for social care services from an ageing population, governments are increasingly keen to share their responsibility for meeting this need. Even in the UK, where healthcare is overwhelmingly state-funded, the private sector is now the main provider of nursing home beds.The overall geriatric disease burden in India is massive. In the US, geriatric patients utilise close to 28 per cent of health resources, while their utilisation through similar estimates would be close 15-17 per cent in India.

What kinds of options are available and where are the gaps? The geriatric services market is estimated to be worth about $250 million in India and expected to grow to over $1 billion by 2013 and $2 billion by 2017. However, the segment is extremely niche and few players have explored the market. Apollo Hospital in Chennai is amongst the few hospitals that has a department of geriatrics along with Heritage Hospitals (Hyderabad) and Max in Delhi.These departments aim to focus specifically on the needs of the elderly and have treatment and management programmes designed especially AUGUST 2013

for ailments afflicting this genre of patients. Most of these players offer medical check-up services for the elderly and health monitoring options. Some also offer diet help and wellness routines. Geriatric care is an emerging healthcare model - ideally an integrated unit where the elderly can receive end-to end healthcare support: from health management to monitoring and diagnosis. A different kind of model is Association of Senior Living India (ASLI) which is a voluntary membership association for developers/service providers/corporate that operate in the senior living industry. While not focused on healthcare, ASLI is a great platform for providers to realise and address the needs of the elderly in India. However the number of such facilities is very less and a major portion of the population doesn’t have access to these.The issue is compounded by the fact that a larger portion of the elderly cannot afford these services. A major gap lies in the current medical education system which doesn’t have any specialisation for geriatrics.This leads to a gaping deficit in the number of qualified personnel trained to treat and manage healthcare for elderly in India.

What are the global trends as per the KPMG report, 'An uncertain age: Reimagining long term care in the 21st century'? Some of the trends highlighted in the KPMG report – In terms of demographics the report enunciates the rise of the elderly population globally along with the narrowing longevity gap.The report illustrates these trends with examples of countries like Singapore and China which are forecasted to have relatively higher ratios of elderly people in the coming years. The need for elderly care is further highlighted owing to the increasing pressure on traditional family based care. With the rise in number of divorce rates, single parent households, nuclear families etc – the elderly are far less likely to receive adequate care. From a business model perspective the report highlights two major trends. Firstly, the integrated model for elderly care - which brings together varied areas of healthcare and offers end to end services to a patient.The geriatrician, community nurse, pharmacist, dietician etc all work as an integrated unit to serve all needs of the elderly patient. And secondly, the integrated model also pushes for a patient centric approach which highlights the focus on patient rather than ailment – consequently quality of life (QOL) over treat-

of a patient. Needs of each patient should be assessed and solutions provided should be custom made to genuinely ensure the well being of the patient. These social models of care are better equipped to take care of the elderly than medical models.

According to the report, where does India and other emerging countries stand in comparison with developed countries on these parameters?

ment of a disorder.

What are the new models of integrated care mentioned in the report? Most models based around integrated care mentioned in the report have the following characteristics: they bring together personnel with different capabilities and expertise in different areas of geriatric care, provide all round care not restricted to healthcare needs and focus on QOL rather than disease conditions or impairments A noteworthy example is the Geriatric Flying Squad, a rapidresponse, multidisciplinary nursing service for sub-acute care recipients living at home. Developed in 2010 by a hospital in New South Wales, Australia, it includes a clinical nurse specialist, a doctor specialising in geriatric care, a social worker, occupational therapist, physiotherapist and clinical psychologist. Another example is Programme of All-Inclusive Care for the Elderly (PACE). Developed in San Francisco in 1973, it’s a publicly funded system of integrated care for eligible frail and disabled adults living in the community. Enrollees attend a day care centre where they receive most services from a multi disciplinary team.

What should be the new approach to medicine in long term care? The approach in long term care should be patient centric over institution centric.The management of health should be a priority rather than the mere treatment of the disorder. Since elderly patients may not necessarily need medical treatment but activities to occupy their mind and companionship – players in this domain should consider these factors. Wellness centres, diet regimens and mind activities are recommended to most geriatric patients – an institution which caters to geriatric patients should have these facilities that foster the QOL

Countries like France, Germany, Finland, Japan, Norway, UK etc have a publicly funded insurance system in place which takes care of the healthcare needs of the elderly. In some countries this funding is shared by the government as is in Singapore and Australia, whereas China and India do not have a structured programme for geriatric care.

What should be the road map to reach these levels in India? India has a long way to go in terms of geriatric care. Although home care as a segment is emerging in India the domain is fairly niche. The traditional healthcare providers are currently not prepared for the coming challenges of the increasing elderly population because of the sheer size and diverse needs of this aging generation. These challenges include both physical and mental health care needs – with the latter issue even more largely neglected than the former. The Indian system of care is not patient centric and care is still a reactive approach rather pro-active – with emphasis on treatment rather than management. Further, geriatrics as a subject is not considered widely in India’s medical education system. As mentioned before there a few players that have entered the segment, however these players are far and few and their offerings are not comprehensive. Geriatric care as a segment has a large addressable market size and immense potential. Further the business is relatively less capital intensive and hence scalable. Also, few players in the market make the competitive structure friendly. Health care providers should look at investing in this space. Focus on patient centric geriatric care in an integrated set-up is what Indian healthcare providers should look at in the near future to tap the potential. Also, geriatrics as a topic should be given its due importance in the medical education system in India. More training institutions and specialisations in the field could partially resolve the huge manpower deficit in the domain. EXPRESS HEALTHCARE




MICA to conduct MDP on 'Managing Hospital Communication' The three-day MDP will focus on ways and means to improve and enhance communication in healthcare facilities


udra Institute of Communications, Ahmedabad (MICA) will be organising a three-day residential Management Development Programme (MDP) on ‘Managing Hospital Communication’ from September 4-6, 2013 at its campus in Ahmedabad. The MDP will be led by Dr Nagesh Rao, President and Director, MICA. Every health facility wishes to offer quality

healthcare where health services provided to patients improve desired health outcomes. However, amidst soaring healthcare costs, suffocating time constraints, ever-increasing competition, and the pressures of using cutting edge technology, unfortunately, a critical aspect of healthcare sometimes takes a backseat – the patient. At the heart of this issue is inefficient and ineffective communication.


Effective providerpatient communication positively impacts diagnostic accuracy, patient compliance, patient safety and satisfaction, and decreased chances of litigation. Increased communication effectiveness among healthcare employees directly impacts their job satisfaction and patient health outcomes. The three-day intensive MDP on ‘Managing Hospital Communication’ will analyse the importance of communication in providing effective healthcare and is expected to offer strategic ways to address challenges and opportunities. Participants will reportedly get a chance to understand the dimensions of communication competence; understand how specific communication issues impact a healthcare facility, and how to manage them. The focus of the pro-

gramme will be both on communication strategies and skills, with a stronger focus on the former. The MDP on ‘Managing Hospital Communication’ will be useful for anyone working in a healthcare context: practitioners (doctors, nurses, pharmacists, occupational therapists, dieticians, etc.), administrators (senior management, quality team, administrative officers, etc.) policymakers, and educators. Contact: Narayanan K Nair Senior Manager, MDP Centre Mudra Institute of Communications, Ahmedabad (MICA) Shela, Ahmedabad 380 058 E-mail: Phone: +91-2717-308250 Fax: +91-2717-308349 M: +91 9724447196 Website:

Coimbatore to host Hospiarch in August 2013 The leading conference series on hospital planning, design and architecture to be held on 30-31 August 2013


he demand for hospital beds in India is expected to be around 2.8 million by 2014 to match the global average of three beds per 1000 population from the present 0.7 beds. India needs 100,000 beds each year for the next 20 years at over $ 10 billion per year. 20 health cities are expected to come up in the next five years.

Understanding these statistics, AMEN and HOSPACCX India Systems present a series of conferences on hospital planning, design and architecture at Park Plaza, Coimbatore on 30-31 August 2013. The topics under discussion would be as follows: ● Architectural challenges involved in building a new hospital

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Budgeting and financial planning for a new hospital project Planning and designing a new hospital Re-planning and redesigning an existing hospital Planning a Green hospital Equipment selection and optimisation for delivery of excellence in healthcare Marketing strategies and branding for a new hospital Manpower planning for a new hospital Designing a CSSD: Techniques and trends Planning and designing lab and other diagnostic

areas of the hospital Quality standards applicable to hospital planning ● Hospital engineering and architectural innovations The registration fees for delegates are ● Delegates: Rs. 5000/- per head ● Students: Rs. 2500/- per head ● Foreign nationals: $ 200 per head The event promises to bring doctors, hospital administrators, architects and consultants on one platform to discuss and deliberate on issues and solutions to improve the Indian healthcare scenario. ●



Sri Balaji Action Medical Institute to host its 34th Fellowship programme The four-day programme, held from September 5-8, 2013, will focus on laparoscopy elhi-based, Sri Balaji Action Medical Institute will host the 34th fellowship course of the Indian Association of Gastrointestinal EndoSurgeons (IAGES) from September 5-8. The four-day programme will offer a unique opportunity to enhance the knowledge and skills in laparoscopic surgery and then be admitted to the fellowship of IAGES. It will



also witness live operative workshop on basic and advanced laparoscopic surgeries by renowned surgeons from across the country. IAGES was established with a motive to promote and spread the advancement of this surgery throughout India and beyond. The fellowship offered by them will feature a balanced mix of didactic lectures by eminent faculty and step by step live demonstrations of basic to advanced laparoscopic surgeries. Topics like endovision system for laparoscopy, newer energy sources in laparoscopy, laparoscopic obesity surgery and laparoscopic versus open inguinal hernia repair will rule the discussion tables. Thus, the objective of the programme is to update the theoretical knowledge by close interactions and improving hand eye co-ordi-

nation. Dr Subhash Aggarwal, Senior Consultant-General Surgery, Sri Balaji Action Medical Institute said, “It is a proud occasion for our hospital to host the 34th edition of this prestigious fellowship programme. Being a FIAGES fellowship holder myself, it is great to be a part of this endeavor which aims to reach out to every practicing laparoscopic surgeon so that they can grab this unique opportunity and be certified as a Fellow of Indian Association of Gastro Intestinal Endo Surgeons (FIAGES).” Besides being a mandatory member of IAGES, the eligibility for the fellowship program will be based on two options of non-examination and examination category. For the non-examination category, surgeons should

hold a minimum of ten years of experience in practice of laparoscopic surgery and must have performed over 250 laparoscopic procedures. The candidates under this category are required to attend the sessions taking place during the first three days followed by an interview on the third day. Meanwhile, for examination category, the candidates are required to have minimum of two years of experience in laparoscopic surgery after post-graduation and must have performed over 25 laparoscopic procedures independently or jointly. They are supposed to attend proceedings on all the three days. Further, they will have to appear for a written examination on the third day and an interview and trainer assessment on the fourth day.

POST EVENT Renal Care Foundation organises round table on peritoneal dialysis and its inclusion in health insurance cover Urges realistic and cost effective management of chronic renal failure as a critical requirement


enal Care Foundation held a round table discussion around ‘Rational and cost effective management of chronic renal failure payer & payee perspective’ on Thursday, July 18, 2013. The forum aimed at giving an opportunity to recognise the need for inclusion of peritoneal dialysis in health insurance cover. The healthcare fraternity chose to address the issue via constructive dialogue at the conference. Present on the occasion were esteemed panelist Dr Dinesh Khullar, Sr Consultant, Sir Ganga Ram Hospital, Dr Gokulnath, HOD, Nephrology, St John’s Hospital, Bangalore and CH Asrani, Sr Physician & Claims Consultant. The spokespersons extended their views on the need for inclusion of peritoneal dialysis (PD) in the health insurance cover and how peritoneal dialysis is a better AUGUST 2013

means of treatment for patients suffering with kidney failure in India. On the occasion Dr Khullar said, “Peritoneal dialysis is a fast growing treatment of choice for End Stage Renal Dialysis (ESRD) patients. Several studies report that patients on peritoneal dialysis, the most common type of home dialysis, are more satisfied with their care and experience a reduced impact of kidney disease on their lives compared to patients receiving in-center haemodialysis. In addition, home dialysis is costeffective, associated with continued employment and can offer more flexibility and time for family and social activities. Recent studies also indicate that more than 75 per cent of dialysis patients are eligible to choose either a home or centre dialysis modality. PD is even more relevant

in India given the geographical expanse, the lack of social (electricity, water treatment, sewage management, personal hygiene) and medical infrastructure (trained nephrologists, dialysis nurse, technician etc.) It is pleasing to see that PD has grown rapidly in India in the last five years from 1800 patients to more than 7000 patients till date with a continuous ambulatory PD (CAPD) penetration of about 17 per cent in India. The inclusion of the treatment under policy cover will allow patients to gain better quality of living.” Dr Gokulnath said, “In India, it has been recently estimated that the ageadjusted incidence rate of ESRD is 229 per million population (pmp), and more than 100,000 new patients enter renal replacement programmes annually. The prevalence of CKD is

observed to be 17.2 per cent with six per cent CKD on stage three or more. It is an urgent need to stress to all primary care physicians taking care of hypertensive and diabetic patients to screen them for early kidney damage. On the other hand, planning for the preventive health policies and allocation of more resources for the treatment of CKD/ESRD patients are imperative in India. As peritoneal dialysis is a growing and better costeffective treatment in India, its inclusion in the health insurance cover is utmost crucial as it will benefit both the patients in reimbursing their expenditure and the health insurance companies to save more than expected revenue.” Talking from the perspective of health insurance companies, Dr Asrani said, “This is an extremely constructive dialogue and insurance com-

panies can help influence health policies by inclusion of treatment options in their plans and offerings. Chronic ailments do get expensive and it will be encouraging for both doctors and patients to opt for them if the burden is eased. Peritoneal dialysis should be a part of all health covers as lifestyle ailments are on the increase and insurance companies should be able to provision packages that help better quality of life to its customers.” The peritoneal dialysis health insurance roundtable created awareness about the benefits of the treatment over haemodialysis and its cost-effective aspect for the common people, the forum also helped to sensitise the health insurance companies about the need to encompass peritoneal dialysis and many such chronic disease treatments in the health insurance cover. EXPRESS HEALTHCARE



Anaesthesiologists gather to latest developments in field Experts discuss anaesthesia for robotic surgery, liver transplant and several other pertinent developments in the rapidly growing field, at a conference organised by Panacea NewRise Hospital & Indian College of Anaesthesiologists




naesthesiologists from across the country gathered for a major conference organised by the Indian College of Anaesthesiologists and Panacea NewRise Hospital to discuss the latest developments and advancements and share their experiences in the field of anaesthesia. The 3rd Midterm Anaesthesia Conference & Convocation “Anaesthesia on the Dot, Current Concepts” intended to highlight the importance of anaesthesiologists and anaesthesia as a speciality that is very important in the field of healthcare. Dr Rajesh Jain, Joint MD, Panacea Biotec, was the Guest of Honour. The day long conference was also presided over by Brig (Dr) TR Prabhakar, President Indian Society of Anaesthesiologists (ISA) and Dr PN Kakar, Chairman of the Conference and also Director of Medical Affairs and Director Anaesthesia & Critical Care, Panacea NewRise Hospital. “Anaesthesia today has matured from a developing speciality to a welldeveloped speciality immensely supported by electronics. It is because of the advancement in the newer development of anaesthesia the various surgical specialities too have developed by leaps and bounds. It is important for young Anaesthesiologists as well as the seniors to remain well abreast with the latest development always,” said Dr Kakar. At the conference, experts discussed on issues like anaesthesia for robotic surgery, liver transplant and recent guidelines for sepsis along with pain management both for acute and chronic pain. The conference had experts in the field from across the country sharing the latest developments and pooling ideas while narrating their own experiences of working in the filed and the challenges that lie ahead.



SMBs: Rising above the challenges The three winners of Microsoft's Completely Boss Challenge competition will get a chance to build a five-year growth plan, with support from various industry experts KTP Radhika


he challenges in the world of small and medium businesses are much different from those of large organisations. Many small and medium businesses (SMBs) even find it difficult to understand their business strengths and weaknesses. As it happens, much of the valuable time of the CEO or owner of an SMB is spent on managing the workplace, attending phone calls, administration related work, fixing IT problems and many more mundane activities. Time that could have been—and should have been—better spent on taking critical decisions, planning for future growth, and other important tasks fit for a “boss.” While most SMB leaders find themselves entangled in the routine operational activities, the three winners of Microsoft's Completely Boss Challenge presented a different story. The winners belonged to Sort India Enviro Solutions (a recycling and waste management company based out of Vadodara), Hyderabad-based Rohini Minerals (a manufacturer of cost-effective poultry and cattle feed) and Mumbaibased Neptunus Power Plant Services (a solution provider for engine-based industrial and marine power plants). And as a reward, they are all going to get support from Microsoft (on technology), LinkedIn (on talent), (on media), WebChutney (on marketing), DOOR (on business consulting) and CRISIL SME Ratings (on knowledge) to develop a five-year robust business growth plan. Organised by Microsoft

Paresh Tulsidas Parekh, Founder, Sort India Enviro Solutions

Gaddam Ranjith Reddy, MD, Rohini Minerals

Uday Purohit, MD, Neptunus Power Plant Services

Office 365, The Completely Boss Challenge was India's first platform to reward and celebrate outstanding business leaders from India’s thriving small and mid-market sector. Around 2500 CEOs from across seven cities (Delhi-NCR, Bengaluru, Ahmedabad, Pune, Chennai, Hyderabad, and Mumbai) contested in first three rounds of the competition. The contest started with registered participants being evaluated on a quiz on knowledge and applicationbased questions, which was assigned weightage by QuizWorks, a leading quizzing company. Phase 2, which was city prelims, included events in the seven cities. The top 50 finalists from each city participated in the next level: an on-ground contest. Three short-listed candidates from each of these seven cities participated in the finals of The Completely Boss Challenge; finally, three allIndia winners were selected. Prashant Gubba, owner of Gubba Cold Storage based out of Hyderabad and one of the finalists of the competition, said that it was exciting to participate in the event

and it gave his company a platform to present its business. Echoing the same sentiment, another participant, Vishwas Kulkarni, Director at Computer Home based out of Pune, felt that The Completely Boss Challenge is a perfect platform for his company to showcase its products and services and will help SMBs to attain greater heights.

be amongst the top three winners in a competition like this, which is a first-ofits-kind. Uday Purohit, MD of Neptunus, opined that Microsoft’s Completely Boss Challenge, targeted at the mid-market segment, is a great platform for SMBs to showcase their unique business models. “The competition opens up a whole new dimension for our business,” he said. Ramkumar Pichai, GM Microsoft Office Division, Microsoft Corporation India, said that the experience of interacting with the midmarket CEOs has been very exciting and fulfilling. "This clearly shows that the Indian market has tremendous potential and it is further validated by the capability of the entrepreneurs who have come for The Completely Boss Challenge. Unique business models, especially that of the winners, showcase immense potential to innovate and grow using technology to achieve competitive strength and business growth. These companies have developed a systematic innovation capability which assures them of a series of successes that deliver business value,” he said. He also felt that programmes like The Completely Boss Challenge will enable SMBs to create, foster and grow innovative business models that have a positive impact on their communities and at the same time are crucial to India’s economic growth.

A platform to grow The main criteria for choosing the winners were their business strength, competitive advantage, how better they manage it and the financial growth of the company. Paresh Tulsidas Parekh, Founder of Sort India Enviro, said, “This has been a great experience for me and I'm glad to be amongst the top three winners. This unique platform will help us to scale our business and we are looking forward to working with the jury to prepare our five-year business growth plan.” According to Gaddam Ranjith Reddy, MD, Rohini Minerals, it was a tough competition wherein CEOs of midsize businesses gave their best shot. However, he felt that it was awesome to




EVENTS UPDATE Green lean six sigma certification training for healthcare

Ahmedabad 380 058 E-mail: Phone: +91-2717-308250 Fax: +91-2717-308349 Mob: +91 9724447196 Website:

Date: August 9, 10, 11; August 17, 18; August 24, 25; August 31, September 1

Clinical Trials Asia Summit

11th National Conference of IART Date: November 22-24, 2013 Venue: Jawahar Lal Nehru Auditorium, AIIMS, New Delhi

Location: Ahmedabad, Total seats available: 15 Organiser: Department AIIMS, New Delhi

Date: September 26 and 27, 2013 Summary: This programme module is specially designed for hospital managers and other healthcare professionals and shall focus on Six Sigma methodologies, Lean Concepts in healthcare systems and service delivery. Participant profile: Hospital CEOs/COOs, Management Executives, Hospital Operations Managers, Quality in charge, MHA/PGDHA/MBA (HCM) final year students Organisers: AUM MEDITEC Trainer: Meeta Ruparel, Certified lean six sigma master black belt Contact: Meeta Ruparel Email:, Website:

HospiArch Coimbatore Date: August 30-31, 2013 Venue: Hotel Park Plaza, Coimbatore Organisers: AMEN and HOSPACCX India Systems Summary: Two-day conference on hospital planning, design and architecture Contact: Paniel Jayanth, Founder & Chief Strategist, AMEN Mob: 09035189824/080-23472633 Email:

MDP on 'Managing Hospital Communication



Venue: Hyderabad Summary: Clinical Trials Asia Summit will have a total of six sessions. They are Clinical trials: Current scenario and complexities; The pain points: regulation, ethics and bottom-lines; Quality Control; Emerging trends: vaccines and BA-BE; Quality by design (QbD); The combined learnings. Speakers who will take part in the summit are Dr TS Rao, Adviser, Department of Biotechnology, Ministry of Science & Technology, Govt of India; Dr Shreemanta Parida, CEO, Vaccine Grand Challenges Program, Dept of Biotechnology, Govt of India; Dr Sadhna Joglekar, Area Medical Director- India/Sri Lanka, Executive Vice President- Medical and Clincial Research, GSK Pharmaceuticals; Dr Rajendra H Jani, Senior Vice President -Clinical R&D, Cadila Healthcare; Dr Rajesh Avinash Chavan, Consultant ENT & Principal Investigator, Jehangir Clinical Development Centre; Kapil Maithal, Director, International AIDS Vaccine Initiative; Dr RS Paranjape, Director, National AIDS Research Institute [NARI]; Dr Siddarth S Chachad, Head Global Clinical Development, Cipla; Dr Prasad Kulkarni, Medical Director, Serum Institute of India; Dr Khalid Saifuddin, Group Head-Central Continuous Remote Monitoring (CCReM), GCOOBD, Novartis Healthcare; Dr Deepa Arora, Global Head, Drug Safety & Risk Management, Lupin; Dr Himanshu Gadgil, Vice President, Intas Biopharmaceuticals; Dr Ranjeet S Ajmani, Chief Executive Officer, PlasmaGen BioScience; Dr Shravanti Bhowmik, General Manager- Clinical Research, Sun Pharma Advanced Research Company. Contact details: Tikenderjit Singh Tel: +91 20 6727 6403/+91 20 6727 6412 Tel: +971 4 609 1570 Email:

Summary: The 11th National Conference of IART will bring together experts from the field of radiology to deliberate on topics such as radiography, radiological imaging, radiology equipment, professional issues related to the subject, radiation protection, patient care and many more Contact: Organising Secretary Department of Radio-diagnosis, Ansari Nagar, New Delhi-110029 Tel: 09868398808, 01126546230 Email:


66th Annual conference of Tamil Nadu and Pondicherry Chapter of IRIA Date: December 13-14, 2013 Venue: Scudder Auditorium, CMC Campus, Bagayam, Vellore Organiser: Department of Radiology, Christian Medical College, Vellore and the Vellore subchapter of the TN & PY chapter of IRIA Summary: The 66th Annual conference of Tamil Nadu and Pondicherry Chapter of IRIA will lay emphasis on the ongoing and upcoming trends in the field of radiology and diagnostic imaging. Contact: Department of Radiology, Christian Medical College, Vellore Tel: 0416 228027 Email:;

Date: September 4-6, 2013

To tie up with

Venue: MICA Campus, Ahmedabad Organisers: Mudra Institute of Communications, Ahmedabad (MICA) Summary: The three-day intensive MDP on ‘Managing Hospital Communication’ will analyse the importance of communication in providing effective healthcare and is expected to offer strategic ways to address challenges and opportunities. Contact: Narayanan K Nair Senior Manager, MDP Centre Mudra Institute of Communications, Ahmedabad (MICA) Shela,



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Internal audit and healthcare: A ‘Strategic Partnership’ PG 32 Evaluating patient expectations for progress PG 34

STRATEGY ‘Our USP is to produce people-centred leaders’ The boom in India’s healthcare sector has resulted in the increasing need for able administrators to steer enterprises along the right path. Mumbai-based Tata Institute of Social Sciences’ (TISS) School of Health Systems Studies (SHSS) has a strong accent on the social context within which management principles and techniques operate and believes in creating leaders, not just managers. Dr CAK Yesudian, Dean, SHSS tells Viveka Roychowdhury about the philosophy of the SHSS, new courses as well as gives suggestions to healthcare policy makers


When was the Department of Health Services Studies started in TISS? Since 1980,TISS was working in the field of health and hospital administration. Department of Health Services Studies was started in 1989 with a generous funding from Ford Foundation. When TISS underwent a major reform and restructuring in the year 2006, the Department of Health Services was transformed into School of Health Systems Studies (SHSS) with two new postgraduate degrees in public health (MPH).

What is the philosophy and vision of this department? The vision is to create a world class workforce in the field of healthcare administration and public health, and undertake research in cutting edge areas to contribute a body of knowledge to the field of healthcare administration and public health.

What is the USP of the Department's postgraduate degree programmes in the fields of hospital administration and health administration? How are they different from other similar courses? We do not produce managers of healthcare industries or public health professionals. We are not a business school. We produce leaders of healthcare industries and public health leaders. Our curriculum does not limit to teaching some management principles, techniques and their applications to the health field but we give a much broader view of the social context within which the management principles and techniques operate. Our USP is to produce people-centred leaders who can create a humane environment within which the health workforce operates. Our students stand out, both in the corporate and public sectors.


What has been the industry's response to these courses? Very positive. Our students are sought after by hospitals (corporate, government and NGO), insurance sector, IT, consulting firms, NRHM and so on.

What are the new courses on the anvil? This year we are launching three diploma

programmes, targeting working healthcare administrators and public health personnel. Among them, the flagship programme is the Executive Postgraduate Diploma in Hospital Administration (EPGDHA).This is a very unique programme offered in dual mode of contact teaching and online learning. It is a two-semester (12 months) programme, which has two weeks contact programme in TISS at the beginning of each semester followed by online learning by keeping in touch with his/her teacher through our courseware, MOODLE. We plan to launch it in October and the details are already posted on our website, In addition to EPGDHA, we plan to launch a Diploma in Health Administration (DHA) and Diploma in Public Health Practice (DPHP). Both these diplomas will be conducted using the franchise model. This means SHSS of TISS will identify organisations that have field expertise in these areas as well as training facilities. SHSS will give the curriculum and monitor its implementation, including the evaluation of the students.The diplomas will be awarded by TISS.These programmes are also meant for working healthcare personnel.

You have also worked with the WHO Kobe Centre in Japan in 1998 and 1999 in the field of ageing and health. What are your views on India's healthcare needs and how can the TISS’ SHSS help deal with these issues? While India is still struggling with maternal and child health issues, Japan has health and disability problems due to old age. In such a situation, they are finding it difficult to deal with long-term hospitalisation, normally needed for older patients, which is not cost effective.They are looking for other options like home care to a great extent. India is in the transition stage. Demographically, the country is slowly moving from a predominantly child and youth population to adult and older population.The country is rapidly urbanising. There is an epidemiological transition from communicable to non-communicable diseases. Finally, there is rapid economic growth. All these make our health issues

highly complex.There is dual disease burden of communicable and non-communicable diseases.There is unfinished agenda of not achieving the millennium development health goals (MDG) but at the same time we need to focus on the health of the older population. SHSS works very closely with the government and gives its input to policies and programmes. I was in the Steering Committee on Health of the 12th Five Year Plan. My other colleagues are in various government committees to contribute to their policy and programmes. We conduct research to evaluate the government programmes to see the relevance for the masses. Our research strength is to view the problem from the people's perspective.

What would be your advice to healthcare policy makers in India, given that India is far from achieving the MDG goals for healthcare indices? There is no one fix for this country. Healthcare delivery should be people friendly.This means different models for different communities. Government should encourage innovation within its own system to deliver relevant and acceptable healthcare to different communities. For this, the government should encourage different models of healthcare delivery operating within the government health system from one community to another.




Internal audit and healthcare: A ‘strategic partnership’ Dr Kapil Mohan, Deputy Manager-Internal Audit and Abhilash David, Assistant Mananger-Internal Audit, Max Healthcare Institute elaborate on the importance of regular internal audits in healthcare facilities to improve efficiency and efficacy of operations

I Increasing litigations/compensation claims and costs associated with it, revenue leakages, greater media scrutiny and complex legal and regulatory compliances call for greater efficiency in managing healthcare services. In today’s rapidly changing healthcare business environment, there is a marked increase in regulations, a greater focus on fraud and a heightened sense of need for risk management. Consequently, C-suite executives and corporate boards are under immense pressure from all stakeholders to achieve the objectives of the business without compromising on the quality of services provided, complying with all legal and regulatory requirements in a cost-competitive manner. The need of the hour is a ‘Strategic Partner’ who can understand the complexities, analyse the trends, professionally assess organisational practices/core business operations, and provide cutting edge yet cost-effective and practical solutions for healthcare providers. A partner who can evaluate the effectiveness of healthcare providers’ risk

management practices, control frameworks, and governance processes to help in achieving the strategic objectives by mitigating the risks involved or in removing the hindrances in achieving them. One who goes beyond assessing compliance, and adds value by working with management and improving governance, risk management, and internal controls to achieve strategic and business objectives.

Healthcare sector (facts & figures)*: The healthcare industry, backbone of any nation's well being, can be broadly divided into five segments, namely hospitals, pharmaceuticals, diagnostics, medical equipment, supplies and medical insurance. The Indian healthcare sector is expected to reach a size of $100 billion by 2015 from the current $79 billion, growing 20 per cent year-on-year, and aims to touch $280 billion by 2020, on the back of increasing demand for specialised and quality healthcare services. ● Indian pharma market is expected to grow at a compound annual growth rate (CAGR) of 15.3 per cent in the same period. ● Medicine exports from India are pegged at about Rs 64,000 crore ($11.62 billion), and about 50 per cent goes to the emerging markets. ● The hospital services market is expected to be worth $81.2 billion by 2015.

The Indian healthcare sector is expected to reach a size of


100Bilion by 2015, growing 20 per cent year-on-year



Dr Kapil Mohan

Abhilash David

◆ Monetary: ● Revenue leakage/loss ● Reduction in market share ● Employee fraud ● Non-payment by health care payors ◆ Operational: ● Increased compensation claims for medical malpractices/negligence ● Unfulfilled expectations of general public ● Increased manpower cost ● Increased overall operational cost ◆ Legal: ● Penalties due to legal and regulatory non-compliances ● Inability to protect Intellectual Property Rights ● Personnel indulging in criminal/unethical conduct ◆ Reputation/Brand: ● Negative media publicity ● Non-accreditation/cancellation of accreditation by accrediting councils ● Lack or inadequate ‘star doctors’ ◆ IT/Information security risks: ● Theft or sale of proprietary, classified or confidential information by employees or external parties. ● With this in mind, it is important to identify, prioritise and thoroughly evaluate the risks that impact organisations. While there are risks that are specific to the industry, there are also those that are likely to be specific to an organisation, depending on its mission, strategy and operations. Business risks are diverse in nature and arise due to

The market for outsourced services to healthcare payors is expected to increase from $9 billion in 2011 to $15 billion in 2016. The healthcare and life sciences sector has attracted approx. $817 million across 29 investments till August 2012, of which a significant contribution was from Private Equity (PE) and Venture Capital (VC). The hospital and diagnostics centre segment in India has attracted Foreign Direct Investment (FDI) worth $1.48 billion, while drugs and pharma products and medical and surgical appliances industries registered FDI worth $9.78 billion and $571.91 million respectively during the period April 2000 to October 2012.

Risks in the business of healthcare providers The demands on healthcare administration are increasing in this complex and highly competitive environment. Risks are seemingly around every corner for healthcare organisations, from legislation and regulatory developments to operational and financial concerns. It is sometimes difficult to keep track of all existing and emerging risks while focusing on organisational strategy, mission and patient care.

Emerging and existing risks specific to healthcare: A snapshot



innumerable factors, and may be broadly classified into two types, depending on their origin: Internal risks: Those risks which arise from events taking place within the business enterprise. These risks can be forecast and the probability of their occurrence can be determined with reasonable accuracy. Hence, they can be controlled by management to an appreciable extent. Some of the various internal factors giving rise to such risks are – Human, Technological, Physical and Operational factors. External risks: Those risks which arise due to events occurring outside the business organisation. Such events are generally beyond the control of management. The resulting risks cannot be forecast and the probability of their occurrence cannot be determined with reasonable accuracy. Some of the varied external factors which may give rise to such risks are – Economic, Natural and Political factors.

Internal audit The ever increasing requirement for organisations to adopt and demonstrate good corporate governance practices is gradually forcing a change in the traditional approach to control assessment in order to fulfil both compliance and operational demands. A strong, strategic internal audit framework integrates compliance, controls and sophisticated risk man-


agement with the organisation’s mission, vision, and stakeholder expectations. As such, it can help in shaping a new governance and risk management paradigm — anticipating issues, increasing effectiveness, eliminating duplication, and identifying areas of potential performance improvement. Using a riskbased approach, a skilled internal audit function can provide the necessary focus to co-ordinating an organisation's response to these new demands. Risk assessment is an important activity in any industry; however, in the healthcare sector it takes on a more significant emphasis as inadequate assessment of risk factors can have ramifications on patients and also on the professional staff charged with their care. At its simplest, risk assessment involves an appraisal of potential difficulties or hazards in any given situation. This often takes the form of an internal audit of obvious and known danger areas; however, nowadays it also includes a more sophisticated approach to identifying additional factors that could adversely affect the organisation. Internal auditors provide a broad range of audit services designed to help and organisation meet its objectives. One of the key roles is to monitor risk responses and ensure that the controls in place are adequate to mitigate significant identified risks. An effective internal audit function is a cornerstone of corporate governance— along with the board and executive management – helping organisations comply with new legislation and regulations for enhanced corporate governance. A professional healthcare internal auditor provides solutions to complex issues with clarity, courtesy, credibility, and consistency. He/she acts as a coach, an advocate, controls expert, efficiency specialist and a problem solving partner all at the same time. In essence, a professional Healthcare internal audit systematically assists the organisation in better managing and mitigating business risks including fraud risks, establishing robust internal controls and legal/regulatory compliance mechanisms, providing independent risk and control assurance, and meeting standards of corporate governance set by regulators and the industry.

Conclusion Risk-resilient healthcare

Domain areas for internal audits in hospitals Sr. Domain areas No


Corporate governance: Mergers and acquisitions, internal control framework, due diligence review, medical strategy and service excellence, capacity management, marketing and branding etc.


Medical and quality: Allied health operations, operation theatre, critical care units, diagnostic services, ambulance services, medical/surgical services, blood bank management, medical records, patient safety – incident management, nurse/ doctors bay etc.


Operations support: Procurement, inventory management, food and beverages, laundry and housekeeping, mortuary management, pharmacy, engineering services, bio-medical engineering, energy and water consumption, IT General/Application controls, ERP, business continuity & DRP etc.


People management: HR – Planning and recruitment, employee training, hospital and clinician relationship management, attrition level management, leadership development initiatives, payroll management, salary benchmarking etc.


Finance and accounting: Budgeting, accounts receivable/payable, fixed assets management, cash and bank management, discharge and billing, capital expenditure, treasury, taxation, financial reporting etc.


Compliance management: Legal and regulatory compliances, environment, occupational health & safety (OHS), internal policies, ISO/ JCI/NABH standards compliance, safeguarding IPRs etc

organisations assume risks profitably while effectively managing the complexities of a rapidly evolving business and regulatory compliance environment. By integrating risk management, internal control and compliance systems, management decisions can be made with increased confidence and clarity. The current business atmosphere of healthcare provider organisations is very complex and competitive. There are pervasive risks in all facets of operations and an increasing amount of regulatory requirements that the organisation must comply with. As management sets objectives and identifies processes, a comprehensive risk assessment and internal

audit can help identify risks and prioritise risk responses within operations, as well as identify potential opportunities. This process will allow the organisation to more efficiently determine where resources should be allocated. Internal auditors are uniquely positioned as an ‘embedded’ resource leading the organisation to deeper insights into Governance, Risks and Controls (GRC). A strategic approach to help identify, assess, map, evaluate, treat and report existing and emerging risks needs a strategic partner, and no one meets this need better than a professional healthcare internal auditor. [*Source – India Brand Equity Foundation (IBEF)] EXPRESS HEALTHCARE



INSIGHT Evaluating patient expectations for progress It is very important to understand the expectations of the patients to enable healthcare providers to fine-tune and deliver quality healthcare services, elaborates Dr J Sivakumaran, Sr VP, SPS Apollo Hospitals



ith competition building up in every industry across market segments, business houses realised that to do well, their business models would have to be customer-centric. Customer satisfaction is the key driver to success. Historically, healthcare delivery has been designed as a one-way route. Hospitals, through their professionals, used to provide care and patients received it. Though this was much convenient to the care providers, the patients wanted much more than this and not mere treatment for their ailment. Patients have become very conscious, selective and particular about their rights. Gone are the days when they were passive recipients of healthcare and reposed blind faith in doctors and hospitals. With increased awareness, patients play an active role in the healthcare delivery system. When patients are not in a position to observe, assess and rate the hospital on the technical quality (what patients get) which is beyond their understanding, they try to observe, assess and rate the hospitals on the functional quality (how they get it). The rating will lead to various decisions on patient revisiting, referrals to friends, relatives, participating in community health programmes etc. Hence, it is very important to understand the expectations of the patients. This will enable the service providers to fine-tune their services to match the expectations of the patients.


doctor to be transparent in sharing information about the disease, health conditions, complications, alternative plans, plan of treatment, healing time, precautions etc., to them or to their relatives. Patients expect their doctor to be competent, thorough in his clinical ability and skills so that psychologically they feel safe. Doctors need to be professional in their approach and should have the ability to perform the promised service dependably and accurately. Prompt and timely activities of the doctor will improve respect for them in the minds of the patients. Whether it is ward rounds, procedure or consultation, timeliness is expected by the patients from their doctor. Patients want doctors to be receptive about their complications, the pain suffered by them, ailments, discomforts, grievances etc. Doctors need to be good listeners. This quality often is the sole difference between a good doctor and others. Patients don’t want their concerns and complaints to be ignored during the process of treatment. Even if the suffering is mild, they want the doctor to listen and take steps to alleviate the suffering. Patients want the doctor to be a coordinator for their healthcare needs and to contribute in the continuity of care, even after discharge from the hospital. Patients often view their doctor as a god-sent messiah and naturally expect a cure from them for all their ailments.

Expectations from the doctor(s)

Expectations from nurse(s)

Patients generally want their doctor to communicate in their local language. They would not like to wait for a long time before being seen by the doctors but want them to devote time hearing out their problems without any hurry. When someone is sick and anxious, waiting for the doctor can be a harrowing experience. Properly scheduled OPDs can minimise waiting time as only a limited number of patients would be seen by the doctor on a daily basis. A doctor who cares for patients gains popularity in patient circles. If the doctor could hear calmly what patients say, the satisfaction of the patients will be high. Maintaining eye to eye contact will enhance the confidence level of the patients. Displaying e m p a t h y through words and body language will create a friendly atmosphere. Informed consents and participatory decision making is important. Patients don’t want any decision on treatment to be made unilaterally by the doctor. They are enthusiastic to participate in the decision making process and curious to know the likely anticipated events during and after treatment. A research study concluded that more the knowledge and understanding of procedures a patient is about to undergo, the better will be his cooperation and recovery. Patients want the

The patient’s first interface with medical professionals in the hospital is most often with the nursing staff. Nurses spend more time with the patients than doctors during hospital stay. Hence it is very essential that these nurses understand the expectations of patients treated under their care. Nurses are expected to create a friendly atmosphere with the patients. Patients expect to be respected and treated as human beings rather than being treated as a defective body part. Patients want the nurses to be empathetic and caring. Nurses need to be soft spoken and adept at soft s k i l l s . Gossiping and chatting with peers, spending time on personal calls when needed, talking over phone very loudly will irritate the patients and will not enhance the experience. Patients undergo tremendous pain, discomfort and trauma. Nurses are expected to be sensitive about patient needs. Good nursing care will help the patient recover faster. Like doctors, patients want nurses also to spend more time with them. Patients rely on nurses for guidance, advice, physical and emotional comfort. Nurses should have good listening skills so that patients don’t feel ignored. They are also expected to have technical knowledge and training to operate relevant bio-



Nurse interacting with patient

Doctor interacting with patient

PATIENTS HAVE BECOME VERY CONSCIOUS, SELECTIVE AND PARTICULAR ABOUT THEIR RIGHTS. GONE ARE THE DAYS WHEN THEY WERE PASSIVE RECIPIENTS OF HEALTHCARE medical equipment and possess the expertise to manage any kind of emergencies. This will give assurance to the patients that they are in the safe hands during their stay in the hospital. The nursing care in the night shift should be as equivalent as day shift. In a recent study, many patients have complained that they didn’t get adequate care at night. The nurses are expected to be prompt and trustworthy in carrying out their duties and protocols. Nurses are the caretakers of the patients. Right from linen changing, wash room cleaning, timely diet supply, doctor’s ward visit, diagnostic appointments, arranging surgical/pharmacy items for treatment up to discharge process, there shall be lot of coordination and follow up required with various departments. Hence they are expected to behave as good public relations officer. Nursing profession is a thankless and endless task. Due to acute shortage of manpower, nursing can be a highly stressful profession, as nurses are often called upon to multi-tasks. The real challenge is to efficiently optimise nursing care in the face of constraints, without compromising on patient safety and quality of treatment.

Expectations from hospital(s) Patients have high expectations from the hospitals, right from infrastructure suitable for a comfortable, safe and infection free stay to quality and hygienic food facilities being provided. It is very important to make the patient leave satisfied, AUGUST 2013

which will bring enormous referrals to the hospital. A satisfied patient will act as an ambassador for the hospital propagating its goodwill in social circles. A disgruntled patient on the other hand can mar the reputation of the hospital. A safe and clean environment is the core requirement when it comes to the patient expectation from the hospital. Patients want proper signage, easily identifiable access to various departments, and an efficient queuing system right from admission desk to the discharge desk. Digital display system will improve the level of transparency in the administrative system. Another expectation from the patients is Patients Relatives’ Management, which is not given importance. When a patient is in ICU or in OT/recovery, the relatives and friends will be curious to know the condition of the patient. Many a time, update is not given to them and they were ignored. As these friends and relatives are also responsible for choosing a hospital, in the interest of the hospital, it is essential to update the condition of the patient with them. Comfortable waiting facilities for attendants near ICU/OT, provision of snacks/drinks, clean and hygienic drinking water will influence the attendant’s perception about the hospital. Every patient in a hospital expects an affordable, ethical billing with proper documentation. Unnecessary investigations and over billing will damage the reputation of the hospital. Patients want an estimate of expenses which will not have substantial variation with the final billing. Before deciding a procedure, the details of package, inclusions and exclusions need to be explained to them. This will enable them to mentally prepare for sufficient funds in advance. Patients require proper information about the hospital, availability of various facilities, details of respective contact persons, billing methodology, tariffs for select services etc. Patients and their family expect to be educated about their disease, do's and don’ts and training on domicile care. Patients need their enquiries to be answered within the shortest time. Patients expect the service providers to be professionally trained in their respective area of specialisations so that they feel that they are in the safe hands. This industry needs to remember that patient satisfaction is the key to their long term success. EXPRESS HEALTHCARE



KNOWLEDGE Hepatitis:The silent killer

Malnutrition: A malefic malaise PG 39

As we mark World Hepatitis Day, there is need to create more awareness on viral hepatitis, which has merged as perhaps the most deadly disease of our times and needs to be tackled head on, says Shalini Gupta


It kills one person every 30 seconds, a death rate that is three times as high as HIV/AIDS, affects more than one million people in Asia every year and every third person around the globe. And no, it is not HIV or malaria. Analysis of new data from the Global Burden of Disease Study (GBDS) 2010 published in the Lancet late last year reveals that the number of deaths related to viral hepatitis is significantly higher than previously thought, also that the Asia-Pacific is where an overwhelming majority of these occur (70 per cent). The study conducted by the Institute of Health Metrics and Evaluation at the University of Washington measures the impact of hundreds of diseases, injuries and risk factors across 21 regions across the world. Viral hepatitis is almost rubbing shoulders with HIV and outscores deaths from malaria when it comes to Asia, having almost doubled in the region since the study was done last in 1990. Not only this, the disease has higher mortality rates than even tuberculosis, which should leave no doubt about how infectious it is, considering the other three are the most prevalent infectious diseases known till date. With one more in its kitty, the world, however, is still grappling.



The disease burden Out of the five kinds of hepatitis viruses- A, B, C, D and E, hepatitis B and C are the major cause of concern in the APAC region. Elaborates Charles Gore, President of the World Hepatitis Alliance, “In Asia Pacific, the number of people dying each year from

viral hepatitis has increased by over 315,000 since 1990. Three-quarters of the total hepatitis B infected population lives in countries within the South-East Asia and Western Pacific regions, with 20 percent of the total hepatitis C population living in South-East Asia.” It is also to be noted that there are now over 450,000 more deaths as a result of viral hepatitis infection each year compared to 1990, he adds. Within Asia, India houses the second largest number of hepatitis B patients after China with two to four percent of the population affected with it. The hepatitis B virus (HBV) is transmitted through exposure to infected blood, semen, and other body fluids. In regions and countries where maternal screening and the use of immunoglobulin is not available, mother-to-child transmission remains a major route of infection. Referred to as vertical transmission, this remains the concern in both India and China. The hepatitis C virus (HCV) is mostly transmitted through exposure to infected blood (transfusions of HCVinfected blood and blood products, contaminated injections during medical procedures, and sharing of needles and syringes among injecting drug users). In India, prevalence of hepatitis C has been observed to be relatively higher in Punjab, Andhra Pradesh, Puducherry, Arunachal Pradesh and Mizoram. While in Punjab, the incidence is highest at four per cent of the population, the North East has more cases of HIV co-infection alongwith hepatitis C by drug users, blood transfusion is responsible for cases in Western part of India and needle stick injuries have been responsible for large scale outbreaks in Gujarat, informs Dr Samir Shah, HOD, Hepatology, Director, Global Hospitals, Mumbai. The incidence of hepatitis C is a bit lower with 0.8 per cent to 1.5 percent of the Indian population currently infected with it. Although Government of

India (GoI) has mandated the use of auto disable syringes for use since 2005, 95 per cent of injections administered are subject to the risk of reuse which in turn accounts for transmission which can be as high as 40 per cent in case of hepatitis C.

Stepping up screening and awareness Even as we have been able to get a bit of grip on the numbers, the largely asymptomatic nature of the disease

coupled with low awareness and the resultant lack of effective screening procedures means that there is a huge chunk of population carrying the virus are unaware of it and yet transmitting it. Hence, it becomes even more important to step up the ante on these fronts. “The problem is we do not know who to screen. Because it is a silent disease, the infection manifests later in life. Only 10 per cent of those affected show symptoms. If someone in the family is posAUGUST 2013





President, World Hepatitis Alliance

Professor and Head, Department of Hepatology & Director, ILBS

Chair, Coalition for the Eradication of Viral Hepatitis in Asia Pacific (CEVHAP)

HOD-Hepatology, Director, Global Hospitals, Mumbai

Three-quarters of the total hepatitis B infected population lives in countries within the South-East Asia and Western Pacific regions

All family members in an index family need to be screened, vaccination of positive patients will not help which is what is being practised currently

Inclusion of the HBV vaccine in national immunisation programmes is crucial to Hepatitis B prevention and has been one of the major global achievements in the past two decades

It is not only the patients who are unaware, but even physicians maybe unable to pinpoint a cause, given the silent nature of the disease

itive, all family members in such an index family need to be screened, vaccination of positive patients will not help which is what is being practised currently,” asserts Dr SK Sarin, Professor and Head, Department of Hepatology, and Director, Institute of Liver and Biliary Sciences (ILBS). WHO Framework for Global Action, also asserts develop-

ment of guidelines for screening as an important part of a coordinated public health response to viral hepatitis, particularly in resource-poor settings. It is with this in mind that as a part of its Global Hepatitis Programme, WHO launched a new initiative called the Global Hepatitis Network in June this year

supported by the Coalition to Eradicate Viral Hepatitis in Asia Pacific (CEVHAP). “The patient lobby has typically been much smaller and much quieter compared with other diseases, with many people often reluctant to speak out owing to the stigma attached to the diseases. Raising awareness is one of the four axes of the WHO Framework for Global Action, and the new Global Hepatitis Network hopes strengthen international collaboration by sensitising policy-makers, health professionals, and the public,” exhorts Gore, founding member of CEVHAP. Poor screening leads to a laxity in controlling transmission. In India it was only in 2002 that it was made mandatory for blood

banks to screen blood for hepatitis C, with most of the statistics on hepatitis C cases coming from people who would go for blood donation. And so, it is important to screen anyone who falls in the high risk group of those who received a blood transfusion before 2002, stresses Dr Shah. He also informs that it is not only the patients who are unaware, but even physicians maybe unable to pinpoint a cause, given the silent nature of the disease.

How much do unsafe injections contribute to the disease burden? What steps need to be taken in order to address this?

tions respectively.

Given the availability of single use and needle stick injury prevention syringes, unsafe injections should in theory be one of the easier transmission routes to tackle, however, given the relatively high cost of these syringes, they are simply out of reach for many resource-constrained medical centres and this is where most unsafe injections are taking place. The WHO’s Framework for Global Action notes that in the year 2000, contaminated injections caused an estimated 21 million HBV infections and two million HCV infections, accounting for 32 per cent and 40 per cent of new infec-

CEVHAP realises the importance of educating donor organisations such as the Global Fund, Bill & Melinda Gates Foundation and the Global Business Coalition for Health, to include viral hepatitis as a funding priority (something that has been so far overlooked) and also to ensure that governments are able to develop evidencebased policies and allocate public funds. The investments made by philanthropists and the private sector to tackle HIV/AIDS have had a huge impact in tackling the disease and sadly we haven’t seen that in viral hepatitis.



nterview with Professor Ding-Shinn Chen, Chair of the Coalition for the Eradication of Viral Hepatitis in Asia Pacific (CEVHAP)

What policy measures can governments take in order to reduce the incidence of the disease? Last year WHO issued their Framework for Global Action, which outlines four key axes to strengthen the national, regional and international response to viral hepatitis. These axes can ultimately form the basis of national strategies, as a comprehensive response to tackle all aspects of viral hepatitis. Our hope at CEVHAP is that the new commitment this network represents will lead to governments adopting their own national strategies, with the


support of experts from within the new Global Hepatitis Network. A lot of this work of course requires funding and that’s where CEVHAP is hoping that international donors and NGOs will play their part. Inclusion of the HBV vaccine in national immunisation programmes is crucial to Hepatitis B prevention and has been one of the major global achievements in the past two decades. To date, 179 countries have introduced the HBV vaccine and WHO estimate that these have prevented approximately 1,307,000 deaths.

How do you hope to tackle the issue of access to medicines for hepatitis? It is important to note that the cost of anti-viral therapies is not the only limit-

ing factor to access to treatment. Indeed, the lack of medical infrastructure and laboratories, efficient and safe distribution channel, combined with the shortage of healthcare workers and diagnostic tools, are real obstacles to securing access to treatment for people living with viral hepatitis. New, innovative therapies are expensive and, as with all new medicines, access to these medicines is a significant hurdle for many populations. Access to health services is first and foremost the responsibility of governments and for this reason CEVHAP is committed to working with governments at all levels, as well as other stakeholders, to develop national action plans, based on the four axes set out in the WHO Global Hepatitis Framework.

The solution Given the complexity of the problem, it needs a multipronged approach, more so, a well developed strategy by the country that could further control the spread. In 2011,

How do you strategise to bring together donors to facilitate funding?




the Health Ministry gave a nod for the inclusion of hepatitis B vaccine shot as a part of the National Immunisation programme. WHO also recommends universal vaccination with the first dose to be given at birth as the best protection against hepatitis B. However, to date, less than half of WHO Member States have a policy to provide HBV vaccine at birth and it is estimated that only 27 per cent of newborns globally receive this vaccine. Taiwan is perhaps the best example, the country was able to reduce the incidence of hepatitis B from 16 per cent to 0.9 per cent 20 years after they Region


implemented universal vaccination. These are early days for India, the benefits are yet to trickle in terms of reduction in disease burden. While some states like Andhra Pradesh have implemented vaccination completely, Maharashtra has only achieved 50 per cent. This becomes even more important since physicians indicate that pregnant mothers should also be tested to rule out the HBV given that vertical transmission is responsible for most of the cases. However, for those who have not been vaccinated at birth, and the infection is chronic, treatment comes in

the form of antiviral medicines that need to be taken lifelong, to keep the viral load under control and cost Rs 30-60 a day, whereas a six-month to one-year medication for hepatitis C comes costs Rs 1.5 to 3 lakhs, informs Dr Shah. But treatment is to the cure, elucidates Dr Sarin. “If treated properly, the patient can become nonviral, but viral clearance does not occur, the virus is part of the subject, you cannot get rid of the infection. Hence the current treatments are suboptimal,” he asserts. It is estimated that there are 45 million carriers in India right now and 60 percent of these have a viral count above

one lakh, which increases their risk of liver cancer by 11 fold. “Hepatitis B is declared as a carcinogen. We have shown in two landmark studies that those who have the virus and their mother is HBV positive, 40 per cent of these with normal SGPT have liver disease,” he further reiterates. Summing up, the fight to eradicate hepatitis is a long one, it begins with awareness first and then a targetted effort from all stakeholders to take sufficient steps to ensure the spread of the virus is controlled in time.

Deaths from viral hepatitis

Deaths from HIV/AIDS

Deaths from TB









Asia- Pacific Total









Americas total









Europe Total









Africa and Middle East total









Total global maortality










Deaths from malaria



RESEARCH Malnutrition: A malefic malaise M Raelene Kambli leafs through a resource book on nutritional status for children below five years in India and catches up with the author, Dr Radhika Mathur to understand the significance of the subject

alnutrition among children below five years continues to be one of India's major human development challenges. Inspite of tremendous economic progress made in the last two to three decades, malnutrition among children in both urban and rural India still claims many lives. However, mounting cases of malnutrition has caught the public eye and so healthcare providers as well as the government are taking the necessary steps to improve the current status of nutrition for children in India. On the other hand, research concerning nutritional values and malnutrition has also been encouraged by government and healthcare providers. The Indian Council of Medical Research (ICMR) funds a lot of research activity in this field. One such research work is 'Nutritional Status of children under five from Urban and Rural India'- authored by Dr Radhika Mathur. Dr Mathur had conducted this study through exploratory survey design and simple random sampling of 160 children under five years of age within the state of Maharashtra. The study was conducted with a view to assess the nutritional status of children below five years from urban slum and tribal villages, to find out the differences in terms of nutritional condition and to find out factors influencing them. Her research was conducted under the guidance of Dr Gajanan D Velhal, Associate Professor, Department of PSM, Topiwala National Medical College (TNMC) and Nair Hospital, Mumbai. It

was recently published as a resource book by Lambert Academic Publishing.

Inside story The book is a complete synopsis of the research conducted by the author. It covers various factors that determine nutritional status for children, causes of malnutrition, its types, assessment of available literature related to the condition alomgwith the researcher’s recommendations. According to the author, nutritional status is one of the basic indicators of the well being of a child and quality of healthcare in a defined area and so the book began with understanding what is the right kind of nutrition needed for Indian children below five years of age. It is then followed by a detailed understanding of malnutrition, the various factors influencing its growth in India as well as effects of malnutrition. The book also highlights some important facts about major outcomes of malnutrition [protein-energy malnutrition (PEM) that causes conditions such as Kwashiorkor, Marasmus and Marasmic kwashiorkor)] among children below five years. Moving forward, the author has presented the motive behind conducting this study and important observations made during the research. Dr Mathur also provides various fact sheets, graphs and indicators that assess and determine various causes that lead to growing malnutrition

rural areas. The important factors responsible for the high prevalence of malnutrition in rural areas and urban areas are poor income of the family, parental education, and lack of personal hygiene practices within the family. However, immunisation status and sanitation level have not shown any significant influence on nutritional status. Moreover the author, during her study, also found that increasing number of children with Vitamin D deficiency suffer from rickets.


Child suffering with Kwashiorkor among children living within urban slums and rural villages of India. In conclusion, the Dr Mathur, cites her observations and recommends some steps to improve the current state.

Sneak peek into the findings “A nutritional deficit in the age group of five years can greatly hamper the well being and normalcy of the individual in the future,” writes Dr Mathur, explaining the importance of determining the nutritional status among children in order to curb malnutrition. In her study, she has found out that prevalence of acute malnutrition is significantly more in rural (92.5 per cent) as compared to in urban areas (61.25 per cent). The author points out that there is micro-nutritional deficiency among children living in the

On the basis of her findings, Dr Mathur has presented some recommendations in her resource book. She writes, “Reduction in grades of malnutrition in 0-5 age group can be ensured by availability of supplementary feed i.e. Greater enrollment of children in Integrated Child Development Services (ICDS) network.” Stressing on the significance of immunistion for the child and the necessity to maintain an immunisation card, she writes, “Special focus is needed on immunisation aspects in 0-5 age group, as this will protect the child from the deleterious effects of diseases that they would be prone to in the early stages of life without adequate immunisation.” She further recommends the healthcare providers to focus on health education among parents, especially the mothers on the exact nutritional requirements in terms of quality and quantity of the child at specific age groups.

In conversation... Dr Radhika Mathur

What led you to take on this research? Why did you choose this topic? I have been a part of Shri Satya Sai Baba, an NGO which adopts small villages within the hinterlands of India and organises various healthcare programmes for people living there.Therefore, as part of the organisation I have come across many children and women who are suffering from acute malnutrition.


Therefore, I choose to conduct a detailed study on the required nutritional status of children below five years.

What is the significance of this subject? Malnutrition, according to me, is a very big problem in India. Lack of basic nutrition that children need to take, no access to proper healthcare centres and no awareness on hygiene, food, contraception, etc., are the major causes of malnutrition.Therefore, it is

important that we understand the intensity of this problem and I believe that research in this field will help us to come up with better solutions to solve the problem.

What were the challenges you faced while researching on this subject? The biggest challenge that I faced during my research was getting feedback from patients. I have seen that people living in rural areas as well as urban slums are illit-

erate so interacting with them and imparting education to them is a tall task.

What are the major findings of this research and what are your suggestions to overcome challenges associated with malnutrition in India? In my research I have highlighted certain important parameters that determine the causes influencing malnutrition in children below five years. Once such

parameter is the lack of immunisation and Vitamin D deficiency which is found to be high among children living in rural villages. For this I have suggested that educating parents on nutrition and immunisation is the need of the hour.

How are you planning to take this research further? Shri Sathya Sai Baba NGO, which has its reach across India, have already put to use some measures provided in the book.




Leveraging technology for progress PG 42


Leveraging the

Power of Data

Sudipta K Sen, Regional Director- South East Asia, CEO & MD - SAS Institute (India) expounds on the ways and means to turn clinical and operational data into actionable, intelligent insights with the help of information technology



pared to succeed in the longrun. Ironically, the solution to most of these challenges are trapped within a mountain of patient and organisational data that’s buried deep within a multitude of clinical and administrative systems — that are neither integrated nor fully utilised. Hence, it is sacrosanct to leverage health analytics and derive trusted insights from data.

W With global concerns about containing the cost of healthcare, most countries and organisations are working towards leveraging technology in order to improve efficiencies. They are required to streamline operations, maximise profits and at the same time, deliver superior healthcare benefits to patients. It's clear that healthcare organisations that can adapt promptly and strategically to changing dynamics and ever-increasing challenges will be better

Identifying challenges and developing analytical capabilities

Sudipta K Sen, Regional Director – South East Asia, CEO & MD SAS Institute (India)

In the face of ever-rising healthcare costs and unforeseen complexities, healthcare providers need to leverage their operational and clinical data in order to facilitate a culture of data-driven decision making. From increasing patient safety, to improving the management and quality of care, and becoming more AUGUST 2013



financially stable through efficiency and cost management, the use of advanced analytics is critical. It must also be noted that typically in the healthcare industry, data comes from different sources and making it available to the front-end business users is often a challenge. While it is important for users in the healthcare industry to observe transactional, clinical and customer data, it is even more important to leverage data in its entirety and not in mere subsets. This complexity requires organisations to create integrated data sources in order to ensure that while deriving insights, useful nuggets of information are not missed out. In addition to transforming data into intelligence, it’s also necessary to ensure that insights are made available to users across the organisation and in formats that are easy to interpret – via web-based portal, mobile, email or any other channel/format. Health analytics encompasses the technologies and skills used to deliver business, clinical and programmatic insights into the complex interdependencies that drive medical outcomes, costs and oversight. Use of analytics can help healthcare organisations in three broad ways: ● Measure, track and enhance performance more effectively and efficiently ● Improve health outcomes and patient safety by delivering evidence-based developments in quality of care ● Save on costs through accurate forecasting and realtime access to information

Moving from a reactive approach to a proactive methodology Using analytics and/or business intelligence as a tool, doesn’t imply that an organisation is using analytics to its full capacity. The Indian and

global healthcare industry is largely preoccupied with descriptive statistics. This helps organisations answer ‘what’, but offer no insights into ‘why’ or ‘how’. This is the typical hindsight, insight and foresight scenario. While hindsight and insight are important in determining the root-cause and description of a problem, foresight is required to answer how things can be done in a better way in the future. Moving from a reactive approach to a proactive methodology is an intelligent way of leveraging insights in decision-making process. Inculcating analytics in the day-to-day culture can help healthcare providers in reducing costs, detecting frauds, driving efficiency and enhancing patient benefits. For instance, The Aarogyasri Health Care Trust (an initiative by the government of Andhra Pradesh) leverages the power of forward-looking predictive analytics to lower health expenses in the state, so more patients and diseases can be treated. The Aarogyasri Health Care Trust relies on SAS analytics to measure performance and keep expenses down. Claims, financial and clinical data are used in forecasts that ultimately root out fraud, spot disease trends, and lead to preventive health measures. Advanced analytics must be fully utilised to drive improvement in patient outcomes and gain in-depth insights into clinical performance. Through modelling, optimisation, predictive analytics and business intelligence, organisations can gain insights to enhance financial and budgetary performance, deepen consumer-centric relationships and improve the way healthcare is delivered for superior outcomes across the entire spectrum of health industries. With latest technologies such as

Memory Analytics and Data Visualisation, healthcare organisations can resolve complex problems in near real-time, derive accurate insights, leverage data in its entirety and generate easy-tounderstand reports that can be accessed by users across the organisation via mobile devices. SAS has in-depth domain knowledge and unmatched experience of delivering health analytics to the healthcare industry for fraud detection and prevention, health and condition management for improved outcomes, actuarial analysis for improved financial performance and new databased methods for customer retention.

Informed decisions for improved outcomes Progressive healthcare organisations are leveraging advanced analytics to data and deriving sophisticated predictions that have the potential to improve healthcare services and business outcomes. The utilisation of such technology has the potential to benefit patients and their families. However, that’s not all. Using predictive analytics to reduce re-admissions can have an impact on a healthcare organisation’s bottomline, as providers in many countries are now facing monetary consequences from payers that have tied financial penalties directly to unwarranted patient readmissions. With advanced analytics, healthcare organisations can gauge what interventions are working and then fine tune them in real-time for certain segments of patients. For instance, the analysis could drill down to evaluate what works for say young patients who are suffering from a certain disease, are members of a specific socio-economic group, and live in a certain region. Instant and easy

access to such forward-looking insights can be helpful to users across the organisation in not only treating the patients well but also in increasing efficiency. A vital aspect that must be factored before commencing the analytics journey in healthcare is understanding the pain-points that need to be addressed before selecting the technology. Most healthcare organisations land-up doing it the other way round, where they focus on the technology first. Healthcare as an industry is vastly diversified – they could differ based on speciality, geography, scale of operations, etc. It is therefore important to understand the business challenges and the magnitude of each challenge, before starting-off with an analytics initiative. Analytics, especially in the healthcare industry, is not merely a project. It is the confluence of people, processes and culture; which finally helps in benefitting the patients and their families in the best possible way. To summarise, there has never been a greater need to derive trusted, forward-looking insights from data, and the use of health analytics is critical. Creating a solid analytics foundation is imperative for the healthcare industry which is facing unprecedented transformation. Healthcare organisations must utilise operational and clinical data from multiple disparate sources and empower their users to quickly and easily derive intelligent insights from these massive chunks of data. A culture of data-driven decision making can help healthcare organisations to better utilise their resources, eliminate gut-feel and hunches, comply with regulators, streamline processes and above all – deliver superior healthcare benefits to patients. EXPRESS HEALTHCARE



Leveraging the power of technology for progress “Report is mailed to you.� The LIMS system can even generate a unique patient ID and password which can be generated at the time of registration. This ID and password can act as a login ID and password. This can    be printed on       patient’s payment receipt. Later the patient can login using the ID and password on the  patient portal to    view or download his reports. Also as soon as the reports are ready, a message 

   goes to the patient informing, “Report uploaded on the Patient Portal.�

Kishore Shinde, VP-HMS, Indisoft Consultancy gives a detailed overview on lab information management systems


oday, pathology labs play an important role in the healthcare industry. With the growing number of new viruses and diseases it is the pathology reports which give the data for accurate diagnosis to the doctors. With the population increasing and with sophisticated equipment required by the pathology labs, it is economically not viable to have the labs equipped with all the high tech equipment. Hence, there is a trend in localising the high-tech equipment at a centralised facility and having collection centres at around different places to feed these labs. The labs give back the results to the collection centre for the ease of the patients. So, the total time for the test is reduced, assuring better service through the sophisticated equipment to the patients. Hence, there is a need for a lab management system to fulfill these requirements.

Dashboard Every


Current scenario A patient visits a local doctor. The doctor prescribes him certain tests before he can diagnose the illness in detail. The patient walks to the nearest collection centre, gives the samples and then the samples are sent to the main labs where the actual tests are conducted and the reports are sent back to the patient. In a traditional system, the paper reports had to be carried physically to the collection centre or the patient had to come to the lab and collect his reports. But with technology coming into place these things can be managed online and it’s the main reason for introducing the Lab Management system.

Seamless integration The patient comes to collection centre. First he gets registered with the LIMS, then he pays for the test to be conducted. After the payment he will get the receipt from LIMS. Then he gives the sample where all the sample details along with the test to be performed can be entered. When the sample details are initially entered into the system, the LIMS can print a barcode label with a unique Patient ID and sample number. Therefore it is easy to track the sample. The samples from the collection





â—? â—? â—? â—? â—?

Security in LIMS Security features: The LIMS administrator can configure the LIMS for optimal data integrity. He can define the permission levels, for example updating the sample details, updating test results entered, payment related options, statistical reports, printing e-signature. Audit log: LIMS provides an extensive audit trail for changes made to any sample. Complete log of, the time, date and user are recorded along with the change details which can be viewed by the administrator.

Equipment calibration and maintenance Accuracy in test results is a must. To obtain quality results the equipment calibration and maintenance has to be done on regular intervals. So that no errors takes place while getting the results. The LIMS system provides an utility to maintain equipment Calibration and maintenance record, so that reminders/notifications can be generated to perform calibration and preventive maintenance.

Laboratory Information Management System (LIMS) A lab information management system takes care of a whole lot of processes from sample management to delivering reports, including the accounts. It handles: â—? Patient management â—? Sample management â—? Reporting â—? Accounts and billing.


data quality is improved (Machine Integration) Automated log-in, tracking and management. Ready standard templates makes reporting faster. (Radiology Test Findings Templates) Automated integration of handheld LIMS devices. (Barcode Scanners) Abnormal result alarm or markings. (H- High and L- Low) Daily and monthly reports are readily available. Easily accessible data via the web.(Patient Portal) Secured encrypted reports can be sent via email Inventory management

Inventory management

Working of LIMS centres will be sent to the centralised laboratory for testing. Once the tests result are ready, they are directly transferred to the LIMS through the machine. The LIMS also shows the abnormal markings if the test result is not in the normal range. The setable formulas for pathology, ready templates for radiology findings, automatic age / gender wise normal ranges, interpretations, method used for testing, makes the work easier and faster. As soon as the reports are ready and the payment is complete, the report can be mailed directly to patient. Even an SMS can be sent, saying that the “Lab report is ready please collect it� or

accessing the LIMS with specific role can view the details related to their role in a single screen called dashboard. For example, lab technician, radiology incharge or account incharge. They can get a complete overview on a single dashboard. Below is the dashboard of the lab technician.

Benefits of a web-based LIMS â—? â—?

â—? â—?

Information readily available with the click of a button Years of data can be kept easily without the need for traditional archiving Improved business efficiency As the instruments are integrated,

This is a challenge for many laboratories for the management, and tracking of laboratory consumables. LIMS will help to keep track of reagents consumed for each test. The user can define the reagents required for each test. It can also track expiry of consumables. LIMS can also provide advanced notification of the expiry. Every single inventory details are maintained in LIMS.

Conclusion LIMS can be used in collecting information, to aid decision making and to influence reviews and future developments it can also help in data management and analysis. With the advent of new technologies, labs with multiple collection centres (at different locations) need to maintain data integrity along with quality. So there is a need of good webbased LIMS which will cater to all the requirements of the diagnostic centres. AUGUST 2013

HOSPITAL INFRA ‘Medisystems pioneered electronic nurse-call systems, introduced bed-head panels and invented OPD patient-call systems’ The healthcare infra space is a hotbed of opportunity and the industry players across various verticals in this sphere are vying with each other to put their best foot forward. CP Thadhani, Director, CR Medisystems, talks about the sector, its evolution, challenges and his company's offerings as well as plans to optimise the segment's growth spurt, in an interaction with Lakshmipriya Nair

INTERVIEW How has the healthcare infra space in India evolved over the years ? The healthcare infra space – landscape, if you will – has evolved considerably over the last three decades. For many years, the largest hospitals in India were run by the Government – Central, State or (as in Mumbai) even by the local municipality such as KEM Hospital, Sion Hospital, Bhabha Hospital, etc. A few of the so called ‘private’ hospitals were usually founded, funded and managed by charitable trusts and some by well known catholic missions. With few exceptions, most of these hospitals were modest in size (usually under 500 beds). Since those days, the corporate sector has stepped in and the hospital landscape has changed dramatically. For one, the planning of new hospitals is now organised through professional hospital consultancy groups comprising a mix of doctors and engineers. Most of these hospitals are 300 beds + as smaller units are not considered to be economically viable. They also prefer to be ‘multi-speciality’ hospitals as these tend to bring in the maximum revenue. All of them are run and managed by professionally-trained hospital administrators. Many even rely on advertising as a marketing tool though this practice is frowned upon by the Medical Council of India (MCI). In general, however, the presence of such hospitals has substantially improved health-



care facilities, and outcomes, to the point where most Indians do not feel the need to travel overseas even for difficult medical problems and, in fact, we now have a nascent and growing 'medical tourism' industry.

What are the opportunities and challenges for players in this space ? As the country gears up to improve its healthcare infrastructure, each segment in healthcare space throws up its own needs. Government hospitals, dormant for long, have finally started putting their expansion and upgradation plans in place. The organised corporate sector is busy constructing several new hospitals and/or acquiring older smaller hospitals and upgrading them. Newer, ‘branded’ corporate hospital ‘chains’ are cropping up with regularity. Religious and charity trusts, especially those in the South and West of the country, have also put up hospital projects as part of their commitment to social welfare. Smaller, modern, hospitals are also coming up in tier-II and tier-III towns all over the country, often as investments by local groups of doctors and doctor couples. The challenge is to manufacture well designed and affordable infrastructure equipment for each of the above segments.

ensure that the country has the best crafted infrastructure in its hospitals, requiring minimum or no maintenance. A hospital needs to focus mainly on its patients and should not have to constantly divert its resources to get its infrastructure functioning.

How does CR Medisystems intend to play a role in the progress of this sphere ?

How does your offerings serve to enhance the infrastructure in a hospital set up ?

With several years of prior experience in patient monitoring, defibrillation and ICU equipment, Medisystems entered the hospital infrastructure space more than 15 years ago. We pioneered electronic nurse-call systems, introduced bed-head panels and invented OPD patient-call systems. All of which were carefully designed to fit in with local user practice all over India, and also to fit in within Indian healthcare budgets. To these products were added ceiling mounted pendants for OTs and ICUs. As the healthcare market expands, Medisystems will add newer technology and products to

We can illustrate with two examples: bed-head panels and electronic nurse-call systems. Too many hospitals, even today, do not understand the need to converge multiple utilities behind the patient bed in an organised manner. Medical gas pipelines and terminals, electrical fittings, patient-bed lighting, telecom and data terminals are all independently and separately planned for, with multiple contracts for execution – often through small time local wire men and contractors. On the other hand, bed-head panels are factory assembled units designed to converge all the above utilities neatly and systemati-




cally in an aesthetic enclosure mounted behind the patient bed. Properly configured and coordinated with installation of the other services, such panels can be installed within minutes at each bed, with no damage to the walls and other utilities. They require no maintenance, and service, if ever needed, is vastly simplified as no wall fixtures need to be removed. The panels are lightweight and can be easily mounted on gypsum board walls which are slowly becoming the norm in modern hospital architecture. Medisystems has installed more than 15,000 such panels in more than 100 hospitals all over the country. The nurse-call bell function has traditionally been handled through crude (and unsafe) electrical bell systems, borrowed




from offices for calling peons. Even today, most electrical plans and tenders for hospitals budget for just such types of systems. These systems function so poorly, that nursing staff routinely have them disabled with the help of ward staff. Electronic nurse-call systems of the type manufactured by Medisystems smoothly overcome all these issues and present the hospital with a patient-friendly, nursefriendly and administration-friendly solution. Rugged, scalable and loaded with features these systems meet the most stringent requirements of JCI and NABH. Being of indigenous origin they also bear a huge cost advantage over imported systems of similar capability. Medisystems has, to-date, equipped this ultra modern system for more than 40,000 beds in 280 hospitals all over the country. Similarly, all our infrastructure products are designed to enhance and deliver sustained and reliable service, wherever they are installed. The range of installations extends from huge hospitals in the metros, to more modest establishments in the smaller towns and all the way even to charitable institutions set up in rural areas to take modern healthcare to the village.

Tell us about your recent installations? Are there any new projects or deals in the pipeline for CR Medisystems? How would they impact the company? We have several project installations afoot at present. Of the 20 under active

installation, about a third have opted for the triple combination of bed-head panels, patient-bed lamps and nurse-call systems, the rest have opted for the nursecall system. In most such cases, their existing electrical contractor and/or gas pipeline commitments prevented them from going in for configured bed-head panels. With the need for the organised management of revenue earning outpatient departments in hospitals and polyclinics, the requirement for our OPD patient-call system has also risen. We expect to install several such in the next two years. Under our contractual terms our clients do not permit us to publicly name the institutions we are installing in. The impact of all these installations on the company is, however, comfortable. Whenever the hospitals are commissioned, patients benefiting from these facilities will also find them most useful – a source of great satisfaction to the entire Medisystems team.

What are the lessons that we can learn from the global market? The lessons we can learn from the global market are straightforward. Recognise that the ultimate beneficiary is always the patient and not the hospital. Deliver products of impeccable quality and design, because it is often a life-saving function that is being addressed here.





‘Northern states in India are leading in volumes of refurbished equipment sales' PG 51 Sanrad Medical Systems: Carving a niche in radiology' PG 52 Simulation in radiology PG 56 ‘In India we have approximately one MRI per million people’ PG 60 MRI is superior to CT in the evaluation of the uterus and ovaries’ PG 63 'Speech recognition is the wave of the future because patient records will undoubtedly become digital' PG 65 ‘Diagnosis is making all the difference in today's healthcare management’ PG 68


Old is gold: Aye or nay? In India, the demand for refurbished medical equipment is increasing. Raelene Kambli analyses the trend to evaluate its impact on healthcare delivery and finds how beneficial or detrimental it would be to the industry and the patients

T Technology, the most significant growth driver for the medical device market, is advancing rapidly thereby driving healthcare providers to keep abreast of the latest happenings in order to provide high quality care to their patients. This, in turn, shortens the intervals at which hospitals and diagnostic centres purchase superior quality systems and a large number of these repairable used medical equipment is being returned to the Original Equipment Manufacturers (OEM) or bought by third parties who refurbish them for resale. This worldwide market activity has given rise to an emerging trend of refurbished medical equipment. Refurbished medical equipment mainly involves the restoration of used devices to conditions which are consistent with OEMs’ specifications. This means that the used product is repaired, cleaned and updat-

IAMERS predicts that the sector is slated to be worth



Bil ion AUGUST 2013

with CAGR of 7.8 per cent by 2017.

ed to relevant patient safety standards similar to those of a new item. The process of refurbishing medical equipment also retains the service lifetime of the product and helps healthcare providers to save considerably on equipment buying costs. Globally, the refurbished medical equipment market is operated by mainly two kinds of players; OEMs and third party manufacturers. Major OEMs include GE Healthcare (UK), Siemens Healthcare (Germany), Philips Healthcare (The Netherlands), Stryker Corporation (US), Johnson & Johnson (US) and Toshiba Medical System (Japan) and third party vendors including Soma Technology (US), Agito Medical (Denmark), DMS Topline Medical (US), First Source (US) and Sanrad Medical Systems (India). Keeping an eye on the growing demand for refurbished medical equipment globally, the International Association of Medical Equipment Remarketers and Servicers (IAMERS) predicts that the sector is slated to be worth $8.45 billion with a CAGR of 7.8 per cent by 2017.

Worldwide impetus According to industry analysts, the refurbished medical equipment sector picked up momentum in the last 10 years with smaller hospitals and diagnostic imaging centres from various developing countries opting for such products. However, the economic meltdown and tightened healthcare budgets in the US and Europe, along with the increase in trained professionals in the refurbished medical equipment sector, have driven the growth of this segment among the wealthier economies as well. A report published by Transparency, a market research company based in the US, provides an insight into the latest happenings within the global refurbished equipment sector stating that North America, specifically the US, is contributing the maximum share to the refurbished medical

device market. The US market is primarily driven by private practitioners. Developing countries such as Latin America, specifically Chile, Ecuador, Caribbean, Bolivia, Mexico, and Peru, are also contributing largely to this growing market. However, there is a lot of latent market opportunities in the Asian market, reveals the report. This market is considered to be the most lucrative place for these refurbished products in the near future. So, how is the sector performing in India?

The Indian market In the past 5-10 years India’s B-towns and cities have been attracting many healthcare players who have set up small hospitals and diagnostic centres that cater to the healthcare needs of people living in and around these areas. However, these healthcare set-ups which are mainly run by private practitioners have a very tight budget and incorporating brand new X-ray, CT scanners, MRI machines and ultrasound devices will cost them an arm and a leg. Therefore, these hospitals opt for an affordable option refurbished medical imaging systems which help save capital cost. Speaking about the burgeoning segment in India and also giving OEM’s point of view, S Karthikeyan, Head – Ecoline Systems, Siemens Healthcare, says, “The refurbished equipment market is going to be very important in India. It is fast growing which is complementing the new equipment market. There is a good demand from customers for refurbished equipment, when budget constraints do not allow them to opt for new, highend medical equipment. Good quality refurbished systems enable healthcare professionals to provide quality treatment to their patients at a lower cost, which also enables affordable diagnosis and treatment.” Adding to this he goes on to say, “Refurbished equipment market complements the market of new systems,

with lower price points. This will help the customers and the OEMs, especially in a difficult economic environment. If more high quality refurbished systems are installed by OEMs, it will help dispel the negative perceptions associated with refurbished units and also help grow the market.” While OEMs feel that the refurbished medical equipment market compliments the market for new equipment, users of refurbished equipment feel that these systems are blessings in disguise. Talking about how incorporating a refurbished CT scan within their hospital has been light on his pocket, Dr Nitin Kadam, MD, MGM Hospital, Vashi, Navi Mumbai states, “Knowing that all the high-end diagnostic imaging equipment are 100 per cent manufactured abroad, we are fully dependent on import for these systems, thereby spending huge amounts in foreign exchange. By buying good quality refurbished equipment we save almost 40 per cent of the overall cost of equipment and if supported by good after sales service support we can easily sail through successfully with our investments. Moreover, a good quality refurbished system of a desired equipment has the same specification and functionality as that of a new system. The lower capital cost of these equipment enables us to sustain the overheads of maintaining such highly sophisticated units thereby offering patients services at affordable costs.” Dr Santosh Prabhu, MD, Matrix Diagnostix, Kolhapur, Maharashtra feels that in tierII and III cites where hospital entrepreneurs have a tight budget for setting up their facilities, refurnished equipment is the best option. He goes on to say, “In a place like Kolhapur almost all the CT scan equipment is refurbished! Healthcare industry demands delivery of good quality images at patientfriendly reasonable costs, with uninterrupted service and all these needs are being EXPRESS HEALTHCARE


I|N|I|M|A|G|I|N|G served by the refurbished equipment we currently use.”

The good, bad and grey... Agreed that incorporating refurbished medical system within healthcare set-ups can lessen the burden of huge capital investment on medical technology, but what about the safety standards? Is there any government body that scrutinises these products? Unfortunately, there is no governing body that plays the role of the watchdog for medical devices in India. Nevertheless, all medical devices imported, manufactured or refurbished have to follow guidelines that are laid down by the Atomic Energy Regulatory Board (AERB). Elaborating on the same, Dr Farah Deeba, VP-Medical Quality, Qualimed Heathcare says, “Though Government of India has permitted the use of these machines, there are certain aspects to be considered relating to radiation safety and quality of image, before buying and using these machines.” She lists down few essentials that refurbished companies have to follow: ● Availability of technical specification, in detail, including details of accessories, along with their make, date, etc. (e.g. pressure injector, non-invasive BP apparatus, table movement and gantry tilt, in a refurbished CT machine, to name a few) ● Technical evaluation by a qualified and authorised personnel ● AMC/CMC – Details, specifically with regard to availability of spare parts off the shelf, immediately as and when required. ● Availability of high-end software, medical grade monitors and work stations. ● Ensuring application of AERB and other C e r t i f i c a t i o n ( F D A / T U V / C E ) Guidelines. ● Ensuring regular periodic maintenance, calibration and quality assurance. Giving more insight on




Head – Ecoline Systems, Siemens Healthcare

Vice President, Sanrad Medical Systems

Refurbished equipment can save a lot on the cost of new equipment, but is definitely accompanied by large problems related to patient safety and legal liability

There is a good demand from customers for refurbished equipment, when budget constraints do not allow them to opt for new, high-end medical equipment

Every equipment which is undergoing refurbishing in a factory environment has to go through certain defined process for image quality, functional and service tests

precautions that users have to take, Som Panicker, VP, Sanrad Medical Systems, informs, “The customer will have to get the necessary operating licenses from concerned authorities like AERB in case of radiation emitting equipment like CT.” Moreover, experts warn that these products can be seized if hospitals and diagnostic centres using these products do not hold the required licenses and certifications. Well, although there is an AERB who has laid down certain guidelines, we cannot deny the fact that absence of regulations can be detrimental to both, the sector and the patients. This loophole has given rise to some malpractices in this business. Karthikeyan elaborates on this issue, “In India, the refurbished equipment market is predominantly catered to by third party vendors. These vendors are not authorised by the original manufacturers and are generally not licensed to sell or maintain refurbished systems. They often source old units from abroad, which are then sold at very low prices, since there is no technical refurbishment performed. But it is often difficult to maintain

these old units and the customer is saddled with malfunctioning units after a while. Such vendors have created a negative impression in the market for refurbished equipment. It thus becomes an uphill task to convince customers to opt for good quality refurbished systems from OEMs, since these are more expensive than that from dealers, due to the better product and refurbishment process.” Moreover, these malpractices have also raised the eyebrows of many healthcare providers. Dr Bhawan Paunipagar, ConsultantRadiology & Sonology, Global Hospitals, Mumbai is sceptical about refurbished equipment and this growing segment. “Hospital closures and mergers have created a glut of repairable used medical equipment that is being reconditioned and sold back into the healthcare marketplace. Depending upon its condition, this refurbished equipment can save a lot on the cost of new equipment, but is definitely accompanied by large problems related to patient safety and legal liability,” he asserts. Elaborating on his point he explains, “The FDA acknowledges the re-processing industry which is involved with a certain amount of re-marketing of used medical devices that were refurbished, rebuilt, serviced, conditioned, cosmetically enhanced or marketed ‘as is’ for further use. But the concern has been that re-marketing used medical devices may consist of activities that significantly change the finished device’s

performance, safety specifications or intended use. As defined as Quality System regulation, these activities constitute ‘remanufacturing’ the original equipment.” As contentions hem in, how will refurbished equipment vendors clear the air? In reply to this, Panicker justifies, “Every equipment which is undergoing refurbishing in a factory environment has to go through certain defined process for image quality, functional and service tests. We distribute only those refurbished equipment which has successfully passed all the tests and possess the required quality certificate from our overseas principal. These guidelines are prepared by the quality assurance department of our principal factory in accordance with the international guidelines of quality assurance.

Consultant-Radiology & Sonology, Global Hospitals



In conclusion... All in all, the refurbished medical equipment market, even with all its contentions, is here to stay due to the increasing demand for these products. It’s also important to note that the users of refurbished medical equipment are also satisfied with cost effectiveness, image quality and the over all durability of these products. The only worry is the malpractices that gives this sector a bad name. Mover and shakers from within the healthcare sector will have to ensure that such culprits are found and blacklisted within the industry to create a healthy business environment.



Northern states in India are leading in volumes of refurbished equipment sales In an interaction with Raelene Kambli, Ratish Nair, CEO, SANRAD Medical System speaks about the opportunities and challenges associated with the business of refurbished medical equipment and gives an update on the sector's progress in India

INTERVIEW How does the refurbished equipment market operate? What is the size of the refurbished medical equipment market in India? A large part of Indian population does not have access to quality healthcare due to very high costs. The healthcare service providers view refurbished medical equipment as an alternative to new equipment. The demand for refurbished medical equipment is increasing in India, as the healthcare service providers are focusing on Indian rural markets. Coupled with cost sensitivity, the demand for refurbished medical equipment is growing rapidly. The refurbished equipment market operates similar to other new equipment business, except for the fact that the business is concentrated more in the tier II-III towns/cities. Presently, the refurbished market is approximately 20 per cent of the overall equipment sold and almost 30 per cent of the sales in the private sector.

What are the major driving factors for the growth of the refurbished medical equipment market in India? Which refurbished medical products have a huge demand in India ? Lower cost of refurbished equipment and increasing occurrence of diseases are the major drivers for the growth of refurbished imaging equipment. It aids small and medium healthcare institutions to provide advanced treatment at lower rates. Refurbished equipment gives an opportunity for the customers to purchase latest technology products for their clinic or hospital. Refurbished medical imaging equipment is likely to be the most viable and affordable alternative to otherwise expensive high-end equipment. In case of individual, corporate or private healthcare institutions, it is necessary to control the budget for new and latest medical equipment and they in turn purchase refurbished equipment which benefits the economy, increasAUGUST 2013

es patient satisfaction, reduces electronic and toxic waste and improves overall healthcare quality throughout the world. Buying refurbished equipment can save you sometimes over 40 per cent of what you would normally pay for brand new equipment. It allows you to own top brand equipment at a low price. It also provides same performance level as that of new equipment and comes with full warranty. It is always best to purchase used and refurbished medical equipment from a reputed vendor, who will ensure that the medical equipment you buy are fully refurbished and tested under Original Equipment Manufacturer (OEM) specifications. For continued growth of refurbished equipment in the Indian market, it is very essential for a refurbished equipment supplier to have complete knowhow of the product and good infrastructure to support the maintenance and repairs of the equipment. The demand for refurbished equipment are mainly in the high value segment viz. CT scanners, MRI scanners, cath labs., etc.

damage to reputations of genuine vendors in the refurbished medical equipment business. It may be very difficult for some hospitals to equip themselves with the latest medical devices, but they still want to be the best possible healthcare providers. Their reputation and standing in the medical community depends on these factors. However, they simply are not able to afford the newest state-of-the-art medical equipment like CT scanners, MRI scanner or any other equipment necessary to perform their basic functions. In such circumstances, refurbished medical equipment supplied by genuine vendors are good alternates for most of them. If good quality refurbishment processes can be created with the active support of the manufacturing company, then refurbishing equipment in India will definitely give a tremendous boost to the business as costs can be greatly reduced as compared to refurbishing at facility abroad. To start a good quality refurbishing facility in India it is essential to have the involvement of the parent company manufacturing these goods, and that practically seems to be difficult presently. Moreover the present tax rates are much higher for manufacturers as compared to direct imports.

Can you name a few cities where the demand for refurbished medical equipment is high? The demand for refurbished medical equipment are more in developing states, specifically in states where infrastructure and healthcare facilities are growing fast. An approximate zone wise assessment indicate that the northern states in India are leading in volumes of refurbished equipment sales.

What are the opportunities and challenges associated with the business of manufacturing and selling refurbished equipment in India? Some cringe at the very mention of used or pre-owned. Whether it's in the eyes of the buyer or the seller, the patient or the healthcare provider, there is often a negative association connected to these terms. Whatever

we may call it, ‘remanufactured, reconditioned, re assembled refurbished, pre-owned’, plainly speaking it comes under one class 'second hand' or ‘used' equipment. Sometimes the customer reaction is justified. There are certainly instances where refurbished equipment will fail every other day or may not meet quality standards. Also, there will be some 'fly by night' operators, in any business for that matter, who will 'join the game' just for profit, causing suffering and loss to customers as well as patients. Just a few of these types can do severe

What is SANRAD’s market share within the refurbished equipment sector? SANRAD is the pioneer in the refurbished equipment sectors, and has a major share of the market due to its technical skills, excellent after sales service and committment towards supplying good quality equipment. SANRAD is not only a wellrecognised brand for medical imaging equipment, but also has turned into a concept by itself. This concept embraces a range of customer supContinued on Page 54 EXPRESS HEALTHCARE




Sanrad Medical Systems:

Carving a niche in radiology market M Neelam Kachhap visits Sanrad’s Peenya facility in Bangalore to gain a better insight on the refurbished medical equipment industry

The Sanrad team at Peenya Facility, Bangalore

Operations and strategising in progress


eenya, Bangalore is considered to be one of the largest industrial areas in Asia and houses some of the most reputed medical and pharmaceutical companies in India. Sanrad Medical Systems, the largest refurbished radiology equipment provider in India, has also found a home here. It recently unveiled a unique 5000 sq ft facility in Peenya, on the outskirts of Bangalore, to address its growing business needs.



The beginning Sanrad had a humble beginning in the economic capital of India, Mumbai in 1994. Initially, the company offered maintenance services and later started selling refurbished Toshiba CT scanners. Since then the company has become the fourth largest medical imaging equipment company in India. It is the only Indian company in the radiology imaging market, that stands tall among reputed MNC. With about 70 employees and offices across the country the company has more than

400 installations under its brand. The founder and CEO Ratish Nair says, "I was working with third party, involved in sales and service of Toshiba Medical Systems and realised that the customers had various issues concerning these high-end equipment. These equipment were mostly present in larger cities." "In an effort to bring such high end equipment closer to smaller cities by reducing costs, we introduced high-end refurbished equipment from Japan." he adds.

Unusual partnership Sanrad works with reputed MNCs based in Japan, Korea and China. "We have had a long association with T-MED corporation, Japan, that deals in refurbished Toshiba CT scanners," informs Nair. The other companies partnering with Sanrad are MDT, USA; ISOL, Korea; and XinAoMDT, China. "The products are imported to the Peenya facility and then sent to the client, where it is installed," explains Nair. "After installations we provide full service and annual mainAUGUST 2013


The products are imported, refurbished and transported to clients for installation tenance contracts (AMCs). Our best marketing is done by our own satisfied customers and our prices are reasonable. In fact, we do not end the relationship with a sale, in fact our relationship starts with every new sale and lasts for life," he adds. Stressing the robust after-sales service, he says, "We are known for our prompt services. None of our machines have down-time in days. We understand that time is of essence in our business. In fact down-time does not only mean losses but also life of the patient. No AUGUST 2013

client has to send a second reminder for service or maintenance. It is done promptly. We are always stocked with spares."

The products The company is known to provide factory refurbished CT scanners and MRIs. "Our portfolio consists of single, four and 16 slices CT scanners as well as permanent open MRI models in 0.3T and 0.45T from MDT, US," says Nair. Soon the company would start rolling 1.5T MRIs from the Bengaluru facility. "We are work-

ing with a Korean company to start sales of fresh equipment in India. This is a powerful 8/16 channel subsystem with fully automated scan operation." informs Nair. "We work with an independent Quality Assurance company that certifies our products after installations." he further adds.

In future Sanrad has ambitious expansion plans for the future. The facility at Peenya will be expanded in the coming months to add around 5000 sq ft

more to the existing facility. The new facility will house the new X-ray division, that will oversee the marketing and sales of new DR systems in the Indian market. The company also plans to venture into equipment software development in future. Sanrad will also look at joint-venture manufacturing in future where the non-Indian partner will provide the technical know-how and Sanrad will provide infrastructure, manpower and finance Nair informed. EXPRESS HEALTHCARE



Continued from Page 51 port systems that have been designed for cost conscious customers in India for a market that is both technology oriented and demanding. Our reference customers are key growth initiators in our business. It is important for the customers to check with existing user of the same equipment about the vendor, equipment, spare parts, failures, service support etc. We do not sell old technology equipment that are used more than approximately five to six years. SANRAD invests in extensive training, and development of knowledge driven manpower on all ranges of CT Scanner models including the newest versions. The lead engineers at SANRAD are trained at Japan. SANRAD believes in customer relations, which is our core value, and we ensure that the equipment delivers the same output as a new one, we have the largest inventory of spare parts in the country and offer them ex-stock to our customers, wide network of service support. Our wide network of service offers fastest

response time for customer support and is acclaimed as the best in the industry. The most important benefit that SANRAD offers its customer is a ‘First Service and Pay Later’ attitude that has been crucial for keeping the systems running at more than 98 per cent efficiency and saving many lives today. As part of the SANRAD culture, our engineers and marketing professionals understand the customers requirements, cost and business pattern. Based on those factors we help the customer select an appropriate model of equipment to meet all their imaging requirements. This is one of reasons for our success and hence our customers are growing year on year. As a reputed vendor we feel that its our moral responsibility to support the performance of our equipment and supply spare parts at least seven to eight years from installation and above all cater to the safety of the customers’ investment. This adds to our credibility within the industry. As a preferred service provider, SANRAD believes in building

Testimonials Dr Santosh Prabhu, MD, Matrix Diagnostix, Kolhapur Why did you opt for refurbished medical equipment rather than new equipment? I chose to incorporate refurbished imaging system at my centre because at an affordable cost I get to use state-of-the art technology that gives me excellent image quality as well.

Among refurbished medical equipment players, what parameters did you use to choose the supplier of your choice, in this case Sanrad? SANRAD's solid reputation of supplying high quality refurbished equipment with excellent service backup and minimum down time as well as availability of necessary spares with the company.

There are many contentions related to the quality and durability of refurbished equipment, how would you justify the same? Our facility has been using refurbished equipment for last 13 years. We have zero problems with it provided you choose the right vendor. Otherwise, if you have a wrong vendor (and there are many fly-by-night operators in this segment) beware of them ... it’s a nightmare !



relations with the customers, and the key people belonging to medical fraternity, through trust, integrity and emphasis on quality.

Refurbished equipment vendors have few responsibilities to which they must adhere. Can you name a few parameters that you consider while designing refurbished medical equipment at SANRAD ? Due to complex nature of the equipment, the after sales support, quality of the product provided by the vendors directly impacts the reliability. Most important parameters being considered by SANRAD are age of the systems, emphasis on latest technology of the equipment, upgradability of systems, ease of availability of spare parts, actual users review in terms of stability of product and Installation base in international market. Indian customers demand latest technology equipment supported by proper technical service with and assured 95 per cent + uptime for equipment and this is the key to future business.

Where do you see this market in the next five years? India is the biggest market in Asia for refurbished medical devices. M&M predicts Asia will be the most lucrative market for refurbished devices in the near future. India is one of the largest emerging medical equipment markets in the world. It is estimated to grow at a rate of 15 per cent with a Compounded Annual Growth Rate (CAGR) to exceed $4 billion by 2015. The increased need can be attributed towards growth in medical tourism, increase in health budget, rise in population associated with increase in lifestyle diseases and growing economy have led to stupendous demand for medical devices. As a country, we are cost conscious and still evolving strategies towards managing toxic wastes. Refurbished medical equipment allows for affordable machines without sacrifice of quality. More and more customers are using refurbished equipment just like a new equipment. .

Dr Nitin Kadam, MD, MGM Hospital, Vashi, Navi Mumbai Why did you opt for refurbished medical equipment rather than new equipment? Most of the high end medical equipments are imported from abroad, and I feel we should use our resources wisely and prevent meaningless waste of our earnings. Moreover a good quality refurbished system of a desired equipment has the same specification and functionality as that of a new system. Moreover the lower capital cost of these equipments enables us to sustain the overheads of maintaining such highly sophisticated units thereby offering patients services at affordable costs.

Among refurbished medical equipment players, what parameters did you use to choose the supplier of your choice, in this case SANRAD? We see major three parameters in choosing the right equipment: ● Equipment has to be of latest technology, not very old. ● System should be sturdy with proven performance ● Technical competence and efficient after sales service of supplier In the case of SANRAD we feel that they are the only company strongly committed to the above conditions.

There are many contentions related to the quality and durability of refurbished equipment, how would you justify the same? I personally use refurbished CT scan-

ners supplied by SANRAD since last 15 years and I must say with pride that they provide good quality latest technology equipments with excellent after sales service. Companies like SANRAD have played a major role in establishing the confidence of healthcare industry professionals in refurbished equipment. With a good saving in capital cost, considering the vast installation base of SANRAD, I feel they have helped our country save more than RS 150 crores in foreign exchange. Also, the re-use of high end medical equipment reduceS e-waste and helps in preventing CO2 emissions produced during the manufacturing processes.



RADIOLOGY HIGHLIGHTS Telerad Tech’s RADSpa signs six new contracts RADSpa is also available in Spanish and will soon be available in other languages ADSpa, a teleradiology work-flow, pioneered by Telerad Tech and Teleradiology Solutions has won six new contracts. The new clients represent a mix of healthcare verticals and diverse locations, informs a company release. Telerad Tech continues its expansion in Africa with a new installation in Togo. It has also made further inroads into South America with reportedly installations in 29 different hospitals in Mexico and moving towards 50 hospitals by the end of the year. Additionally, RADSpa has signed up with an OEM vendor in the veterinary space. Other contracts include an electronic health record vendor in the hospital space, and with a distributor in the imaging centre and clinical space. Letters of intent have been received from partners in two other countries in South America. “Mutual non-disclosure agreements have been signed with these partners who are re-branding the RADSpa. In all these agreements, the radiology workflow offered by RADSpa has been the main differentiating feature for RADSpa,” said Mohan Mysore, VP of Sales and Operations for the Americas, Telerad Tech . He continued, “There is a huge need for ‘non-traditional’ cloud-based RIS/PACS solutions and radiology workflow enhancement technologies in the rapidly emerging markets.”


According to Ricky Bedi, CEO, Telerad Tech, “There

is a great need for a system such as RADSpa as it is much more than just a RIS PACS. It is a complete teleradiology workflow-something today’s radiologists

increasingly need. This teleradiology work-flow is vendor agnostic and can be integrated with telemedicine, EMR and other EHR systems making it a value

add for distributors and companies in this space who do not own a radiology work-flow of their own.” EH News Bureau






Simulation in



imulation training has positively affected the teaching and training of professional pilots by creating consistent exposure to challenging situations in high-risk simulated conditions without exposing the pilot or passengers to real risk. Simulation training serves as a technology aid that when properly utilised, maximises the value and efficiency of teaching. Radiology training as many specialities in medicine has been affected by reimbursement changes in the US, and these changes threaten the quality of radiology education and potentially the quality of trained radiologists. It may well be that the implementation of simulation training may benefit radiology training. The traditional radiology training model over time has primarily emerged as an 'apprenticeship' model, where radiology trainees primarily learn the craft by working closely with a practising radiologist or group of radiologists. This model includes a considerable time investment by the teacher in a close association of the trainee with the teacher. Even though radiology training includes additional elements



as curricular elements including didactic lectures, self-learning including reading, and caseconferences, the primary method of learning for trainees is directly from teacher-practitioner to apprentice. The resident, through close association, observation, and emulation understands and learns how radiologists integrate their knowledge of the field into practical application of the three major segments of practice which include image interpretation which consists of analysing and documenting, radiology procedures which range from barium swallows to biopsies and vascular interventions, and consultation where referring physicians are guided to the specific test that will best answer their patient’s clinical need. The apprenticeship model typically lasts the fouryear duration of current residency training, and as a direct result of financial pressures on the field is threatened. The apprenticeship model has inadvertently and dramatically changed over the past 10 years. In the traditional model, a

Simulation training serves as a technology aid that when properly utilised, maximises the value and efficiency of radiology, explains Alex Norbash, Chairman and Prof of Radiology, Boston University Medical Center

radiology resident would look at a series of studies accumulated over the previous several hours on their own, and after formulating an initial set of impressions, the resident would then sit with the attending physician who would then patiently review all studies with the trainee, and as part of apprenticeshipteaching would then correct any misconceptions or misinterpretations the resident might have. The resident would then dictate every single study, and once the study was transcribed, the attending physician would review the report, make any necessary corrections, and then review the transcribed dictations and suggested corrections with the trainee. The amount of time the attending physician spent with the trainee was high, the efficiency of the process as regards patients throughput and image visualisation was low, and additional technical challenges in the traditional model existed including such things as lost films, prolonged transcription time for dictations, a lack of certainty regarding the transcribed report since work-

flow did not provide for the transcribed report being reviewed by the interpreting physician a second time in the presence of the study. The current model in most academic institutions has evolved as we have moved away from sheets of film and technology has permitted the creation of workstation-based picture archiving and communication systems (PACS), which allow viewing of studies from multiple sites on computer monitors. Almost simultaneously, voice dictation has contributed to changes in the training model allowing high throughput, which has also arisen as a need due to progressively lower reimbursement per study. The current model for training therefore consists of a radiology resident reviewing a number of studies as images on a computer monitor, and then intermittently engaging the attending physician for a batch review. While the radiology resident is reviewing their studies, typically, the attending physician is reading a series of studies on their own which will likely never be reviewed by a radiology resident. This is a current develAUGUST 2013


Radiologist reading CAT scan opment which is in distinct contrast from the traditional model. The radiology resident is therefore deprived of seeing a significant percentage of studies which could be educational. Of greater significance, the attending physician reviews the studies with the radiology resident in a relatively hurried manner following which the attending physician returns to his own workload, allowing the radiology resident to then voice dictate the report. The voice dictated report then goes into a queue which is reviewed by the attending physician, who then signs off the final version of the report. In the current system, therefore, the attending physician only reviews some rather than all of their studies with the resident. The attending physician is under greater productivity pressures and therefore tends to rush through teaching, and with a view to throughput the attending physician rarely has an opportunity to go over the resident’s transcribed dictations with the resident to help them learn how to craft such a report in a more refined manner. The advantages of the current system include high throughput, increased work efficiency, and remarkably more rapid turnaround for the final report. As profit margins have diminished over the years, however, the overwhelming pressure for radiology departments has been to maximise throughput, which now results in the teaching effort being significantly comAUGUST 2013

promised. In summary, the generous margins previously available from clinical work permitted the teaching mission. With diminishing margins, the teaching mission now cannot identify a substitute subsidisation basis. Given the technology advantages possible with current computing systems, a natural question arises concerning whether diagnostic radiology simulation is possible, in a high fidelity manner. Such a high fidelity simulation system would duplicate the work-flow of a radiologist, and would include multiple cases which would be graded based on performance. This would necessitate the creation of dictionaries where the radiology resident would dictate and voice transcribe their impressions concerning a particular case, and once their dictation is completed then either individual dictations or batches of dictations would be graded. The grading of the dictation would reflect a spectrum of performance allowing a new resident to know how they perform against their peers, as differentiated from how an experienced resident would perform against their peers. Ideally feedback from such an educational simulation system would include comments regarding findings which should never be missed, and also would point out interpretation of exceptionally high performance. The intent is to categorise performance against one’s peers and delineate performance expectations.

The current curriculum for trainees includes didactic sessions with lectures, case conferences which may either be multidisciplinary including a variety of physicians or which may include exclusively radiologists, and a considerable amount of independent reading. One could easily envision a future educational paradigm which includes didactics and self learning, however, with incorporation of a radiology simulator as part of their daily work, individuals can then more clearly identify their gaps in knowledge and ability. This type of gap assessment would direct the educational participant to media and enduring materials designed to specifically address their personal gaps. One can readily envision advantages and disadvantages to such a training methodology. The advantages of such a methodology would include a consistent method for measuring performance, and potentially the initiation of lifelong learning utilising integrated educational systems. The disadvantages of such training methods could be early abandonment of apprenticeship, overutilisation of the simulation system at the expense of didactic and reading opportunities, and excessive reliance on such simulation systems would deprive the trainee of exposure to individual attending practitioner approaches to the practice of radiology. The contributory challenges in creating such a system include the

ment of dictionaries to cover the full variety of necessary cases contained within a domain, the actual grading of the cases to reflect varied performance expectations by seniority of the examinee, and creating a sufficiently simple system to promote inputting of cases into an extractable data base from which such cases could populate educational simulators. These are not simple tasks. Although an initial version of such a simulator has been created, challenges remain in the ergonomic creation of a system which allows simple case entry, and simple case taxonomy and grading. As we consider the greatest needs in creating such a simulation system, it may well be that particular organ systems could most easily benefit from prototypes of the same. As an example, if there is a particularly high demand for breast imaging practitioners, and if there are consistent terminology and batches or recognised cases in the clinical domain of breast imaging, it may be a comparatively simple matter to create an educational simulator for breast imaging. When looking for needs, once radiology residents are prepared for independent call an “emergency imaging” simulation system may serve as the ideal examination tool to confirm and grade their readiness for independent call. An additional opportunity for the practical implementation of such tools is an ongoing performance assessment of practitioners, or

rejuvenation of skills which may have lapsed in practitioners. As an example, if I choose to read head and neck MRI’s following a one or two year hiatus, I would value greatly an opportunity to engage a simulation tool to rejuvenate my skills and grade them against performance expectations. In an envisioned future where performance measurement becomes commonplace and expected we may seek continuous objective measures of performance for practitioners; we may be able to integrate test cases into the daily work-flow of every radiologist, to ensure that acceptable and defined performance standards are actually being met. As with many simulation examples, we have much to learn from the airline industry. New pilots undergo extensive simulation training as part of their education. All pilots undergo routine and recurrent simulator training and performance measurement, and if their performance is below acceptable standards, they are not allowed to serve as airline pilots until remedial training takes place to acceptable standards. Pilot performance is measured, and benchmarks and targets are established. Passenger’s lives are entrusted to pilots once they establish their abilities and document their performance. This performance review takes place on a recurring basis. Patient lives are just as valuable as airline passengers lives. EXPRESS HEALTHCARE



‘In India we have approximately one MRI per million people’ Recently, GE Healthcare launched India’s first Digital Broadband 1.5T 16 Channel MRI System. Dr Karthik Kuppusamy, Director, MRI; India and South Asia, GE Healthcare spoke to M Neelam Kachhap about their MRI business in India and the product Many congratulations on the new product launch. Your announcement comes at a time when ‘Internet of things’ is being hailed as the technology that will change the way healthcare is practised today. Tell us why connectivity is so important for medical devices in today’s world? Connectivity is very important both within a hospital and also for communicating with referring doctors and patients. This is because of googlisation of healthcare. Let me just elaborate. First of all, for a hospital or a diagnostic imaging centre there are various diagnostic equipment and pathology tests which need to be quickly connected to each other while reporting to referring doctors. Secondly, diagnostic imaging is now spreading out deeper, to smaller towns and cities and there is a need for faster connectivity in releasing the reports online to many referring doctors and patients.

The newly launched MRI product has digital broadband technology, tell us how this makes a difference to the image clarity? Most of the 1.5T MRIs have conventional analog copper cables to carry the analog data from the magnet room to equipment room. While carrying the signal there is an external environmental noise which leads to signal loss. So, while receiving the data in the equipment room, which is 10-15 feet away, the signal-to-noise ratio decreases. MR360 Advance is designed to feature the digital broadband MR technology, the data will now be carried using optical fibre cable which will significantly reduce the effect of noise and improve the signal to noise ratio. OpTix offers high channel count, analog to digital signal conversion where it matters – inside the scan room to minimise noise and signal degradation, but away from the patient to enhance comfort and safety. OpTix provides up to 27 per cent higher signal-to-noise ratio (SNR) over conventional, analog signal receivers, improving image quality and clinical confidence.

Does higher clarity in image provide any diagnostic advantage to the physician as compared to the normal MRI image?



INTERVIEW having a MRI system such as yours?

Yes, MR360 Advance Digital broadband MRI provides superior high definition image quality

Both hospital and diagnostic centres across the geographies can benefit from the MR360 Advance. We have already installed our MR systems in tier I, II and III towns

Kindly explain how the ownership cost of the new MRI will be lower than the existing MRIs in the market? The ownership cost of the new MRI will be lower than the existing MRIs in the market in following ways. Our new MRI product is engineered to use ecomagination-certified technologies like efficient gradients, watercooling, super capacitors, and a power distribution unit, reducing power consumption by 50 per cent as compared to similar premium 1.5T competitor MR systems. With all of these ecomagination features, these systems are intended to lower the total cost of ownership while still delivering excellent clinical performance. Other premium 1.5T systems requires UPS ratings of 100-140KVA while MR360 Advance uses only 60KVA UPS. Advanced applications like propeller 3.0 which helps in motion correction while neuro, body and musculoskeletal imaging will help to reduce rescans. It reduces effects of patient voluntary and physiologic motion and thus reduces artefacts and rescans. The product also helps to save on use of contrast agents through the needle free suite consisting of Inhance Suite- Arterial and venous flow anywhere in the body with no need for contrast. Its other features are: 3D ASL - Non contrast, whole brain, quantitative perfusion assessment rapidly and accurately assess tumour perfusion, TIA, stroke, stenosis, etc. 3D Heart - Non-contrast heart vasculature in clear details simply and precisely evaluate arterio-venous malformation, aortic dissection, etc.

MRI has been advocated as a better means to view abdominal tissue specifically liver. What is your opinion on the same? MR abdominal imaging is increasing rapidly. GE has many breakthrough applications which are not available in conventional 1.5T MRI. For example, one of them is IDEAL IQ for needle free liver fat and iron quantification. Nonalcoholic fatty liver disease (NAFLD) is an emerging cause of chronic liver dis-

What is the approximate cost of the machine? Where does it stand (in terms of cost) in the present array of machines in the market? (high end/ low end?) It approximately costs Rs 5.5 crores. It is one of the most advanced and premium systems developed in the US with an affordable price and low total cost of ownership.

ease and can lead to cirrhosis, hepatocellular carcinoma and liver failure.The prevalence is on par in the Indian population due to increasing socio-economic status. It is paralleling the epidemics of diabetes and obesity. Liver biopsy is the current gold standard and can establish a definite diagnosis, determine the severity of the condition and provide information about prognosis. However, it is invasive and associated with complications, and suffers from sampling variability. The lack of a safe, inexpensive, and noninvasive method for accurate identification and quantitative grading of NAFLD has been a major barrier to understanding its epidemiology and pathophysiology. It has the potential of becoming a rapid, accurate, and non-invasive test for the estimation of hepatic fat content without the need for performance of percutaneous liver biopsy.

Which imaging facilities (in what geographical and economical settings) will be benefited by


MRI is an expensive technology. What are you doing to address the price point issue as India is demanding less expensive diagnostics? Through this Advance MR 360 system, which is one of the most advanced and premium systems developed in the US, we are getting it to India with an affordable price and low total cost of ownership. It has all the premium 3.0T MR technology and applications in 1.5T now.

Please tell us about the size of MRI market in India? What is your share of the market? There are approximately 1400 MR systems in the Indian market and the exact market share data is proprietary and confidential and we cannot share that. We are one of the major players in the MR market.

What is the future of MRI market in India? MRI market has been growing in the last three years at an average growth rate of 10-12 per cent and this trend will continue in the next decade as MRI is non-invasive, non-contrast and non-radiation modality and has a huge scope for growth in future. In the US there are approximately 25 MRs per million people, in Japan there are approximately more than 40 MRs per million people. While in India we have approximately one MR per million people. So you see there is a tremendous opportunity for the growth of MRI systems in India. AUGUST 2013


GE India Technology Centre, Bangalore hosts its 6th Annual IP Symposium It addressed the evolution of the Indian innovation ecosystem and the need for a secure IP environment he GE India Technology Centre, Bangalore recently hosted its 6th Annual Symposium on Innovation & Intellectual Property (IP) Rights. The symposium served as a platform to bring internal and external experts from across industry and academia to share their experiences and insights on the changing IP landscape in India. This year, the symposium addressed the evolution of the Indian innovation ecosystem and the need for a secure IP environment. The symposium brought to fore the steps that need to be taken for securing the innovation created by the country. The day-long event included sessions on diverse topics ranging from ‘Accessible Healthcare in India’ to ‘National IPR Strategy’. During her inaugural address, Sukla Chandra – Director Patent Analytics Centre of Excellence, GE Global Research Bangalore & General Manager, GE Global Research, Bangalore said, “Change is the only constant in a fast moving world and the only constant in GE is innovation. With over 6,000 engineers in the country, we at GE are persistently working on solving some of the world’s toughest problems through innovation.” During his keynote address, Dr Avneesh Agrawal, President and CEO – Qualcomm India and South Asia talked about the emerging innovation ecosystem in mobile communication. In addition to this, he also highlighted that this industry today, is the biggest platform in the history of mankind and how it is transforming adjacent industries such as healthcare and banking. The panel discussion on ‘Accessible Healthcare in India’ included panelists Terri Bresenham, President and CEO – GE Healthcare, India, Dr Mohansankar Sivaprakasam, Director – HTIC, IIT-Chennai, Naresh Malhotra, CEO – Modern Family Doctor Chain, Dr Mallik Sundaram, Co-founder and CEO – Mitra Biotech, Dr Rajakumar DV, ConsultantDept of Neurosurgery – Fortis



Hospitals and Dr Swarna Bharadwaj, Director – Sri Sathya Sai Institute of Higher Medical Science. The panel

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shared its thoughts on affordable healthcare. Some points discussed included a model for sustainable, accessible and affordable healthcare, the huge market for healthcare in emerging markets, personalised healthcare, and the role

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of IP in the healthcare sector. Dr Gopichand Katragadda, CMD, GE India Technology Centre said, “The symposium brought together thought leaders from the healthcare, energy, IP and marketing sectors. It was a learning experience to

interact and debate on topics such as affordable healthcare, litigation scenario and IPR strategy in India and technology push vs. market pull in innovation.” EH News Bureau

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Yashoda Hospitals organises MRI Abdomen – Update Inaugurated by Dr Kakarla Subba Rao, the one-day CME programme aimed to highlight the importance and uniqueness of MRI in imaging the abdomen ashoda Group of Hospitals, in association with Indian Radiological and Imaging Association (IRIA) – AP Chapter conducted a one-day Continuing Medical Education (CME) programme on MRI Abdomen Update at Hotel Manasarovar ‘The Fern’ at Chiraan Fort Club, Hyderabad. The programme was inaugurated and presided over by noted personalities in the medical fraternity, Dr Kakarla Subba Rao as the chief guest. Dr GS Rao, Managing Director, Yashoda Group of Hospitals and Dr Anand Abkari, President, IRIA – AP State Chapter were the Guests of Honour. The programme is reportedly the first of its kind in India, conducted solely on Magnetic Resonance Imaging (MRI) evaluation on the disorders of the abdomen. The conference, open to all the doctors across India, was


attended by a large number of doctors. MRI Abdomen-Update aimed to highlight the importance and uniqueness of MRI in imaging the abdomen, as compared to CT scan and ultrasound that are more commonly performed as initial screening modalities. Dr Sanjaya Viswamitra from University Arkansas Medical Center, Little Rock USA was the Programme Director. He delivered a lecture on diffuse liver disorders. He has a vast experience in imaging abdominal and pelvic diseases. Dr Vijayabhaskar Nori, an experienced and senior radiologist from Hyderabad, was the coordinator of the programme. He delivered a lecture on focal liver disorders and imaging of ductal systems of liver and pancreas (MRCP). Speaking on the occasion Dr Rao said, “This initiative is part of our mission to bring the latest in medical science and research. At Yashoda, we aim to deliver comprehensive health services with quality

care at affordable costs. We have been consistently providing value to our patients through ethical medical practices and sustained investments in research and technology to meet the challenges of the future.” Dr Chandrasekhar, Radiologist and COO, Yashoda Hospitals said, “This CME is one-of-its-kind in the country and is being attended by a large number of doctors across the country. MRI is one of the most advanced diagnostic equipment and is safe as it is free of radiation.” Dr P Lalitha Reddy, Organising Secretary to the programme and Vice President, IRIA said, “This conference will be of great value and a significant learning experience for all doctors, especially radiologists, medical and surgical gastroenterologists.” Other eminent faculty at the programme included Dr Shalini Thapar, Professor, Institute of Liver & Biliary Diseases (ILBS), Delhi, Dr LT Kishore, HOD Radiology, Continental Hospitals, Dr M

Chalapathi Rao, HOD, Department of Radiology, KIMS, Dr Vital, Consultant Radiologist, Yashoda Hospitals, Dr Karthik Kuppusamy, Director MRI, India & South Asia, GE Healthcare, Dr Sunitha Lingareddy, Director & Chief Radiologist, Lucid Diagnostics, Dr P Lalitha Reddy, Consultant Radiologist, Yashoda Hospitals, Dr Sapna Marda, Yashoda Hospitals, Dr Srikala, Consultant Radiologist, KIMS, Dr Anjani, Consultant Radiologist, Yashoda Hospitals, Dr Krishna Mohan, Consultant Radiologist, Vijaya Diagnostics, Dr Rajini, Consultant Radiologist, Yashoda Hospitals, Dr Eshwar Chandra, Chief Radiologist, Kamineni Hospitals, Dr Jyotsna, Professor, Nizams Institute of Medical Sciences, Hyderabad, Dr Uma, Consultant Radiologist, CARE Hospitals, Dr Srinivas Raju, Consultant Radiologist, Continental Hospitals. EH News Bureau

Ensocare signs PPP agreement with Govt of Punjab The PPP is a healthcare delivery model which aims to benefit 140 million people Raelene Kambli EH News Bureau nsocare, the healthcare division of Enso Group, has recently signed a Public Private Partnership (PPP) agreement with the Government of Punjab for providing affordable diagnostic services within 21 district hospitals of the state. This is Ensocare's second PPP agreement in this sphere. The first PPP was signed in May 2013 with the Government of Maharashtra and GE Healthcare wherein, Ensocare will act as the operating partner and GE Healthcare as the technology partner to provide affordable diagnostic services to 22 district hospitals. Ensocare's partnership with the Government of Punjab will run on similar lines. The PPP projects will aim to make this service available to approximately 140 million people for both the states of Maharashtra and Punjab. Giving more details on the company's role in the partnership, Vaibhav Maloo, Chairman, Ensocare informs,




“Through the PPP, we would be setting up a well diversified range of diagnostic facilities like MRI, CT scanner, X-Ray, DR X-Ray, ultrasound, and mammography in both the states. It will include four units of 64 slice CT scanners, 13 units of advance, 16 slice CT scanners, eight units of cutting edge 1.5T MRI with 16 channels, 22 high-end digital radiography systems, 39 colour Doppler’s and 39 analog X-ray units. Women’s health is given a special boost with the inclusion of 20 screening mammography units for early breast cancer detection. However, district hospitals in Punjab, will specially include DEXA scan- a cancer scanning procedure apart from housing regular diagnostic facilities. The equipment will be procured from various original equipment manufacturers, particularly GE in Maharashtra, and combination of known few in Punjab. The centres will also be given a thorough makeover in terms of look and feel to add to the delivery of quality services. Customer-friendly IT innovations will also facilitate in adding to the targeted quality benchmark and run

tions on 24/7 basis and provide services at Government recommended rate cards for the benefit of larger population.” When asked about the time span fixed for both projects, Dr Akil Khan, Vice Chairman, Ensocare says, “We aim to be functional by the end of 2013 in Maharashtra. Punjab will take more time as standalone structures are being built for the diagnostic centres’ within the hospitals.” Speaking about the Government's commitment in this partnership, Suresh Shetty, Health MinisterMaharashtra said, “The Government of Maharashtra is committed to provide better and affordable healthcare to its people. Today, we are on to a first-of-its-kind, large scale modernisation of district hospitals with latest diagnostic technologies. By working together with partners like Ensocare, we can advance healthcare to support all economic groups. We hope to cover a minimum of 60 per cent Rajiv Gandhi Yojana Scheme card holders in the state and also lower the cost of treatment by 50 per cent

through this PPP model.” Furthering this initiative, Ensocare is looking forward to replicate this healthcare service model in states like Andhra Pradesh, Madhya Pradesh, Karnataka and Gujarat. The company is also working on a few private healthcare insurance models. When asked about how will they monitor the impact of the initiative, Maloo replied, “Our processes are organised in a manner to get real time updates on timely intervals, so that we can control and command centres with reference to patients’ footfall, details of tests done and their reports. We will also be closely monitoring the time taken for various tests with the help of state-of-the-art mechanised software and hardware which will be unmatched in the country. The data will help us to improve our services. We will have ample ways for consumers to give us feedback as well. Since healthcare is a sensitive sector, we plan to stay focused and evaluate each and every details concerned.” AUGUST 2013


‘MRI is superior to CT in the evaluation of the uterus and ovaries’ Recently Yashoda Hospitals, in association with Indian Radiological and Imaging Association (IRIA) – AP Chapter, conducted a unique one-day Continuing Medical Education (CME) programme on MRI Abdomen - Update at Hyderabad. In the current era of increasing health awareness, MRI, which is an imaging modality with no radiation exposure, has proven to be one of the best, showing many of abdominal and pelvic abnormalities with great precision and detail. This helps doctors in making a specific diagnosis and giving accurate treatment. Till date, MRI is the only imaging modality that best demonstrates the tiny ductal anatomy in liver and pancreas very precisely thereby helping in making an accurate and pinpoint diagnosis. M Neelam Kachhap talks to Dr R Chandrasekar, COO & Chief of Radiology and Imaging Sciences,Yashoda Hospital, Secunderabad to know more about abdominal MRI

INTERVIEW What lesions in the abdominal cavity can be viewed with a higher precision by MRI? MRI is very good at characterisation of the composition of lesions (blood, fat, etc.), hence finds great use in the evaluation of liver, adrenal and pelvic masses. Certain MR sequences which selectively depict fluid containing tracts such as biliary system (Magnetic Resonance Cholangio Pancreatography- MRCP) and the urinary tract (MR Urography) are useful not only in diagnosis but also in planning surgery.

What pelvic abnormalities can be seen in detail by MRI? MRI is superior to CT in the evaluation of the uterus and ovaries. Conditions such as congenital mullerian duct anomalies, fibroids, adenomyosis, endometriosis, adnexal cysts and masses are better imaged on MR.

It is also useful in local staging of malignancies of the prostate, rectum, urinary bladder, and endometrium. MR Fistulogram provides a good roadmap to the surgeon in patients with perianal fistulas.

tion of dysplastic nodules and hepatocellular carcinoma in cirrhotic liver. Along with serum alpha-fetoprotein, MRI of the liver is useful as a screening modality in patients with cirrhosis and in the early detection of hepatocellular carcinoma.

Why is the use of MRI restricted in abdominal imaging?

MRI is a good substitute when contrast CT is contraindicated. Your comments.

The major drawback of MRI over CT is the long acquisition time. Multiple sequences have to be acquired and most of the sequences require good breath hold by the patient to prevent motion artifacts which is difficult in old and sick patients. Most recent sequences require 1.5 or 3 Tesla MRI where the availability of the equipment and cost restricts the use. One other disadvantage of MRI is its inferior spatial resolution in comparison to CT.

be done using MRI. Do you agree?

Though MRI cannot completely substitute for CECT, it can be useful in many situations due to the inherent soft tissue contrast that it offers. For example, the urinary tract can be imaged with a non-contrast MR Urogram when contrast CT Urogram is contraindicated; focal lesions in the liver which are difficult to detected on non contrast CT can be imaged using MRI .

Screening for haepatoma should

MRI is more sensitive than other imaging modalities in the early detec-


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'Speech recognition is the wave of the future because patient records will undoubtedly become digital' Technology has played a very vital role in furthering healthcare delivery, especially radiology. While high tech devices have made imaging, diagnosis and treatment more effective, several other technological marvels have simplified operations to improve its efficiency. Dragon Medical, a speech recognition software from ICONS Infocom, is a very good example. Manish Goenka, Country Head, ICONS Infocom elaborates on the various features of this product and its advantages for radiologists, in an interaction with Lakshmipriya Nair

INTERVIEW Kindly elaborate about your offerings for the radiology market? The product that we offer is Dragon Medical Indian English speech recognition software. It basically converts your spoken words to text, so that one does not have to type the lengthy reports or wait for the stenos.The radiologists can just dictate, and the software shall type the same because it has an inbuilt medical dictionary. It is three times faster than typing, moreover there are no typo errors or spelling errors. In radiology, voice-recognition systems type the report as the doctor 'reads' it into a microphone, eliminating the transcription step.The doctor then reviews the transcription before signing it. Typically, a report if typed takes 30-45 minutes, the turnaround time by speech recognition averages 10-15 minutes, but many people do it in five to eight minutes flat. Using the template

feature the same can be reduced further; thereby giving them more time to interact with their patients. A point to be noted is that this report is ready for print, unlike the old fashioned way of recording a dictation or dictating to a transcriptionist, after which a copy is passed to the doctor for proof reading and goes for print only once it's checked by a doctor.This is a long and repetitive process. It also wastes a lot of stationeries and is not a green practice. Speech recognition eases doc-

tors' growing issue of not getting medico-stenos. Moreover it is fast, accurate yet instant, cuts dependency, saves costs and the reports can be elaborated for better patient care through medical coding. Speech recognition is the wave of the future because patient records will undoubtedly become digital. So, all physicians, and not just radiologists,

will be typing, dictating, or using some combination of these and other digital input technologies, as the electronic patient record replaces the thick multivolume patient chart, which is sometimes difficult to locate and occasionally challenging to decipher.

What are the challenges in serving the radiology market vis-a-vis other verticals? There are not as many challenges now, as we had to face when we had originally launched the Indian English edition of Dragon Medical for the Indian market.The Indian English edition Dragon Medical has now established itself. Radiologists know it for what it’s worth and we have a close to thousand satisfied users in India. However, in the earlier days, the challenge was to tackle users' initial apprehension about speech recognition.

Convincing them to even consider a demonstration was hard but once that was done most of them were convinced with the efficacy of the product.

How has technology like what is


ICONS’ iconic offering ICONS Infocom, a 14-year old ISO 9001: 2008 certified organisation based in Mumbai, is an exclusive national distributor of Nuance specialised software as well as Andrea and AcousticMagic hardware products. ICONS has a pan-India presence and aspires to become a market maker, builder of new economy, delivering excellence in consulting, technology, outsourcing, and alliances. It is redefining the marketplace by adding innovative capabilities to better serve the needs of both mature and emerging clients. ICONS aims at enhancing and simplifying future technology. Its mission is to partner with its clients in using technology to invent better ways of doing business. It believes that people are the critical element of their business; they are the single most important reason for success or failure. It has a dedicated team of service support staff and provides consistent service delivery compatilibilty. Dragon Medical is one of their



premier product Dragon Medical speech recognition software is the fastest, most complete way for doctors to make clinical documentation instantly available and to cut down on document creation costs. Dragon Medical makes it possible to eliminate administrative overhead and dictation costs to deliver better quality of care in the context of unprecedented financial challenge.By using Dragon Medical, doctors can use their voice to efficiently navigate clinical systems and dictate medical decisions and treatment plans directly into a patient’s electronic record. Dragon Medical allows doctors to dictate in their own words, generating ‘once and done’ documentation which they can dictate, edit and sign in succession. Doctors further accelerate the dictation process by operating macros to re-use frequently-dictated text. This

approach dramatically reduces the time doctors spend documenting care. Dragon Medical is the only product from the Dragon family that automatically encrypts all audio and text data, there- by supporting patient security and confidentiality, a necessity for all medical organisations. Dragon Medical helps to provide high quality care through more efficient and accurate clinical reporting. Key features of Dragon Medical are as follows: ● Windows-based EMR systems ● With a large medical vocabulary ● Hidden Mode. ● Indian Regional Accent support ● Variety of dictation input devices ● Dictaphone PowerMic user interface ● Voice macros ● Free text dictation within EMR ● Flexible workflow options ● Shortcuts/templates ● Train word capability ● Network-wide speech profiles ● Ready to use out of the box ● BlueTooth support AUGUST 2013


offered by you served to enhance radiology?

Tell us about your new projects and your plans for this sphere?

Dragon Medical offers 99 per cent accuracy with minimum training time. It not only reduces the turnaround time to generate an accurate report as it is much faster but being very easy to use, it enhances productivity as well. It works with most hospital information systems (HIS), picture archiving and communication systems (PACS), radiology information systems (RIS) and electronic medical records (EMRs) and requires no integration, making it a very cost effective tool. It is user friendly and can reduce and eventually almost eliminate all reporting backlogs. It’s the next-gen reporting tool, already used widely in the West and fast catching up here. Radiologists and clinicians are able to provide detailed clinical notes than typing or EMR point-and-click templates alone, without the costs or delays associated with manual transcription. By enabling clinicians to rapidly and completely document patient encounters via their voice, Dragon Medical reduces transcription costs, improves clinician productivity, enhances patient care and increases insurer reimbursement. Dragon Medical 11 now calibrates to regional accents through an initial voice screening process.The software adapts to Indian accents. It has therefore managed to get a grip on the Indian market by fighting against all odds.

There are a few big projects which we are working on.They are for much larger hospitals with wide implementation across various departments, though they are still in the very early stages. More details on the same cannot be disclosed at this point in time since we have signed non-disclosure agreements (NDA).

Tell us about some of your installations in healthcare set ups? Our user base is very diverse. Dragon Medical 11 supports more than 80 medical disciplines, from family medicine and internal medicine to orthopaedics and cardiology with proprietary medical speech recognition vocabularies. So, clearly besides radiology the software is also being used other departments like pathology, histopathology, ophthalmology, haematology, neurology, and oncology.etc in midsize hospitals and diagnostic centres. It can also be used for preparing discharge summaries. With these specialised vocabularies available we have a track record of very satisfied and happy users. Our clients vary from large hospital chains, medical institutes and mid-size healthcare set ups to small and individual diagnostic centres. AUGUST 2013

Where do you see the radiology market in India going and how do

you plan to tap from its growth? Healthcare is a growing industry and the graph is only getting better. The demand for speech recognition software is also going growing in the healthcare domain. Doctors have used dictation for years as they compile patient care history, post-care summaries, orders and prescriptions. However, not surprisingly, the short supply of human resources in this field has caused the doctors to make a shift from traditional means to a recording device and pay transcribers

to put it on paper. We have simplified matters with our Dragon Medical speech recognition software that enables the doctor to dictate directly into any Windows-based applications like his PACS/RIS/EMR while he views the report, thereby eliminating the need for a steno or a transcriptionist yet delivering quicker, faster and accurate reports for critical patient care. As I said, it is the future in the reporting system. It's a global shift.

The Most widely used speech recognition system in Medicine today.

JUST TALK & IT Types…Indian English Edition– Dragon Medical. Key Benefits o Dictate faster and more accurately than ever before o Dictate anywhere in your EMR o Accelerate clinician adoption of EMR systems o Eliminate transcription costs o Spend more time with patients o Dictate in clinician’s own words o Support higher level of reimbursement and reduce denials o Improve clinician satisfaction

Key Features o More Accurate Than Ever. 20% more accurate than Dragon NaturallySpeaking Medical 10–and over 38% more accurate than Dragon Professional when used in clinical settings. o EMR Support. Navigate and dictate inside EMR software; History of Present Illness, Review of Systems, Assessment and Plan.

Dragon® Medical: Accelerate EMR Adoption in Practices CHALLENGE: How can clinicians spend less time typing or clicking inside their EMR? SOLUTION: By using dragon Medical, clinicians can efficiently navigate and dictate medical decision-making and treatment plans directly into a patient’s electronic record. Dragon Medical helps clinicians in mid-sized practices provide more efficient, profitable and higher quality care.

o Medical Vocabularies. Covers nearly 80 specialties and subspecialties. Dictate with confidence using your specialty’s vocabulary. o Now with Indian English Accent Support. Accented speakers get higher out-of-the-box recognition with advanced adaptation techniques and accent-specific acoustic models. o DragonTemplates with Voice Fields. Automate form filling applications by adding fields in dictation templates. o PowerMicTM Ready. Program buttons to run any function or user voice command. o MyCommands. Personal voice commands appear in Command browser for faster use.

Dragon Medical is designed and priced especially for practices. Large Hospitals: Lilavati Hospital, Seven Hills Hospital, Deenanath Mangeshwar Hospital, NIMHANS, AIIMS, CMC, Medanta, Kovai Medical, Narayana Hrudalaya, Apollo Hospitals, Mahavir Hospital, Ruby Hall, Jupiter Hospital,PGI (Chandigarh)…etc Diagnostic Centers: Piramal Diagnostics, Credence Imaging, Star Imaging, SRL, Manisha Diagnostic (Kol), Shree Imaging, Sun-Scan…etc.

Improves financial performance, reduces reporting time, Enhances Productivity & Cut dependency. HO- : 206 Kartik Complex, New Link Road, Opp Laxmi Ind. Estate, Andheri (W), Mumbai - 400053, India.

ICONS Infocom P.Ltd

For online live demo:

Contact Number: 93200 42667 / 93723 42667

Website: | Ahmedabad | Bangalore | Chandigarh | Chennai | Hyderabad | Kochi | Kolkata | Lucknow | Mumbai | New Delhi | Pune |




RADIOLOGY EVENTS 53rd Annual State Conference of IRIA AP State Chapter Dates: November, 16-17, 2013 Venue: KREST, Hyderabad Organisers:IRIA AP State Chapter Description: The event will cover various aspects in women's imaging with a focus on the latest trends and technology in this field. Contact Dr N Eshwar Chandra, Organising Secretary IRIA AP State Chapter# 8-1-300/2, KREST Building, Shaikpet, Hyderabad, AP Tel: 040-23560005 Mob: 09246150529 Office Manager Mob: 09177210443 Email: iriaapstatechapter@ Website:

1st Indian Cancer Congress (ICC 2013) Dates: November, 21-24, 2013 Venue: Kempinski Ambience Hotel, Delhi Organisers: Indian Cancer Congress Description: The members of the top four oncology associations of India, viz. Association of Radiation Oncologists of India (AROI), Indian Association of Surgical Oncologists (IASO), Indian Society of Medical and Pediatric Oncology (ISMPO) and Indian Society of Oncology (ISO), have come together for the first Indian Cancer Congress (ICC 2013). The common thread that binds each attendee at this conference is the urge to stand up to the challenge of cancer. Attendees could be undergraduate and postgraduate students of medicine aspiring to take up oncology as a career, or clinicians already involved in cancer care or a researcher wanting to innovate. Cancer patient as well as care givers or someone who wants to overhaul the existing system of cancer care by influencing policy making can also attedn the conference. Contact Dr Harit K. Chaturvedi Organising Secretary, ICC 2013B-4/262, Safdarjung Enclave, New Delhi, India-110029 Tel: 011-42334196,011-41015661 Email : Website:

RSNA 2013 Dates: December, 1-6, 2013

Venue: McCormick Place, Chicago Description: RSNA hosts the world’s premier radiology forum, drawing approximately 55,000 attendees annually to McCormick Place in Chicago, and publishes two top peer-reviewed journals: Radiology, the highest-impact scientific journal in the field, and RadioGraphics, the only journal dedicated to continuing education in radiology. Through its educational resources, RSNA provides hundreds of thousands of continuing education credits toward physicians' maintenance of certification—more than one million CME certificates have been awarded since 2000. The Society also develops and offers informatics-based software solutions in support of a universal electronic health record, sponsors research to advance quantitative imaging biomarkers, and conducts outreach to enhance education in developing nations. Through its Research & Education (R&E) Foundation, RSNA provides millions of dollars in funding to young investigators, helping to build the future of the profession. Contact Radiological Society of North America (RSNA) 820 Jorie BlvdOak Brook, IL 60523-2251 US Tel: 1-630-571-2670 Toll Free US and Canada: 1-800-381-6660 Main Fax: 1-630-571-7837 Membership Fax: 1-630-590-7712 Website:

The 67th Annual Conference of Indian Radiological & Imaging Association-2014 (IRIA-2014) Dates: January 23-26, 2014 Venue: Hotel J.P. Palace & Convention Center, Agra. Organisers: Indian Radiological & Imaging Association Description: This annual conference of the IRIA is one of India's radiology events that covers the latest trends, technologies and issues related to the field of radiology in India. The event also has the largest radiology exhibition wherein leading radiology and imaging equipment companies showcase their best products. The focal point of the event is the conference which serves as an platform for knowledge exchange for experts from around the world. Contact: Dr Vinit Nanda & Dr. Vanaj Mathur Organising Secretaries Ahuja Ultrasonography Centre Dr. Sarkar Market, Delhi Gate Agra-282 002 Tel. 0562-3092959, 21052605 Fax: 0562-2150296, Mob +91 98370 44202 Email:

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‘Diagnosis is making all the difference in today's healthcare management’ The radiology department at BLK Hospital, New Delhi might just be four years old, but it is taking the right steps towards functional imaging, finds Shalini Gupta


LK hospital in the heart of New Delhi is a modern state-of-the-art tertiary care hospital that has several specialities under one roof. NABH and NABL accreditation in the very first year of operations is testimony to the hospital’s commitment for patient safety and quality. We were out to find what distinguishes its radiology department from those of others. Situated on the ground floor for easy access to patients, the department was set up in May 2008, and became completely functional in November the same year, even as the hospital became functional officially from April 2009. Talking about the objective at the time of inception, Dr Prem Kumar Ganesan, who heads the department, informs, “Our goal was to set up a state-of-the-art diagnostic centre with all the latest imaging equipment so that we are able to provide accurate precision diagnostic facilities to the patients as well as the consultants.” He strongly



believes that clinical support from radiology is rapidly changing the disease management process. “Diagnosis is making all the difference in today's healthcare management,” he adds. Despite being a relatively new set-up, efforts have been made to match it up with the best and catch up with its peers as far as advanced equipment is concerned. The department boasts of 1.5 Tesla MRI, 1.28 slice cardiac CT and digital fluroscopy or CINI fluroscopy. The latter in particular makes optimum use of special radiological equipments. “We also take pride in a state of the art ultrasound, in which we also have fusion imaging, a fusion of ultrasound and fluroscopy to target and perform intervention procedures and see lesions less than 1 cm which we can't see on ultrasound,” Dr Ganesan says. The aim of the department is to engage with other departments as well and work in conjunction with them across all modalities. The main focus is

on neurology, neurosurgery, gastrointestinal surgery as well as providing support to gynaecology, medicine and paediatrics. The main thrust is on oncology, with a team that focusses on radiation oncology and surgical oncology. “Major support is for the oncology team since we regularly do triple phase CT angiography, wherein we are delineating the size and the extent of the tumour and its spread,” chips in Dr Ganesan. The department also does CT coronary angiography, a non-invasive screening method for identifying coronary artery disease along with whole body angiography like brain angiography, pulmonary angiography and peripheral angiography. Apart from this, the team of radiologists also works with renal transplant donors and recipients and liver transplant donors and recipients to do a detailed evaluation of arteries, veins, segments of liver so as to better guide the surgeon on which part of the liver needs to be transplanted.



“Diagnostic radiology is going to contribute a good amount of information on leukaemias 10 years from now but it needs to be used with sensitivity,” he exhorts. Dr Ganesan himself is a MD in radiology from AIIMS with training in fusion imaging from Italy to perform ablation and various other procedures. He has 23 years of experience behind him and has been associated with the department since its inception for the last four years. He has a team of seven radiologists under him trained in MRI, CT, fusion imaging and ultrasound. What is unique about how the department works is that each consultant chooses a particular organ system, so there will be someone working on neurology and neurosurgery, one on gastroenterology and GI surgery and one on oncology. So, each consultant is responsible for a particular modality and they upgrade themselves on the latest in their particular areas from time to time. Technology forms a crucial part of the radiology department,

but that does not mean one can discount technical training and competence. So the staff needs to be regularly updated on the technology, while also being patient centric. “Radiology will always have the risk of radiation dosage, so the consultants and the staff have to be sensitive to the radiation dose that the patient is getting in a particular study. So, for instance a CT has been asked for in a particular study and we feel that MR will give the answer, we'd go ahead with the MR, because when we do the CT, there'll be a certain amount of radiation dose. This applies for children and those who have earlier had a lot of radiation studies, X-rays, MR, CTs, PET etc.,” elaborates Dr Ganesan. The team also performs perfusion imaging in liver and stroke patients. Although the hospital still doesn't have research trial permission from the Government of India it runs a DNB programme in radiology and research could be the next frontier. Being an interdisciplinary field images don't make any sense, unless they are of clinical use. And hence to train the staff in this area, there are regular weekly interactions with each department be it gastroenterology, neurology, gynaecology etc. All the cases in that particular department are taken up with the clinical team and analysed along with the reports to get critical feedback on their operating findings. Clearly, clinical outcome and clinical correlation is of topmost importance. Touching on the trends in imaging Dr Ganesan says, “Imaging is going from anatomical imaging to functional imaging. In a stroke patient, in the first four hours, CT scan may not show anything but MR will still show something. But perfusion is going to say, how much of that tissue is salvageable. Fusion imaging has a great future too, you can target a 1 cm lesion which you can't see in an ultrasound, do a biopsy and then do something to ablate it as well.” Finally he boils down to the core of it, a patient centric approach, at the same time understanding the needs of the clinical team. “We need to interact more with the patient to understand his past problem and the present issue or medical condition,” he concludes.

The aim of the department is to engage with other departments as well and work in conjunction with them across all modalities. The main focus is on neurology, neurosurgery, gastrointestinal surgery as well as providing support to gynaecology, medicine and paediatrics. The main thrust is on oncology, with a team that focusses on radiation oncology and surgical oncology AUGUST 2013



Sunset years of solitude Even as our cities get populated and social networking connects us all, those in the silver years make an effort to stay in touch, not to be left behind, finds Shalini Gupta


It was a rainy day and I was running late for a meeting. As I hurriedly reached the venue and rang the doorbell, a pleasant looking septuagenarian lady slowly opened the door. I was led inside to the dining table where I politely took my seat as an elderly gentleman in his late 70s sat with a laptop, accompanied by a girl who I could see was helping him navigate



through his Facebook account. With disarming courtesy, he introduced himself to me and I responded in kind. His nimble fingers went back and forth on the keyboard pausing and reflecting, as he displayed a childlike curiosity, questioning the girl beside him, as he typed a happy birthday message to someone. And no, the girl is not his daughter; rather this is just a glimpse of a ‘shadowing session’ by an elder care specialist (ECS) from Epoch Elder Care, which provides home care to the elderly. A report by United Nations Population Fund (UNFPA) last year indicated that India would be home to around 300 million elderly above the age of 60 (up from 100 million today) and also

pointed out the need to ‘strengthen geriatric care services in the existing public health system so that the increasing care demands of the elderly can be met’. While medical care is a necessity owing to age related disorders, it is social inclusion and staying mentally engaged that is a crying need. This is what caught the attention of Kabir Chadha, Founder of Epoch, as he went through a personal experience and set out to address the challenges. “Non-medical needs such as being motivated enough to enjoy each day to the fullest, and the urge to be a part of a lively social environment are just as important as their medical needs, even a notch higher, when it comes to the elderly,” says Chadha.

Armed with a team of 30 elder care specialists or ECS, Epoch which began operations last year serves 150 clients in Delhi, Mumbai and Pune. While one third of them have children living in India, but not with them, the children of the rest stay abroad. Most elderly suffer either from dementia and Parkinson’s and a very small percentage are clinically depressed, informs Chadha. Each ECS goes through an inter simulation interview to gauge how good they would be when interacting with the elderly. Patience, persistence and resilience are the key, since they need to make all efforts to become the best friends of the clients, by understanding the deeper nuances of their personality, hence the term shadowing. AUGUST 2013


A care plan is devised for each client by gathering information through a set of questions to understand their requirements including any medical condition they might be suffering from, background, culture (e.g. pre partition era, not a very happy married life) dynamics of the family, profession and academics, hobbies (or interests) personality (introvert, takes time to open up, suspicious, spiritually inclined) etc. This is then supplemented with the clients expectations to work out the final strategy, informs Neha Sinha, Senior Elder Care Manager at Epoch. The aim then is to connect intellectually, offer emotional support and help them keep track of routines (bills, salaries of domestic help, medicines, doctor appointments etc) Typically an ECS visits a family twice a week. In the shadowing session that I attended, the ECS helped the gentleman recall important and even unimportant life events, egging him to write down his thoughts (such as birthday wishes to his grandchildren) and then share them, even translating a book in Urdu to English. We even played a round of golf after which he sportingly displayed a few magic tricks. All this may sound normal, nothing special too, but I could sense for myself the


gap that the ECS was trying to fill. Opening up to a stranger is not easy though, when it is the company of our loved ones that we crave, so it might take time to gel along and even get comfortable with them. Add to that a person who has seen and achieved much in life and now has to accept help from someone he doesn't know, it can be challenging. The key then is empathy, sensitivity and perception, asserts Sinha. “Relationships cannot be defined in black and white and so if the person is refusing to do something, the ECS needs to be perceptive enough to understand the reason behind it.” Also, people can have the most interesting hobbies and interests, for instance a client was interested in history and maharajas, one wanted the

ECS to show all monuments around Delhi, while another wanted to visit another city, recounts Chadha. Look at it from another perspective, learning and growing and that is life, so if that is what we do in the initial years of our life, why hit the pause button, just because we are old! For the two hours that I attended the shadowing session, I was enamoured by how much childlike effervescence one could have in the twilight years, taken down memory lane by someone who has dementia as he recalled important life events letting us all into his personal space, learnt to putt and share a meal with people I didn't know a while back. As I was leaving, he sweetly asked me to visit again, so he could show me a new

magic trick next time, it was heart warming. Two days after I was back from my visit, I saw a piece in a national daily of a 77year old man, a retired Air Force officer, suffering from dementia, who died after five days of being lost in a city where no one had the sensitivity, leave alone the courtesy to ask him if he needed help. It paints a soulless, picture of a callous, heartless society. And so even as services such as Epoch light up the lives of some, I hope our society can muster up enough empathy towards our elderly. They are not to be left out, but to be taken in together. Let’s not forget, sunsets make for an equally breathtaking sight as do sunrises.

PEOPLE Dr Alok Pareek becomes Prime Vice President of LMHI He is the first Asian to be elected to this post



r Alok Pareek has been unanimously chosen as the first Asian Prime Vice President of the International Homoeopathic Medical League officially known as Liga Medicorum Homeopathica Internationalis (LMHI). Established in Rotterdam in 1925, LMHI represents homeopathic physicians in more than 70 countries all over the world. The purpose of the association are the development and securing of homeopathy worldwide and the creation of a link among licensed homeopaths with medical diplomas and societies and persons who are interested in homeopathy. The LMHI is exclusively

devoted to non-profit activities serving philanthropic benefits. It is noteworthy that the LMHI has always been dominated by Europeans and Americans in its governance and Dr Alok Pareek is the first Asian to be its Vice President. Dr Pareek’s unanimous election indicates his popularity as a homoeopathic authority. Dr Pareek has been in active homoeopathic practice since 33 years and a renowned teacher in Homoepathy globally, travelling to seven to eight different countries each year. He is also regarded as the introducer of homeopathy in several countries.




New book launched on hospital administration The book titled ‘Hospital Administration: Prinicples and Practices’ is being hailed as a publication which would be of considerable assistance to professionals in healthcare administration


&K Chief Minister Omar Abdullah recently released a book “Hospital Administration: Principles and Practices”. Co-authored by Dr Yashpal Sharma, MD NRHM, J&K, Dr RK Sharma and Dr Libert Anil Gomes, the book is expected to be of is of great assistance to the administrators and managers of various health care providing institutions. J&K Chief Secretary, Mohammad Iqbal Khandey, Commissioner Secretary Health and Medical Education, Shaleen Kabra; Union Health Secretary, Keshav Desiraju and Union Additional Secretary, Anuradha Gupta, who is also Mission Director, NRHM were also present on presidium and joined the Chief Minister during the book release. Dr Sharma said, “We have presented various topics in this book which are ‘mustknow’ for every hospital administrator. Various important topics including clinical care services, nursing services, support services, medical records, public relations, medico-legal aspects includ-

Foreword by Dr DK Sharma “It is a comprehensive book on the subject of hospital administration which is bound to attract a lot of attention from various healthcare organizations and hospitals from public as well as private sectors in view of the growing demand for better health care facilities from the stakeholders.The authors have a long experience in hospital and health care administration in various prestigious public and private hospitals including teaching and training of the postgraduate students. The various topics including clinical care services, nursing services, support services, medical records, hospital hazards, medicolegal aspects,

Title: Hospital Administration Principles and Practice Author: Dr Yashpal Sharma, Dr RK Sarma, Dr Libert Anil Gomes Edited by: Dr Alexander Thomas & Dr Nagesh Rao Publisher: Jaypee Brothers Medical Publishers Pvt Ltd Pages: 384 ISBN: 9789350907337 Price: ` 395.00

ing the recent legislations and hospitals are also discussed.”The book is recommended for faculty, UG/PG students pursuing hospital/healthcare administration, hospital/healthcare administra-

public relations, medicosocial services and evaluation of hospital services are discussed in detail for the benefit of the students and faculty of hospital administration.This book is of great assistance to the administrators and managers of various healthcare providing institutions. The book has adequately covered the responsibility of the hospital organisation towards the patient, the various facets of patient care, both clinical and managerial issues like ward management system, administrative procedure, intricacies of authority responsibility and model regulation and resource management approach.The basic steps of corporate planning towards a good human relation and productivity have also been highlighted.The government guidelines and regulation of waste manage-

tors and managers of various healthcare organisations. The copies of the book are available throughout with the publishers' (Jaypee Brothers) branches, online and telephone sales.

ment, Organ Transplant Act, Application of Consumer Protection Act and telemedicine in hospitals, approach to patient satisfaction are some of the areas of importance which are well-documented in text and can be termed as the special feature of the book.Throughout the book, the primary purposes of hospital administration and the carefully developed procedural guidelines have been highlighted. The text emphasises the importance of standards for the hospital on a level commensurating with the demands of services and size which are to be met by the hospital managers.The authors have documented a need for application of fundamental principles of management in a hospital scene.”

J&K CM releasing the book along with other dignitaries




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FACEMATE ES-330: A new age ultrasonic massager PG 93 Three-year-old child treated for high dysplastic spondylolisthesis PG 94 Aquacut Quattro: A cut above the rest PG 95 Viroblock launches face mask PG 96



TRADE & TRENDS Pushpanjali Crosslay Hospital offers top class neonatal services It has a fully functional neonatology unit which comprises ultra-modern, state-of-the-art facilities


ushpanjali Crosslay Hospital (PCH), located in the eastern part of NCR at Delhi-Ghaziabad border is a 350+ bedded super speciality hospital. It aims to provide the highest quality of healthcare to a broad mix of local and international patients, and is amongst the few hospitals in the region to have National Accreditation Board for Hospitals and Healthcare Providers (NABH) accreditation. PCH has several highly specialised Centers of Excellence that comprise multispeciality treatment facilities including Centre for Comprehensive Child Health which looks after all the problems of children, from birth to 16 years of age. Centre for Comprehensive Child Health is headed by Dr SK Mittal, former Director, Prof and Head, Department of Paediatrics, Maulana Azad Medical College, New Delhi along with a team of full time neonatologists, paediatricians and paediatric surgeon. As a part of the Neonatology and Paediatrics Department, a Neonatal Intensive Care Unit (NICU) was established in 2009 with four beds, which today has increased to 24 beds. The department is fully equipped with level-3 NICU facilities for neonatal, medical and surgical needs.

NICU Admissions

THE DEPARTMENT IS FULLY EQUIPPED WITH LEVEL-3 NICU FACILITIES FOR NEONATAL, MEDICAL AND SURGICAL NEEDS All 24 beds in NICU, are equipped with ultramodern, state-of-the-art facilities including the bedside monitor and eight-bedded central monitoring unit, five ventilators-including two high frequency ventilators and 18 phototherapy units including two double surface phototherapy units. The department is selfsufficient in management of neonatal respiratory distress syndrome (RDS,




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HMD); meconium aspiration syndromes, persistent pulmonary hypertension (PPHN), septic shock; and various neonatal surgical problems such as tracheoesophageal fistulas and congenital diaphragmatic hernia. Apart from this, it also offers round-the-clock investigation facilities like ABG etc. The Neonatal Unit has been providing care to increasing number of babies over the years with excellent outcomes, even among the most vulnerable of them i.e. those with low birth weight (<1500 gm.) The Neonatal Unit also

offers facilities for transportation of sick new born with a trained transport team, incubators, ventilators and specially equipped ambulance. Over the last three years, the unit has transported 212 neonates with excellent results. The unit has dedicated full time neonatologist and full time paediatricians available round the clock. The unit is the first, in the whole of Western UP, to receive accreditation from National Neonatology Forum. It has also started Fellowship training courses in neonatology, in affiliation with NNF. AUGUST 2013

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FACEMATE ES-330: A new age ultrasonic massager The ultrasonic body massager and skin conditioner offers six functions in one instrument


aceMate Ultrasonic Massager is a unique equipment as it has 1 and 3 mhz plates. The small disk generates 3 mhz (three million waves per second) sound waves that penetrate just 1 or 2 mm and is perfect to massage skin, including the face. The larger disk generates mhz The larger disk may go four inches (20 mm) into the body helping muscles relax. It has six important functions.

High energy light (660 nano meter wave length) can activate enzyme C in the cells and help skin. ● Skin moisture test: It can test the skin if the skin is dry, average or moist. Ultrasonic gel and moisturiser are recommended while applying this device. This is an electronic device with lighted digital display. Automatic shut-off and timer. There is a six-months limited manufacturer's warranty offered with the product for personal use. It also comes with an input adapter: 110V, or 220V. AC15V, 350mA.


1MHz Ultrasonic (1 million waves/sec). 8 intensities to induct ions 3 to 6 cm. deep into muscles. 3MHz Ultrasonic (3 million waves/sec). 8 intensities, only 1 or 2 mm into skin to smooth wrinkles and tighten skin. Negative ion: After using ultrasonic, inducting neg-


ative ion for 5 minutes can make skin soft and supple. Mixed wave micro current: Use micro wave

to massage the face, it can activate cells, improve metabolism, hence extend the life cycle of cells and prevent furrow.

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Therapeutic ultrasound A brief overview on therapeutic ultrasound, its applications and myriad benefits



herapeutic ultrasound is a method of stimulating skin tissues using high frequency sound waves that can penetrate up to five inches beneath the skin's surface skin without heating the skin. The technology is the same as that is used to inspect foetus in mother's womb. The benefits of ultrasound are well established. Therapeutic ultrasound is typically between 800,000 and 3,000,000 hz. This sound cannot be heard by humans. The higher the frequency, lesser the depth of penetration. At 3mhz, penetration can be just 1 or 2 mm, perfect for skin care and treatment. The ultrasound waves vibrate, or move body cells

and thus massage and relax them. The massaging effects of therapeutic ultrasound have three primary benefits: ● Ultrasound therapy increases blood flow in the treated area which speeds the healing process. Very little heat is generated. ● Ultrasound therapy reduces swelling and edema which are the main sources of pain. ● Ultrasound waves gently massage the muscles, tendons and/or ligaments in the treated area and enable medicines to reach deep inside. This enhances the recovery rate of damaged tissue without adding strain, and softens any scar tissue that is usually present in an injured area.


What can be treated with ultrasound? An incredibly wide variety of ailments are treated using ultrasound. Essentially, anywhere there is a desire to promote blood circulation

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Three-year-old child treated for high dysplastic spondylolisthesis while reducing such deformities), only screw of L5 and S1 were locked and others were not locked so as to allow growth of the girl and posterolateral grafting was done only between L5 and S1 with no interbody fusion. There have been reports in the medical literature (throughout the world) of the treatment of such cases but all these cases have been reported in children who are 10 years and beyond. This is a special case when this high grade variety has been noticed in a three-year-old child. This also poses problems in surgical planning as usually these patients need surgery for correction of there deformity which require instrumentation. Since this is a three-yearold child, the bony structures are very small for the implants to hold. Second fusion which is an accepted method of treatment in such patients is another point to ponder upon keeping in mind the growth which is still to come in this case. Post operatively the child was neurologically normal and was made to walk two days after the surgery and was walking straighter.

Dr Vikas Tandon, Consultant Spine Surgeon, from Indian Spinal Injuries Centre, Delhi conducts the successful surgery which took over five hours


r Vikas Tandon, Consultant Spine Surgeon, from Indian Spinal Injuries Centre, Delhi recently treated a three-yearold girl child, Zoya, from Kota (Rajasthan), who had a deformity on the lower back and was walking with a stooped posture with bent knees. She was found to have a condition called Spondyloptosis of L5 over S1. This is a congenital deformity with a defect in the vertebrae and thus leading to slippage of one vertebra over the other. It is known as a high dysplastic spondylolisthesis. After a lot of surgical planning the child was operated and the listhesis (slipped vertebra) was reduced back successfully back by Dr Tandon. The surgery which took about five hours, was done from behind and the spine exposed. Pedicle screws were inserted from L3 to S2 with reduction screws in L5. After thorough decompression of the roots (especially of L5 which is at danger



Pre-operative X-rays

Post-operative X-rays AUGUST 2013

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Aquacut Quattro: A cut above the rest Pankaj Sanghavi, Director, D-Max Imaging explains how Aquacut Quattro by Velopex offers an advanced approach to minimally invasive dentistry


quacut has been developed to provide a new and unique way to improve the dental experience. It can be used to treat problems early on and conserve as much original tooth structure as possible. The machine has been designed to make a routine visit to the dentist a more pleasant one which builds patient confidence.



How does Aquacut achieve the above? It is important to understand that despite the huge advances in the treatments available, the majority of the public do not perceive a visit to the dentist as something to look forward to. Aquacut has the capability to change the dental experience, it can reduce for many the need for the use of the drill and needle which are among their highest concerns and the cause of much anxiety.

tain of fluid that acts against the tooth. According to the type of powder selected, Aquacut will either clean or prepare cavities. The change of function is achieved by the simple twist of a switch. The above duality gives Aquacut a diagnostic capability, switch to cleaning and begin the procedure by cleaning the area of the mouth to be treated. This provides a clear view of any problems that may be developing. Simply switch Aquacut to cavity preparation mode and begin treatment of any indication of decay. For the patient the above procedure will have been a completely comfortable experience.

How does Aquacut change the patientâ&#x20AC;&#x2122;s experience?

Introduction to Aquacut

Simply! Aquacut operates without direct contact with the tooth structure. It cuts or cleans using a high speed stream of powder surrounded by a complete cur-

Aquacut is divided into two sections; one dedicated to prophy procedures such as cleaning and stain removal. The second section is dedicated to cavity

preparation, amalgam stain removal and roughening areas to increase bonding. To change procedure, simply twist the selected switch to the appropriate section. The liquid that assists in the cutting and cleaning procedures is contained in the tank on the right hand side of the unit and can be easily topped up when required. A variety of powders are available for different procedures and are supplied in convenient coloured cartridge so that theyâ&#x20AC;&#x2122;re easily identifiable for use. Changing cartridges takes less than a minute just turn off the unit and allow it to depressurise, unscrew the chamber and change the cartridge. The user has control over all the elements. From the control panel one is able to adjust the volume of powder air and fluid to achieve the optimum performance. The Aquacut foot control

is also incredibly versatile; it provides a three stage action to the hand piece. This enables the hand piece to be used not just for cleaning and cutting but to wash and dry the area eliminating the need to keep changing instruments and so speeds up any procedure. The hand piece is light and the plastic tip is replaceable for each patient. The main body is removable for autoclave sterilisation. A range of tip sizes is available for special procedures. The unit is pneumatic so only requires connection to a compressed air supply capable of providing clean dry air at a minimum pressure of five bar. The Aquacut Quattro by Velopex is the ideal tool for a dental practice.

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Viroblock launches face mask Contains proprietary novel cholesterol depletion technology which traps and kills H1N1, H5N1 flu viruses and human corona viruses


iroblock, a Swiss startup, presented new data at ICPIC 2013 in Geneva, showing that their face-mask containing proprietary novel cholesterol depletion technology traps and kills over 99.9995 per cent of H1N1 flu viruses (swine flu), 99.999 per cent of H5N1 flu viruses (avian flu) and 99.997 per cent human corona viruses on pass through air. Aimed at helping protect people from these respiratory pathogens, the mask is up to one hundred times more effective than a similar mask without Viroblock technology. The company will now start direct sales in Switzerland and is looking for distributors in other countries. “Aerobiology tests for face-masks simulate real life situations, in which the user is exposed to viruses coming in. The mask helps prevent transmission from and to the person wearing the mask,” commented Dr Thierry Pelet, CSO,

Viroblock. “The stringent testing demonstrates the efficacy and speed at which the cholesterol depletion technology works”. Aerobiology tests, carried out in high security laboratories, create a mist of viruses on the outside of the mask, a pump is used to draw air and viruses through the mask, and finally testing for live virus occurs on the inside of the mask.

“We believe that our protective face-mask can help protect healthcare, agriculture and security workers effectively, with added advantages of comfort of wear and easy identification,” said Dr Jamie Paterson, CEO, Viroblock. Viroblock is a CTI Certified Swiss start-up located in Geneva, Switzerland. Founded in 2006 and supported mainly by Swiss investors, the com-

pany is focused on developing a unique anti-viral technology based on cholesterol depletion. Viroblock’s first product is an anti-viral face mask and other air filtration products are planned.

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Express Healthcare August, 2013  

Why should one invest in Geriatric Care? Quite simply because there is an untapped market. India is waking up to geriatric care and finding...