Express Healthcare (Vol.11, No.4) April, 2017 by Indian Express

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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 18 days of class room lectures and five & a half month field and case study work 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 2 years of experience and currently working in hospital. Candidates sponsored by hospitals will be given due preference. Candidates working in any part of the world can join the programme, without leaving their job. Total Seats: 50 only. Application form and admission: Candidates are required to apply online through the E-application process only, website: www.tiss.edu. Candidate having difficulty in applying online or where there is no internet facility may contact below numbers. The application fees is Rs1030/- for online transfer. Application fee through bank challan is Rs. 1000 + bank charges. Please refer application form for payment details. The last date of receiving application is MAY 19, 2017. Admission will be based on the interview at TISS, Mumbai. Programme Fee: The total fee for the programme is Rs. 1,20,000/- (One Lakh Twenty Thousands only), payable in two installments. The fee include tuition fee, learning resources, library and computer services.

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CONTENTS Vol 11. No 4, APRIL, 2017

GAGGED UP

MARKET

Chairman of the Board Viveck Goenka

SYMHEALTH 2017 TO BE BE HELD IN PUNE FROM MAY 4-6, 2017

STARTUPS INTEND TO CREATE A NEW PARADIGM FOR HEALTHCARE IN INDIA AT TIECON CONCLAVE

FE CFO AWARDS HELD IN MUMBAI

Sr Vice President-BPD Neil Viegas Editor Viveka Roychowdhury* Chief of Product Harit Mohanty BUREAUS Mumbai Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das, Mansha Gagneja Delhi Prathiba Raju Design National Design Editor Bivash Barua Asst. Art Director Pravin Temble Senior Designer Rekha Bisht Graphics Designer Gauri Deorukhkar

Reinstatement of the Global Gag Rule causes wide-spread fear that progress of maternal health in developing countries would be severely hit| P-08

Artists Vivek Chitrakar, Rakesh Sharma Photo Editor Sandeep Patil MARKETING Regional Heads Prabhas Jha - North Harit Mohanty - West Kailash Purohit – South Debnarayan Dutta - East Marketing Team Ajanta Sengupta, Ambuj Kumar, Douglas Menezes, E.Mujahid, Mathen Mathew, Nirav Mistry, Rajesh Bhatkal PRODUCTION General Manager BR Tipnis Manager Bhadresh Valia Scheduling & Coordination Ashish Anchan CIRCULATION Circulation Team Mohan Varadkar

INTERVIEWS

START UP CORNER OPINION

P12: DR BS AJAIKUMAR

PARAMEDICAL PROFESSIONALS: THE DRIVING FORCE OF ANY HEALTHCARE INSTITUTE

ON ADVOCACY OF SAFE INJECTION AND INFECTION PREVENTION

CARDIAC SECTOR IN INDIA

Chairman & CEO, HealthCare Global Enterprises

P25 : DR SAMEER KHAN Chief of Business, CallHealth

P26: ASHIM ROY CEO, Cardiotrack

P39: LALIT PAI CEO, Nightingales Home Health Services

GOQII: TREADING ITS WAY TO THE TOP

STASIS LABS: A VITAL VENTURE

POLICY WATCH

NATIONAL HEALTH POLICY - INDUSTRY GIVES ATHUMBS UP

PROGRESS REPORT ON CHILD HEALTH TARGETS

P41: CHARY MUDUMBY CTO, HTC Global Services

LIFE

BOOK SHELF

Express Healthcare® Regd. With RNI No.MAHENG/2007/22045. Postal Regd.No.MCS/162/2016-18. Printed and Published by Vaidehi Thakar on behalf of The Indian Express (P) Limited and Printed at The Indian Express Press, Plot No.EL-208, TTC Industrial Area, Mahape, Navi Mumbai-400710 and Published at 2nd floor, Express Towers, Nariman Point, Mumbai 400021. Editor: Viveka Roychowdhury.* (Editorial & Administrative Offices: Express Towers, 1st floor, Nariman Point, Mumbai 400021) * Responsible for selection of news under the PRB Act. Copyright © 2017. The Indian Express (P) Ltd. All rights reserved throughout the world. Reproduction in any manner, electronic or otherwise, in whole or in part, without prior written permission is prohibited.

EDITOR’S NOTE

Pragmatism wins over populism

ndia finally got a new National Health Policy (NHP), 15 years after the last one. The NHP 2017 takes a cautious stance, with the accompanying situation analysis, as a background to the NHP acknowledging the uphill task. The backgrounder sums it up very succinctly: The failure to attain threshold minimum levels of public health expenditure, remains the single most important constraint. This pragmatism has been met with cautious support from industry. The NHP 2017 proposes to increase health expenditure by government as a percentage of GDP from the existing 1.15 per cent to 2.5 per cent by 2025. Experts point out that the draft NHP proposed to reach this percentage earlier, by 2018, but the government realises that this was too tall a target, given the budgets and the lack of time. The accent on Preventive and Promotive Health, witnessed in the move to a more holistic package of services to be dispensed by Health and Wellness Centers gives hope that the approach will be more broad based. NHP 2017 is also very clear that it is not yet feasible to make healthcare a fundamental right. Again, this was mentioned in the draft with health activists pressing for a health rights bill, making health a fundamental right, like the Right To Education. But NHP 2017 makes the point that for health to be a right, there has to be a certain level of infrastructure available and secondly, when health is a state subject, would it be desirable or useful to make a Central law? So the NHP 2017 very pragmatically advocates a progressively incremental assurance-based approach, with assured funding to create an enabling environment for realising healthcare as a right in the future.' Another sticky issue that NHP 2017 tries to tackle is engagement with private healthcare providers. The policy specifies a dozen odd areas where ‘strategic purchasing’ is permitted to fill the gaps in the public healthcare system and the incentives to private players. But are the incentives strong enough for the private sector to provide beds, diagnostics, medicines free or at a subsidised rates?

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April 2017

Adose of pragmatism in the NHP2017 is better than a placebo pretending to be a panacea for everyill

Some of these incentives have not worked in the past. Many corporate hospitals complain that they face delays in payment from the government. Pharma companies supplying medicines too face the same problem. Payments delays are a huge disincentive. For example, Cipla stopped making Lopinavir syrup, an antiretroviral drug, used for the treatment of paediatric HIV/AIDS cases, which it supplied to National AIDS Control Organisation because of payment delays from 2014. Faced with bad press and an appeal from children living with AIDS, the government released `6 crore to Cipla but this is but a single example. This is why many PPPs in the healthcare have been mired in legal issues and have sputtered to a stop. Is poor implementation and coordination between the private and public healthcare organisations the only factor, or does it go deeper, to a clash of two diverging mindsets? Attributed to guidance from Prime Minister Modi, one TV channel quickly dubbed NHP 2017 as NaMoCare, a take on President Obama’s signature Obamacare. But there are lots of learnings that the Health Ministry can take from Obamacare, which was roundly criticised by his successor. President Trump who failed to roll it back but the buzz is that Obamacare might just roll to a halt on its own as more insurers stop backing it. NHP 2017 should beware the same fate. With elections due in 2019, the government stayed clear of promises that it would find difficult to keep. NHP 2017 might have been a disappointment for people hoping for big bang announcements. But it sets the right course, and if we can implement these steps, the nation's public health will see a slow but sure improvement. As Union Health Minister JP Nadda himself cautions in the last paragraph of NHP 2017, a policy is only as good as its implementation. Let us hope we see this take shape in the days to come. A dose of pragmatism is better than a placebo pretending to be a panacea for every ill. We have had enough of meaningless sugar pills. VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

LETTERS QUOTE

MARCH 2017

The policy aims for attainment of the highest possible level of health and well-being for all at all ages, through a preventive and promotive healthcare orientation in all developmental policies, and universal access to good quality healthcare services without anyone having to face financial hardship as a consequence Check out the online version of our magazine at

www.expresshealthcare.in

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JP Nadda Union Minister of Health and Family Welfare during the lunch of National Health Policy

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April 2017

MARKET INSIGHT

Gagged Up Reinstatement of the Global Gag Rule causes wide-spread fear that progress of maternal health in developing countries would be severely hit

he Global Gag Rule (GGR), reinstated by the US President, Donald Trump, will severely hamper access to legal abortion and the repercussions would be felt on Family Planning and Reproductive Health in developing countries. Alok Vajpeyi, Director Programmes, Population Foundation of India (PFI) points out, “As it would cause cuts in services, increase in fees and closures of clinics; the result will be increase in unintended pregnancies, unsafe abortions, maternal deaths and newborn deaths. Nearly 225 million women in developing countries who want to avoid pregnancy but have no access to modern contraception will be affected by GGR, as it will put birth control even farther from their reach.” According to the World Health Organization (WHO), every eight minutes a woman in a developing nation will die of complications arising from an unsafe abortion. For every woman who dies of pregnancyrelated causes, an estimated 20 women experience acute or chronic morbidity, often with tragic consequences. Family planning prevents 272,000 maternal deaths worldwide. Experts highlight that GGR broadens the gap between women and access to safe abortion. It hampers impor-

EXPRESS HEALTHCARE

April 2017

tant efforts by governments and NGOs around the world to deliver needed services, to engage in advocacy and free speech on safe abortion. The progress made so far toward s providing women with the right to abortion would be slowed by the GGR, inform global NGOs.

An injury to global reproductive health Access to contraception gets severely compromised under the GGR will have terrible consequences for women’s health, the incidence of unintended pregnancies, unsafe abortions and ultimately maternal deaths will rise. Maternal morbidities such as obstetric fistula cases would escalate. Highlighting the impact of GGR on women’s health globally, Ulla Müller, President and CEO, EngenderHealth, of a leading global women’s health organisation says, “While GGR was in effect between 2001 and 2009, the policy forced clinics to reallocate their funds and cut back on a range of critical health services that have nothing to do with abortion, such as family planning, obstetric care, HIV testing, and malaria treatment. 20 developing countries in Africa, Asia, and the Middle East lost US-donated contraceptives, and many organisations and clinics were forced to reduce services, lay off staff, or shut down entirely.” More than 22 million women every year—almost in all developing countries—will have an unsafe abortion because they lack access to safe, high-quality abortion care. Stating that Trump’s GGR will overall have a more insidious and damaging affect on women’s health, Vajpeyi states, “GGR is a violation of women’s rights and, by making essential services out of reach. It will

BY REINSTATING GGR, INDIAN NGOS SUCH AS MSI, PSS (AN OFFSHOOT OF MSI) AND FAMILY PLANNING ASSOCIATION OF INDIA,WILL HAVE TO CHOOSE BETWEEN CONTINUING TO PROVIDE INFORMATION, COUNSELING, SERVICES OR REFERRALS FOR ABORTION AND STOPPING ABORTION-RELATED ACTIVITIES TO BECOME ELIGIBLE TO RECEIVE FUNDING FROM USAID ULLA MÜLLER, President and CEO, EngenderHealth

GGR WILL RESULT IN WIDE-RANGING COLLATERAL DAMAGE – MOST ORGANISATIONS THAT OFFER ABORTIONS ALSO OFFER INTEGRATED SERVICES IN THE REALM OF SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS LIKE HIV TESTING AND CERVICAL SCANS TO CHECK FOR CANCER ALOK VAJPEYI, Director Programmes, Population Foundation of India

GGR WILL HAVE A DEVASTATING ECONOMIC EFFECT IN DEVELOPING COUNTRIES.WHEN AWOMAN OR GIRL CAN’TACCESS FAMILY PLANNING AND SAFE ABORTION, SHE RISKS DISCONTINUING HER EDUCATION DUE TO UNINTENDED PREGNANCY, FINANCIAL HARDSHIP AND THE INABILITYTO CONTRIBUTE TO THE WELL-BEING OF HER FAMILYAND HER COMMUNITY VINOJ MANNING, Head, Ipas, India

MARKET also increase unintended pregnancies and unsafe abortions at the cost of women’s health and lives, especially in the poorest countries of the world.” As per experts, GGR denies women the fundamental right to make informed decisions about their bodies and their health. It also denies women access to sexual and reproductive healthcare that includes comprehensive abortion care and contraceptive care. Citing an example on the impact of GGR in developing countries, Vinoj Manning, Head of global reproductive rights charity, Ipas in India said, “In 2003, the Planned Parenthood Association of Ghana lost $200,000 in USAID funding when they refused to sign onto the Gag Rule. The impact was devastating — the organisation was forced to lay off key staff and to reduce its nursing staff by 44 percent. This leads to a 40 percent reduction in family planning use by clients served by the organisation. In total, more than 1,327 communities in Ghana were affected by the cuts.” When it comes to India, though the country's stand on abortion has been clear, unsafe abortions continue to be the third largest reason for maternal deaths. In this scenario, GGR can adversely affect family planning and reproductive health system of India as well.

abortions, including unsafe abortions, increased maternal and child morbidity and mortality,” points out Müller. According to EngenderHealth, India has an estimated modern contraceptive prevalence rate (mCPR) of 52.4 per cent and unmet need of 31.1 per cent as of 2015. This translates

GGR denies women access to sexual and reproductive healthcare that includes comprehensive abortion care and contraceptive care

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Collateral damage to India? Ipas, a global non-profit that works to enable women's to exercise their sexual and reproductive rights, informs that nearly five million women in India this year will have an unsafe abortion because they lack access to safe, high-quality abortion care. These are women who want to avoid pregnancy but lack knowledge and awareness on modern contraception methods. “If affordable contraceptives are not provided to Indians, we will see an increase in the unmet need for family planning. This would mean that there would be more unplanned and unwanted pregnancies, resulting in more

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April 2017

into 30,100,000 women who have an unmet need for family planning services. The consequences of GGR on rural women is likely to be more as the US agencies provides considerable aid to India. In 2006, 69.1 per cent of women reported satisfaction in terms of using modern con-

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MARKET traceptives to avoid pregnancy and these contraceptives were provided by the United States Agency for International Development (USAID). In 2015, USAID reportedly spent $21 million dollars on Family Planning and Reproductive Health in India, and a year prior to that, it spent $13.9 million. Manning gives a detailed overview of the scenario and states, “India’s stand on abortion has been bold and clear since 1971 with the passage of the Medical Termination of Pregnancy (MTP) Act. The Act permits termination of pregnancy for a broad range of conditions. Abortion care as such in the public sector in India may not be affected by this decision since comprehensive abortion care is an integral component of the interventions under the National Health Mission.” He further elucidated, “However, it may impact NGOs that receive US funds for family planning services if their work includes counselling on abortion services or safe abortion service delivery. Some women may not be referred to a public health facility for abortion and instead turn to unsafe methods of ending their pregnancy. Cuts to their funding would have an associated impact on women’s access to information and services because of fragmented information on maternal health and family planning without abortion,” he added. However, Vajpeyi feels that restricting universal access to family planning and reproductive health services will not adversely affect health and family planning services in India. Explaining his rationale he says, “Very few NGOs receive funds from international donors or the US. In India, family planning and reproductive health services are mainly provided by the government. Organisations which were giving valuable technical assistance and US-donated contraceptives, including condoms would be lacked.” Besides, PFI also informed that India has a robust network which supplies contraceptives, including condoms, oral pills, IUDs, tubal rings, ECPs and pregnancy test kits.

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April 2017

“Our public health centres are also equipped to provide sterilisations under certain mandated guidelines. Between 2014 and 2015, nearly 176 million condoms were provided, along with 102.84 million oral pills and 102.38 pregnancy test kits. The annual report from the Ministry of Health and Family Welfare says that a total of 40,36,683 women were sterilised and 51,28,893 women opted for IUCD insertions,” Vajpyei asserts. He further informed that the Indian government has estimated that the current unmet need for family planning can be fulfilled within the next five years, which would help the country to avert 35,000 maternal deaths and 12 lakh infant deaths. “But family planning is directly linked to the health of women and children, GGR will result in wide-ranging collateral damage – most organisations that offer abortions also offer integrated services in the realm of sexual and reproductive health and rights like HIV testing and cervical scans to check for cancer,” he added. Most NGOs and organisations which deal with family planning and reproductive health offer integrated services, which means people who seek information on abortions and family planning may also require auxiliary services like HIV testing and cervical scans to check for cancer. "As a result of the reinstatement of the GGR, Indian NGOs such as Marie Stopes (MSI), PSS (an offshoot of MSI) and Family Planning Association of India, to name a few will have to choose between continuing to provide information, counselling, services or referrals for abortion and stopping abortion-related activities to become eligible to receive funding from USAID. At that point, NGOs choosing to be eligible for USAID funding will have to give up life-saving abortion care services, thus leading to an increase in the prevalence of unsafe abortions and maternal mortality in the country," Uller highlighted. She also informed that

MARKET EngenderHealth, being a USbased NGO, is not directly subject to the restrictions of the GGR. However, they run projects in India through other NGOs that are subject to GGR. Likewise, they collaborate with international NGOs like International Planned parenthood (IPPF) and MSI in their global projects. “We may no longer be able to work with those local and international NGOs, if they decide or continue to be involved in abortion care. Though EngenderHealth’s projects in India are funded by private donors, this restriction on NGOs may have a bearing on the amount of funds we can spend in India,” she added. Thus, experts caution that the far reaching effects of GGR would range from loss of thousands of jobs, cutting access to healthcare in hardto-reach areas, and increased vulnerability of girls and women in these areas to unsafe abortions and other desperate and harmful measures to access care. “The GGR will have a devastating economic effect in developing countries. When a woman or girl can’t access family planning and safe abortion, she risks discontinuing her education due to unintended pregnancy, financial hardship, and the inability to contribute to the well-being of her family and her community,” Manning warns.

Need for a responsible policy Thus, experts unanimously agree that GGR will have terrible consequences on the health and lives of poor women and their families in ways that have nothing to do with abortion. From 2001 to 2009, when the then US President George W Bush reinstated GGR, 20 developing countries in Africa, Asia, and the Middle East lost US-donated contraceptives, and many organisations and clinics were forced to reduce services, lay off staff, or shut down entirely. Meanwhile, data provided by the Guttmacher Institute, a research and policy organisation committed to advancing sexual and reproductive health

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and rights in the US, stated that in 2016, $607.5 million aid has been used for family planning, which has granted 27 million women access to the basket of contraceptive choices, averted six million unintended pregnancies, and prevented 2.3 million abortions. Loss of US funding will bur-

GGR is likely to have terrible consequences on the health and lives of poor women and their families in ways that have nothing to do with abortion

den more than 225 million women globally. In the absence of the GGR and full access to the US funding, healthcare providers would have been better equipped to help women in developing nations have safe pregnancies, avoid unsafe abortions, and have access to modern contraceptives.

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I N T E R V I E W

‘Healthcare Global Enterprises is growing at 20-22 per cent currently and will further focus on expansion of its centres’ HealthCare Global Enterprises (HCG) has been one of the fastest growing cancer care network in India is very soon going to launch around five new centres. After the IPO, the companies has scaled up its expansion and has plans to set up its cancer care centre in Africa. Dr BS Ajaikumar, Chairman & CEO, HealthCare Global Enterprises shares the company's growth story and plans for 2017-18 in an interaction with Raelene Kambli You launched your first hospital in 2005. What did it take to finally make that decision? Once you had made it, what were some of the steps you took to learn the business skills? Back in the early 2000s, we realised that the delivery of cancer care was poor in India, and so were the clinical outcomes because of low use of technology. We were aware that India was a poor country, unable to afford quality cancer care – all of which created a perception amongst people that cancer was a disease to be feared. To me, these reasons were unjustifiable. The growing number of cancer patients required more attention to make cancer care both accessible and affordable, and we felt that the government alone was not in a position to deliver such care in India. It was clear to us that private enterprise had a big role to play and could penetrate most markets. Around 2003-04, I returned to India and set up the hub and spoke model shortly after that, in 2005. From a business angle, we had to make our model viable and we turned to private equity. There is always the concern that equity is more expensive than debt – which is true. Debt, however, is like a sword hanging over your neck, while in the case of equity, value is created for the investor. Keeping this in mind

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we chose equity. Although dilution is a fear with equity, it did not matter to us because our goal was not to make it a business but a social enterprise, by using our business acumen. These are some of the bold steps we took to make HCG a successful venture. We then opted for more private equity to expand across the country, got ourselves a good name, increased our transparency and were able to successfully go public as a cancer care provider – something that was completely unimaginable a decade ago. You’ve built a fast-growing business- India’s largest cancer care network. What was your strategy in building a business so rapidly, especially in cancer care? What were some of the steps you took? Some of these steps I have partly explained above, our main strategy was that the business can and should go ahead based on the need and the opportunity. Cancer in India was increasing significantly, and from our experience it was clear that cancer, as a lifestyle disease, would increase to epidemic proportions. So, we decided to build a hub and spoke model, the hubs being centres of excellence and the spokes in partnership with doctors and experts, in big

cities as well as in tier II and III cities, extending cancer care expertise to a larger public. In just 10 years, we have been able to set up over 20 comprehensive cancer centres in India and make cancer care affordable even in tier II and III cities like Vijayawada, Ranchi and Kanpur. This kind of expansion hasn’t been done globally, and has been possible through our hub and spoke model, centralisation of services, and our partnership model with doctors.

We have always been interested in creating doctor entrepreneurs especially in niche areas – IVF is one of these areas

What have been some of the most strenuous challenges that you have faced? How did you overcome those challenges, and what did you learn from them? The first challenge for us was to create a model with the knowledge and the technology needed to address a disease as complex as cancer. Some of our questions back then were: how do we bring in the funding finance, and how do we create a hybrid financing model where there is equity and debt, which as I have explained earlier, is a challenge we overcame. The next challenge was to identify where in the country we wanted to be and at what point. The third challenge was to create a model of partnership with doctors, a new model for India. This last step required a lot of awareness building amongst doctors, financial investors, banks and private equity in-

MARKET

vestors and working with equipment manufacturers. The other challenge was of course to set up the centres, keeping in mind the many regulatory issues and concerns of that particular region. We believe that we have now, to a great extent, mastered how to address these challenges and we feel more confident in executing future projects in a more timely manner. What are some of the most surprising, innovative things that you have tried out? You began with IVF centre, MILAN. Could you tell us the story? I would think our centralisation of services stands out as a good example of innovation in cancer care, i.e. our offerings in tele-physics, tele-radiology, tele-medicine and virtual tumour boards. Sometimes it is difficult to get highly-trained physicists in a centre such as Ranchi. But having 25 highly qualified physicists coordinating with the centre from Bengaluru allows us to replicate the same quality of care that we deliver in Bengaluru. Also, because of the virtual tumour boards, patients do not have to travel long distances and can avail expert opinion at their doorstep. What is surprising, however, is that there is quite a lot of reluctance by local doctors and it requires counselling on our part to encourage the acceptance of such a model. What we need to explain is that cancer is a complex disease and requires a multi-disciplinary approach –people who are experts on sub-specialities of the disease must provide their opinions, and we must collect data on the disease as we go forward. Such an approach was lacking in the medical community and HCG has taken a leadership role in working with doctors, to encourage the building of this oncology knowledge base. I find it surprising that we have not yet focussed on taking such a multi-disciplinary approach to cancer care in India. We often find ourselves saying ‘there is no study so far for such a treatment’ so why is it

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that we cannot do our own study here in the country itself? We are capable of such innovation by taking a leadership role in onco-care. With regard to our IVF centre, we have always been interested in creating doctor entrepreneurs especially in

niche areas – IVF is one of these areas. We have a leader like Dr Kamini Rao, who has been instrumental in starting IVF offerings in the country, and when we had a discussion, it was very clear that there is opportunity and need for IVF in India. With our decision to

take up a major stake, today we are happy to see the centres expand from three to eight in number, and I am confident that you will hear more about this growth in the future. How has it been after the IPO?

In terms of business, we have continued our expansion as indicated prior to the IPO and new centres have been launched in oncology and fertility. Overall our presence across the country and large addressable markets continues to grow as we build on our leadership in

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MARKET these niche specialities. It has been very good overall, and every three months we report our earnings. I feel that we can now focus on the growth of the company. We have been meeting interesting people – investors, innovators, researchers, all of whom have contributed to the growing visibility of HCG. Globally, people are looking at us to see how to provide access and affordability while improving cancer care outcomes. Tell us about your growth numbers so far especially

after the IPO? What are your profit margins for 2016-17? Our revenues have been growing at 20-22 per cent on a yearon-year basis and EBITDA has been growing at around 25 per cent. Our EBITDA margins at consolidated level are around 15 per cent and our PAT margins are at approximately 3 per cent for FY2017 – YTD Dec’16. We are not able to give guidance for the full year of FY17 at this amount. How much do you invest in research y-o-y? We do invest a significant

amount of both money and time in R&D, but do not evaluate this investment as separate from our overall expenses. We have a large research team that is involved in the molecular diagnostics division, the clinical trials division and in data collection. We do get a lot of this research published in academic publications, creating a bio-repository that helps us move towards predictive analysis and next-generation sequencing. What is your opinion about the use of algorithms to

detect and treat cancers? The use of data is becoming increasingly important in cancer care, and algorithms have become particularly helpful in this regard. For instance, if you have two patients with breast cancer, where one responds to treatment and the other does not, we look at the genetic and biological characteristics of both patients and based on the findings, we create a databank of recall that can be used to treat the next patient. Today, with the use of such predictive analytics, the focus is shifting from evidence based medicine

to precision medicine and personalised care. Genomics will now play an important role as we go forward in cancer care. What are your projects for 2017-18? We have around seven to eight new projects which are expected to be launched in the coming 12-18 months across Mumbai, Kanpur, Jaipur, Kolkata and Kochi. We are also working actively on opportunities in Africa and could potentially have a project there soon. raelene.kambli@expressindia.com

PRE EVENTS

SYMHEALTH 2017 to be be held in Pune from May4-6,2017 The event will explore enriching healthcare delivery by application of knowledge from different disciplines and facilitate innovation and enterprise THE FACULTY of Health & Biomedical Sciences (FoHBS), Symbiosis International University (SIU) will organise SYMHEALTH 2017, an international conference on healthcare in a globalising world. The objective of the event will be to explore enriching healthcare delivery by application of knowledge from different disciplines and facilitate innovation and enterprise. SYMHEALTH 2017, to be held in Symbiosis Center of Health Care, Pune, will be a step towards forging new dialogues with various stakeholders of the healthcare community beyond academia, both in India and abroad, bringing in new insights and perspectives from other fields, offering a platform on which to foster intellectual fellowship amongst all stakeholders and most importantly, being the instrument of global advances in healthcare. The conference will be an initiative to bring a near 360degree perspective on the

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Conference will deliberate on the modalities for enhancing knowledge, sharing ideas and finding innovative ways theme. It is envisaged that the conference will deliberate on the modalities for enhancing knowledge, sharing ideas and finding innovative ways of applying the different disciplines, for improving the availability, accessibility, affordability and quality of healthcare, in this well-connected and knowledgeable world. Various tracks for the conference include: ◗ Track I: Healthcare Economics & Financing ◗ Track II: Healthcare Communications ◗ Track III: Healthcare Laws ◗ Track IV: Healthcare: Engineering Design & Geospatial

Applications ◗ Track V: Healthcare IT ◗ Track VI: Healthcare: International Relations ◗ Track VII: Healthcare: Innovation and Entrepreneurship ◗ Track VIII: Healthcare: Integrative approach in Indian setup JP Nadda, Union Minister for Health and Family Welfare, GoI, will be the chief guest for the event. Amitabh Kant, CEO, NITI Aayog, GoI and Dr Soumya Swaminathan, Director General, Indian Council for Medical Research (ICMR) will also grace the occasion as Guests of Honour. The valedictory ceremony will be held on

May 6, 2017 in the august presence of Dr Henk Bekedam, WHO Country Representative, India and Dr Devi Prasad Shetty, Chairman, Narayana Health. Some of the other speakers include Alok Kumar, Advisor, NITI Aayog, GoI, Dr Mohan Agashe, Former Director, Maharashtra Institute of Mental Health, Suman Billa, Joint Secretary, Ministry of Tourism, GoI, Sachin Pilot, Member of Parliament (Loksabha), Dr K Srinath Reddy, President, Public Health Foundation of India (PHFI), Bhupendra Singh, Chairman, National Pharmaceutical Pricing Authority, GoI, Dr Pradeep Krishnatray, Director, Research & Strategic Planning, Johns Hopkins Bloomberg School of Public Health, USA, Dr Yaron Wolman, Chief of Health Division, UNICEF India, Dr Roderico H Ofrin, Regional Coordinator, WHO, SEARO, New Delhi, Prof Kris Gledhill, Director of

Clinical Legal Education, AUT Law School, Auckland, New Zealand, Prof John Tingle, Reader in Health Law, Nottingham Trent University, UK, Dr Nitin Tripathi, Professor, AIT, Bangkok, Linda Roberson, CEO Paper Tracer Software System, USA, Dr Shirshendu Mukherjee, Mission Director, Grand Challenges India, BIRAC, and Dr Raghunath Mashelkar, National Research Professor. SYMHEALTH 2017 will thus facilitate a conglomeration of various stakeholders beyond academia and industry under one roof. It promises to be an excellent branding and networking platform. Participants will get a good opportunity to showcase their organisation, innovations, ideas, projects and achievements. Proceedings of the conference will help understand latest emerging market trends & recent advances in healthcare sector which will help define future strategies.

MARKET POST EVENT

Startups intend to create a new paradigm for healthcare in India at TiEcon conclave The conclave had workshops, panel discussions, fireside chats, knowledge sharing sessions and exhibition Raelene Kambli Mumbai FROM PRECISION medicine to virtual care delivery platform, data analyticals to interoperability, diagnostic kits to medical devices to various innovative services, start-ups in healthcare are changing the way healthcare is perceived as well as delivered. This was quite evident during TiEcon's two-day startup conclave organised by The Indus Entrepreneurs (TiE) Mumbai Chapter. The conclave had interesting workshops, panel discussions, fireside chats, knowledge sharing sessions and exhibition. The theme of the event was ‘2022 – India Ahead’ which attracted more than 1,000 delegates and representatives from across industries over two-days. The first day focussed on banking, financial and other retail sectors. The second of TiEcon focussed on start-ups from the lifesciences sector. The sessions were conceptualised and curated by QuintilesIMS team. Around 50 healthcare and pharma startups and more than 125 representatives from the lifesciences space congregated on the second day. The day began with, Amit Mookim, Managing Director,

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MARKET South Asia, QuintilesIMS, addressing the audience on the opportunities for healthcare startups in India. Since Mookim is involved in mentoring new-age healthcare entrepreneurs and also helps them get access to other mentors, industry players and funding institutions, he began his address by saying digitalisation is future of healthcare. Expounding on the current scenario he said, “There are three pillars on which convergence in the healthcare space is taking place. First pillar is patients; today they have access to huge amount of information especially through Internet. Therefore, they are increasingly taking decisions on their own. This has a huge implication on how they are engaging with doctors, healthcare providers and peers. The second pillar is the doctors. Two-third of the doctors today are on Internet and are using social media. The third piece is that the blocks are being put in place to build the supply chain despite the fact that India is a hugely fragmented country. The traditional way of doctor-patient engagement and healthcare delivery has been gradually making a shift towards a more focussed and personalised approach with the help of technology.” “The healthcare startups can tap into this prospect by connecting all three pillars and cater to widespread demographic, both in terms of doctors and patients. Healthcare SIG is our effort to provide an open forum to entrepreneurs wherein they can have access to share ideas with not only VCs, but also with established players and peers. Our aim was to create largest congregation of healthcare startups that focusses on ideas, innovation and work, not limiting to the size of the startup,” he added. Thereafter, in a very interesting panel discussion on Life Sciences – The road to digital, analytics and interaction with broader healthcare ecosystem, panelists Sudarshan Jain, MD, Abbott Healthcare; Amit Bakshi, Founder and MD, Eris Life Sciences; Manish Gupta, Cofounder and CEO, Indegene, Rashid Khan, Director, Rxmedikart Technology; Saurabh Arora, CEO, Lybrate;

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Amit Mookim, Managing Director, South Asia, QuintilesIMS, Sudarshan Jain, MD, Abbott Healthcare; Amit Bakshi, Founder and MD, Eris Life Sciences; Manish Gupta, Co-founder and CEO, Indegene; Vishal Gondal, Founder, CEO and CFO, GOQii; Rashid Khan, Director, Rxmedikart Technology; Saurabh Arora, CEO, Lybrate

Saurabh Arora, CEO, Lybrate, Vishal Gondal, Founder, CEO and CFO, GOQii along with moderator, Amit Mookim brought out keys aspects of the healthcare system in India and also deliberated on ways and means to utilise digital technologies to address challenges. The discussion began with emphasis on the pre-requisites of building a strong healthcare ecosystem. Jain highlighted the importance of the newly launched National Health Policy by the government. He said, “The National Healthcare Policy framed by the government is a major step towards attaining an inclusive healthcare system. However, there lies a huge gap in what needs to be done and what is being done. There is a need for strategic buying of healthcare services and the physical reach of medical infrastructure needs to be ensured. Availability of technically skilled manpower is another issue that needs close attention. While all this is important, the most critical element is to have affordable healthcare across all strata.” Gondal, spoke on the need to shift focus from a curative healthcare system to a preventive one. “It is rather important to put technology to work to bring in lifestyle changes. The gap between the medical manpower that is available and that what is needed today is huge. With the amount of data that is available and which can be stored with the help of technology, a lot more efficiencies can

be achieved,” he exclaimed. He also spoke on the need to build trust among all stakeholders in order to build a cohesive healthcare system. Bakshi gave an interesting perspective on the relevance of scalability of health services in India. “Everybody within the healthcare start-up ecosystem is trying to solve a problem, which is good. But until we start writing a digital prescription, scalability of healthcare services is going to remain a problem. Scalability of healthcare services is a huge opportunity. Patient education is much more than just reminding someone to take a pill on time,” he argued. Adding to Bakshi's concerns, Khan pointed out that statistically 67 per cent of people going to a chemist never get counselling on how to take the medicine properly. Emphasising on the importance of patient education, he said, “An informed patient leads to an informed decision.” Arora chipped in saying, “Building trust among patients is very important. Right information at the right time is the need of the hour.” “There are multiple probes in healthcare. Compliance has evolved and players are getting more serious now”, opined Gupta. He further emphasised on the regulatory factors being the drivers for change in the future. “Regulations are the biggest drivers of the healthcare sector. They have helped the industry change and evolve

for the better”, he said. The next panel discussion titled 'Digital Healthcare– Predictive analytics, enhanced patient experience and better healthcare delivery ' furthered the deliberation on how start-ups can pave a way for the future. Panelist Subhashish Sircar, Founder and CEO, Health Vectors; Vamsi Chandra, CEO, ENLIGHTIKS; Mudit Vijayvergiya, Co-founder, Curofy; Pradeep K Jaisingh, Chairman, HealthStart and Atin Sharma, Partner, RoundGlass exchanged insights on building sustainable healthcare businesses in India. Jaisingh said, “India needs to look at the cultural aspects of the entrepreneurship in healthcare. A collaborative model is needed and can be sustainable in the future. We need to look at the challenges in healthcare as opportunities.” Chandra spoke on the good, bad and ugly side of the startup culture in healthcare. “Healthcare is currently going through a renaissance in the last 8-10 years. It is an industry which is going to stay. However, the approach taken by most start-ups in this space is incorrect. You will find that very few unique companies that have a different business model. Most of the startups are photocopies of the others. This could be detrimental for any business environment', he stated. He further spoke on how startups should pick a problem and solve it differently than its

competitors. Chandra also highlight three aspects of success for startups- either a company has phenomenal technology for healthcare or pharma, or a company is building a revolutionary business process for the sector or the company is making profits via its unique business model. Vijayvergiya spoke about his business model and explained how entrepreneurs need to keep their focus on larger business goal. Sircar emphasised on the need to build businesses around technologies that complements healthcare providers.” We all talk about the importance of sustainability in business but that require us to be flexible to change.” Sharma gave an overview of the funding scenario for startups in healthcare and shared this vision for healthcare as a venture capitalist. The session was followed by an intriguing presentation on important questions that startups should ask themselves before they visit venture capitalist by Praful Akali, Founder and MD, Medulla Communications. Akali in this session raised pertinent questions on scalability, sustainability and reliability of a various business models. The day ended with networking sessions among startups, funders and healthcare providers present at the event. raelene.kambli@expressindia.com

MARKET POST EVENT

FE CFO Awards held in Mumbai The event celebrated the excellence, best practices and outstanding achievements by India’s leading Chief Financial Officers

THE FE CFO of the Year Awards 2017, an initiative of The Financial Express, recently celebrated the excellence, best practices and outstanding achievements by India’s leading Chief Financial Officers in Mumbai. The keynote address was delivered by Bibek Debroy, Member, NITI Aayog. Debroy said the government expected the second Income Declaration Scheme (IDS II), which will end on March 31, to yield around ` 2 lakh crore. “This does not mean all the money that is back has become legitimate and has been converted into white. The scrutiny is going to happen now,” he cautioned, however, that while tax inspectors “go after the mala fide accounts, there is also the danger they would go after some bonafide ones.” Debroy noted that the business environment in the country must be improved for every entrepreneur, pointing out that not every entrepreneur was necessarily a corporate entity. He added that a large part of entrepreneurship was in the infor-

mal economy, which was why Prime Minister Narendra Modi had stressed on the importance of start-ups. A total of 26 awards were given away across three main categories, which were: ◗ Gross turnover less than ` 500 crore ◗ Gross turnover greater than or equal to ` 500 crore and

lesser than ` 1000 crore ◗ Gross turnover greater than ` 1000 crore Under each main category the winners were divided into two sub segments. The winning performances – across six categories – were picked by a high-powered jury chaired by R Seshasayee, chair-

man, Infosys. The other members were YM Deosthalee, Chairman, L&T Finance Holdings, Leo Puri, MD, UTI Asset Management, Pradip Shah, Chairman, IndAsia Fund Advisors, and Amit Chandra, MD, Bain Capital. Performances of 150 firms were assessed. Deosthalee received the Lifetime Achievement award. He successfully managed the complex financial portfolio at the engineering giant for more than two decades. He ensured all risks were covered, all exposures hedged and that the treasury operations were robust. R Shankar Raman, Director and CFO, L&T, walked away with the CFO of the Year award. Shankar Raman managed the finances of L&T at a time when growth is subdued and cash flows are slow. His excellent management of working capital ensured that L&T has more than weathered the storm. The number crunching was done by Deloitte, the knowledge partner for the awards, which ensured all the right ratios were used to arrive at shortlists.

CFO of the Year : R Shankar Raman Lifetime Achievement: YM Deosthalee TURNOVER BELOW `500 CRORE Rank Manufacturing Rank 1 Symphony Rank 2 Caplin Point Laboratories Rank 3 La Opala RG Rank 4 Kewal Kiran Clothing Rank Services Rank 1 Credit Analysis & Research Rank 2 Thyrocare Technologies Rank 3 Accelyakale Solutions Rank 4 Wonder La `500 – 1,000 CRORE Rank Manufacturing Rank 1 Bajaj Corp Rank 2 Kitex Garments Rank 3 Hawkins Cooker Rank 4 Triveni Turbine Rank Services Rank 1 Dr Lal's Pathlabs Rank 2 Repco Home Finance Rank 3 GIC Housing Finance Rank 4 Navneet Education ` 1,000 CRORE PLUS Rank Manufacturing Rank 1 Coal India Rank 2 Torrent Pharmaceuticals Rank 3 Ajanta Pharma Rank 4 Bajaj Auto Rank Services Rank 1 Tata Consultancy Services Rank 2 Rural Electrification Corporation Rank 3 GRUH Finance Rank 4 Jagran Prakashan

Platinum Gold Silver Bronze Platinum Gold Silver Bronze

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FOCUS:BRANDING

Factors such as changing consumer behaviour, increased competition, rapid technological transformation and regulatory uncertainty are constantly influencing price, innovation and service quality within the Indian healthcare sector. Hence, top medtech companies are reinventing their branding strategies to achieve brand equity BY RAELENE KAMBLI

id you know why top multinational medtech companies so far have a competitive edge over its domestic opponents in India? Largely people would attribute this advantage to the brand equity these top companies savour. In some ways that is a valid viewpoint. Authors and branding experts Denise Creary, Mortgage Processor, BankAtlantic and Corey Shore Executive Director, JPMorgan Chase write that brand names have the potential to influence market structures. It also has the ability to shift demand curves of products in any given industry. Amit Mookim, GM, South Asia, QuintilesIMS, opines that a strong brand image enables organisations to earn

customer loyalty, command high prices as well as leverage brand equity and expand their offerings. For instance, top medtech multinationals world over have enjoyed brand equity which enables them to capture huge market shares as well as monopolies in certain product segment across globally. This global dominance for a long time has also influenced consumer behaviour in India, making them market leaders in here. Chandu Mukkavalli, Partner-Business Advisory Services and Narendra Sengupta, Director-Advisory services, EY, are of the opinion that brand image has facilitated top medtech companies in India to enjoy price advantage over their competitors. It has also earned sweet spots within

the sector. An analyst from a reputed company, who does not wish to be quoted cites examples of how top medtech companies have market control on certain product segments in the market. He informs that, Siemens holds a large market share for MRI systems in India, GE Healthcare dominate the ultrasound segment globally and infant warmers in the emerging markets, Medtronics is famous for its stents and J&J for orthopaedic implants. To understand this better, Express Healthcare conducted a small exercise and spoke to some leading hospital CEOs, administrators, radiology department heads, purchase managers, and diagnostic imaging promoters to understand their thought process while making a purchase deci-

sion on equipment for their organisations. The parameters set for this exercise were: cost effectiveness, features, after sales services, training facilities, innovations and brand name and the experts were asked to rank them in terms of their priority. Here is a priority list based on their choice: ◗ Cost effectiveness and ROI ◗ Innovations and features of the products ◗ Brand name ◗ Response time for repair service ◗ Training services This exercise indicated that cost-effectiveness of the products, ROI and brand name plays a significant role in medical technology purchase decision. Another interesting observation was that

Courtesy: Report published by Qmed in 2015 on top medical technology and devices manufactures' market share globally

Rank

Company Name

Stock ticker

Total revenue

Market capitalisation

Johnson & Johnson

NYSE: JNJ

$28.7 billion

$294.2 billion

General Electric Co

NYSE:GE

$18.1 billion

$243.6 billion

Medtronic

NYSE:MDT

$17.1 billion

$61.2 billion

Siemens

DB:SIE

$17.0 billion

$92.2 billion

Baxter International.

NYSE:BAX

$16.4 billion

$38.7 billion

Fresenius Medical Care AG & Co. KGAA

DB:FME

$15.2 billion

$21.1 billion

Koninklijke Philips

ENXTAM:PHIA

$11.8 billion

$26.1 billion

Cardinal Health

NYSE:CAH

$11.0 billion

$25.1 billion

Novartis AG1

SWX:NOVN

$10.7 billion

$227.5 billion

Covidien plc

NYSE:COV

$10.4 billion

$40.1 billion

Stryker Corp.

NYSE:SYK

$9.3 billion

$30.8 billion

Becton, Dickinson and Co

NYSE:BDX

$8.3 billion

$21.8 billion

Boston Scientific Corp

NYSE:BSX

$7.2 billion

$15.6 billion

Essilor International

ENXTPA:EI

$7.2 billion

$22.9 billion

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cover ) IN CERTAIN WAYS TOP MEDTECH COMPANIES HAVE HAD THE FORESIGHT TO SENSE THESE CHANGES AND ACT UPON IN THE RIGHT WAY while speaking of brand name as a parameter for a purchase decision, most people confessed that they would first find out on the offering given by top multinational companies as these companies have a great brand recall. So far, so good; medtech giants played it right. However, now the tide is turning. Changing consumer behaviour, increased competition, rapid technological tranformations and regulatory uncertainty that influences price, innovation and service quality has created a volatile market condition for top medtech players in India. The pressure now rests upon brands to perform well in order to stay ahead in the race. Are these companies ready to take the next leap?

Reinventing brands In certain ways top medtech companies have had the foresight to sense these changes and act upon in the right way. Most of these companies have already started investing heavily in research, product innovations, M&A, collaborations with governments and marketing activities in order to re-establish their company marques and achieve the desired brand equity even in these difficult times. Here are few examples of the same. Siemen as a health enabler Last year, Siemens hived off its healthcare business as part of their global strategy to

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manage healthcare as a separate entity. The healthcare company now enjoys entrepreneurial freedom and flexibility to deal with the market challenges in each country. When the company announced the new strategy it also stated that this move will strengthen its focus on the healthcare segment in India, by aligning it with its global strategy and management framework as well as margin accretive. The new name for the company is Siemens Healthineers. As part of their branding strategy they now project the company as an enabler of healthcare providers. “Engineers and Pioneers together makes Siemens Healthineers,” says Vivek Kanade, Executive Director, Siemens Healthineers. He further reiterates the words of their global CEO, Bernd Montag, who during the launch of the new company mentioned that Siemens has had an exceptional track record of engineering and scientific excellence and are consistently at the forefront of developing innovative clinical solutions that enable providers to offer efficient, high quality patient care. “Going forward as Siemens Healthineers, we will leverage this expertise to provide a wider range of customised clinical solutions that support our customers business holistically. We are confident in our capability to become their inspiring partner on our customers' journey to success. Our new brand is a bold signal

for our ambition and expresses our identity as a people company,” the CEO announced last year. This move has not only given Siemens a new name but also poses a new challenge of establishing Siemens Healthineers a brand. So how does the company plan to build the brand? Way back in 1960s, Siemens entered the Indian market with the glocalisation approach for product innovation. They intend to move on with the same approach but with an added advantage of new branding strategy. “Our new approach offers pioneering spirit and its engineering expertise in the healthcare industry. It is unique and bold and best describes the organisation and the people accompanying, serving and inspiring customers, the people behind outstanding products and solutions. And these people, the 45,000 employees worldwide, are working on the basis of seven business principles, which give them a common language and a common culture with a vision to empower healthcare providers to optimally serve their patients,” adds Kanade. Well, the strategy seems right for Siemens as soon after the company re-established their healthcare business as the company’s shares rose up 3.5 per cent in Frankfurt at €108.20 the last quarter of 2016. GE’s personalised marketing tool

Similarly, when GE Healthcare and Philips Healthcare took on the mentorship role for fostering innovation in healthcare both companies increased their market share worldwide. They focus on encouraging research and innovations in various disciplines of healthcare by setting up innovation hub in various countries. GE Healthcare's innovation Hub in Bengaluru itself is a vital cog in driving the digital transformation. Moreover, in 2015, GE Healthcare opted for a personalised marketing strategy by using automation to track customer behaviour. In an interview with a marketing magazine based in the US, Stephanie Meyer, Global head of marketing, GE Healthcare explained how the concept of personalised marketing works for the company. She said, “We thought if there was a way to talk to a radiologist in the UK who has very different needs from a radiologist in India. How would we talk to them differently and wouldn’t that be cool? In addition to that, just within the UK you might have a director of radiology, a chief financial officer and potentially a technician who can all make purchase decisions. In the former world, we would give the same message to all of those people. Now we tailor these messages and it has challenged us to think differently about content. There have been some amazing things we have been able to think about in terms of elevating our marketing skills and content but also our reach and

STRONG BRAND IMAGE ENABLES ORGANISATIONS TO EARN CUSTOMER LOYALTY, COMMAND HIGH PRICES AS WELL AS LEVERAGE BRAND EQUITY AND EXPAND THEIR OFFERINGS. TOP MEDTECH MULTINATIONALS WORLDOVER HAVE ENJOYED BRAND EQUITY WHICH ENABLES THEM TO CAPTURE HUGE MARKET SHARES AS WELL AS MONOPOLIES IN CERTAIN PRODUCT SEGMENT ACROSS GLOBALLY

cover ) COMPANIES ARE TO LOOKING INCREASE THEIR PRESENCE IN TIER-II AND TIER-III CITIES OF INDIA AND ARE PARTNERING WITH GOVERNMENT AGENCIES AND SERVICE PROVIDERS TO INCREASE THEIR PRESENCE relevance in the market place.” This approach was instrumental in pushing up sales for the company. Philips innovation path Philips Healthcare on the other hand has embodied a strong social media marketing strategy. The company posts variety of contents. As per experts, this strategy contributes to the social sphere that focusses on healthcare and technology. Of particular interest is the brand’s LinkedIn page, Innovations in Health—a vetted community of health professionals who are interested in sharing, developing and fostering innovative solutions in healthcare. By creating an exclusive community of like-minded individuals with a passion for innovation, the brand stands to gain a great deal of insight into its audience’s interests. With this the brand opens itself up to a pool of the knowledge it can use to bring in new innovations—and with 140,969 members currently active on the page, that pool is clearly deep. Mookim further provides examples of multiple strategic options adopted by top medtech giants to tap into opportunities available in the Indian market.

THE CURRENT REGULATORY PRESSURE AND INCREASED GOVERNMENT OVERSIGHT DEMANDS FOR REDESIGNING PRICING POLICY WITHIN ORGANISATIONS

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Product localisation: Companies have leveraged local market insights to develop value products which are relevant to Indian healthcare landscape. ◗ GE Healthcare has introduced various products in India, which are designed to

meet the local requirements e.g. GE introduced MAC i machine which was battery operated, weighs less than 1kg and requires minimal training and analysis cost. ◗ Philips launched compact VISIQ ultrasound system which is a portable device and can scan continuously for 2.5 hours on a single battery charge. Due to compact size and less complexity with VISIQ, Philips tried to address the challenges around accessibility to ultrasound devices in the remote areas. Low cost strategy: To compete in the value-driven Indian environment, companies are adopting strategy focussing on becoming a cost leader. Companies are achieving this either by increasing their efficiency i.e. delivering the same quality of care with lower resources or by increasing their effectiveness i.e. delivering a higher quality of care with same resources. This allows companies to deliver healthcare at lower costs and/or higher margin. ◗ Philips launched Efficia ECG100 which is portable, easy to use device, built to work with app-enabled smartphones and tablets for android. This low cost ECG functions without any additional infrastructure e.g. Wi-Fi. Geographical expansion: Companies are to looking increase their presence in the tier-II and tier-III cities of India. Companies are partnering with government agencies and service providers to increase their presence. In July 2010,

Wipro GE along with Medall Healthcare entered into an agreement with the Andhra Pradesh government to build facilities and install equipment for diagnostics. All of the above mentioned strategies clearly indicate that these medtech giants look at branding in a very different light. Its not just a marketing strategy but a business culture that they intend to expand as their business grows. Sengupta points out that innovation will play a significant role in branding strategies of all top medtech players. Companies will continue to reinvent strategies to have a brand recall on their customer’s mind. Also, factors such as cost and maintainence will also drive buying decisions in the future for which medtech players will need to adhere with. Going forward, Mookim warns medtech players on the times to come. He says that the current Indian government is determined to bring the medical equipment and device manufacturers under regulatory framework. A strong brand recall is therefore needed. Mookim further suggests ways to strengthen their existing brand image. ◗ Companies should build on their brand equity and engage directly with patients so that patients / customers are able to appreciate the value that quality players bring to the table ◗ Companies should adopt Health Technology Assessment (HTA) programme to establish the economical and

clinical effectiveness of their products. ◗ Companies should strive to innovate and develop Indiaspecific solutions thereby improving their acceptance in resource constrained settings.

At the end.... Examining the efforts taken by these medtech giants in building their brands, it certainly reveals a compelling link between strong brands and market performance. As experts put it, powerful brands drive consumer choice, improves business performance and ultimately increases shareholder value. We have already seen this happen when Siemens hived off its healthcare business and came up with a new strategy and their shares surged thereafter. Having said that, I would once again draw your attention towards changing consumer mindset where cost effectiveness of a product becomes a dominant factor for a purchase decision. Are medtech companies addressing this requirement while they build their brand name? Also, the current regulatory pressure and increased government oversight demands for redesigning pricing policy within organisations. Are medtech players willing to consider price control to make medical devices and equipment affordable? Will price control ever be part of their business strategies? Or will medtech players continue to bet on their brands to enjoy price advantage? raelene.kambli@expressindia.com

START UP CORNER CASE STUDY

Goqii: Treading its way to the top

VISHAL GONDAL CEO and Founder, GOQii

GOQii has emerged a leader in the fitness wearables segment by identifying white spaces in the industry and leveraging them effectively. Mansha Gagneja catches up with Vishal Gondal, CEO and Founder, GOQii to find out more about his plans to sustain the growth momentum of his start-up and retain an edge over his counterparts in a very competitive arena

he proverb ‘A stitch in time saves nine’, holds true for the healthcare sector, both literally and figuratively. Due to rising awareness and soaring healthcare costs people are also coming to terms with the fact that indeed prevention is better than cure. They are now welcoming options that can assist them in leading a healthy lifestyle which in turn has opened up new growth avenues for startups in fitness space. With an aim to guide people follow healthy patterns, these startups are coming up with innovative ideas and advanced technologies to facilitate the shift from curative care to preventive care while they also improve accessibility and affordability of healthcare services. One such startup is GOQii, a virtual fitness coaching platform dedicated to enable a shift to a healthier lifestyle. It's vision is to create a one stop solution for all health and lifestyle needs.

Inception Vishal Gondal its CEO and Founder, was a game developer and leading an unhealthy lifestyle during his stint in the gaming industry. In order to improve his health, he resorted to many wearables. Though, these wearables provided him all the vital stats, they failed to guide him to work towards a better lifestyle. Understanding the root cause, he came to a conclusion that lack of human factor is reason for the inefficiency of these wearables. This realisation led him to develop

more integrated platform.They have also tied up with Axis Bank for Near-field communication (NFC) to help consumers make contactless payments.

Funding

a platform that would combine the two elements- monitoring and coaching and GOQii was born. He highlights that the major issue with preventive care is the lack of motivation which give rise to the demand to create an integrated platform for healthcare. Even though people have knowledge about the healthy habits, the larger chunk still fails to follow. To help them embrace a healthy lifestyle constant reminders and coaching is required. He further elaborates that just wearing a heart rate monitor is as useful as a lay man using a stethoscope. If a trained professional cannot analyse the data then it is of no use at all. So, the coaching model in GOQii was introduced and they are constantly working towards introducing more aspects such as diabetes and senior living which can help users attain a healthier lifestyle.

How does GoQii stand out? The coach marketplace model that GOQii offers differentiates it from the other players in the arena. According to International Data Centre, GOQii holds a market share of 16.1 per cent in the wearable segment for the second quarter of CY 2016, pipping China’s Xiaomi. It’s unique selling point of providing access to a personal trainer, creating an ecosystem has helped it become a market leader. Gondal proudly states that this feature will help revolutionise fitness coaching by empowering a coach based anywhere in world to offer services to users irrespective of their location. GOQii incorporates coaching from healthcare professionals, consultations from doctors who can access the user’s data through various technologies like accelerometers, GPS and mobile network etc. In addition, GOQii has partnered with Thyrocare and Max Healthcare to create a

GOQii is backed by many angel investors including Google’s Amit Singhal and Rajan Anandan, Microsoft’s S Somasegar and Vijay Vashee. It raised $13.4 million in Series A funding in 2015 led by global venture capital firm New Enterprise Associates. China’s Cheetah Mobile and Great Wall Club, besides existing early-stage investor DSG Consumer Partners and other angel investors also participated in that round. The funds raised will be used to scale up the company’s operations in new markets such as US and China, expand into different business segments and develop new technologies.

Revenue Model It is subscription based model wherein the consumer subscribes to a plan. Their plan ranges from quarterly to yearly and includes a tracker, a coach, a doctor along with a healthcare locker to store the previous health records. GOQii has offerings to cater to corporate demands also. Creating a platform which can meet multiple healthcare needs has given GOQii a competitive edge over other players in the segment.

Innovations It's latest service offering- GOQii Heart Care focusses on cardiovascular health. The consumers have to share their

health and heart rate data via the new GOQii tracker, the doctor will go through this data and provide specific inputs to the users on how to maintain good cardiac health. Value additions such as these have spurred GOQii’s success story. GOQii also plans to venture into various health segments such as diabetes and senior living. They have already introduced a latest version which caters to the heart patients. They look forward to collaborate with the state governments with the intention to reach out to the masses.

Going forward Gondal’s vision to create a one stop solution for all healthcare and lifestyle needs is a great one. His plans to scale up in the future involves creating a mindset shift from a curative to preventive healthcare on a massive level. But will he be able to make this platform more cost effective and affordable for all? As he seeks to partner with state governments, how will he persuade them to subsidise the subscription costs of wearables which currently comes to ` 4000 per annum? And what innovations will he bring in to keep consumers engaged and motivated? These are the few integral questions GOQii needs to ponder upon before it takes the next leap. The farsightedness to perceive upcoming opportunities in the fitness sector and devising innovations to suit them may act as the key factor for GOQii to sustain its impetus. manshagagneja@gmail.com

EXPRESS HEALTHCARE

April 2017

START UP CORNER

Stasis Labs: A vital venture Stasis Labs, a two-year-old start-up with a solution to monitor vital signs, is enabling more data-driven healthcare organisations to spur more informed clinical decisions and plug gaps in the current healthcare system, finds Lakshmipriya Nair

tasis Labs, a cloudpowered health monitoring company, set up by Dinesh Seemakurty and Michael Maylahn, young entrepreneurs and co-alumni of University of Southern California, has been in the news for all the right reasons. Its vital signs monitoring system has caught the interest of investors and healthcare providers alike. The solution has been installed in leading healthcare facilities like Narayana Healthcare and Cloudnine in Bangalore. The company received $5 million funding last year from a set of investors led by RTP-Healthcare Ventures, the healthcarefocused investment arm of RTP Ventures. Wonder Ventures, Techstars Ventures, were some of the others who participated in this round of funding. TechEmerge’, a World Bank Group initiative to bring together startups and bigger corporations on to a single platform and forge partnerships has also endorsed the technology.

Serving an unmet need So, what makes it so interesting? Its ability to a provide an effective solution to the grave problem of under monitored beds in hospitals through effective use of technology at affordable costs. Reportedly, only 25 per cent hospital beds in India are continuously monitored vis-à-vis 50-70 per cent in matured markets. In fact, the demise of his beloved grandfather due to inadequate monitoring of vital signs led Seemakurty to develop a solution to this serious concern and Stasis Labs was set up. Designed in collaboration with the Cedars-Sinai Medical Centre in Los Angeles, Stasis' vitals monitoring solution, combines custom hardware with a tablet-based patient chart and an online patient portal to monitor six key patient vitals continuously – heart rate, SPO2,

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April 2017

three-lead ECG, respiratory rate, non-invasive BP, and temperature. Integrated with an online dashboard, the system collects and presents data in an easily interpreted format to facilitate clinical decisions based on patient vitals trends.

rics like average length of stay and average revenue per occupied bed.”

In times to come

Improving clinical outcomes Seemakurty elaborates on the solution and states, “Stasis was designed to seamlessly integrate with existing clinical workflows. Clinical staff are often too busy to make large changes into their workflow; thus, Stasis was careful to only change the right elements. The Stasis Monitor automatically records patient’s vital signs without causing unnecessary stress in the patient room through a simple iconic display. The Stasis Tablet saves nurses time by avoiding manual documentation of those patient records. The Stasis Dashboard ensures that clinicians can check up on their patients from anywhere rather than having to call up a nurse to ensure the patient is stable. In a single integrated system, Stasis allows hospitals to go from no monitoring to fully cloud connected monitoring overnight.” Thus, in a country like India that faces a severe scarcity of manpower and beds in the healthcare sector, Stasis' solution for continuous monitoring can reduce the average length in the hospitals for patients and reduce ICU transfers, thereby helping to speeden up the treatment process and boost the quality of healthcare delivery. Seemakurty points out, “The Indian healthcare system is limited by a shortage of skilled doctors and nurses for the quantity of patients. This, paired with the lack of accessibility to technology solutions, results in sub-par care for patients who are at risk. Stasis solves this issue with an internet

With Stasis, hospitals are able treat more patients with less time, allowing them to reduce overall healthcare costs while maintaining profitability connected monitoring system that allows doctors and nurses to treat more patients with less effort and less time. By making India’s existing personnel more efficient without a burden to their workflow, Stasis will have a significant impact on clinical outcomes in the country.” He further informs, “The Stasis Monitoring System is live across multiple hospitals in Bangalore including the reputed Narayana Health and CloudNine Maternity Hospital. We have been able to successfully catch patient deterioration and ensured that patients are able to leave the hospital sooner and with increased clinician confidence.”

Affordability: A key advantage Seemakurty also highlights that it is an affordable solution, a key advantage in a country like India. He says, “From the beginning, the goal of Stasis was to provide patients across the

world with access to continuous monitoring. By manufacturing our product in India, we are able to provide fast and reliable service to our customers. Stasis was also built around the latest technologies, allowing us to keep our costs down and pass on those low costs to our hospital partners. With Stasis, hospitals are able treat more patients with less time, allowing them to reduce overall healthcare costs while maintaining profitability.” He further states, “As hospitals are transforming into more data driven organisations, they require data to be collected in many more aspects than just billing and occupancy. Stasis provides data on the quality of patient care along with business analytics information regarding the usage and occupancy on a significantly more minute level within the facility. We focus not only on providing data to the hospitals, but also providing actionable information about how they can improve their key met-

Seemakurty informs, “We have seen strong adoption for our product with all of our hospital partners and we believe we can become one of the largest players in the health monitoring across India in just a few years. As more patients expect hospitals to provide continuous monitoring, Stasis will become a status quo.” Thus, the founders are very optimistic of growth and feel that in a scenario where hospitals have to become data driven, technology companies like Stasis are going to be pivotal to ensure progress. Hence, it has charted out an ambitious growth strategy for itself. After consolidating its position in Bangalore, the company aims to penetrate into other tier-I metros across India such as Delhi and Mumbai. Within the next three years, the plan is to to have pan-India coverage with strong penetration into tier-II and tier-III markets. “The new funds allow us to continuously improve our solution for our customers rather than focusing on just selling the product as it is today. We are able to receive input from the hundreds of doctors and nurses that touch our product every day and integrate them into updates that get rolled out to every hospital in the Stasis network. By listening to our customers, we can create the best product to solve their problem. By solving their problem, we can easily scale across the country,” outlines Seemakurty. In times to come, as sustainability has emerged as key to any start-up’ s success, it would be interesting to trace Stasis Labs’ strategems to stay relevant and viable as it embarks on a growth trajectory. lakshmipriya.nair@expressindia.com

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CallHealth aims to cover an urban populace of approximately 450 m in India CallHealth is building a new age enterprise with an aim to capture both domestic and the global markets. Dr Sameer Khan, Chief of Business, CallHealth, shares his vision with Mansha Gagneja Give us an overview of the integrated care model offered by CallHealth? CallHealth is pioneering the delivery of personalised services from wellness to prevention to cure and to assisted care. We have curated a 3-Dimensional system to enable seamless access to medical and healthcare services across our platform. This includes Virtual Dimension, where services such as doctor consultation, second opinion, emotional wellness can be availed virtually at your convenience (through phone or video call); Physical dimension, services such as collecting blood samples and tests, nursing care, physiotherapy and delivery of medicines are delivered at the usersâ&#x20AC;&#x2122; doorstep anytime and anywhere. Our physical dimension also extends to our partner network of hospitals, diagnostic and imaging centres, as and when required. The third dimension is the CallHealth Intelligence Platform, where we store and perform data integrationcollected over the course of services provided, ranging from lab reports, diagnostic tests to prescriptions, on a single platform which helps enables seamless accessibility to the information. In recent years, many players have entered the healthcare delivery market. However, most of them offer only listing and appointment services or at best one or two healthcare services that are delivered at home. Many a times, remote consulting of doctors is also limited to Tele/

Video connect without enabling the doctors to physically examine the patient. The integrated care model has been structured keeping in mind that the patient will always remain at the centre of the ecosystem. And, all facilities can be availed by her/ him on one single platform. Your focus is to give personalised healthcare, how do you plan to accommodate population health? In my opinion, to improve the healthcare index of the country, we need to focus on access and affordability to all. This is possible only when all healthcare needs of the country spanning across all age groups and geographies are made available at the customerâ&#x20AC;&#x2122;s convenience without any additional cost. At CallHealth, our focus on personalised healthcare enables us to service our customers, across all life stages and lifecycles; anytime, anywhere. We blend physical and virtual dimensions of healthcare delivery that allow services like medicine delivery, diagnostic sample collection, checking physical vitals on a real-time basis through our partnered team of healthcare professionals including physicians, nurses and field officers. Similarly, those services such as doctor consultation via video / audio or text are made available through our virtual platform. Not only are these services affordable and convenient, but also provide better price offerings across a

gamut of healthcare services through our platform. We also believe in improving the efficacy of healthcare outcomes. By leveraging the third dimension of intelligence, CallHealth has been designed in a manner that captures valuable patient data in a secured and robust manner. With this, we create personalised health records that can be used by patients and their doctors. The data captured through the service utilisation profile helps us understand family history and disease heredities. Diagnostics is further supported by symptomology tools and info aids developed by our medical protocols team. In other words, by capturing and analysing the patient data, we are not only able to spot the interventions required across the three vulnerable groups i.e. women, children and seniors; but are also able to map key disease patterns across geography, age groups and genders, and create special programmes and packages to help prevent them.

We plan to transform the way healthcare is delivered not just in India but also in other countries that have a similar fragmented healthcare delivery system

Brief us about your revenue model? Penetration, active customers and orders (per active customer) are the major drivers of revenue for CallHealth. Despite being at an early stage, we have seen an encouraging response from the market. At present, we have serviced over 1.8 lakh calls (averaging at 2200+ customer calls per day; connecting a customer at every 30 seconds), 1.25+ lakhs orders (servicing a customer order for every 80 seconds) and have over 60000 cus-

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April 2017

START UP CORNER tomers registered on the CH platform (servicing 11000+ customers every month). Over the coming years, we aspire to reach out to a larger customer base. At this point, our prime focus is to create customer delight first and ensure that we deliver the right experiences and tap into a market share of ` 13,000 crores, considering the total healthcare market size of urban India is ` 465,000 crore. Who are your current investors? CallHealth has raised over `200 crores from family and friends. The initial funding came from the promoters and a network of individual investors. We will continue to look at professional sources for funding for our growth initiatives. Our initial investment went towards creation of an integrated technology platform and enterprise architecture and we are now actively investing towards our growth and expansion. Further, we are in the process of setting up prototypes for analytics, diagnosis and prescriptions, developing external facing communication platforms and marketing tools. CallHealth is a new age organisation and this lays the foundation for rapid scaling at an incremental cost. How do you plan to scale up? Over the next few years, CallHealth aims to cover an urban populace of approximately 450 million in India. We started our operation from Hyderabad and spread out to Tier II, III cities in Telangana and Andhra Pradesh using the Hub and Spoke model. Each metro city such as Hyderabad will become a Hub to the Tier II, III cities, in this case - Visakhapatnam, Rajahmundry, Vijayawada, Guntur, Nellore, Kurnool, Warangal and Tirupati; surrounding it. The hub cities where we will introduce our services are Delhi, Bengaluru, Chennai, Mumbai and

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April 2017

Kolkata from where we will develop a spoke model to service the corresponding areas around. CallHealth aims to grow its market in India and across other developing countries. How do you fulfill the affordability factor? We provide a wide range of personalised and integrated services across the healthcare eco-system. This, as we mentioned, is at no additional cost but convenience centric to users. It is not only the tangible items such as costs, but also, more importantly the combination of tangible and intangible elements such as time saved and patient comfort. We believe, there is an untapped opportunity to provide medical and healthcare expertise in the rural set up as urban areas have more available and accessible healthcare solutions. Could you share your vision for CallHealth? Our vision is to be the world’s best fully-integrated Platform for ‘Everything about Health’ that brings better focus to preventive care. We plan to transform the way healthcare is delivered not just in India but also in other countries that have a similar fragmented healthcare delivery system. CallHealth offers a set of customised healthcare solutions, taking care of each one’s life stage and life cycle and focus on ‘getting well to living well’ by concentrating on preventive care. We aim to disrupt traditional healthcare delivery by employing a world-class technology platform to enhance our reach and scope. We will aggressively expand our service portfolio and augment customer experience with future technologies like, artificial intelligence and personalised medicine. It will enable us to leverage data monetisation and opportunities and use the analytics to improve healthcare. manshagagneja@gmail.com

I N T E R V I E W

Aiding and abetting heart health Cardiotrack is a portable, affordable and wellconnected technology, which effectively diagnose the heart of a patient, informs Ashim Roy, CEO, Cardiotrack, in an interaction with Prathiba Raju What is Cardiotrack? How did you evolve with this concept? We wanted to disrupt the healthcare diagnostics solution by reducing the cost of diagnostics and making the healthcare delivery more efficient. For example, in a Primary Healthcare Centre (PHC) in Meerut, we saw the dire need for diagnostic equipment, which were not available and the conventional devices, which were not handled properly due to lack of training. Similarly, in many point of care facilities like private clinics in tier-II and tier-III cities, this is the situation. This led us to come up with Cardiotrack, a multi-parameter, light weight healthcare IoT device, enabled with a mobile health software that helps to screen cardiovascular diseases and hypertension. The device can be used like a regular ECG unit. It has no screen or printer that will give an ECG reading, but the information can be had in a cloud format where it can be viewed and analysed by a physician. The device provides its own waveform analysis and can issue a warning if it detects a critical cardiac condition. The diagnostics solution addresses two key challenges faced by healthcare providers which are: high cost of diagnostic equipment and lack of trained professionals, especially in semi-urban areas. What differentiators do you offer in respect to other products in the segment? How will it help to change the cardio disease burden in the

country? Equipping the point of care clinics is our main focus, as most of the people would be going in for the health checkups, be it PHC, urban health centres or neighbourhood clinics. In many of these facilities, the equipment used are still limited to BP monitor and use of thermometers are not sufficient to track chronic illnesses. The current conventional technology has its own limitation in terms of cost and design. So, we want to bring in more portable, affordable and wellconnected technology. Cardiotrack is not a wellness category device, it has electrocardiogram which can very effectively diagnose the heart and is made for clinic use. This IoT device is a multiple parameter hand-held diagnostic device, including 12lead ECG monitor, pulse oximeter and blood pressure monitor integrated with mobile-based practice management solution and cloud backend. With low cost and added advantage of portability and networkconnectivity, the machine can be accessed at primary-care level and a scan result of the patient can be delivered instantaneously to a specialist on real time anywhere in the world. This approach leads to efficient use of specialists’ time, enables early diagnosis of patients suffering from heart diseases and thus reduces the need of expensive invasive intervention. On the sensor side, we will be adding more devices to the platform; on the software side also, we are

adding more features. Apart from it, we are coming out with a patient app which will help the patients to have EMR, and share the scan report to the physicians. If you look at bigger companies like GE, BPL and other large medical equipment vendors, their focus has always been ICUs, cardiac centre and big hospitals. They have not focussed on the concept of preventive healthcare and are not in touch with the PHCs and general physicians practicing in a remote place. Their equipment can work in an airconditioned environment and they have to be treated carefully. Our equipment, even if it falls down from four feet, nothing happens to it. With the AI, we can instantaneously send a patient’s report from a remote village to a cardiologist sitting in a super-speciality hospital in the city. We bridge the wide gap of doctor and patient ratio. What is your global market presence? We are looking out for technology partners globally, the Artificial Intelligence (AI)-based solutions will bring a tremendous change to affordability and accessibility of quality heart health diagnosis and intervention. We have our presence in Myanmar, Indonesia, Mexico and US. Recently, we have signed a MoU with Cardiologs, a French AI company, which specialises in ECG signal. It delivers best-in-class predictive diagnosis for cardiovascular diseases. Now, we are also working

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with private health clinics in tier-II and tier-III cities and are willing to collaborate with government PHCs. Since our inception in September 2015, nearly 17,000 patient scans have been conducted using over 200 devices. So, we are willing to present the data for the government on the cardiovascular issue. For example, in the age group of 40 years and above, every third person has a cardiovascular issue. WHO data informs that 60 million people that is five per cent have cardio vascular disease in the country, but I would say many of them are not diagnosed. With the data from our scan results, I would say that atleast 13 per cent of them have an irregular ECG and it is much higher than the WHO data. How does Cardiotrack help maintain healthy lifestyle among the patients? Procedures like by-pass surgery, stents dealing with cardiology are costly and here we offer a simple hand-held device, which enables an individual to keep track of his/her baseline study of heart health. The intervention helps to change lifestyle and food habits of a person. We have our presence in tier-I and tier-II cities of Karnataka and Gujarat and our product is popular within network of doctors including general physicians and specialists. In remote places across Karnataka, general physicians were happy to

use Cardiotrack as it helped them scan patients and refer them to cardiologists closer to their location.

Procedures like by-pass surgery, stents dealing with cardiology are costly and here we offer a simple hand-held device, which enables an individual to keep track of his/her baseline study of heart health.We have our presence in tier-I and tier-II cities of Karnataka and Gujarat and our product is popular within network of doctors including general physicians and specialists

What is the cost of the device ? We give the device on subscription to general physicians, cardiologists and the cost depends on the duration of the engagement with the doctors, the location and the region. The time frame of the subscription is two to three years. As of now, our clients are mostly from Gujarat and Karnataka and subscription varies from `2000 to `3000 per month. We also have subscription from Healthcare at Home from Noida and another healthcare facility Gurgaon. We are scaling up our productsâ&#x20AC;&#x2122; presence by continuous enhancement of the product and hope that the device cost will come down as the volume of users go up. How important is the usersâ&#x20AC;&#x2122; experience in the eHealth platform. Where does Cardiotrack device fit in? Our product is patient-centric with more information. In a data format, patients are aware of their condition. Also, we would soon be creating a patient-centric app, which will educate the patients to understand about the health challenges. How much market share did you gain in the past two years?

A group of paramedics used Cardiotrack for the crew in a Caribbean ship and diagnosed them for months. The data of the crew was transmitted to a group of doctors in Alaska, so that they can analyse the data and provide assistance to the crew in midst of the sea. Though located in the middle of the ocean, the connectivity was not an issue, as we have designed our product which combat the issue of poor Internet connectivity and helped the crew to get assistance. The training procedure was simple and three paramedics in the ship were trained via Whatsapp for a week and they were able to use the device. Even in India, Internet connectivity in tier-II and tier-III cities and remote villages are not robust, however, IoT devices are developed in such a way that they can overcome these hindrances. What is the scope of startups future in the healthcare sector? Importing source material, and procuring things out of our country has been a challenge for start-ups. It has not been simpler and we hope that over a period of time, there will be a change. In two to three years, we think importing components will be much more simple. With programmes like Digital India, Make in India, we hope manufacturing and testing capabilities within the country will improve significantly. prathiba.raju@expressindia.com

EXPRESS HEALTHCARE

April 2017

POLICY WATCH

National Health Policy 2017 Industry gives a

thumbs

up T

he Union Cabinet has approved the National Health Policy. Health Minister JP Nadda made a suo motu statement in the Parliament to make details of the new policy public. It makes health an entitlement but not a fundamental right as the draft policy had envisaged. It stops short of a legislative backing for right to health. A Right to Health legislation in the nature of right to education would need a constitutional amendment to bring health in the concurrent list from where it currently is on the state list.

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April 2017

In the current policy, health services are merely “assured”. It, however, talks of imposing a health cess much like the education cess that was imposed after RTE was legislated. It talks of increasing public expenditure on health to 2.5 per cent of GDP — as demanded by experts for a long time. The draft also addressed the issues of universal health coverage, reducing maternal and infant mortality rate, as well as making drugs and diagnostics available free at least in the public healthcare system of the country. It suggests that the Centre must

amend laws to align them with the current healthcare scenario. The policy has also assigned specific quantitative targets aimed at reduction of disease prevalence/incidence under three broad components viz. (a) health status and programme impact, (b) health system performance and (c) health systems strengthening, aligned to the policy objectives. Industry stalwarts share their opinion on National Health Policy

DR PRATHAP C REDDY

SURESH RAMU CEO, Cytecare Hospital

Founder Chairman, Apollo Hospitals Group

The proposition to train ASHAworkers for oral,breast Avisionarystep to assure qualityof life and health services and cervical cancer treatment is a great initiative

e congratulate the Union Cabinet for approving the National Health Policy. This is a visionary step towards assuring quality of life and quality of health services to every citizen of India. Strengthening the primary care system, health education, preventive interventions along with ease of access to quality health facilities will help India tide over the communicable and non-communicable disease burden. Government’s focussed initiatives have led to significant progress in containing communicable dis-

eases, reducing infant and maternal mortality, and tremendous progress across vital health parameters. However, non-communicable diseases (NCDs) need a concerted and all-encompassing effort and the government has once again taken a laudable step to expand preventive and curative services in NCDs. The Government’s inclusion to target NCDs at the primary care level and to partner with like-minded institutions across the health ecosystem will act as a force multiplier to fight this scourge.

he revision in the National Health Policy is a landmark event as this has been revised in India after 14 years. The policy highlights the increased spend in healthcare which will go up to 2.5 per cent of GDP, hopefully in the next five to 10 years. As a cancer care hospital, the policies introduced for non-communicable diseases (NCDs) are of prime importance to us. According to the World Health Organization, an Indian today has over twice the odds of dying of a noncommunicable disease than a communicable disease. As the cost involved in care and equipment of NCDs is extremely high, hence increasing spend in communicable diseases will help reach out to a large populations in India. The policy also recognises that there are certain types of cancers which can be addressed early through screenings. The proposition to train ASHA workers

DR RAJIV I MODI

HIMANSHU BAID

Chairman,CII National Committee on Pharma,& CMD,Cadila Pharmaceuticals

Chairman,CII Medical Technology Division & MD,PolyMedicure

Make in India focuswould strengthen manufacturing capabilities of medical devices in India

ational Health Policy 2017 would likely provide the long awaited thrust to Indian healthcare sector and its focus on Make in India would help in strengthening manufacturing capabilities of medical devices in India. This will help achieve the desired balance between availability of innovative, quality and affordable medical technologies and will make India a global hub for medical value travel.

across the country for oral, breast and cervical cancer treatment is a great initiative as it will help early detection and reduce mortality rate even in the lower strata of the society. As a lot of patients rely on treatment from private institutions, managing costs for generic drugs and medical devices will be hugely beneficial. Along with this, we need to ensure that the cost of diagnostics and medical equipment is also controlled. The ‘Make in India’ thrust in the healthcare segment will help in initiating technology development, clinical trials, research and innovation so that India can have access to advanced medical care at the same time as the western countries. After heart and lung disease, cancer is the third largest cause of death in the country and I hope that the health policy would have a separate section to address the issues in cancer care.

National Health Policydelves upon all critical aspects governing healthcare delivery

ational Health Policy, announced by Health Minister Jagat Prakash Nadda, is a forward looking policy which would revive India's healthcare system by ensuring that Indians have access to affordable and quality healthcare. This would essentially improvise the overall healthcare ecosystem in India, and

help India move notches higher in SDGs. The policy delves upon all the critical aspects governing the healthcare delivery mode. Besides, integration of this policy with 'Make in India' initiative especially with regard to drug discovery for meeting growing healthcare needs, could prove to be a boon for our country.

THE ‘MAKE IN INDIA’THRUST IN THE HEALTHCARE SEGMENTWILL HELP IN INITIATING TECHNOLOGY DEVELOPMENT, CLINICALTRIALS, RESEARCH AND INNOVATION EXPRESS HEALTHCARE

April 2017

POLICY WATCH

DR NARESH TREHAN

DR BS AJAIKUMAR

Chairman,CII National Healthcare Council and CMD, Medanta – the Medicity

Chairman and CEO, Healthcare Global Enterprises

National Health Policy2017 has its heart in the right place

National Health Policy2017 appears to be verydetailed

DR BAGASRAWALA

Policyhas made inroads to better health and wellness of citizens

II welcomes the National Health Policy which will prove to be the game changer in access to healthcare for all. With shift to wellness and prevention from sick care, and the increase in public health expenditure to 2.5 per cent of the GDP, the National Health Policy 2017 has its heart in the right place. CII welcomes the National Health Policy, it shows the commitment of the government to put health of its citizens first. Specific focus on reducing specific disease burden, improving their treatment levels provides a direction. The game changer will be the integration of AYUSH by way of promotion of cross referrals, co-location and integration in practices. The focus on ‘Make in India’ on devices and drugs was expected and along with it we welcome the emphasis on improving the regulatory environment and ease of doing business. The private sector is already partnering the government in this journey and has submitted draft frameworks for PPPs in several areas viz medical education, NCDs, teaching hospitals etc. The CII will offer its assistance through the Healthcare Council which has membership from all segments of the healthcare industry – medical device equipment manufacturers, pharma and biotech, health insurance, healthcare providers and Ayurveda groups.

DR SHIKHA SHARMA

JYOTSNA PATTABIRAMAN

Founder,Dr Shikha’s NutriHealth

Founder and CEO,GrowFit

It is a welcome step which will impact the economypositively

his move by the Government to increase spend on healthcare is a welcome step which will positively impact the economy in the coming years. The burden of disease shall go down in the future if adequate steps are taken by the government and private players towards better accessibility to healthcare which also includes preventive healthcare. However, policies need to be designed keeping in mind that the whole of India cannot be painted with the same brush. In this country, people are plagued with problems related to under-nutrition as well as overnutrition and both have severe health complications. The government should also consider remote healthcare incentivisation. Delivering remote healthcare needs to be more cost effective as it is of utmost importance for a large nation like India.

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April 2017

he National Health Policy 2017 appears to be very detailed and certainly looks to address lifestyle diseases, maternal and infant mortality and certain communicable diseases. However, while the grand plan is good, the methodology to implement these measures and achieve the objectives becomes equally important. As the largest cancer care provider in the country that has played a role in creating a paradigm shift in cancer care over the last 10 years, it is important for us to know and understand how we can work with the nation to implement such preventive measures. For example, how can we reduce the increasing obesity in the middle and upper class; in rural areas, how do we improve hygiene to wipe out cervical cancer; and how can we decrease the incidence of smoking amongst the youth? Could we perhaps implement tobacco taxation to tackle such chronic diseases and use this funding to encourage private enterprise to address issues concerning these diseases? I would like to see the government forming a committee by involving private leaders in healthcare, particularly those in cancer and cardiac care, who understand the ground level problems in the country and whose expertise will help us address the nation’s health needs in a more effective manner.

Policywill strengthen public health system byreducing disease burden

Associate Director - Medical Affairs,Saifee Hospital

ational Health Policy focusses on various aspects such as preventive healthcare, pre-screening, population stabilisation and targeting NCDs to lowering costs of medical services and medical education. The policy recognises the need to halt and reverse the growing incidence of chronic diseases. The current scenario demands us to improve the average health and wellness of the country's population, and the policy has made inroads on that with starting to have provisions for mental healthcare. We should promote 'Make in India' and 'Treat in India' which will give the technology side of the healthcare sector a boost.

he approval of the National Health Policy, 2017 by the Cabinet is a favourable step towards promoting quality healthcare services in the country. Given that most of the existing health policies in our country are directed towards the treatment and management of diseases, this is a welcome shift wherein the primary focus would be on wellness as opposed to sick- care, with thrust on prevention and health promotion. It will help in strengthening the public health system by reducing the burden of disease and eventually eradicating these. The provision to raise health spends to 2.5 per cent of GDP is especially designed to implement this in the remotest part of the country, thus entailing accessibility to healthcare for all. Mental health has been given due importance as the policy advocates private sector collaboration for achieving national goals which includes capacity building, skill development programmes, awareness generation, developing sustainable networks and mental health services. Also, digital health is set to get a major boost with the proposed establishment of National Digital Health Authority (NDHA). The Government's efforts towards delivering efficient healthcare are highly appreciable.

POLICY WATCH

Progress report on child health targets The NFHS-4 health report card of 13 states and two Union Territories reveals improvement in child health but also indicates the need for more measures for further development. A compilation of some interesting findings from the report ALIGNING PROPER mother and child care has been a long-term objective for India and the first phase of NFHS 4 survey showcases that the country is improving in child health and nutrition. But the progress showcased amongst the 13 states and two Union Territories is uneven as they are fairly rapid in some fields, and slow in others. The large-scale, multiround survey’s first phase was conducted in a representative sample of households in Andhra Pradesh, Bihar, Goa, Haryana, Karnataka, Madhya Pradesh, Meghalaya, Sikkim, Tamil Nadu, Telangana, Tripura, Uttarakhand, West Bengal and two Union Territories of Andaman and Nicobar Islands as well as Puducherry.

IMR: On a gradual decline The survey also noted a reduction in the infant mortality rate (IMR), by 16 points over the last 10 years. The ratio declined from 54 deaths per 1000 live births in 2005-06 to 41 deaths per live births in 2015-16. The IMR has dropped by more than 20 percentage points in Tripura, West Bengal, Jharkhand, Arunachal Pradesh, Rajasthan and Odisha. The under-five mortality rate has also decreased from 74 in the last NFHS (2005-06) to 50 in the current one – revealing a 24-point reduction in deaths. At 99.9 per cent in both urban and rural areas, Kerala has the highest institutional births in the country. Tamil Nadu is a close second with 99.2 per cent institutional births in urban areas and 98.7 per cent in rural areas. But both states do not fare greatly when it comes to initiating

breastfeeding within one hour of birth. At 64 per cent, Kerala is below Goa’s average of 73 per cent. Similarly, Maharashtra with 90 per cent institutional deliveries has 57.5 per cent for early initiation of breastfeeding compared to Tamil Nadu’s nearly 55 per cent. The overall institutional births conducted at hospitals and health institutions increased by 40 percentage points, from 38.7 per cent during the last NFHS to 78.9 per cent this survey. The Empowered Action Group (Bihar, Jharkhand, Uttar Pradesh, Uttarakhand, Rajasthan, Madhya Pradesh, Chhattisgarh and Odisha) and Assam, saw an increase of more than 40 percentage points. However, more babies have been delivered through caesarian than through normal delivery, indicating a push, especially by private players, towards C-sections. The nationwide average on the number of caesarians conducted has increased from 8.5 per cent of all deliveries in NHFS 3 to 17.2 per cent in NFHS 4. Although the survey indicates a slight improvement, the country still needs to take large strides when it comes to IMR which stands at 41 currently, while comparatively poorer countries like Bangladesh ranks 31 and Nepal stands at 29 while African countries like Rwanda and Botswana is at 31 and 35 respectively. India's underfive mortality (50) is substantially worse than its poorer neighbours, such as Nepal (36) and Bangladesh (38) and Bhutan (33).

NFHS-4 SURVEY

THE NATIONWIDE AVERAGE ON THE NUMBER OFCAESARIANS CONDUCTED HAS WITNESSED AN INCREASE FROM 8.5 PER CENT OFALL DELIVERIES IN NHFS 3 TO 17.2 PER CENT IN NFHS 4 NFHS-4 SURVEY

NFHS-4 SURVEY

REDUCTION IN THE INFANT MORTALITY RATE (IMR), BY 16 POINTS OVER THE LAST 10 YEARS

THE RATIO DECLINED FROM 54 DEATHS PER 1000 LIVE BIRTHS IN 2005-06 TO 41 DEATHS PER LIVE BIRTHS IN 2015-16

India needs to take large strides when it comes to IMR which stands at 41 currently

Though it has reduced infant deaths by 48 per cent over 23 years, from 79 in 199293 to 41 in 2015-16, India is far from the 2015 millennium development goal -- set in consultation with the United Nations -- of an IMR of 27.

Rise in immunisation As for immunisation, 62 per cent of Indian children between the ages of 12 and 23 months were fully immunised --for BCG, measles, and three doses each for polio and diphtheria and tetanus -- up from 43.5 per cent in 2005-06. At least six out of 10 children have received full immunisation in 12 of the 15 states / Union Territories. In Goa, West Bengal, Sikkim, and Puducherry more than four-fifths of the children have been fully immunised. Since the last round of NFHS, the coverage of full immunisation among children has increased substantially in the States of Bihar, Madhya Pradesh, Goa, Sikkim, West Bengal and Meghalaya. When it comes to full immunisation coverage among children aged between 12-23 months, it varies widely among states. For example, Chhattisgarh had the highest IMR (54), and Madhya Pradesh the highest under-five mortality (65) in the country, while Kerala's IMR (6) and under-five mortality (7) rates were the lowest. Mizoram was the only state to report an increase in infant mortality- from 34 deaths per 1,000 live births in 2005-06 to 40 in 2015-16. As many as 90.7 per cent of children were immunised in public health facilities, compared with 82 per cent in 2005-06; children immunised in private facilities dropped

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POLICY WATCH

Another highlight of the survey was that the overall sex ratio at birth was marginally improved slightly from 914 females to 1000 males in 2005-06, to 919 in 2015-16

Source: MoHF&W from 10.5 per cent in 2005-06 to 7.2 per cent.

Improving health statistics The proportion of children under the age of five who reported suffering from diar-

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rhoea in the two weeks preceding the survey was nearly constant over the decade with 9.2 per cent in 2015-16 compared to nine per cent in 200506. However, the proportion of children with diarrhoea who received the recommended

treatment of oral rehydration salts (50.6 percent) doubled compared to a decade ago (26 per cent). Increased awareness about common childhood diseases and recommended treatment among parents, dipped diarrhoea-affected children from (67.9 per cent) compared to 2005-06 (61.3 per cent) . There was a 10 percentage point decrease in stunted children low height-for-age below age five: From 48 per cent in 2005-06 to 38.4 per cent in

2015-16. Also a seven-percentage-point decrease was seen in children under five who were underweight (low weight-for-age), from 42.5 percent in 2005-06 to 35.7 per cent in 2015-16. Fewer children between age of 59 months to six years suffered from anaemia in 2015-16, (58.4 per cent) compared to 69.4 percent in 200506. However, the proportion of children under five who were wasted -- low weight-for-height -- increased from 19.8 per cent

to 21 per cent. The number of severely wasted children increased from 6.4 per cent to 7.5 per cent. Another highlight of the survey was that the overall sex ratio at birth was marginally improved slightly from 914 females to 1000 males in 2005-06, to 919 in 2015-16. Chhattisgarh had improved from the national average ratio of 977, Haryana marked the highest improvement from 762 to 836. This was again led by Kerala which has the highest sex ratio (1047). While the overall contraception usage has decreased by two percentage points from NFHS-3 to NFHS-4, pills and condom usage have shown increasing trend. There is, however, a vast gender disparity in sterilisation with the national average standing at 0.3 per cent for males and 36 per cent for females. (Compiled by Prathiba Raju)

OPINION INSIGHT

Paramedical professionals: The driving force of anyhealthcare institute

DR CLIVE FERNANDES Group Clinical Director, Wockhardt Group Hospitals Consultant

Dr Clive Fernandes, Group Clinical Director, Wockhardt Group Hospitals Consultant, highlights that healthcare delivery has become more complex with the emphasis on multidisciplinary teams and holistic care

f I were to ask you which organ is more important in the body, the heart or the brain it would be very unfair for me to expect any one answer as they both have vital roles to play in the body for effective functioning. In healthcare too we face a similar paradox. Healthcare has always been synonymous with the doctor and rightly so as they are the key drivers but there are many other professionals whose role is equally important if the desired healthcare outcomes are to be achieved. Healthcare delivery today has become more complex with the emphasis on multidisciplinary teams and holistic care falling into place and for all the right reasons. However, before I begin, I would like to reiterate that at no point I am saying that the physician’s role is not important, they are the drivers of healthcare but they are supported by many paramedical departments which contribute in achieving the desired outcomes of care. Though I would like to share in detail about each department, I am going to highlight just a few departments and they are not necessarily in the order of importance. Nursing – This quote describes nursing perfectly, “Save one life and you are a hero, save hundred lives and you are a nurse.” For a patient the most reassuring sight is to see a healthcare provider available 24*7 and this provider is none other than the nurse who takes care of the patient’s needs while in the hospital. The term 'Nurse’ is synonymous with compassion – many

expect less but get much more. Nursing professionals face challenges daily, from staffing and job responsibilities to the many tasks that they are accountable for. Depending on which unit/ward they are based in, there are guidelines outlining the number of patients a nurse should take care of but these ratios are more for reference rather than statutory. Also, there are no defined JD’s for a nurse hence the nurse patient ratio and the workload depends on the type of institution the nurse is working in. A nurse should ideally spend a significant amount of time at the patient’s bedside but again depending on the type of institution, a nurse spends nearly 30 to 40 per cent of time in documentation of records, ordering labs, indenting medications, patient handovers, arranging the records and coordinating the patient admission and discharge leaving very little time for actual patient care. If something happens to the patient, the first person to be blamed or held responsible is the nurse just by virtue of them being there 24*7. How often have nurses been commended when patients go home completely fit after a debilitating illness or a complex surgery? Are the many men and women in the nursing profession getting the recognition and remuneration that they so rightly deserve? Pharmacy associates and the Clinical Pharmacist- This is another very important department as nearly every patient admitted and more than 50 to 60 percent of out-patients need medications – enter the

Healthcare is evolving and the concept of multi-discipl inary teamwork is being recogn ised. It’s time we recognise the importance of paramedical associates in healthcare pharmacy. Many mistakenly think that a pharmacist’s role is limited to dispensing what the physician has prescribed. The pharmacist’s role goes way beyond that – managing all statutory regulations, ensuring supply chain integrity from the manufacturer and distributor to the consumer. There are medications that need the cold chain to be maintained to be effective. Then there are narcotics that statutorily need specific storage and prescribing compliances, purchasing quality generic medications that are as effective and much cheaper for the patients. These are just a few key functions that this department silently performs. The IOM report in 1998 ‘To err is human’ and the subsequent awareness towards medication errors has created a new category of para medical professionals in the last decade

the ‘Clinical Pharmacist’ whose main role is to ensure that the patient receives the right medication in the right dose, route and frequency and there are no drug interactions when multiple drugs are prescribed by multiple physicians. These paramedical professionals have become a part of the team and join the doctor on patient rounds advising on drug doses, interactions and dilutions that could be missed at times. Ward rounds by the clinical pharmacists, on the spot checks and pill counts have helped in identifying and preventing many medication errors. The healthcare industry has started appreciating the contribution of the pharmacy and clinical pharmacists in making healthcare delivery - especially medication management more safe and we need to do the same at our institutions. Dieticians – When it comes to the patient’s diet, every healthcare administrator knows that no matter the quality of food provided, the patient feedback form at discharge always says that the food was tasteless and the quality of food needs improvement. No prizes for guessing why! A dietician’s role is very important - apart from medication, diet is of paramount importance, as we all understand the nuances of providing a diabetic and hypertensive patient with a normal diet. Calculating dietary requirements in terms of calories and BMI i.e. body mass index may not be the first thing we normally do at home but we all understand the need to do so in the context of a hospitalised patient. In addition, the dietician needs to ensure that no food

drug interaction occurs. There are certain foods to be avoided if a patient is on certain medications and the dietician physician combination would be able to guide the patient. Physiotherapists - Not all aches and pains require the patient to be put under the surgeon’s knife and then there are times after surgery a proper rehabilitation programme with exercises and muscle strengthening over a period of time holds the key to achieving the desired outcomes. A physiotherapist’s role is to ensure exactly this and like the other paramedical associates mentioned, they go about doing their job silently but hold the key to a successful outcome. Many times surgical interventions have been avoided due to physiotherapy and that itself is a testimony of the importance this group plays in healthcare. Technicians- This is another very important group of paramedical professionals present in the OT, Cath lab, dialysis department, radiology and lab services who silently go about doing their bit to ensure that our patients have excellent clinical outcomes. Healthcare is evolving and the concept of multidisciplinary teamwork is being recognised. Just like most sports teams have a captain, in the world of medicine the physician is the captain but each member of the team has their role defined. No role is small or big and each is equally important. It’s time we recognise the importance of paramedical associates in healthcare and appreciate and applaud their efforts.

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OPINION INSIGHT

On advocacyof safe injection and infection prevention

RAJIV NATH Joint MD, Hindustan Syringes & Medical Devices

Rajiv Nath, Joint MD, Hindustan Syringes & Medical Devices and Trustee Safepoint India, talks about how right strategies can prevent the spread of bugs in healthcare facilities ANTIMICROBIAL RESISTANCE (AMR) control in most countries like India is just being understood and limited to antibiotics resistance stemming from unrestricted access to antibiotics, and it has not being realised that all encompassing holistic infection prevention control strategies are required to fight this war with bugs ! Not just stronger and newer drugs ! Other than the factor of indiscriminatory self-prescribed antibiotics leading to resistance, the biggest cesspool to breed these bugs are so called healthcare facilities which inadvertently do the opposite. Patients get admitted in hospitals to seek treatment and cure, not realising that they may be exposing themselves to unwanted life threatening infections in hospitals, especially in the developing world. Many of these hospitals can be downright dirty or even if superficially clean may be acting as amplifiers to microbes and blood / fluid borne or touchbased infections. You have unsafe injection practices ranging from inadvertently double dipping a syringe reused on an operated patient into a multi-dose vial and then transferring infection into another patient, even on using a new syringe for this other patient or the bad practice of blatant reuse of syringes on multiple patients and other single use devices, to other malpractices of unsafe reuse of IV sets on same patient on change of his IV Catheter, reuse of stainless instruments e.g. vaginal speculum, dental forceps, without proper steam sterilisation etc. Then you need to be cautious about ventilators and dialysis machines where these bugs hide and multiply. All these un-

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safe practices are common and unfortunately overlooked in the developing world hospitals (at times too in developed world) and these healthcare facilities become infection amplifiers. You admit a patient for a simple hernia operation for onetwo days and he catches secondary infections in post operative care, then you pump him with antibiotic injections to which he may be immune and he gets further exposed to one the 12 dirty life threatening bugs because of poor and unsafe injection or infusion practice and then it's a downhill battle with his already weakened immune system. Now imagine a patient with HIV or with drug resistant TB or Hepatitis gets admitted in this hospital which is already contaminated with these dirty bugs and you have recipe for a cocktail of infections - good luck to antibiotics and doctors trying to fight these ever increasing hordes of stronger bugs. So how do you win this war? Simple â&#x20AC;&#x201D; first step is break the cycle of infections and cross infections, isolate and overpower. We have the Infection Prevention and Control - IPC tools but these are not headline grabbers for politicians. Bad news are. Politicians focus on headline grabbing bad news but we need champions to do serious sincere work on implementation of intervention strategies for healthcare system strengthening and this is actually in practice simple stuff and common sense and what's common is not fashionable, so announcement to enforce restrictions to freely access medications and antibiotics without doctors' prescriptions are common but have you heard of announcements for deploying auto disable syringes in curative

We need coherent policies on injection safety and implementation on IPC strategies to prevent infection, isolate them, weaken the hordes of bugs services in hospitals to help break cycles of cross infections? Or stated policy that every time an IV Cannulas is changed the IV set needs to be changed? (The wet nozzle of a disengaged IV set touches the contaminated bed, dirty IV stand, the supposedly clean nurses uniform - becomes a bug carrier, and when re-attached to a IV Cannula now you are infusing the innocent hapless patient with bugs swimming on the wet nozzle of the IV Set). Are you aware that an epidemic of HIV spread from reuse of a syringe used on only one patient in Cambodia as recent as 2014? The entire patients' extended family and a large number of villagers got infected by a quack . It is a very rare occasion when the US CDC is called to do an investigation of an HIV outbreak. This was officially made public in 2015 and even pub-

lished in the MMWR. A few years before that, you had in the US itself, a developed country the infamous Nevada outbreak of Hepatitis C, which was similarly from reuse of syringes with multi dose vials. Antiretroviral resistance in HIV is building up in all countries, unsafe health care can spread drug resistant HIV from patient to patient. So there are more and more new cases of HIV infection who already have drug resistance. So what do we need ? Not just policy and access to free curative treatment like free antiretrovirals that gets politicians brownie points for taking care of the hapless infected patients but we need allocated budgets, we need coherent policies on injection safety and implementation on IPC strategies to prevent infection, isolate them, weaken the hordes of bugs if we are talking about tackling AMR. We need periodic monitoring of these intervention strategies and document improvements / achievements. In management of problems usually one follows the Pareto 80:20 rule, focus on top 20 factors to achieve 80 per cent success- well in infection prevention you can't have this luxury of ignoring any factor so all interventions need to be applied simultaneously- and let's not talk about prices when it comes to war on bugs - e.g. how much more we have to pay to use an auto disable syringes? One cent ! That's too much - hmmm ... and the daily cost of extra day stay in hospital and of antibiotics and daily window to infection to bugs surrounding the patient and feast on him? WHO estimates that over 6-8 billion injection are unsafely

given every year that means daily over 20 million hapless patient are being injected not with life saving antibiotics or medicines but with a cocktail of bugs! WHO itself stated that for every $1 invested in injection safety the macro healthcare cost savings are $14 and that compares favourably with every $1 spent on immunisation which saves $16! With such attractive RoI it should be a no brainer but then we have disbelievers and instead of just going ahead with implementation of WHO DG's advisory to all developing countries to switch to SMART Syringes that are auto disabling we keep on delaying this by conducting further studies to validate this and wait for prices to come down to save a quarter of a cent while daily 20 million patients continue to get infected with HIV or Hepatitis or Drug Resistant TB or anyone of the 12 Super Bugs and we ignore the millions of dollars spent on treatment of these hapless patients. Regions with poor economic progress who can't afford organised qualified private healthcare and dependent on public healthcare or ill equipped quacks, the infection related problem is most acute. So clearly we need to focus on strengthening rural and urban public healthcare systems and institutions so that there is no need for villagers and slum dwellers to access quacks. NGOs and public awareness can ensure that quacks do follow better IPC and do not needlessly prescribe antibiotics. How many people are aware of WHO's guidance not to inject antibiotics post surgery unless there's a known infection?

OPINION

INSIGHT

Cardiac sector in India

DR. K M CHERIAN Chairman and CEO, Frontier Lifeline Hospital, Chennai

Dr K M Cherian, Chairman and CEO, Frontier Lifeline Hospital, Chennai, talks about the current sector of the cardiac sector, the challenges invloved and the way ahead

ndia has seen a dramatic change in disease burden over the last two to three decades, changing from communicable disease to non-communicable disease (NCD), with cardiovascular disease (CVD) causing the largest cause of mortality, accounting for half of all deaths from NCDs. CVD' is the fastest growing illness in India at more than nine per cent annually. The incidence of CVDs in the age group of 25 to 69 is close to 25 per cent. The age standardised mortality in 2005 for developing countries like India was 300-450 per 100,000 whereas it was 100200 per 100,000 for developed nations like the US and Japan. India has progressed well in treating CVDs, with major milestones such as legalisation of brain death and transplants taking place as early as 1994. India is also one of the countries where cardiac stem cell research is progressing at a fast pace, and our country has one of the largest series of cardiac stem cell studies in the world. Work on artificial hearts, synthetic biology, biomaterials, clustered regularly interspaced short palindromic repeats (CRISPR) technology applications for cardiac care etc are progressing in our country, though some of these are at early stages. While we are technologically advanced and at par with developed nations, affordability and reaching out to wider patient population remains a big challenge. Growth in Indiaâ&#x20AC;&#x2122;s younger working population is also posing challenges we have not seen before. High stress levels, unhealthy and sedentary lifestyle, increased intake of processed foods, increased to-

bacco / alcohol use etc are giving rise to other co-morbidities like diabetes, hypertension and dyslipidemia / obesity which in turn accelerated the growth of CVDs in India and incidence of premature deaths. The major challenges being faced in cardiac care in India are low availability of quality The future of cardiac care should have a holistic outlook treatment. There is limited availability of preventative and curative cardiac care facility across India. There is also shortage of trained doctors, nurses, technicians and specialists. In addition, with a majority of the hospitals with cardiac facilities being located in urban areas and major cities, the rest of the country is faced with no access to quality care when it comes to CVD. Incidence of Congenital

With a majority of the hospitals with cardiac facilities being located in urban areas and major cities, the rest of the country is faced with no access to quality care when it comes to CVD Heart Diseases (CHD) is another major threat that the country is facing. India has a high number of children with CHD and many of the parents find it difficult to treat these children due to the affordability factors mentioned above. Many acquired valvar, myocardial and vascular diseases need treatment in childhood and adolescence. Although a few paediatric cardiology cen-

tres have developed in India, the requirement of paediatric cardiac care and paediatric cardiac specialists is far in excess of what is available. There are no guidelines at present in India for uniform care or training in paediatric cardiology and surgery. As a result, a large number of patients with congenital heart disease remain untreated or partially treated. While many of them

die prematurely, considerable numbers survive into adulthood with major physical limitations and causing serious complications from the perspective of health, economics and ultimate productivity of these individuals. Current knowledge and experience from established centers clearly show that most congenital heart diseases are correctable, and that early repair is the best way to achieve good long-term outcome. The challenge in India therefore, is to detect and correct all heart diseases in children before irreversible damage has occurred. Low penetration of health insurance and lack of insurance coverage for preventive, diagnostic and outpatient care, along with affordability is posing a real threat. Affordability remains a key challenge, especially India being a country depending upon import for more than 80 per cent of our device and patented drug requirements. Lack of infrastructure for research and lack of understanding from banks, financial institutions and the investment community remains other key challenges. To address these challenges, public private partnerships (PPP) need to be strengthened in diagnostics and healthcare delivery systems. Product, process and business model innovation are already happening, but in piecemeal, and needs a more government policy led approach. Another major challenge yet to be addressed is promoting indigenous healthcare research and providing adequate financial infrastructure for it. For example, a valve that is im-

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OPINION

ported at about 25 lakhs, if manufactured indigenously, can be made available to patients at about 3 lakhs. While many patients can afford a 3 lakh valve, how many can afford a 25 lakh valve remains a big question. But the problem at hand is who will invest time and money for this and wait for five to seven years. The long gestation period involved in developing a drug or device has to be understood by the banking and financial institutions as well as the investment community, if our country has to progress on this and make healthcare affordable to all. Research is a business that can pay back handsome returns to the investor. The advantage is low capital outlay (provided the basic infrastructure is available) but the disadvantage is the long gestation period. In any usual business, returns

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THE FUTURE OF CARDIAC CARE SHOULD HAVE A HOLISTIC OUTLOOK come from the second or third year, but in case of healthcare research, it will take seven to eight years to start generating returns. This long gestation is offset by attractive returns, as evidenced by research based healthcare companies who earn anywhere between $2055 billion (approx `15,000 â&#x20AC;&#x201C; 40,000 crores) in annual revenues. If research was a bad business, these companies would have been non-existent today, but the Indian mindset is yet to be adapted to long term thinking. To address these challenges, the government has

taken some drastic steps in this direction, including capping the price of stents. Majority of the medical devices and drugs are being imported. Capping of prices alone is not a permanent solution to the problem of affordability, the best thing that can happen is indigenous development of devices, implantables and drugs. Promoting indigenous research is easier said than done, but the current government is taking multiple efforts in this direction with new biotechnology strategies and policies being adopted. Providing industry status to healthcare research, building up infrastructure such as CROs and Animal Testing Facilities for drug and device development etc could go a long way to promote indigenisation of R&D. Policy level changes are required in this regard, and it is

a good sign that the current government is coming up with commendable policy initiatives to support healthcare R&D in the country. The 2017 budget has pushed for amending drug rules and ensuring that drugs are available at reasonable prices and focusses on new rules regarding medical devices, aimed at attracting investment in the sector and ensuring the reduced cost of devices. The new rules for pricing medical devices should benefit the common man, which has been clearly shown by capping the coronary stent prices (Drug eluting stents `29,600 and bare metal stents `7500). Finally, the ultimate way forward is to have a coordinated and concentrated effort by the government, industry and community towards improving service delivery, financing and infrastruc-

ture to provide affordable and accessible health care to reduce the growing burden of CVDs in India The future of cardiac care should have a holistic outlook with preventive care, rehabilitation, affordability and indigenous innovation as its main themes. We have to ultimately understand that healthcare may be an industry, but caring for the sick is never an industry. In matters of healthcare, the country should move forward with a futuristic mindset, tightly embracing the highest standards of ethics, and putting compassion and patient care as values ahead of business interests. This will have a cascading effect on the corporate and business side of healthcare, ultimately resulting in a well balanced development of social responsibility and business interests.

STRATEGY REPORT

NATHEALTH-PwC report highlights need for innovative modes for healthcare funding It reveals that the government will need to play a critical role as a catalyst by creating an enabling ecosystem which draws investments from both domestic and international players

ATHEALTH in association with PwC, recently released a report titled, 'Funding Indian healthcare: Catalyzing the next wave of growth' at NATEv2017, an annual seminar organised by the Healthcare Federation of India (NATHEALTH). It reveals that India will need much more participation from the private sector and conventional modes of healthcare funding will need to be aided by innovative modes funding to improve healthcare investments in India. The report also recommends four scaling innovative modes which should be introduced for funding Indian healthcare. These include fund of funds such as pension funds, investment route through PPP, long–term debt. Report bats for financing through pension funds which may provide access to a large pool of money. It also suggested funding through business trust entity like Real Estate Investment Trusts along with bilateral investment treaties. While underlining the need of huge funding requirements, the report says the FDI in the sector has been significantly increased in the last three years. However, healthcare expenditure’s share in GDP remains around 1.6 per cent in FY 16 and innovative funding modes would support the target of taking to 2.5 per cent 2030. It also highlights the fact that private equity deals are supporting the funding in the sector and value of transactions has increased from $94 million in 2011 to $1,275 million in 2016—a jump of 13.5 times.

The report also examines the key challenges the healthcare industry is facing and the opportunities with which Indian healthcare system can overcome these challenges.

Excerpts from the report: Private equity deals ◗ Value of transactions has increased from $94 million in 2011 to $1,275 million in 2016—a jump of 13.5 times.A

EMERGING TRENDS INHEALTHCARE FUNDING Growth of venture capital and private equity – heightened investor interest in the past 5 years, with transaction value increasing from $94 million (2011) to $1,275 million (2016) – a jump of over13.5 times1 The success of initial public offerings (IPOs) – four key IPOs over the last 18 months – Dr Lal PathLabs, HCG, Narayana Hrudayalaya and Thyrocare – all IPOs were oversubscribed, reinforcing investor confidence inthe sector2 With the recently announced National Health Protection Scheme (NHPS), a precursor to Universal Health Coverage (UHC), the government is increasingly moving towards the role of being a payor. Despite the best of efforts, public private partnerships (PPPs) are yet to meaningfully impact the healthcare delivery system. A slew of investments by global health players, including the Parkway Group and a host of Middle East players, have strengthened the perception of India as an attractive healthcare investment destination. References 1. Merger Market 2. Money Control

gradual increase in the ticket size is now evident. Some of

EFFECTIVE IMPLEMENTATION OF REITS AND NHPS IS EXPECTED TO GIVE IMPETUS TO HEALTHCARE FUNDING; PRICE CONTROL ON STENTS COULD IMPACT INVESTOR SENTIMENTS Real estate investment trusts (REITs) ◗The Securities Exchange Board of India (SEBI) introduced regulations in relation to business trusts, i.e. infrastructure investment trusts (InvITs) and REITs in 2014. ◗ These regulations should pave way for additional investments in creating healthcare infrastructure in the country. National Health Protection Scheme (NHPS) ◗ The government will provide for over 100 million families below the poverty line through NHPS. It envisages an annual coverage of `1,00,000 for a family. Implementation plans for NHPS are under way. Price control on stents ◗ The National Pharmaceutical Pricing Authority (NPPA) capped the price of coronary stents, which is inclusive of a maximum of eight per cent of trading charges and hospital handling charges, if any. The prices of bare metal stents and drug-eluting stents have been capped at `7,260 and `29,600 respectively excluding local taxes.

SIGNIFICANT INCREASE IN TRANSACTIONS AND FOREIGN DIRECT INVESTMENT(FDI) INFLOW OVER THE LAST FEW YEARS

PRIVATE EQUITY DEALS

FDI Healthcare has seen a significant increase in FDI inflow over the last 3 years. Healthcare FDI inflows (million USD) 685 663

647

318 257

240 FY11

FY12

FY13

FY14

FY15

FY16

1.2%

0.8%

1.1%

2.8%

2.1%

1.6%

Healthcare FDI as a percentage of total FDI for the year Source: PWC

the key deals (over $50 million) include:

Company

Amount (million USD)

Key investors

Date

Vijaya Diagnostic Centre 63.5

Kedaara Capital

Dec ’16

Apollo Health & Lifestyle 68

IFC

May ’16

Care Hospitals

221

Abraaj Group

Jan ’16

Cloud Nine

60.5

India Value Fund

Dec ’15

Metropolis Healthcare

127.5

Carlyle

Sep ’15

Metropolis Healthcare*

KKR

Apr ’15

Sutures India

TPG Growth

Feb ’15

Manipal Health Enterprises

150

TPG Capital

Jan ’15

Medanta Medicity

113.5

Temasek

Jan ’15

Aster DM Healthcare

India Value Fund, May ’14 Olympus Capital Source: Venture Intelligence

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STRATEGY INNOVATIVE MODES FOR FUNDING INDIAN HEALTHCARE one-third reduction in investment Life expectancy at birth

Healthcare investment (2014–34) Without leap

With leap 15 10 135

245 billion USD

156 billion USD

Required additions (2024–34) Bed equivalent

Financing through pension funds ◗ Access to a large pool of money ◗ Intervention by the government required to use this pool based on redefined riskassessment criteria ◗ Can be channelled through fund of funds

000s

90 billion USD

2,250 (950)

25%

2034

60%

REITs/business trust entity ◗ Dividing the asset operations and medical operations will trigger faster actions ◗ Help in overcoming real estate costs ◗ Insulated from instability of stock and bond markets

15%

20%

>40%

65%

15%

>35%

2024 Required additions (2014–24) Bed equivalent

2014

Fund of funds ◗ Healthcare investment and improvement fund with a multi-billion dollar corpus to accelerate the overall pace of development – similar to India Infrastructure Finance Company Limited (IIFCL) ◗ Management body appointed by the government to handle the portfolio, allocation and management of fund ◗ Sources of funding – pension funds, others ◗ Investment route – PPP, long-term debt, social impact bonds

Fierce catch-up

Bilateral investment treaties ◗ As an attractive investment destination, India already has 74 bilateral investment treaties ◗ Has a low cost of financing, e.g. India offers much higher returns compared to countries like Japan ◗ Potential for huge capital inflow

000s 1,400 (500)

Long-term debt instruments ◗ Tax-saving and tax-free bonds for financing healthcare infrastructure ◗ Source for long-term debt financing ◗ Potential for huge capital flow via participation from retail investors

Leapfrog

PwC

Source: PWC

GOVERNMENT FACILITATEINVESTMENTS IN THE HEALTHCARE SECTOR Increase spend on healthcare

◗ Increase public expenditure on health to at least 2.5 per cent of GDP by 2025 ◗ Focus of this spend to be on government’s role as a payor ◗ Increase in spending will spruce up private participation in creating new healthcare infrastructure

Move towards UHC

◗ Facilitate UHC framework development and subsequent implementation ◗ UHC, once fully implemented, should focus on these three pillars: ◆ Measurement and focus on health outcomes ◆ Due weightage to quality of care ◆ Adequate private sector participation

Fiscal incentives for hospitals in Tier 3 cities and below

◗ Provide tax benefits for setting up healthcare infrastructure in Tier III and IV cities as well as rural areas ◗ Similar to the now withdrawn North East Industrial and Investment Promotion Policy (NEIIPP), 2007 ◗ Pan-India focus (NEIIPP focused on the northeast)

Health savings fund

◗ A fund similar to the provident fund should be introduced for salaried employees ◗ It could be also used to pay for outpatient services and preventive health checks ◗ Investments into this fund could be tax deductible under section 80C of the ITAct

Development of healthcare-specific standard PPPs

◗ Scaling up PPPs in the healthcare sector will require effort to standardise concession agreements and collateral and exit clauses ◗ Clauses should ensure financial viability to aid exponential growth of such PPPs

National priority status

◗ Healthcare should be given a priority sector tag (currently, agriculture, MSMEs, export credit, education, housing, social infrastructure, renewable energy and others have been given this status) ◗ This will help channelise funds from the banking sector to create necessary healthcare infrastructure

Zero tax under the GST regime

◗ Healthcare services should continue to be charged zero tax under the GST regime ◗ Levying GST can add to the financial burden on the patient and/or patient’s family

Enhancement in medical reimbursement exemption limit

◗ The limit of `15,000 p.a. for medical reimbursement was fixed in 1999 ◗ Adjusting it with the healthcare inflation of ~10.4 per cent*, the amount should be around `80,000 intoday’s terms ◗ This limit needs to be revised to at least `50,000 p.a. with a provision to increase the same as per medical inflation every year

Timely reimbursement of scheme dues

◗ Multiple healthcare schemes such as RSBY, CGHS, Rajiv Aarogyasri and Yeshasvini by both the central and state governments, where beneficiaries can also avail of cashless treatment at empanelledprivate hospitals ◗ Government reimburses the private hospitals at notified/agreed prices ◗ These payments should be adequate and on time, which will ensure viability of the sector.

*Average inpatient medical inflation since 1996

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STRATEGY I N T E R V I E W

â&#x20AC;&#x2DC;We focus on creating comprehensive home care solutions around key therapeutic areasâ&#x20AC;&#x2122; Lalit Pai, CEO, Nightingales Home Health Services, throws light on the growth of home healthcare industry and how they work towards building a clinical-quality home care solutions in a conversation with Mansha Gagneja Home healthcare scenario is drastically changing. What are your strategies to cope with these changes? When we stepped into the home healthcare industry back in 2014, it was at a nascent stage. However, in a short span of two to three years, home healthcare has become an established category in the healthcare industry. Besides providing resources and care to a patient at home, our approach is to create a structure where patients and their families can expect good outcomes on a sustained basis. This requires the service provider to establish protocols which must be followed, metrics that must be measured and above all, holistic training of all the care providers responsible for extending our services. A solution-based approach is what we have introduced in the industry and this has been crucial in shaping customer expectations. We believe that this approach will provide genuine clinical value to patients and clinicians. Nightingales is on an expansion spree. Which other cities do you plan to tap and why? Yes, we are on an expansion spree. Currently, Nightingales is present in Bengaluru, Hyderabad and Mumbai and has more than 11 offices across these cities. We started off with around five people and currently, have more than 900 full time employees which in-

cludes doctors, nurses, and other staff. We opened our first branch in Nariman Point and have recently opened third branch in Santacruz. We intend to open 10 centres altogether in Mumbai and Pune. We are also exploring other metro cities in India. Our intention is to focus on each metro-city and continue to work on expanding our presence. We will be able to update you on our expansion plans in detail in a couple of months.

turn to good health easier and faster. In addition, detailed medical history is shared with each Nightingales doctor, so that they can be fully aware of patient's health status. The industry is mostly an unorganised one. What are the other challenges and how do you plan to tackle them? We have been able to attract talent from the unorganised sector because we have always been fair in the way we treat our staff â&#x20AC;&#x201C; we only deploy full-time employees and not contractors. We adhere to all the labour rules and regulations and spend time and effort to ensure that our employees are trained on a continuous basis.

What is your plan of action for growth in these centres? We have always focussed on creating comprehensive home care solutions around key therapeutic areas like neuro rehab, oncology, pulmonology, wound care and infusions. To achieve this, we constantly have to educate patients and the medical community about the clinical effectiveness of the solutions that we provide. How do you train your staff to create awareness among your patients? The team of medical care experts are specially trained in providing home-based care. We customise the care plans specifically to suit patient's needs, which are prepared by an advisory board of experts along with the lead specialist in the condition that is being treated. They frequently monitor patient progress and share it with them on the Nightingales App to ensure they re-

We intend to open 10 centres altogether in Mumbai and Pune. Our intention is to focus on exploring each metro-city and continue to work on expanding our presence

With new players entering the home healthcare sector, what USPs are you offering? Irrespective of the home healthcare sectors growing and new entrants entering the market, we have kept our USP very simple and we adhere and believe in it. We provide comprehensive, clinical-quality home care solutions where patients can experience a better quality of life. This is delivered using clinical protocols with trained and experienced staff and measured on a regular basis so that their progress can be monitored regularly by the clinicians treating them along with the family of the patient. manshagagneja@gmail.com

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April 2017

STRATEGY INSIGHT

Transforming healthcare deliveryin India

SAI PRATYUSH, Additional Vice-President – Product Marketing – Managed Services, Tata Teleservices

Sai Pratyush, Additional Vice-President – Product Marketing – Managed Services, Tata Teleservices, elaborates on whether technology can rescue Indian healthcare services from the dismal state it is in and transform healthcare delivery into a world class service AROUND 70 per cent Indians live in remote villages, more often than not, lying way outside the catchment area of government hospitals.1 A country of more than 6,00,000 villages has a little more than 23,109 singlephysician clinics (primary health centres) serving it with not more than four to six beds each.2,3 The shortage of qualified medical professionals is one of the key challenges facing the Indian health care industry. Deloitte’s Healthcare Outlook Report 2015 states that India’s ratio of 0.7 doctors and 1.5 nurses per 1,000 people is dramatically lower than the WHO average of 2.5 doctors and nurses per 1,000 people. The report estimates that the industry needs an additional 1.54 million doctors and 2.4 million nurses to match the global average. Can technology rescue Indian healthcare services from the dismal state it is in, and transform healthcare delivery into a world class service? While there are many hurdles and loopholes, technology is triggering an evolution of healthcare services in India. Today, patient care experiences are top of the mind in the healthcare industry across the globe. According to a report by Frost and Sullivan, India's healthcare information technology market is expected to hit $1.45 billion in 2018, more than three times the $381.3 million reached in 2012. Discrepancy in number of hospital beds and patient-doctor ratio is a humongous challenge, but enhanced medical technology is steadily helping solve this problem. It is practically not possible to have reputed hospitals or even med-

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April 2017

ical centres in every village or district. In such cases, tech-enabled systems and messaging technologies come to the rescue. Government agencies and healthcare centres are now able to collate information on healthcare indexes and the progress of people’s health in a particular district or village. Online patient health records, has cut down on redundant procedures such as physically filling forms before admitting a patient or meeting a doctor. Moreover, Mobile apps help track doctors, including specialists that suit your requirement, and also aid in managing vitals to test blood pressure and sugar levels. In many ways medical technology has transformed our attitude toward healthcare. Technological evolution has shifted focus of the medical fraternity toward prevention, unlike earlier when doctors and researchers would only react to medical emergencies. Individuals have become proactive rather than reactive to health. For example, Fitness Bands empowers a person to monitor his fitness parameters depending on the number of steps he walked during the day, and in some cases even detect heart rate. In terms of medical information, all you need to know about a disease is available at a click of a button. Due to increased Internet penetration and rise in ownership of handheld devices and laptops, the individual today is well-informed about his/her medical condition. From a patient’s perspective medical technology is beneficial in terms of bringing down hospitalisation costs. Those who

6,00,000 23,109 villages

single-physician clinics (primary health centres) India’s healthcare information technology market is expected to hit

$1.45

in 2018

can’t afford to pay hefty hospitalisation bills now have access to cost-effective medical services. Outpatient care in hospitals is either unavailable due to lack of space in the hospital or lack of resources with the patient. Technologically advanced surgeries have reduced the duration of hospital stay. In case of a heart bypass surgery, a person doesn’t have to be hospitalised for a long time. With real-time sensors doctors can monitor spikes in heart rate of a post-op patient. From the healthcare industry perspective, the advantage is the utilisation of tech-enabled infrastructure both within and outside the hospital. Ambulances with location-based devices are helpful in a countrylike ours where traffic is a persistent issue. GPS services help identify alternative routes and reduce the duration required to reach the person in need of immediate medical care. Additionally, ambulances equipped with enhanced machines empower the medical staff onboard to examine the vitals of a patient in transit to the hospital. High-end conferencing devices can scale-up med-

ical services, as doctors can connect with the ambulance staff and guide them in case of an emergency. Hospital infrastructure is transformed as well and resulted in efficient functioning. Tech-enabled building management solutions features such state-of-the-art sensors that can detect anomalies related to temperature required to transport and store life-saving drugs are helpful. Insulin, for instance, can go bad after about 28 days if kept at room temperature. On the other hand, properly refrigerated insulin is known to last for up to 12 months from date of purchase. 4 Technology is not just connecting hospitals through data and voice technology, but has gone beyond that. Patients can today look at apps where they can find the nearest doctor based on his/her speciality, scan through feedback from others and then take a call on who they want to consult. Easy availability of information to both patients and doctors has fastened the process of diagnosis. While the former is now more aware of medical conditions, the latter can take decisions on real time basis. Most of these sophisticated services are more often found at private hospitals, since the public ones are vulnerable to implementation challenges such as lack of funds. However, thanks to mobile apps, Anganwadi and government healthcare workers are empowered to take corrective measures. For instance, earlier lack of communication services made it difficult to remind rural families about vaccination drives in their village or

nearest town. Today, a simple SMS alert is sufficient to ensure that polio drops are administered to every child even in inaccessible areas, in time. With messaging technology such as WhatsApp, doctors can access patient records irrespective of their location; one doesn’t need to travel to another city or country for a second opinion. India’s healthcare sector is yet to scale-up to its complete potential. There is a dire need to improve health outcomes, especially at the grass-root level. Making medical services available, accessible, and affordable to a billion plus people spread across the length and breadth of the nation is a major challenge. Adding to this is lack of adequate funds that can expand medical infrastructure. In such a scenario it’s about time that we leverage technology to develop state-of-the-art ambulances and diagnostic labs, which have the potential to reach people in the remotest part of the country. Technology has and will further help create patient-centric healthcare systems that can improve response time, reduce human error, save costs, and impact the quality of life. While the IT-enabled transformation journey has just begun, it is safe to diagnose that technology is democratising the world of healthcare services. References 1.http://www.gramvaani.org/?p=1 629 2. https://en.wikipedia.org/wiki/ Primary_Health_Centre_(India) 3. https://en.wikipedia.org/wiki/ Village 4. https://nfb.org/images/nfb/publications/vod/vodsum0401.htm

IT@HEALTHCARE

I N T E R V I E W

‘Analytics help hospitals to continuously improve post discharge care’ Chary Mudumby, CTO – HTC Global Services explains the benefits of utilising mobility solutions in optimising post discharge care by hospitals and how technology can be leveraged to attain business growth, in an interaction with Raelene Kambli What functions need to be performed as part of the post discharge care? Hospitals are complex environments performing many connected and synchronised activities as well as eventbased activities in providing patient care. There are a slew of activities that need to be performed to allow for safe discharge of the patient. Proper planning for post discharge care is very important. This includes the medications, exercises, relaxation techniques including meditation, diet, lab tests, administration of simple procedures using home equipment such as nebulisers, follow-up visit schedule and any literature that might help patients in understanding the dos and don’ts. Hospitals should also plan on proper monitoring of the medical condition of the patients depending on the disease. At the minimum, hospitals need to make follow-up phone calls inquiring the general well-being, monitor parameters that are pertinent to the condition of the patient such as sugar levels, blood pressure and more importantly alert them on the tests they need to go through. What are the challenges faced by hospitals in maintaining and providing good quality post discharge care? The first challenge is in providing all the relevant information to patients or their caregivers, before the discharge. Patients usually are

home-sick and will be in a hurry to get back. A proper documentation of everything that a patient needs to follow at home in-order to recuperate, regain and maintain health must be given in a referenceable and easily understandable format with no ambiguity. Hospitals need to maintain adequate staff for the post discharge follow-up. Most hospitals are generally short staffed even to handle the patient care while patients are still in the hospital. Another challenge is that many hospitals do not have an integrated electronic health or medical records systems. What are the prerequisites for building improved patient monitoring systems in order to provide post discharge care? A good planning, availability of well documented general information for various common diseases and conditions which can be modified to suit a particular patient’s need, an adequately staffed post discharge care unit for necessary follow-ups and recording of the information from the follow-up are necessary to implement a good post discharge care. Such a care surely reduces the recurrence of the disease or manages it within limits. How can mobility solutions help in overcoming these challenges? All the instructions to the patients or the care-givers can

A hospital or health system backed by technology with proactive outlook, focussing on wellness will serve a higher population compared to those that are involved in just disease management

be delivered in a very friendly format on the smart phones and tabs. User experience can be enhanced using augmented reality. For example, patients using their mobile camera can scan the medicine or the home equipment or the icons that are provided to them representing diet, lab tests etc., in order to view relevant specific information customised to the patient. With the connected medical devices that use IoT, patients will be able to make the information on the vitals etc, directly available in realtime to the health providers. In addition, disease specific monitoring apps can be provided by the hospitals to the patients. Patients will in turn be able to use these apps which will automatically provide the information to the hospitals for monitoring and preventing the reoccurrence of conditions through proactive measures as well as early intervention where necessary. For example, we developed a mobile app for a hospital to monitor the health condition of infants with congenital cardiac conditions. This is a simple to use in-home monitoring app to be used by the parents or other care givers of the infants. This provides information to the medical staff to help them detect worsening health conditions with signs of poor systemic oxygenation, acute dehydration and respiratory distress.

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April 2017

IT@HEALTHCARE Explain the role of healthcare analytics in post discharge care? Analytics help hospitals to continuously improve post discharge care. All the information that is monitored and collected through post discharge care programmes can be analysed to identify common causes, conditions under which the symptoms or conditions re-occur, and the population dynamics and demographics that causes the occurrence of conditions. This helps in devising better home care programmes post discharge. Can post discharge services backed by healthcare analytics reduce readmission rates within hospitals? A well planned and designed post discharge care programme will proactively identify the health conditions of the patients before they worsen and require admission for the in-patient care in the hospital’s intensive care units or others. For example,

a long-term diabetic patient with a history of kidney issues needs to be monitored carefully at home, maintaining the sugar levels through insulin or other medication while looking for the parameters to alert on Kidney and heart conditions such as increased creatinine levels, oxygenation etc. Early identification of these symptoms allow for the relief from the condition or symptoms with intervention that can be performed at home or through simple out-patient visits and procedures, thus reducing the occurrence of a serious condition requiring admission into the hospital. What impact it can have on the hospital’s balance sheet? Hospitals need not look at reduction in readmissions as reduction in revenues. In most places in the world, there is a shortage of hospitals, equipment, beds and medical staff including nurses. As a result, a number of people are always in

Mobility and IoT backed by analytics and machine learning will definitely provide better care to the patients in increasing the health of the patient as well as aggregate health of population queue, waiting for appointments and vacancy in the hospitals for admissions.

Will it help to reduce the operating cost of the hospitals or will these services add to the cost? A good monitoring programme will cost money, but this is a good investment. Use of technology especially mobility and IoT will come in handy to bring down the costs of post discharge care. These costs can be passed on to the patients as part of the hospital charges for their visits or as a separate charge for specialised post discharge care in cases where it is necessary. This can be an incremental cost to the patients but the patient’s overall healthcare costs will be down as he/she has fewer hospital admissions. How can hospitals use these technologies to improve business success? Mobility and IoT backed by analytics and machine learning will definitely provide better care to the patients in increasing the health of the patient as well as aggregate health of population. While

hospitals should still be concerned with disease management, the focus needs to shift to wellness management. Any population has people with illness, and healthy individuals or supposedly healthy individuals whose health conditions have not been discovered yet. People with illness have varying degrees of sickness – occasional sickness to chronic to very sick to terminally sick. Hospitals have been generally engaged in dealing with sick patients leaving out the healthy people or people on the boarder of sickness. A hospital or health system backed by technology with proactive outlook, focusing on the wellness will serve a higher population compared to those that are involved in just disease management. Those institutions will contribute to the overall health of the population progressively reducing the sickness. Those institutions will be successful businesses serving satisfied patrons not patients. raelene.kambli@expressindia.com

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Express Healthcare accepts editorial material for the regular columns and from pre-approved contributors/ columnists. Express Healthcare has a strict non-tolerance policy towards plagiarism and will blacklist all authors found to have used/referred to previously published material in any form, without giving due credit in the industry-accepted format. As per our organisation’s guidelines, we need to keep on record a signed and dated declaration from the author that the article is authored by him/her/them, that it is his/her/their original work, and that all references have been quoted in full where necessary or due acknowledgement has been given. The declaration also needs to state that the article has not been published before and there exist no impediment to our publication. Without this declaration we cannot proceed. If the article/column is not an original piece of work, the author/s will bear the onus of taking permission for re-publishing in Express Healthcare. The final decision to carry such republished articles rests with the Editor. Express Healthcare’s prime audience is senior management and professionals in the hospital industry. Editorial material

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April 2017

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addressing this audience would be given preference. The articles should cover technology and policy trends and business related discussions. Articles by columnists should talk about concepts or trends without being too company or product specific. Article length for regular columns: Between 1300 - 1500 words. These should be accompanied by diagrams, illustrations, tables and photographs, wherever relevant. We welcome information on new products and services introduced by your organisation for our Products sections. Related photographs and brochures must accompany the information. Besides the regular columns, each issue will have a special focus on a specific topic of relevance to the Indian market. You may write to the Editor for more details of the schedule. In e-mail communications, avoid large document attachments (above 1MB) as far as possible. Articles may be edited for brevity, style, relevance. Do specify name, designation, company name, department and e-mail address for feedback, in the article. We encourage authors to send a short

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IT@HEALTHCARE I N T E R V I E W

There is a need to develop an ecosystem based on data integration in public health In the public health domain, medical evidence can be created only through a strong data integration system. Angshuman Sarkar, Principal Consultant, ThoughtWorks, in an interview with Raelene Kambli explains the relevance of this subject What do you mean by integration of services in the public health domain? How each stakeholders can be part of this integration? So far, people in the healthcare space worked in isolation. Digital tracking system were developed and used only for monitoring and evaluation of specific health programmes, for example the insidious programme for the mother and child tracking system.which is deployed only at the community health centre level. If the patient moves to another district, or state then healthcare providers loose all the information stored at the community centre as there is no connect or integration of data between these stakeholders. The patient in this regard become the only bearer of the information. To solve this issue, the government came up with different health cards where the information on vaccinations, treatments etc., is documented. Since, these cards are hand written there is a possibility of damage or of these cards getting lost in transit, which means, we cannot rely on these health cards for any kind of evidence. Therefore there is a need to develop an ecosystem based on data integration that involves all processes at every level. Be it community health, district level, state or at the national level, keeping in mind the patient needs. How important it is to think beyond monitoring and tracking system while designing digital platforms

for public health? It is very important to think beyond tracking system while designing products. There is certainly a need to develop IT systems that can integrate various informs collected by different tracking system to provide data which can be utilised to make medical decisions. For example, if I have my entire medical history then I can seek medical advice from any doctor sitting in any state or district. This technique will be useful for the rural population in India. The state of people living in the rural areas is such that they cannot even explain their medical conditions properly. Moreover, as the information does not flow between the IT system, patients bear the cost of retest and excess diagnostics. Therefore a platform that can address these issues will be of great help in the public health domain. What about security of data? Yes, security of patient information is paramount and technology providers need to take this very seriously. At ThoughtWorks, data security is one of the key things we focus on. Do you think that technology solutions like yours can be utilised to generate evidence? Certainly, our solutions can be leveraged to create evidence for strengthening our public health system in India. A major challenge that technology players face is the reluctance of healthcare providers to utilise such technologies. How do you go

doctor the systems that they need which can save their time and extra efforts. What are the pre-requisites for integrating data for public health? We will always have IT systems that will be developed for a specific purpose. But they should all be able to talk to each other using intra-operability standards. If the data captured at a community centre level does not flow upwards then the doctor sitting at a primary level will never be informed about the medical decisions. Training is also an important element that solution providers need to keep in mind. Data security is another important element which cannot be ignored.

There is certainly a need to develop IT systems that can integrate various informs collected by different tracking system to provide data which can be utilised to make medical decisions about convincing doctors? We build our IT system keeping in mind healthcare providers and patients. In my experience, I have seen how difficult it is to convince healthcare providers in the rural areas to understand these applications. Therefore, we design our solutions to be user

friendly. Also, we provide training to them. Moreover, all these doctors need to send some reports or the other. We actually, go about explaining the benefits of these applications and show them that documenting these report digitally saves time and their efforts. Basically give the

So, do you think there is a need for building intraoperability standards for IT solutions in India? Yes, I absolutely believe there is a need for assimilation of a comprehensive standard as there are too many players available in the market. People are confused which one to choose. A comprehensive intra-operability standard will help to make the right decisions. Scale is another challenge that technology players face in India. How do you fix this problem? This has to be done at the very planning phase of a health programme. Providers need to think how they would leverage technologies to scale their health services. Also, timely upgradation of technology is essential for any technologybased health programme. raelene.kambli@expressindia.com

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April 2017

KNOWLEDGE I N T E R V I E W

‘The awareness levels in India with respect to Fragile X are considerably low’ Shalini N Kedia, Founder Member and Chairperson, The Fragile X Society India, in a chat with Mansha Gagneja, expounds on the need to create awareness for Fragile X and highlights the various treatment options available to manage it Give us an overview of the current prevalence of Fragile X syndrome in the country? India has over 4, 00,000 affected children. If one considers, Fragile X Syndrome (FXS) and its associated disorders, it increases to 40 lakhs. It is a very huge number. FXS is a rare disorder. It is caused by a change in a gene that is inherited at the time of conception. When the gene called the FMR1, found in the X chromosome undergoes a change and does not function properly, it affects brain functions. It causes a wide range of cognitive impairment, from mild learning disabilities to severe intellectual disabilities (ID) that can impact individuals and families in various ways. There are, organisations all over the world focussed on creating awareness for Fragile X. Nearly every state in the US has a Fragile X society working towards this goal. Approximately 1 in 3,600 to 4000 among males and 1 in 4000 to 6000 among females are affected by FXS. Usually, males are more severely affected by this disorder than females. Therefore it is vital to spread awareness among the medical fraternity especially pediatricians and gynecologists’ as well as parents and the couples planning to have a child, so that children with FXS are detected early in life. Due to advancement in medical sciences, there are many treatments like medication and therapies available at different centers, which significantly improve the quality of life of a child or an

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April 2017

individual affected with FXS. What is the extent of awareness amongst practitioners regarding this syndrome? The awareness levels in India with respect to other countries are considerably low. However, over the years, with the efforts of The Fragile X Society, India, the awareness level in India has increased considerably and as a result parents of affected individuals are taking them to centers for medications and therapies. In the past, in countries like the US, toddlers at the age of 36 to 42 months were detected with FXS, whereas children in India were diagnosed at ages of 10 years, 12 years, 16years or even 40years. Thus, it led to a huge gap in their treatment cycle. Today it is different. The youngest Fragile X affected child we have seen was just one year old. This has happened only because of awareness amongst professionals. What are the different diagnosis and treatments options available for the Fragile X syndrome globally? How are they positioned in the Indian Fragile X Syndrome market? FXS cannot be cured. However, there are many treatments available. These include therapies, behaviour modification and medications to reduce the symptoms. Medications are not expensive and there are many centres which provide therapies at subsidised rates for those who come from a lower economic back ground. Early intervention makes a huge difference to the prognosis of the child. As the researchers

FXS cannot be cured but treatments are available, which include therapies, behaviour modification and medications to reduce the symptom gain newer insights into the syndrome and its connected connections, the treatments for the same are evolving too. With the rising awareness in India one can say that we have excellent treatments for children affected. The professionals in India work very hard to provide the families with the best available care. Brief us about the importance of pre-natal tests?

Pre-natal tests are important for early diagnosis and treatment of FXS and its associated disorders in the unborn child. There are two different methods to evaluate the genetic status of the fetus; Amniocentesis and Chorionic villus sampling (CVS). They both use fluid and/or tissue that is made up of fetal cells and the fetal DNA is analysed in the cells obtained from the procedure. ◗ Amniocentesis Amniocentesis uses a small (two tablespoons) sample of the amniotic fluid that surrounds the fetus. This fluid has fetal cells that can be grown and studied for various genetic conditions. The procedure is usually performed between 15 and 20 weeks of gestation, which is determined by ultrasound (sonogram) and /or by the first day of the last menstrual period. With the ultrasound affording a view of the womb, the physician inserts a very thin needle through the abdomen to withdraw the fluid from the uterus. The risks of the procedure include miscarriage, bleeding, cramping, and amniotic fluid leakage. The risk for miscarriage is approximately 1 in 300. ◗ Chorionic villus sampling (CVS) Chorionic villus sampling involved obtaining a small sample from the developing placenta. The placenta contains genetic material that is of fetal origin. Chorionic villi are small finger like projections on the edge of the placenta. The cells can be studied for chromosome abnormalities such as Down syndrome and FXS, if the mother is a known carrier. Unlike amniocentesis, CVS

does not detect neural tube defects such as spina bifida. A blood test is therefore recommended at 15 to 20 weeks gestation to detect neural tube defects. CVS is performed earlier in pregnancy than amniocentesis, usually between 10 to13 weeks of gestation. The procedure is performed under ultrasound guidance. Some women feel cramping or pressure, while others do not find it uncomfortable. Like amniocentesis, there is a small risk of miscarriage (less than 1 per cent). If performed earlier than 10 weeks’ gestation, there is an associated risk of limb defects. Why has the Indian Academy of Pediatrics (IAP) come forward to support the cause? The Indian Academy of Pediatrics (IAP), has extended their support to The Fragile X Society, India to take forward the motto of a better FXS care among the affected individuals in every nook and corner of India. They feel that awareness needs to be increased in India as far as FXS and its associated disorders are concerned. Cases of FXS and its associated disorders are mostly not reported in India. Therefore, the IAP is preparing guidelines for management of the syndrome, as it is necessary to create awareness among the doctors who will manage the children or individuals affected with FXS and its associated disorders. It is therefore vital to utilise the knowledge gathered from the guidelines so that it can be used for early and better diagnosis of the syndrome and plan its treatment accordingly. manshagagneja@gmail.com

TRADE AND TRENDS

New age EMR solutions Nishant Nambiar, Director and Vinod Sasi, Technical Director, Inforich Technology Solutions, elaborate about the company's offering for the healthcare industry

nforich Technology Solutions, an Indian company, has built an IP platformbased electronic medical records (EMR) solution using smart client technology. This gives the end user like doctors and nurses a rich interface and the response time is faster as compared to earlier systems in the market. The application is superior than web and desktop versions of software in terms of operational efficiency and robustness. The application covers starting from patient registration, patient billing, medical records collection, electronic lab, radiology and pharmacy orders, lab and radiology result entry and pharmacy billing, insurance and medical reports generation can be viewed. The cloud ready solution

tors. It integrates with any third party applications in market like appointment management systems, online pharmacy and consultation services etc. Inforich is working closely with the Ministry of Health and Family Welfare where paperless initiatives have been taken for primary care centres.

R&D in progress

L-R: Nishant Nambiar and Vinod Sasi

can be customised as per the user requirement and specialised care workflow. The platform supports interoperability with lab equipment, vital sign equipment, mobile de-

vices and PACS system. There are mobile applications for patients which will help to view the medical records and manage appointments and handheld device support for doc-

The company has also developed a common platform for radiologists, medical students and medical imaging researchers to enable a collaborative study on medical cases by sharing good quality radiology images and medical details, which is undergoing trials in a research university in Ireland. Another area of focus is machine learning on EMR to

make the system more interactive and support user starting from front desk to management for decision making. To mention this concept in a line, it is an EMR integration platform with speciality-based customisation and simple screens. It liked by doctors endorsed by technology companies to lower healthcare costs by standardisation and auto reporting features, globally. Inforich is looking at expanding the offerings in other developed countries like the UK and the US where the medical standards are defined and a platform of this kind is the need to the hour to capture data smartly and use it effectively. Contact details Tel: 91-9744615635 nn@inforichpic.com

Carestream Health’s successful R&D efforts earn 43 US patents during 2016 C

arestream Health has been awarded 43 new patents from the US Patent and Trademark Office last year for innovation in radiography, cone beam CT imaging, healthcare IT, dental imaging and other areas. The company also received 52 additional patents in European and Asian countries last year. “These patents demonstrate Carestream’s continued success in developing advanced imaging and healthcare IT technologies that serve providers around the world,” said Susan Parulski, Chief Patent Counsel, Carestream. “We are committed to delivering new products and services that can enhance image qual-

Company develops innovative new technologies for medical, healthcare IT and dental imaging systems

ity, deliver greater productivity and offer new capabilities to help improve quality of care.” New patents earned by the company’s scientists and en-

gineers include: ◗ New medical image capture technologies related to the development of cone beam computed tomography (CT) systems designed for orthopaedic

extremity imaging ◗ Enhancements to Carestream’s portfolio of healthcare IT systems that manage, store and share patient data and medical imaging exams ◗ Continued technology advances in Carestream’s growing portfolio of radiology systems that can enhance diagnostic image quality for a wide range of healthcare providers ◗ New technology and features for dental imaging, dental image processing and software and dental restoration systems; and ◗ Continued advancements in Carestream laser imagers that provide affordable output of digital X-ray exams onto med-

ical film and paper. The company’s product portfolio includes digital imaging systems for general radiology and speciality areas such as women’s health, orthopaedics and paediatrics; digital laser imagers that output medical images to film and paper; and the latest healthcare IT solutions and cloudbased services for hospitals, clinics and physician practices. Carestream Dental develops and markets film and digital imaging solutions, anaesthetics and practice management software. Contact details Call: 18002090190 Visit: www.carestream.in

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April 2017

TRADE AND TRENDS

Internet of Medical Things: Giving a shot in the arm to the healthcare sector Murali Krishnan, Associate Vice President, HCL Infosystems, chalks out the reasons on how IoMT is likely to gain more traction this year LET’S BEGIN with a simple quiz. Do you or any of your friends or family use a fitness band to track your heartbeat and pulse rate? Or a smart watch to track steps taken, speed and calories burnt? Or know someone who has a pacemaker implanted? If the answer to any or all of the above is in the positive, then you are already a part of the latest and biggest wave in digital healthcare – IoMT or Internet of Medical Things. Armed with a solid head start, IoMT is likely to gain more traction this year. Digital technologies and processes are proving to be the game changers in the healthcare industry by minimising human intervention and dependency, allowing hospitals and medical professionals to keep tabs on the location/ condition of medical devices, health of patients etc. Technology is enabling processes must be streamlined and re-engineered to create paperless automated digital workflows. For example, Electronic Medical Records (EMRs) are being widely implemented to help track patient health data and support medical decisions. Though the use of ICT in the healthcare remains low in comparison to many countries, both the union and the state governments are working together to make use of the immense opportunities offered by ICT. Technologies such as IoMT can be the game changer in Indian healthcare by reducing human intervention and dependency. Mobile medical applications or wearable devices now allow patients to capture their health data. Dig-

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Murali Krishnan, Associate Vice President, HCL Infosystems

ital medical imaging systems are quickening the process of reviewing medical images by physicians and other healthcare professionals. Imagine an apartment complex in any of our metropolis or even a tier-II town, which has more than 200 elderly members living all by themselves. Let’s envisage a situation where the medical records of all the members living in that community are captured electronically. Further, if the elderly members of the community are tracked or monitored remotely with a sensor on their pendant or bangle, then in case of any medical emergency for such patients, the patient’s relatives can be alerted immediately. Further, the doctor will be able to take informed decisions quickly on the basis of accumulated data of the patients. This reduces a lot of ambiguity about time-critical information (and thereby quickens any required interventions) like allergy to drugs, current medication to manage med-

ical condition, blood group, last medical health check-up so on and so forth. Hospitals should extend workflow through mobile health (mHealth) initiatives, which enables physicians and patients to use mobile devices such as smartphones and tablets to record and find the right information and resources anytime from any location. This is just one view of how an IoT technology could look and the impact it might have on both the patient and provider. However, this transition to embracing IoT technologies has its unique set of challenges. With the rapid ad-

vances in technology there are platforms available to accurately capture data from various sources, such as Electronic medical records (EMRs), wearables, clinical information systems, mobile devices and more. Humongous amount of Patient-Generated Data (PGD) would be handled by an ecosystem of diverse set of organisations across geographies, each consuming the data for a different purpose. Analytics will be the key to unlock this massive volume of data generated. Also, challenges arise when sensitive health information is handled by various organisations in the ecosystem. Thus, the

real extent of benefits of IoT and digital PGD will rely upon an effective answer to these challenges. IoT technologies promise exciting possibilities for the healthcare sector. The challenges that the medical industry faces in this transition are substantial but surmountable. The Digital India campaign by the government is also expected to enable new technologies like IoMT to increasingly play a key role in providing efficient and better healthcare to many more Indians. I am positive that in 2017 we will make substantial progress in touching more lives through technology.

TRADE AND TRENDS I N T E R V I E W

‘We want to make India our main manufacturing hub’ DiaSys recently unveiled its new facility in Navi Mumbai 'DiaSys House.' Bertrand de Castelnau, Dr Guenther Gorka and Peter Zoller, MDs and CEOs, DiaSys in Germany, in an interaction with Sanjiv Das, elaborate more about the new facility and how it will help the healthcare sector Tell us more about DiaSys House? DiaSys in Germany develops, manufactures and markets diagnostic systems of superior quality to laboratories, hospitals, and physicians in more than 100 countries. Since its foundation in 1991, we have introduced more than 90 liquidstable reagents for routine and special diagnostics completed by calibrators and controls. DiaSys’ top priority is to provide our customers with the best quality products and services. At DiaSys, we believe in the importance of a quality diagnostics which improves the efficacy of curing and reduce the therapy costs As for DiaSys India, created 30 months ago, a clear vision has been developed ◗ To be a respectable member of the DiaSys family with the same quality standards and requirements ◗ To be a preferred partner to the testing sites all over India ◗ To become an innovative point of care testing specialist, building a pillar to the worldwide DiaSys Strategy, and exporting products internationally from DiaSys India As for India, initially, 30 months ago when we acquired the business, we have had an office in Kurla, apart from our R&D in Goregaon, Mumbai and a production facility in Pawne, Navi Mumbai. Now, we have opened this new facility in Mahape, Navi Mumbai. The facility will bring production, administration, R&D, manufacturing and delivery of products under one roof. Why did you choose Navi Mumbai as the preferred destination? DiaSys India is part of the Di-

German mother company. Do you plan to go for any tieups? India is a strategic market on one side and our PoCT strategic branch is also critical. We will consider partnership to reinforce our success in both directions. What will be the employee strength at DiaSys House? Our employee strength based in DiaSys New House is around 60, and overall in India we have 128, including 60 sales personnel and 30 engineers based in our regional centres in Kolkata, Chennai and Delhi.

(L-R) Bertrand de Castelnau, Dr Guenther Gorka and Peter Zoller

aSys group since September 2014 when DiaSys acquired the diagnostic business from Piramal Healthcare. Since then a lot was taken care to roll out the ambitious plans and the positive contribution of DiaSys to Indian healthcare system. India is one of our major focus areas as the key country where DiaSys can contribute to the healthcare system. DiaSys group has also daughter companies in other countries like China, Brazil, Indonesia, besides Germany France and Japan. Navi Mumbai offers all the facilities and a very conducive environment to run the operations. We want to make India our major R&D centre for the DiaSys Group Strategy, but also our key manufacturing centre for India but also for export. A special focus will be made on the environment where there will be an emphasis on reusing

water, energy etc. What will be manufactured in the new facility? Will the products also cater to other parts of the world? In DiaSys India New House, we will manufacture chemistry kits (liquid stable reagents) for the Indian diagnostics centres. We will also manufacture laboratory instruments to equip the same diagnostics centres, complementing our range of fully auto analysers coming from Germany, of which 200 units are active all over India. We will also manufacture kits for rapids testing, from our newly created R&D Indian centre. Our products will be delivered to hospitals, diagnostic centres within the country. We already have a tieup with All India Institute of Medical Sciences, Thyrocare, Appolo etc.

Eventually, we will export the products manufactured in DiaSys House to other parts of the world. The DiaSys Group has distribution facilities in over 100 countries, and also DiaSys India has sister companies in countries like China, Japan, Indonesia, France, Germany, Brazil and the US. What are your future investment plans? We have already invested over Euro 5 million in India. There are plans both in R&D and in additional production. In addition, we will further invest in sales and services, apart from export activities. How are you going to raise the amount for the said investment? For the time being, the entire investment has been funded through long-term and shortterm cash support from the

Are there any plans to ramp up the employee strength? We started two years ago on our journey with 96 employees and currently we have 128 employees. There are plans to hire more. The National Health Policy was recently unveiled by the Ministry of Health and Family Welfare. What is your say on the same? We welcome the initiative by MoHF&W on National Health Policy. If diagnostic is well taken care of, then less cost is incurred for treatment, as an early accurate and quality diagnosis will have a positive effect on curing the disease. The Make in India initiative by the government has motivated us in our investment in India. Still we at DiaSys decided to go beyond to conduct research and development in India, and also export out of India. Our motto is to do R&D to manufacture and to export from our newly launched DiaSys India New House. sanjiv.das@expressindia.com

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Intensive care unit facility design Deepak Venkatesh Agarkhed, General Manager –Engineering,Facilities & Quality, Sakra World Hospital, gives an insight about certain parameters which should be followed while designing an ICU

he intensive care unit (ICU), designated as high risk area from infection prevention point of view, has a concentration of lifesaving medical aid and nursing care for patients who are critically ill. The engineering controls both during design, commissioning and operation play a major role. The designer of an ICU should not only have insight of clinical work flow and protocol but have a sound knowledge of engineering controls. The design consultant should capture requirement of patients, intensivists, surgeon, nurses, technicians and infection control officer and in-house engineers (both general and clinical) for efficient design of ICU. The fine balancing act of quality, cost and time factors during design planning and execution will yield better results to hos-

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pitals on a long-term basis. Any flaws in ICU engineering control may result in serious compromise in patient care as evident from above mentioned examples. The following facility related points are required to be considered as part of facility planning and further engineering controls during operation.

◗ Space programme The guidelines for ICU design should be based on criteria set by ISCCM, India given below. Level I, six to eight beds — small district hospital, small private nursing homes, rural centres. Level II, six to eight beds — larger general hospital Level III, 10 to 16 beds-tertiary level hospitals The new level III ICU are further planned based on type

/usage of ICU i.e. general or speciality-based like medical, cardiac, neurosurgical, transplant, paediatric. The location of ICU should be close to the operation theatre, imaging diagnostic services and laboratory. The floor space area size of each patient bed space for ICU can be decided based on classification of open space ICU or cubicle /separate room. The floor spaced per ICU bed can be planned 3 m X 4 m (12 sq. m) to maximum of 5 m X 5 m (25 sq. m) based on consideration of application of ICU including services and equipment positioning. The outside environment viewing window for each patient bed is strongly suggested as part of the design. A minimum of one to two metre distance should be kept between two beds as per NABH standard. The height between floor

and false ceiling should be three metres to facilitate to bring in engineering services from the ceiling. The ideal single leaf door size for each ICU cubicle or separate room having clear space of 2.1 m X 1.2 m height and width with wide view panel for visual access to patient is suggestive. It is indicative to have 12-16 beds per ICU area for optimal design considering all essential support functions. The total area of ICU should be 2.5 to three times the total space of ICU beds which includes supply and service corridor/ passageway of 2.4 metre width. At least one patient cubicle as isolation with anteroom facility having negative pressure is recommended within the ICU. The overall design of the ICU should consider patients, staff and visitor movement, storage space of equipment

and medicine, location of essential areas like nurse station, clean and dirty utility etc. The other essential areas in floor plan of ICU may contain nourishment room, stat lab, linen storage, staff lounge and utility services.

◗ The civil structure The structural cost of ICU is mainly decided by type of patient area planned i.e. open space or cubicle /separate room. The walls for separate room should be finished plaster wall of six inch block/brick wall .The wall finish should be durable, tough wearing and should withstand water and routine cleaning by chemicals. Many hospital acquired infections, such as MRSA, are spread by direct contact with contaminated wounds or hands, typically those of

TRADE AND TRENDS healthcare workers. Two coats of anti-bacterial paint with approved shade on primer applied wall and ceiling will help to kill harmful bacteria that can cause hospital superbugs, including MRSA and E. coli. The fabricate protective wall strips at bed level height should be provided to protect the wall from damages. The cubicle-based patient room should have partition wall which should be seamless, can be easily washed like ACP panel /HPL board with toughed glass at height of 0.9 metre for visual access of patient. It should be easily cleaned and must withstand temperature from 10 to 250 decelsius and humidity range from 25 per cent to 65 per cent Rh. Curtain tracks for each patient area should be provided for the privacy of patients. There should be enough space between ceiling and false ceiling to route entire electrical, plumbing, data and medical gases across patient area, as well as in-support service area based on functional requirement. Imperforated false ceiling with good acoustics and monolithic finish need to be installed in ICU area. The flooring of ICU should be smooth, seamless and durable as there will be heavy movement of patient beds and medical equipment like portable X-Ray like vinyl 2.5 to 4.5 mm thickness. The flooring should be able to sustain wet things like water, chemical solutions without losing its characteristics. As per International Noise Council, the noise level in an ICU should be under 45 dB in the daytime, 40 dB in the evening and 20 dB at night. The material selection and planning should consider the above noise level limit aspect.

◗ Electrical services The main electrical circuit breaker panel should branch out to individual feeder line for each ICU. The emergency power source like DG power should quickly take over in case of city power failure. Each patient cubicle should have at least seven duplex grounded receptacles 5/15 amp as per AIA guidelines. The location of

these receptacle can be either on wall, bedhead panel, ceiling suspended pendant units or vertical column based on choice from hospital team. It is strongly suggested to have at least 50 per cent of electrical receptacles connected to uninterrupted power supply (UPS) with proper label . Each receptacles or cluster within an ICU should be serviced by its own circuit breaker in the electrical panel preferably located in utility room of ICU. The lighting distribution illumination control should be planned based on routine physical examination (around 350 lux), during procedure of patient (around 1000 lux), during night time (around 5 lux). The lighting distribution board should be separate from power distribution board. The emergency lighting should be connected to few light fixtures to avoid a complete black out scenario. The energy conservation aspect like LED lights and more natural daylight should also be considered.

◗ Air-conditioning heating, ventilation services Sterile air having low velocity with 21-240 centigrade with 3060 per cent Rh in ICU should be planned. The central air conditioning system or ICU specific air conditioning system has to be planned based on guidelines of ASHRE standards i.e. for ICU cubicle the requirement of six minimum air changes per hour with two minimum outside air changes per hour having positive pressurisation. It is better to have dedicated air handling unit (AHU) having 99 per cent efficiency down to five microns for each ICU unit. The fresh air for AHU unit must not be located near potential contaminated air like DG /Kitchen exhaust hood, vehicle parking area or laboratory hood. The design guidelines for immunosuppressed patients like organ transplant is further stringent. The energy conservation aspect like individual control of temperature, humidity using VAV controls with BMS integration needs to be considered.

◗ Water supply

Deepak Venkatesh Agarkhed General Manager Engineering,Facilities & Quality

The ICU being high risk clinical area , careful engineering services planning, execution and periodic maintenance will help patient care and facilitate to improve clinical outcome Water supply inside the ICU with sufficient pressure can be broadly classified into three types i.e. domestic soft water (hot and cold) for sinks and scrubs, RO water for dialysis port and for drinking purpose and treated sewage water for flushing in commodes. The domestic water should adhere to IS 10500 standard and RO water for haemodialysis should comply with AAMI standard. Zone stop valves must be installed on pipes entering ICU to allow service to be shut off, in case there is a break in pipeline. The provision of hand free sinks having hot and cold water facility at major functional area like

nurse station, clean and dirty utility and ICU with cubicles has to be planned. The dirty utility should have provision for bed pan washer. The supply and drainage line for haemodialysis RO supply should not mix with other plumbing lines. Drainage pipelines should be avoided in the ICU ceiling. Regular domestic water sample test for bacterial contamination, pH, hardness, TDS etc. and endotoxin level for RO water need to be carried out as per NABH FMS standard. The technique of hyper chlorination, increased hot water temperature and regular storage tank cleaning will help to reduce the waterborne pathogens.

◗ Piped medical gas system Continuous supply of oxygen, compressed air and vacuum is essential for any ICU. HTM 02/01 and NFPA 99 are the standards which deal with piped medical gas system. Each patient should have provision for two number each for oxygen, vacuum outlet and compressed air outlet. Audible and visible low and high pressure alarms must be installed both in the ICU along with manual shut-off valve provision for each medical gas system. Each type of gas outlets should have specific diameter indexed safety system to prevent inadvertent connection to incorrect gas.

◗ Firefighting and detection system The National Building Code (NBC) has given norms on firerelated infrastructure like installation of extinguisher, sprinkler and alarm, water storage tank and pump capacity based on building height and plot area. In high rise building where ICU is located, the fire escape routes should be clearly indicated. Location of various types of fire extinguishers should be placed at prominent place. Smoke, heat sensors, sprinklers, manual call points and hydrant systems should be tested on a regular basis.

◗ Extra low voltages Speakers of public address sys-

tem can be installed in the ICU for safety code like code blue announcement. IP surveillance camera as part of security surveillance system can be installed in the ICU area without affecting patient privacy. Access controlled ICU door having proximity cards and exit switches integrated to building management system can be installed to avoid unauthorised access for people inside the ICU. The nurse call system with call button facility for patient at bedside can be planned to observe audio-video signal at central nurse station nurse. Each patient area should have at least two data point i.e. one for patient physiological monitor and other for hospital information system. The nurse station should have at least five data points and three voice points. TV provision can be planned in each patient room /cubicle based on requirement. The infrastructure for e-ICU, telemedicine and pneumatic chute can be considered as part of futuristic design.

◗ Interior design and civil finish A bedside utility column (freestanding, ceiling mounted, or floor mounted) or horizontal bedhead panel having provision of electrical power, oxygen, compressed air and vacuum, and data points besides accessories like IV poll, procedure lamp facility should be decided post mock-up stage itself. The interior work including fixed furniture should be planned based on other services like medical gas, plumbing etc. The storage space in each specific area like clean, dirty utility should be sufficient to keep items without closed shelves. Care should be taken to ensure that services like medical gases, electrical should be concealed rather than exposed on walls. Reflected ceiling plan, coordinated drawing and interior drawing should be signed off before execution of actual work on ground. The ICU being high risk clinical area , careful engineering services planning, execution and periodic maintenance will help patient care and facilitate to improve clinical outcome.

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TRADE AND TRENDS

Roadmap to tackle antibiotic resistance Dr Neeraj Adkar, Joint Replacement Surgeon and Sports Medicine specialist, Saishree Hospital in Aundh, Dr Narendra Vaidya, MD and Chief Joint Replacement Surgeon, Lokmanya Hospital, Dr Vikram Padbidri, Consultant – Microbiology and Infection control, Jehangir Hospital, talk about why there is a need to prevent rampant use of antibiotics

eath of a Nevada (US) woman due to superbug to which she was resistant to all antibiotics recently spread panic waves throughout the world. Now, the World Health Organisation has published its first ever list of priority pathogens – a catalogue of 12 families of bacteria that pose a great threat to human health. Bad news for the country and hence the city is that most of these superbugs are already found to be present here. “The main reason why antibiotic resistance develops is rampant use of antibiotics not only at the hospital level, but also OPD level. Sometimes, these are prescribed without giving much thought or exercising caution. This results in

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unnecessary prescription of higher antibiotics. There is a need for a hospital infection committee at every hospital which should also contain microbiologists which will govern this,” informed Dr Neeraj Adkar, Joint Replacement Surgeon and Sports Medicine specialist, Saishree Hospital in Aundh. Referring to Chennai Declaration where a joint meeting of medical societies in the country and prominent doctors and researchers had congregated in the year 2012 to discuss this issue, Dr Adkar said, “Despite the meeting, there has been no action taken on it.” As we enter in post-antibiotic era, the list was drawn up by the international health

body to promote research and development of new antibiotics considering that the present ones seem to be at the end of their life. Considering that the market of these drugs is not lucrative, newer antibiotics are not being developed. Therefore, WHO is of the opinion that if it is left to market forces alone, newer antibiotics which are needed to be developed urgently will not be developed. Dr Vikram Padbidri, Consultant – Microbiology and Infection control, Jehangir Hospital has hailed this move. “It is a good move by WHO to release a list of the high priority pathogens, as infections caused by these organisms are and will continue to be a major cause of sickness and death.

Dr Neeraj Adkar Joint Replacement Surgeon and Sports Medicine specialist, Saishree Hospital in Aundh

Whether companies do invest in R&D remains to be seen. But what is more important that this should serve as a wake up call for all of us, as it is more important that we continue to practice judicious antibiotic use and infection control measures in our hospitals to minimise the emergence and spread of these pathogens. It is better to do what is in our hands, rather than be hopeful of what might not be. Hospitals all over India, not just in Pune are coming across these pathogens. Indiscriminate use of antibiotics and ability of the bacterium to adapt and develop resistance to the antibiotics. Indiscriminate use of antibiotics like taking antibiotics for viral infections like common cold, influenza etc, not adhering to a course of antibiotics prescribed by a doctor, omitting few doses, self medication, etc,” he said. Referring to the Chennai Declaration, Dr Padbidri said, “It is too early to tell if it has helped, but it is a step in the right direction. Regulation of antibiotic usage in poultry and agriculture and good infection control measures in hospitals can help to combat this problem.” "India is a hub for infectious diseases including viral, bacterial and fungal infections. Judicious use of antibiotics is the mainstay for treatment of these infections. Aggressive marketing of newer antibiotics, lack of policies on antibiotic usage, inadequate knowledge about pharmacology of these drugs and inadequate therapy are the

Dr Narendra Vaidya MD and Chief Joint Replacement Surgeon, Lokmanya Hospital

Dr Vikram Padbidri Consultant – Microbiology and Infection control, Jehangir Hospital

main reasons that contribute heavily for developing resistance against that particular drug. This means that the antibiotic which was initially effective later becomes useless for that infection due to the resistance developed by the bugs. Presently, resistant infections is a huge problem in case of critical patients. If we do not address these issues, we may lose precious lives especially patients on ventilator. Strategy to tackle these superbugs has to be comprehensive and has to include awareness among the general public. Western nations have been driving strong public campaigns against indiscriminate use of antibiotics. In our country too a meeting of various medical associations, government organisations and all the stake holders was held in Chennai wherein a five-year policy has been framed,” informed Dr Narendra Vaidya, MD and Chief Joint Replacement Surgeon, Lokmanya Hospital.

TRADE AND TRENDS I N T E R V I E W

Shanghai-based MicroPort Scientific Corporation eyes Indian market At a time when NPPA has brought price regulation for the coronary stents in India, Shanghaibased MicroPort Scientific Corporation, a global medical technology company that recently launched its latest third generation Target Eluting Stent, is positive that it will be able to serve the Indian coronary stent market under new price regime with its best –in-class technology due to its operational efficiency. Talking about the newly-launched stent, Riyaz Desai, MDIndia, elucidates to Express Healthcare about the opportunities envisaged by the Chinese medical device company in India National Pharmaceutical Pricing Authority (NPPA) has implemented new price regulations for coronary stents. Do you think the move will give you enough room to make a decent margin? We understand the decision taken by the Government of India to ensure quality healthcare access to every Indian at affordable prices. At MicroPort, we appreciate the endeavour of the Government of India and we hope that we can work shoulder to shoulder to make best in class medical solutions available to Indian population at affordable prices. However, we strongly feel that Government of India should consider reasonable margins to the entire value chain so that new and latest technologies can be made available to Indian population as and when these are introduced worldwide. Indian patients deserve the very best and Government of India must implement the policies which are both patient and industry friendly. Unlike many other companies in the same industry, we are well poised to build our Indian operation keeping in mind the new price regulation. We will build the lean and efficient business model in India without compromising on the quality of service. Can you share some details

about the FireHawk stent? How different is it from other premium stents? Firehawk is one of the most innovative third-generation coronary stent. We term it as rapamycin Target Eluting Stent because this is a stent which is designed to release the drug only to the targeted cells. The drug is released in 90 days and the polymer which is outside in specific areas of the stent is fully absorbed in nine months. Firehawk features cuttingedge technology like ultramicro 3D printing and abluminal (the side which touches the artery) groove filled design and it is proved to be a major success in patients with coronary diseases. The stent containing the drug and the polymer in the micro grooves helps achieve the same clinical efficacy as other market-leading drug-eluting stent with approximately only 1/2 dosage of the drug and approximately one third of the polymer load. It also minimises vessel wall inflammation through a reduction in the spatial and temporal interaction between polymer, drug and vessel wall. Chinese products are always looked as inferior in India. How will you combat this fear? Throughout the world, there is a stereotypical mentality that the Chinese manufactured de-

MicroPort was established by a very accomplished engineer Dr Chang who had worked in the USA for many years in R&D with the objective of manufacturing the best in class technologies at affordable price. Our tagline is ‘The Patients Always Comes First.’ This is just not a mere tagline but we are walking the talk by spending more than 18 per cent of our topline in the R&D to create world class technologies

vices are of low quality. However, in MicroPort, we assure the technology provided is the best-in-class and we have clinical evidence to prove that Firehawk is the best-in -class stent globally at par with other stents made by Abbott, Boston Scientific & Medtronic. This is proven based on various clinical trials. MicroPort is 18 year old and we launched our first stent in 2004, since then it has been the number one market share leader in the coronary stent market in China. Today, China is the second-largest stent market in the world and growing. The medical devices industry’s safety and quality guidelines in every country are rigid and our products are present in 25 countries. Besides, implanting so many devices in people around the globe itself shows that it is a product of high quality meeting the efficacy and safety norms of many countries. The idea that all China-made products are of inferior quality is beginning to change. We have also seen similar phenomenon in many consumer products like the mobile handset industry. Most of the smartphones used in India are of Chinese origin and many big Western brands are leveraging China’s ability to manufacture high quality products. Today China is India’s biggest trade partner with approximately 20

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TRADE AND TRENDS per cent of the imports by India is from China. Chinese exports to India rely heavily on manufactured items to meet the demand of fast expanding sectors like telecom and power. Stents have huge developmental cost and it is not a typical generic product. How much importance do you give to R&D? MicroPort is driven by innovation and it is one of the few medical devices companies which spend high on the R&D. We invest 18 per cent of our revenue back in R&D. Today, we have 1805 applied patents and 1169 applied trademarks. There are over 100 on-going projects in R&D. Today, 5000plus hospitals are using our technologies worldwide. Every 15 seconds, MicroPort products are deployed in some patient somewhere around the world. How do you see MicroPort's growth in the Indian medical devices market? We, as a company, see tremendous growth in the Indian medical devices market. Today, the US is number one coronary stent market followed by China, Europe and India but the market in US and Europe are either stagnant or declining. However, the coronary stent market in China and India are believed to growing at the rate of 14-15 per cent annually. It is believed that five years from now, top two coronary stent markets in the world would be China and India. As India is an emerging market, we want to introduce all our technologies in India, be it interventional cardiology, endovascular, orthopaedics or neuro vascular devices. Our next product line to be launched in India would be hip and joint implants. In China MicroPort is enjoying market leading position for more than a decade, in India too we would have substantial presence. What it means for us in the future is that MicroPort would have leading position in Worldâ&#x20AC;&#x2122;s leading angioplasty markets, i. e. China and India.

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MICROPORT PRODUCTS ARE OF HIGHEST STANDARDS T

hroughout the world, 'Made-in-China' still brings to mind phrases like 'not built to last.' In reality, China is the manufacturing base of the world. Virtually all luxury brands get a significant percentage of their product lines produced in China. However, the fact is that many companies and organisations are utilising Chinese manufactured goods to save expenditures, increase production and benefit in many other ways. There is a stereotype mentality that the products manufactured by Chinese companies are of low quality. However, we need to understand that low quality products can be manufactured and sold only in the product segment which is not regulated because their usage does not pose any threat to human life. Also, since there is a market for such products in developing countries, China has been catering to this segment. This is not true at all when it comes to the medical device industry since understandably any compromise in the quality will have an adverse effect on the human life. In every country, the safety and quality guidelines for medical devices are rigid because it involves human life. Our products have met the benchmark of efficacy and safety, set by different countries and are approved and available for sale in more than 25 countries worldwide. More than 3.5 million stents of MicroPort have been implanted in more than 1.5 million patients worldwide. This in itself is a testimony of efficacy and safety of our products. Not only that our stents have been proved safe and efficacious in clinical practice, but our FireHawk has been proven to be both safe and efficacious based on various clinical studies in more than 18000 patients and clinicians would agree with us that very few stents can claim this honour. We would like to assure each and every patient of India that products manufactured by MicroPort are of the highest standards and can meet the benchmark of safety and efficacy set by any country in the world.

Do you think expiry date is a must for stents? Yes, there should be an expiry date for stents. Firehawk has two yearsâ&#x20AC;&#x2122; shelf life which is more than sufficient for the stent. How do you see the recent Medical Devices Rule and other steps taken by the government in regards with the medical devices? The dedicated medical device rules and regulations

will definitely help the industry get faster approvals leading to faster access of cutting-edge technologies for Indian patients. In our view, the Indian government should not only focus to provide universal health coverage but also focus on delivering high quality healthcare to all the classes. MicroPort is well poised in aligning with the government of India as well as health care professionals in delivering the best

in class technologies at affordable prices, which will have a profound impact on Indian patient outcomes. It is not just about being able to access a range of innovative products with a proven track record like our breakthrough stent Firehawk to treat coronary artery disease but also Indian healthcare can leverage on MicroPortâ&#x20AC;&#x2122;s vast experience in R&D in bringing highquality medical technologies

at affordable prices. We are here not only at an opportune time, but I genuinely feel that Indian medical ecosystem is maturing and forcing manufacturers to provide the best in class medical care at affordable prices. At MicroPort, we are positioned well to offer our best in class medical technologies to the Indian patients and we are proud to be a part of history in making as far as patient care in India is concerned.

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Hemant Surgicals: Providing dialysis treatment at an affordable price Kaushik Shah, Director, Hemant Surgicals, elaborates more about the functioning of dialysis centres

emant Surgical Industries aims to provide economical and affordable dialysis services to the needy one’s with the help of private and government support. Over the years, it has been observed that the government has taken appropriate measures and initiatives to provide affordable dialysis to the needy ones and we sincerely appreciate and thank the government for taking the adequate steps. However, it has also been observed that private; semi and charitable organisations carry dialysis under various government foundations, which is affordable to dialysis patients. In such cases, reimbursements made by the government organisations to private hospitals are inadequate. Due to inadequate reimbursement, the private hospitals are not been able to maintain the quality and hence sometimes safety is at stake. We request the government to increase the level of reimbursement so that private, semi and charitable dialysis centres carrying dialysis can provide quality and safe dialysis treatment. Our organisation has an experience of 18 years in establishing and operating dialysis centres on a turnkey basis. Recently, we have come across government plans to set up dialysis centres in various states of the country to cater to the people in need of these services with participation from private organisations having experience in this line. We are interested to start a state-of-the-art dialysis centre in co-ordination with the government, private, charitable institutions.

Functions of a dialysis centre

◗ Dialysis centres has to be preferably installed in the premises within the hospital whereby they have a facility of intensive care unit (ICU) during a case of emergency. ◗ Quality of water. It is the most essential part for providing the quality dialysis treatment ◗ Stable electricity for stable and proper functioning of dialysis machines ◗ Local nephrologists should be associated with dialysis centre ◗ Feedback regarding rate of kidney failures per annum and average numbers of patients in vicinity The above mentioned points should be kept in mind while starting a dialysis centre:

Renalcare dialysis machines

Our scope of work: ◗ Providing dialysis machines, RO Plant, Bicarb Mixture and other functioning of dialysis centres ◗ Deputing a technician cum biomedical engineer with experience of more than 15 years for proper functioning of dialysis centres and looking after services of dialysis machines ◗ AMC and CMC will be our responsibility during the course of contact ◗ Training the local paramedical staff which would be helpful during long term and course of dialysis ◗ Providing quality disposables for the dialysis treatments Your scope of work: ◗ Providing sufficient space inside the hospital or commercial premises ◗ Maintenance charges like water, electricity and other sundry expenses ◗ Providing proper paramedical staff like nurses and ward boys required during the course and their salaries

We request the government to increase the level of reimburse ment so that private, semi and charitable dialysis centres carrying dialysis can provide quality and safe dialysis treatment

◗ Local documentations and licensing Other necessary information and discussion can be done during finalisation. Looking forward for a long-term business relationship and establishing chain of dialysis centers for providing pure and economical dialysis treatment.

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TRADE AND TRENDS

Indian Hospital League to be held in Mumbai IHL aims to raise maximum funds for charity while creating a platform for industry to network COLLECTIVE HEADS has been servicing clients associated with the healthcare sector for over seven years now. Realising that there is a need for a platform which brings together healthcare industry members, they have come up with the idea of Indian Hospital League (IHL). It is first-of-its-kind box cricket league played among Mumbai hospitals. It is a charity sporting event for hospitals to raise funds

for an NGO which will be held at Raghuvanshi Mills, Lower Parel on April 15, 2017. It would act as a networking field for various stakeholders of the industry in a non-competitive environment while assisting them to raise funds for various social causes Each hospital will play towards raising maximum amount for charity and all members of the organisations will participate. They intend to take

Each hospital will play towards raising maximum amount for charity

this across to top metro cities of India. IHL has two objectives — raising maximum funds for charity and aid networking within the industry. Various players in the healthcare industry are likely to join this platform in various capacities. Industries which provide support to the healthcare sector will also get an opportunity to interact and build connections

with them. The first edition of IHL will have eight hospitals participating which include Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Jaslok Hospital, SL Raheja Hospital, Nanavati Super Speciality Hospital, Global Hospitals, Hinduja Healthcare, JJ Hospital and Lilavati Hospital. The Franklin Templeton Investments is the lead sponsor.

Meditek Engineers: Reforming healthcare, inspiring life Meditek was established to provide unrivalled service and support for all medical equipment MEDITEK ENGINEERS is a privately-owned company led by a competent team with many years of experience in providing excellent service to both public and private hospitals. Meditek was established to provide unrivalled service and support for all medical equipment. We have an efficient infrastructure and highly trained and multi-skilled staff to bring you a range of services to suit every situation. First generation entrepreneur Anil Phirke realised the need of quality production of medical equipment and established Meditek Engineers in the year 1989. Meditek Engineers is an ISO 9001:2008 and ISO 13485 certified company engaged in the business of manufacturing and marketing full range of medical beds and furniture. Ranging from five function motorised intensive care beds to operation theatre trolleys, we have solutions for every need of the hospital. Meditek Engineers is headquartered at Mumbai. The display showroom and manufacturing plant are in Ambernath

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April 2017

near Mumbai and spans a pan India presence. With exceedingly superior hospital solutions, the company has also marked its international footprints in African countries.

The management The managing body of Meditek Engineering is a team of experienced domain experts. With a passion to deliver superior results, the company has complemented each other well. The team’s proficiency encompasses all the factors, necessary for the governance of a successful hospital equipment manufacturing company.

A state-of-the-art manufacturing facility Being a solution provider for hospital equipment and allied components, from ‘Concept to Delivery’ Meditek Engineers' engineering and design centre is self sufficient in technology for conceptualising, developing, testing and manufacturing of related products. The company is proud to have developed a setup that is absolutely wellequipped and state-of-the-art

The team’s proficiency encompasses all the factors, necessary for the governance of a successful hospital equipment manufacturing company as per global standards. It offers a turnkey medical device manufacturing service that spans the entire supply chain from component procurement to distribution, all within a quality controlled environment. It generates, develops and refines the product concept to ensure that all the requirements for a commercially and technologically viable product are met.

Meditek takes pride in its full-fledged in-house manufacturing facilities such as ◗ Hydraulic shearing. ◗ Bending and pipe bending machine. ◗ Seven tank pre-treatment plant for metal surface treatment. ◗ Automatic conveyorised polyester epoxy powder coating plant. ◗ Modern assembly and welding set up with test laboratory. The excellence thus acquired is aptly reflected in the performance and quality offerings of the company. It has developed a surprisingly unique range of advanced products required for the healthcare industry, making it the most costeffective manufacturer of the given product range.

the patients and efficiently support the latest healthcare practices.

5103 - Five function semi motorised ICU bed

ICU advanced care

◗ Polymer moulded head and foot end boards. ◗ Tuck type split moulded railings (Set of 4). ◗ Patient handset ◗ Electric actuators for backrest and height adjustment ◗ Manual operation for kneerest, Trendelenburg / Reverse Trendelenburg position ◗ Four non-rusting 125 mm dia. Polyurethane wheels 2 with brakes and 2 without brakes. ◗ Stainless steel telescopic IV rod. ◗ Four IV location. ◗ Body coloured PVC buffer on all four corners.

These are technologically advanced, high-tech products built with perfection and precision. These beds have been envisaged considering the complexity of the ICU operations and the critical stage of the patients' health. It provides maximum comfort to

Contact details Meditek Engineers W-13(A) Additional MIDC, Near Hotel Krishna Palace,Ambernath(E) 421506, Thane, Maharashtra Tel: +91 251 2620200, 2620258 Mob: +91 98220 92808 email: info@meditekengineers.com

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Trusted name in Healthcare since 1985

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Blood Collection Monitor

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Blood Bank Refrigerator

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REMI SALES & ENGINEERING LTD.

Remi House, 3rd Floor, 11, Cama Industrial Estate, Walbhat Road, Goregaon (East), Mumbai-400 063. India Tel: +91 22 4058 9888 / 2685 1998 Fax: +91 22 4058 9890 E-mail: sales@remilabworld.com l Website: www.remilabworld.com

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